Coronavirus (COVID-19) Information and Operational Updates within our Practices and ProgramsCoronavirus (COVID-19) Information

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Coronavirus Testing

As the COVID-19 pandemic continues to develop, new information about the virus is being learned by doctors and researchers each week. Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, has answered some frequently asked questions about the latest information related to the testing and diagnosis of coronavirus.

How is COVID-19 Diagnosed?

The COVID-19 infection is diagnosed by a test called polymerase chain reaction. Samples are taken from places like the back of the nose or mouth, or deep inside the lungs – places that are likely to have the virus. After the sample is collected, a process of extracting particles of the potential virus takes place. Those particles are then tested by a procedure that involves converting the particles to DNA and using a fluorescent signal to test for a viral sequence.

Anyone with symptoms of COVID-19 should contact their primary care provider to see if they need to be tested. These symptoms include fever, chills, cough, shortness of breath, sore throat, loss of sense of smell or taste, diarrhea and excessive muscle aches or body pains.

What Is An Antibody Test?

Antibodies are proteins produced by your body to help fight off infections in response to foreign invading particles, such as viruses. Antibody tests are blood tests which check your blood for antibodies. This shows whether you had a previous infection with, or exposure to, the virus. Antibodies may not be found in someone who has a current COVID-19 infection depending on the timeline of infection and when the test was performed. These tests should not be used to diagnose someone as being currently sick with COVID-19.

What If You Test Positive On The Antibody Test?

A positive test shows that you have antibodies which likely came from an infection of SARS-CoV-2 (the specific virus that can cause COVID-19), or possibly a related coronavirus. Research is still underway to see if those antibodies give you protection (immunity) against getting infected again. We also don’t yet know how long any immunity may last, if immunity is possible at all.

If you have no symptoms you likely do not have an active infection and no additional follow-up is needed. However, it’s possible to test positive for antibodies even if you don’t have or never had symptoms of COVID-19. This is known as having an asymptomatic infection, or an infection without symptoms. Patients with positive tests still need to follow social distancing guidelines, wear masks while out in public and in business and practice good hand hygiene and cough etiquette.

What Does It Mean If The Test Is Negative?

If you test negative for COVID-19 antibodies, you probably did not have a previous infection. However, if you have symptoms, you could have a current infection. It’s possible that you still could get sick if you’ve had a recent exposure to the virus as antibodies don’t show up for one to three weeks after the infection takes place. This means you could still spread the virus. Some people may take even longer to develop antibodies, and some people may not develop antibodies at all.

What Are Other Uses Of Antibody Testing?

Data from antibody tests is used to estimate the total number of people who have been infected with SARS-CoV-2 in the community and helps estimate the level of herd immunity. (Herd immunity is when a high number of people are immune to a disease, therefore protecting others in that society from widespread infection.) In addition, the CDC (Centers for Disease Control and Prevention) is using antibody testing to learn more about how the virus spreads and how immune systems respond to the virus. It may also benefit healthcare workers, as well as letting people know if they could be convalescent plasma donors which is now one of the main treatment options for very sick patients.

Where Can I Get The Testing Done?

Most big labs are now offering antibody testing. If you think that you were exposed in the prior weeks, discuss this with your healthcare provider to see if you qualify for the test. Keystone Infectious Diseases is also providing appointments to discuss this option and can be reached at (717) 709-7909.


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.

Dealing With Stress During Difficult Times

Just like physical health, everyone has mental health. Whether you are mentally healthy or you’re struggling, it’s important to check in with yourself regularly to make sure you are getting the care you need.

At this time we are all facing a new reality due to the coronavirus, and likely a change to our daily routines. People may find they are struggling with this adjustment, and might be feeling anxious, depressed or stressed. Dr. Jagdeep Kaur, a psychiatrist at Keystone Behavioral Health, has some tips for taking charge of your mental health and taking care of yourself during times of high stress.

Pay Attention To Your Mental Health

It is very important to consciously pay attention to our mental health, especially during times of high stress such as the ongoing coronavirus pandemic. Stress affects our physical health, as well as our mental health. Positive emotions boost our immune response, and stress makes our immunity weaker. It is necessary to take a break from stress and cope with it in healthy ways.

Stress Affects Your Body

Severe ongoing stress negatively affects your body. Stress can affect sleep, appetite, mood and energy levels. Stress increases the risk for heart disease, diabetes, depression, anxiety, cancer and many other diseases. Studies suggest that stress increases a hormone in your body called cortisol. High cortisol levels in the body disrupt normal cellular activities and many harmful chemicals are produced which damage the body’s cells. This damage sets the stage for chronic diseases like heart disease and diabetes.

Healthy Ways To Cope

It’s important that you learn to take good care of yourself. Eat healthy, well-balanced meals, stay physically active, get plenty of sleep and avoid alcohol and drugs. Regularly practicing relaxation and deep breathing can help with staying calm. Choose an activity that works for you and that you are likely to continue doing. Start slowly and gradually and work toward making it a regular practice.

Stress In Children

Children experience stress too and they often show it through irritability, lack of patience and poor frustration tolerance. For children, it is very important to have a regular routine and structure throughout the day; otherwise lack of structure can trigger boredom, depression and anxiety.

Seeking Professional Help

I strongly recommend you seek professional help if stress is affecting your ability to function. As human beings, we have personal and occupational responsibilities. If you are struggling to keep up with fulfilling these roles, it is time to seek professional help. You can call your medical doctor and ask for his or her advice or you can contact behavioral health resources in your area.  Keystone Health offers a 24/7 crisis line for those who are experiencing a mental health, drug or alcohol crisis and can be reached at (717) 264-2555.

Change is usually difficult for everyone. If you don’t accept your current reality, it can trigger conflict, irritability and anger. The key is to accept it instead of creating suffering by being in denial. We can all work together to get through this time.  We need to understand that we can do our part and prevent exposure by following the recommendations from the Centers for Disease Control and Prevention (CDC) which can be found at


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.

Donations Needed!

We have received so many messages from community members asking how they can help. We greatly appreciate everyone’s generosity and willingness to contribute! Here is a list of supplies we currently need at Keystone and would greatly appreciate any donations.

Face shields
N95 masks
Isolation gowns
Gloves (even expired gloves)
Alcohol prep pads

Many people have also asked about sewing masks for us. While we are not currently using cloth masks, we will accept cloth mask donations in case we run out of our current supply. Here are our requests for homemade masks:

1. Form fitting at the top over the bridge of the nose, made with items such as a pipe cleaner, twist tie, etc.
2. Leave a piece of the mask unsewn at the bottom for the insertion of a filter
3. Adult and pediatric sizes are appreciated

Here is a video which shows how these masks can be made:

We are accepting donations at our screening tent located at 111 Chambers Hill Drive, Chambersburg. Thank you so much to our generous community members! We appreciate you!

The Challenges Of Healthy Eating (And Tips On How To Overcome Them)

 Dr. Rebecca Patterson

 Dr. Michael Gaudiose

In today’s culture it’s becoming more and more difficult to maintain a healthy diet. People are working longer hours outside of the home than ever before.  These demands of work, family activities and other personal responsibilities leave many people reaching for quick and easy food options. Unfortunately, these convenience “foods” are often so altered and packed with stuff that’s bad for us that they do not contain the nutrition our bodies need to be their best and function optimally.

Dr. Rebecca Patterson and Dr. Michael Gaudiose of Keystone Family Medicine recognize that it’s difficult to maintain a healthy eating pattern in our current environment. The good news is, when people become more aware about the importance of proper nutrition and make some changes, they often find themselves feeling healthier and motivated to continue the momentum. Today’s article discusses information about nutrition to help readers make an informed decision about their own food choices and support people in navigating a confusing and unhealthy food environment.

Environmental Changes

We face challenges in the 21st century that were not a problem for people in the past. Human bodies are not designed to thrive on the convenient, overly-sweet, high-fat packaged products that are marketed as foods that many people regularly consume today. Our ancestors did not have the abundance of these unhealthy and highly addictive foods that we have to choose from now.  This drastic change that continues to spread is undeniably to blame for the worldwide increase of obesity. Many years ago, humans ate naturally-occurring whole foods like fruits, vegetables and meat. Sugar was not isolated and consumed in the high quantities we find available today. Media and food markets did not advertise and strategically manipulate our food choices as they do today beginning from a very vulnerable stage of early childhood.  Processed foods did not exist, and those whole or less altered foods helped them effectively break down and use energy in between meals.

But since then things have changed. Canned sugar-laden foods of all sorts are now readily available, sweetened drinks and junk food are everywhere we look, and fast-food or processed meals found in plastic containers or bags make a convenient dinner with minimal effort that can be stored longer without worry for spoilage. These calorie-dense foods are not natural. They are high in sugar, fat and chemicals that alter how we taste them and how our bodies can process them.  While they are energy dense, they often lack the nutrients our bodies need.

The food industry has taken advantage of this culture of stress and convenience. Unhealthy foods and drinks are marketed heavily, and portion sizes have continued to go up through the years. Even in grocery stores, you will notice that fresh produce is on the outer edge of most stores, and the majority of the store is filled with a variety of brightly packaged, processed options. When you go to the checkout line, you will be tempted by candy bars, sodas and more. We can’t underestimate the role that our current environment plays on our health today.

How Processed Foods Affect Us

As we discussed in our last article, highly palatable foods (those which are rich in sugar and/or fat and are usually processed) can trigger the brain’s reward system in similar ways as addictive substances. The human body has many different hormones, some of which regulate hunger. Processed foods can interact with these hormones negatively and disrupt the balance of normal appetite regulation. Foods and drinks with high fructose corn syrup such as soda, some juices and candy, can trick your body into feeling hungry even when it’s not.

While it’s common to see young children with juice in their cup or bottle, the American Academy of Pediatrics strongly advises against giving children highly sweetened beverages like sodas, and to limit their intake of natural juice (from 4-8 ounces based on age). Eating fruit is a much better option for people of all ages, as juice has more concentrated sugar and calories with fewer nutrients. Our bodies do not process the sugar in the same way when it is not presented as a whole package of fruit or other whole-food food items.

Eating a diet high in processed foods and drinks can also have a negative effect on the body’s microbiome (the bacteria inside a body) as well as neural pathways (which communicate information throughout the body to the nervous system) and hormones involved in regulating the feeling of hunger or satiety.

It’s important to note that there are many things that affect weight, and weight is not always an indicator of overall health. Someone may be slender and not be in good overall health. Someone may be obese and also have a healthy relationship with food, consuming a healthy diet. Things such as genetics, health conditions and medications can all play a big role. It’s important to take a holistic approach to food, and your health in general, to be at your best.

Healthy Eating Tips

As we mentioned in a previous article, sugar may actually be addictive so it’s important to keep in mind how much sugar (and even artificial sweetener) you are consuming. Cutting sugar from your diet completely may cause your body to crave it even more, as there is evidence that scarcity is actually a necessary component to trigger addictive-like qualities of food). It’s ok to indulge in a sweet treat now and then, but be mindful of how much sugar you are putting in your body, and likely this is in place of more nutritious foods.

It’s best to avoid mindless eating. If you eat while watching television or when you are busy with something else, like driving, your brain is more likely to miss the cues that you’ve had enough. Realize that it will take time for your body to adjust to the tastes of some healthy foods.  Have hope, you will get used to (and maybe prefer!) the tastes of foods with less sugar, sodium, etc. over time.

Fat is not evil. Our bodies do need fat as it helps with feeling full and is necessary for our bodies to function properly (making hormones, cell membranes, etc.). Instead of trying to cut out fat from your diet, place your focus on healthy fats. You could switch out butter for olive oil or even avocado oil for cooking. Salmon, nuts, nut oils and nut butters are healthier types of fats. Try to avoid the types of fat you’ll find in packaged foods like potato chips, cookies, muffins and donuts.

Salt is generally not as overused as sugar, but you should still be mindful about how much you’re consuming. Add salt to foods after cooking instead of before, avoid MSG, and limit salty processed foods.  If you have hypertension (high blood pressure) or heart problems, you should realize that you may need to limit salt more carefully.

It’s best to avoid extreme or “quick fix” diets and focus on an eating plan that can be maintained long-term (the Mediterranean Diet or a whole-foods, plant-based style of eating are good options). Don’t starve yourself or feel bad about yourself when you eat – eating is a necessary part of life, and it’s important to enjoy food, and “treats” in moderation. It’s important to take a complete approach to your health and cravings, including regular exercise, stress management techniques (yoga and mindfulness practices are great options), and choosing foods that will nourish your body.

If you are struggling with your relationship with food, make an appointment with your healthcare provider. He or she will be able to help you develop a strategy that’s best for you and your health. They may suggest a short-term eating plan to help reset your cravings but there is no quick fix or magical trick that will solve the problem. What you put into your body each day is very important for your overall health. Only you can make the choices around what you consume, and therefore use, to fuel your body and ultimately support wellness.

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.

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Food Addictions and Cravings

Dr. Michael Gaudiose

Dr. Rebecca Patterson

In the United States we have a problem with food. Our obesity rates continue to rise, and even those who are in a healthy weight range often don’t have a healthy relationship with food. Fad diets, highly processed meals, a culture of convenience and a lack of understanding about the importance of food choices for nutrition all play a role. Studies have attempted to explain some of these issues by measuring the addictive properties of food.

Dr. Rebecca Patterson and Dr. Michael Gaudiose of Keystone Family Medicine want their patients and the community to understand the impact a bad eating pattern can have on overall health. They shed light on the topic of food addiction and give tips about how to curb sugar cravings in today’s “Take Care” article.

Food Addiction

There is still scientific debate about whether people who have an unhealthy relationship with food (such as those who binge-eat and even those who have strong emotional ties to food) are truly addicted to food. But there is agreement that certain foods stimulate the brain’s reward pathways similar to the stimulation caused by drugs. The opioid and dopamine chemicals (which are both part of the brain’s reward system and allow us to enjoy something and then also to want more of it), can be released by both nicotine and by highly palatable foods. Highly palatable foods are those which are rich in sugar and/or fat, and are usually processed.

In lab studies it has been observed that when rats are given a sugar solution they will binge eat it and show signs of withdrawal when it is taken away. They will also go to greater lengths to get the sugar solution, including enduring a shock, than the rats that were given addictive stimulant drugs. Also, mice will actually choose sugar over cocaine in experiments looking at the addictive properties of sugar.

Given all of this evidence about the brain’s reaction to processed foods, it is no wonder people are struggling in today’s food environment where these foods are more available than ever before, and in much higher quantities.

Cravings vs. Addiction

Most people experience food cravings from time to time, and it’s especially common in pregnant women. The cause for food cravings is still a mystery, but they can sometimes be a sign that you are lacking something in your diet. For example, if you are craving chocolate it can be a sign that your body needs more magnesium.

With a craving, once you eat that chocolate, that bowl of ice cream, or whatever food you were hungry for, you are satisfied for a while and don’t need to keep eating it or have it every day.

Food addiction, however, takes it a step further. An unhealthy relationship with food develops and food changes from something that fuels our bodies to function efficiently to something that harms us and makes us sick. Unlike someone who is addicted to drugs or alcohol, you cannot “quit” food. You need to have a relationship with it in order to survive.

How to Curb Sugar Cravings

Stress, fatigue, diet and more play a role in your body’s hormones, which affect your relationship with food. If you find that your relationship with food is unhealthy, whether it is over-eating, binge-eating, consuming too many processed or sweetened foods, etc., it’s important to first recognize that you want to make a change. Make an appointment with your healthcare provider to discuss what type of changes will be beneficial to your health as well as a plan that you can maintain long-term. They may suggest a short-term eating plan to reset your cravings, but don’t fall for the temptation of doing a “quick fix” diet to lose pounds fast. Most people will gain back the weight after the diet is over. It’s best to find healthy practices you can incorporate into your daily life so you can maintain a healthy weight long-term.

When you are eating foods that are heavy in carbs and sugar, your insulin levels rise and your body tends to store fat and crave more sugar. But if you try to cut out sugar completely, your body will have an even stronger craving reaction. Instead of focusing on completely eliminating sugar or high fat products from your diet, try paying attention to healthier options that you could have instead that have not been processed and will still satisfy your cravings.

Dark chocolate is a healthy and satisfying treat. If you prefer milk chocolate, try to be open to the idea that you may begin to appreciate the dark stuff after less overall sugar in your diet and after trying it a few times. Tastes change over time and you may notice a difference once your body gets used to having less sugar.

For sweets that you bake at home, try replacing some of the sugar with dates or other fruit. You may be surprised by how sweet they are! Artificial sweeteners can be used in moderation, but keep in mind there is evidence they lead to more sugar cravings and increased daily calorie consumption as well as impacting the biome (the good bacteria in your body that plays a role in metabolism and weight). These are found in diet sodas and flavored waters, so don’t be fooled into thinking these drinks are healthy beverage choices or a good replacement for plain old water.

Instead of sugar, try adding cinnamon, ginger or vanilla to your food or beverage. This can help increase perceived sweetness without the sugar. Also, try roasting vegetables and sweet potatoes – this brings out the natural sugars in these healthy foods and satisfies some of that craving while leaving the healthy fiber and nutrients intact so your body can absorb them best. It is very easy to prepare food this way, which is a plus for busy families! Fruit is also a great snack to satisfy a sweet tooth while adding nutrients and fiber to your diet.

In the next “Take Care” article, we will be talking about how our current environment and culture affect our health and well-being, and give more tips for healthy eating.


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.


What Is An Internist?

 Dr. Jason Galicia

While most people are familiar with the term “family doctor,” many don’t know what it means if a physician is an internist. Internal medicine doctors play an important role in their patients’ lives, yet there is still a lot of confusion about this type of medicine, and many people don’t know these services are offered in our community.

Dr. Jason Galicia, an internist and the Medical Director of Keystone Internal Medicine, explains what this type of physician does and who may benefit from seeing an internist in today’s article.

What is the difference between an internist and a family medicine physician?

The American College of Physicians defines internists as “Physicians specializing in internal medicine, a discipline focused on the care of adults emphasizing use of the best medical science available in caring for patients in the context of thoughtful, meaningful doctor-patient relationships.” This type of medicine began to form in the late 1800s, as scientific knowledge about medicine was beginning to grow.

By the early 1900s, it was becoming clear that the medical needs of adults and children were often different, and pediatrics, the specialty of medical care for children, began. In the 1960s, family medicine became a specialty and focused more on the family as a social unit. Family physicians treat patients of any age, from infants to the elderly. Internists only treat patients who are 18 or older, and have specialized training in caring for adults.

Many internists practice “general internal medicine” and are known as “general internists.” These physicians are skilled in diagnosing and treating chronic (long-term) conditions as well as helping their patients prevent disease and live healthier lives. They are trained to treat routine diagnoses, but also to solve complex medical conditions and to care for patients who have multiple health diagnoses.

What special training and education do internists have?

During internal medicine residency, internists spend time learning about general medical conditions as well as training in psychiatry, dermatology, ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, palliative medicine, sleep medicine, geriatrics, and rehabilitation medicine. They also train in neurology and internal medicine subspecialties which include rheumatology, endocrinology, and infectious diseases.

Internists are trained in both outpatient and inpatient care. During their training, they must spend at least one year taking care of hospitalized patients, as well as at least three months with patients in intensive or critical care.

Can an internist be a patient’s primary care physician?

Internists can work in a variety of settings, including primary care offices, hospitals, long term rehabilitation centers and nursing homes. At Keystone Internal Medicine, and many other internal medicine practices, internists are the primary care physicians for their patients. We provide care for chronic conditions such as diabetes or asthma, or short-term conditions like the flu. The training we have as internists allows us to care for patients over their entire adult lives, and we often develop long-lasting relationships with them.

Who might benefit from having an internist as a primary care doctor?

Adults with complex health conditions or multiple long-term health diagnoses may benefit from having an internist as a primary care doctor. Due to our training, we have expertise in diagnosing and treating a wide variety of diseases, and managing patients who have multiple medical needs.

We also commonly care for patients who require hospitalizations, such as those with cancer, autoimmune diseases, etc. We co-manage these patients with other specialists and help with their transitions in or out of the hospital.


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.

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