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Poison Ivy, Oak, and Sumac Tips

While there are many great things about spending time outdoors during the summer, poison ivy, oak or sumac rashes can put a damper on the fun. Shannon Fegan, Certified Physician Assistant at Keystone Urgent Care, shares some advice on what you should do if you come into contact with these plants.

What are the symptoms of poison ivy, oak and sumac contact?

The symptoms include developing a red rash within a few days of contact with the plant. This can develop as bumps, streaks, patches or even blisters that can leak a clear fluid (It is important to know the fluid is not contagious and does not further the spread of the rash).  Swelling and itching also usually occur.  When respiratory contact is made through the plants or vines being burned, you may experience a sore throat, shortness of breath and wheezing. Symptoms from exposure can last 1-3 weeks or more.

What should you do if you think you came into contact with one of these plants?

You should immediately rinse your skin with a degreasing soap (dish liquid), detergent or specialized poison plant wash and lots of water so the urushiol (the oil on the plant that causes the reactions) doesn’t spread further or dry on your skin. Do not scrub the skin vigorously.  Clean under your fingernails with a brush as well.  All clothing should be washed in hot water with detergent, separately from all of your other laundry items.  Also, clean any gardening tools that may have come into contact with the plants with rubbing alcohol, as the urushiol can stay active on the tools for up to five years.

How should you treat a reaction?

You can use cool compresses, calamine lotion, hydrocortisone topical cream, oatmeal baths and oral Benadryl (the topical antihistamine creams or lotions can sometimes cause a reaction that makes your skin more itchy or irritated). Always consult your primary care provider before giving a child Benadryl, as special dosing adjustments are needed.

Are there ways to prevent a reaction?

The most important way to prevent a reaction is avoiding contact with the plants in the first place, and if you think you have come into contact with one of these plants, following the above instructions as soon as possible. There are some skin creams that can be applied prior to exposure if you think you will be in an area you may come into contact with the plants.  Creams and lotions containing bentoquatam are very good at preventing the plant oils from getting on your skin and causing a reaction.  These creams must be thoroughly washed off and reapplied twice daily.  If you know you will be hiking, gardening or working in an area you could be exposed to one of these plants or their oils, be proactive.  Wear long sleeves, pants, boots and vinyl gloves (latex and rubber gloves do not always protect fully).  Do not burn the plants or vines.  If you must burn them, a particulate respirator mask is important to prevent lung irritation and severe reactions.

How can it be spread?

Poison ivy, oak and sumac are spread by contact with their oil, which is released when the leaf or other plant parts are bruised, damaged or burned. Just brushing up against a plant can cause this.  Exposure to an amount less than the size of a single grain of salt will cause a reaction in 80-90% of the population.  This oil can cling to tools, clothing, livestock and pets, so you can develop a reaction by touching one of these things as opposed to direct contact with the plant itself.  It is a myth that you can get “poison” from touching the rash or scratching at the areas; however, scratching the rash can increase the risk for secondary bacterial skin infections to occur.

When should you seek medical treatment?

You should seek medical treatment if your rash is severe, most of your body is affected, your face or genitals are affected, you have a lot of swelling, your rash oozes pus or shows any other signs of being infected or your rash does not get better in 2-3 weeks. If you are not certain whether or not your rash has been caused by poison ivy, oak or sumac, have it evaluated.  Your healthcare provider would much rather see and evaluate the problem for you and provide treatment options, rather than have you worry unnecessarily or allow the condition to worsen.  If you are unable to see your primary care provider, an urgent care or walk-in clinic is a good alternative.


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 — Sue Barnhart

The Employee Spotlight for July shines on Suzanne Barnhart, Keystone Pharmacy’s Lead Technician!

Sue joined the Keystone Health family in 2012 after enjoying a 9-year-career as a Registered Polysomnography Technologist. She lost that job unexpectedly when the doctor she was working for became involved in an insurance investigation. While she loved that line of work, she couldn’t find a similar job close to home that suited her schedule.

She took a part-time job at Target while figuring out her next move, and while there she was trained to work in the pharmacy. It was there that Sue found her next career.

“I felt that I needed to be a part of the healthcare system in some capacity,” she said. “I bought books from Amazon for Pharmacy Technician Certification, and began studying. When I passed my test, I saw an opening at Keystone and decided to apply.”

She’s glad she did.

“It makes me proud to know that I work for a company that sincerely wants to help people,” Sue said. “I declined several job offers because I don’t want to work for an organization that only cares about money. It’s also nice to be treated well by my superiors and to get along with my coworkers.”

Sue’s favorite part of her job is interacting with the patients. “I like to joke around with them and laugh when they call me ‘trouble,’” she said. She has also taken it upon herself to further her knowledge in Spanish, and enjoys getting to know many of the Pharmacy’s Spanish-speaking patients.

She starts her work day at 7:30 am by filling prescriptions that were sent in overnight, and gets ready to open by 8. After that, she keeps busy with answering phones, checking on prior authorizations, calling insurances when needed for billing issues, checking inventories, running reports, and filling more prescriptions.

“It makes me proud to know that I have a part in helping people who can’t afford their medications,” Sue said. “Most places of business will offer the price, and if the patient can’t afford it they usually just go without. We have other options at Keystone to use to help keep our patients healthy.”

Sue lives in Chambersburg with her husband, and she has six adult children: three daughters, one stepson, and two stepdaughters. When she’s not at work, she likes studying Spanish (her goal is to become fluent), and reading about and practicing nutrition and natural health. She completed a Master Herbalist program at the Trinity School of Natural Health, and she enjoys making her own products such as homemade soap, lotions, face wash, face cream, and cleaning products. She is also very involved with music. She plays piano at her church, keyboard with the worship team, sings in the choir, plays violin at the Cumberland Valley School of Music Community Orchestra, and occasionally plays the accordion with her mother and sister at community events.

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

Summer Safety Tips – Part Two

With the warmer season upon us, many of us will be spending a lot of time outdoors. Warmer weather also means we have to be vigilant in the safety of ourselves as well as those around us, particularly children. Angie Wallace, Certified Registered Nurse Practitioner at Keystone Pediatrics Waynesboro, shares a few ways to stay healthy and reduce the risk of harm.

Sun Safety

What are some tips to avoid sunburn?

There are several ways to reduce risk for sunburn. Recommendations include avoiding sun exposure during peak hours (10 a.m. to 4 p.m. in the summer months), applying sunscreen, and wearing sun-protective clothing such as long sleeves, long pants, broad brim hats and sunglasses.

Sunscreen of SPF 30 or greater is recommended for everyone 6 months and older. The American Academy of Pediatrics recommends avoiding sunscreen use for infants less than 6 months of age. However, if shade is not available, a small amount of sunscreen of SPF 15 or higher may be applied to small areas such as the face and the back of hands. Sunscreen should be applied 15-30 minutes prior to sun exposure and should be reapplied every two hours during times of exposure. The sunscreen should not be expired or more than 3 years old. Avoiding tanning beds is also recommended.

How can you treat sunburn?

Sunburn usually heals within a few days. Ways to relieve pain and discomfort include cool compresses or soaks, calamine lotion or aloe vera-based gels, as well as taking oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen. Severe sunburn causing blistering or symptoms such as nausea, vomiting, headache, and/or fever should be evaluated by a Primary Care Provider.

What are the signs of a heatstroke?

Heatstroke is a condition that can occur if a person’s body gets too hot. This is a medical emergency and needs to be treated quickly. Symptoms of heatstroke include a body temperature of 104 degrees F or higher, confusion, hallucinations, trouble walking, seizures or fainting. Other symptoms include fast breathing or fast heart rate, vomiting or diarrhea, skin redness, muscle cramps or weakness and/or headaches.

What should you do to avoid heatstroke? 

Caution should be taken not to be outside during very hot weather or to take frequent breaks. Exercise during the mornings or evenings when temperature is cooler, stay hydrated with water or a sports drink, wear loose and lightweight clothing and avoid being in a hot car. NEVER leave a child or pet in a hot car.

What should you do if you suspect someone is having a heatstroke?

If there is concern for heatstroke, you should call 911. Ways to cool a person’s body include moving them into the shade, spraying them with cool water and sitting them in front of a fan, giving them a cool shower or bath, having them drink water or a sports drink, taking off extra clothing and placing a cool cloth on their neck and armpits.

Pool Safety

What can you do to keep children safe in the pool?

Drowning is the leading cause of death in children 1-4 years of age, usually occurring in a pool. Therefore, it is extremely important to avoid being distracted when children are in or around water. Young children should always be within arm’s reach and it is recommended older children have a swim partner. Teaching children how to swim through swim lessons will also reduce their risk of drowning. Children who are unable to swim on their own should wear a U.S. Coast Guard-approved personal flotation device. This does not include water wings or noodles.

Children should not be able to get into a pool on their own. A fence at least 4 feet high should be around a pool, and a door alarm can be placed on a door leading to the area. “Baby pools” should be emptied and placed upside down when not in use. Adults and older children should learn CPR – education that can provide any parent a bit of peace of mind and is a life-saving skill in a time of need.

What water safety tips should you teach children?

Children should receive swim lessons so they can learn to tread water, float, and stay close to shore when in open water. Children should know that diving is only allowed in areas designated for this due to risk of head, neck and spine injury. Children should be taught it is unsafe to swim near water drains or suction areas as they can become caught by these.

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.

Free Testing – Waynesboro

June 27 is National HIV Testing Day. Be smart about your health and take advantage of this FREE testing opportunity in Waynesboro!


Employee Spotlight – Kimberly Johnson

The Employee Spotlight for June shines on Kimberly Johnson, Licensed Practical Nurse at Keystone Pediatrics Chambersburg!

Kimberly began working for Keystone in July 2010. She previously worked as a second shift nurse manager at a nursing home, but wanted to find a job with a daytime schedule, and one where she could spend holidays with her family.

It didn’t take long to realize Keystone was a good fit for her.

“The best part of my job is the children,” she said. “I love to watch them as they grow through the years. They feel like your own. When they grow older and come in with some differences or difficulties, it is very rewarding to see how the providers help them throughout their teenage years. I love our patient commitment and how I feel we put them first. I’m proud to work somewhere that continuously makes revisions to meet the needs of our patients and their families. In most cases we find a way to see a patient, no matter what the situation may be.”

Kimberly describes a typical day at her office as “very, very busy.” She is Dr. Kaufman’s primary nurse, and has to be prepared for any challenges that could arise.

“I come in early every day to be sure exam rooms are open and ready for when our first patient arrives at 8 a.m. or before,” she said. “Every nurse knows your day can change rapidly. I love that type of challenge. It keeps our day busy and it goes by quickly. Change and challenges are great and refreshing as we grow.”

She also enjoys the people she works with.

“The providers here love to teach and never make us feel as if any question is irrelevant,” she said. “It feels like my home away from home here. I look at this group as my work family and feel we would do anything for each other. When times get tough, we are all here for each other.”

Kimberly and her husband, Tony, who live between Roxbury and Lurgan, have two adult children. Her daughter Brandy served in the US Army as a combat medic for three years, and later spent time as a surgical technician.

“Her dreams and career were short lived after an accident and God having other plans for her,” Kimberly said. “My son Shane works as a diesel mechanic, and is a volunteer firefighter for the Pleasant Hall and West End Fire departments. I know this is a huge risk and worry a lot about him. But I rest comfortable knowing that I’ve raised two children who want to help others no matter what the cost might be.”

Something people might be surprised to learn about her is that she spent twenty years working in CAD operating (computer aided design, software and hardware) and even managed a design department before becoming a nurse.

“I knew that my next career would have to be something I would love just as much,” she said. “I am now a pediatric nurse, and I love these children.”

When she’s not at work, Kimberly and her husband love to help others in whatever way they can. She also enjoys refinishing antiques, gardening, decorating and cleaning their home, and spending a lot of time with her grandson, Carter.

Thank you Kimberly, for all you do for Keystone and our patients!


Summer Safety Tips – Part One

With the warmer season upon us, many of us will be spending a lot of time outdoors. Warmer weather also means we have to be vigilant in the safety of ourselves as well as those around us, particularly children. Angie Wallace, Certified Registered Nurse Practitioner at Keystone Pediatrics Waynesboro, shares a few ways to stay healthy and reduce the risk of harm.

Bug Safety

How can you lower your risk of being stung or bitten? 

You can lower your risk of being bitten by an insect by wearing shoes, long pants and a long sleeved shirt when going outside. Caution can also be taken by applying an insect repellent lightly to exposed skin or clothing (not under clothing), and a thin layer can be applied to the face. Care should be taken to not get the repellent into your eyes or mouth and your hands should be washed after application.

If using sunscreen, it should be applied before insect repellent. Sunscreen and insect repellent combinations are not recommended for children due to the frequency of application necessary for sunscreen. Insect repellent does not need to be frequently applied. DEET is just one example of an insect repellent and is considered the most effective. Insect repellent containing DEET should not be used for children younger than 2 months of age. Repellents with 10%-30% DEET should be safe and effective for older infants and children. They should be used according to the directions on the product’s labels and should be washed off when no longer necessary.

Insect repellent will not protect you against stinging insects as they sting for self-defense. Therefore, not provoking these insects or avoiding them as much as possible is best. Wear shoes so that bees are not stepped upon. Clean up spills and cover food outside so that bees are not attracted. Call a pest control professional if a bee hive is found.

Staying inside during dusk and dawn when mosquitoes are most active will reduce your risk of being bitten. Drain areas of standing water (i.e. wading pools and buckets) as mosquitoes use these areas to breed.  Keeping exposed skin covered will also reduce your risk of being bitten or stung by an insect.

How can you avoid a tick bite?

Ticks are very prevalent in this region. Precautions should be taken to cover exposed skin by wearing long pants tucked into tall socks when in grassy or wooded areas. Skin should always be checked for ticks after being outside in an area where ticks may be present. If a tick is found, gently remove it with tweezers. A tick must be attached for several hours in order to cause infection (i.e. Lyme Disease). If the tick cannot be removed, a rash develops at the bite site, or there are concerns about how long the tick was attached to the skin, it is recommended to see your Primary Care Provider for an evaluation.

How can you soothe a bug bite? 

If stung, all of the venom is released from the stinger within the first few seconds, so the stinger should be removed as quickly as possible. Bites should be cleaned with soap and cool water. A cool damp cloth applied to the bite could help soothe it. An anti-itch medication could be taken or applied, and pain medication could be taken for pain. Avoid scratching at the site. If the bite area should become red, swollen, hot to the touch, very painful or oozing, it should be evaluated by your Primary Care Provider.

What should you do if someone is having an allergic reaction? 

If someone is having an allergic reaction such as anaphylaxis, 911 should be called immediately. Anaphylaxis is a reaction causing difficulty breathing, wheezing, hoarse voice, swelling of the hands, feet, face, eyelids and/or ears, nausea, vomiting, stomachache, dizziness or fainting. After ensuring an emergency response team is on its way, Benadryl may be given if available.

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.

Community Walking Parties – Summer Series

Are you looking for a fun, FREE way to get active and spend time with friends this summer? Walking offers many health benefits. Check out our community’s walking parties!

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.”