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

 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 21^st 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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Click here to learn more about TMS Therapy for Depression, or RSVP to email@keystonehealth.org to sign up for our informational seminar!

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.

 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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For people living with Autism Spectrum Disorder, Attention Deficit Disorder, or other developmental challenges, it can be difficult to follow behavior patterns which are typically expected in society. A child who appears to be throwing a tantrum may not be poorly behaved – he or she may be feeling overwhelmed and is asking for help in their own way. Many children struggle with self-regulation, and by understanding  the topic we are better equipped to help them achieve their full potential.

Joel Desotelle, licensed pediatric occupational therapist and program director of Keystone Pediatric Developmental Center in Chambersburg, often helps his patients cope with self-regulation difficulties. In today’s article, he explains what everyone, and especially parents, should know about self-regulation.

What is Self-Regulation?

Self-regulation is a person’s ability to manage thoughts, feelings and behaviors to be able to accomplish a task, adapt to a challenge or situation, or achieve a goal. Individuals who struggle with self-regulation tend to have difficulty staying focused, keeping still, and are often impulsive and disorganized. This makes it hard to complete tasks or cope with challenges at home, in school, and/or in their community. Likewise, building and maintaining relationships can be very difficult.

Self-Regulation and Behaviors

Certain behaviors are common for children with self-regulation issues. Tasks or demands that require attention and focus are hard, especially when the child needs to sit down for any given time. New or challenging situations can be overwhelming and often lead to emotional outbursts. Kids with self-regulation issues quickly learn that these behaviors can be used to avoid challenging or non-preferred situations, clearing the way for preferred tasks, such as video games and television, which have a low investment, high reward benefit. These behaviors can put a significant strain on parents, siblings, friends, as well as teachers and others. The key is to understand that behaviors related to self-regulation issues are a tool a child uses to try and cope with the demands of their environment. Over time, these become habit, especially if more effective coping strategies are not developed.

Self-Regulation and Self-Esteem

Kids with self-regulation issues and their related behaviors tend to get into trouble more frequently than their peers. This can have a dramatic impact on his or her self-esteem, overshadowing other talents and abilities. It is easier to be patient when one understands that their child is both still developing and also coping with trying to regulate. Helping a child learn to cope with self-regulation issues is critical to their long-term success. It is important that the message stay positive and encouraging instead of punitive. For example, instead of saying, “Why do you always do that,” you can say, “I see you are trying to do this, do you mind if I show you a better way?”

Self-Regulation and the Environment

The environment can have a tremendous impact on how a child regulates, as well as how he or she learns to cope. Environments that are often disorganized, loud, cluttered, etc. challenge these kids who are struggling to organize themselves. Keeping a clean and organized environment helps a child to focus better without being distracted by everything else around them. It is equally important to model the behaviors you expect from a child. A young child is still learning how to cope with stress and other demands and that learning starts at home. Modeling good stress management and communication skills will help a child to manage those situations as they grow up.

Self-Regulation and Therapy

Kids who struggle with self-regulation benefit from occupational and speech therapy services. Kids with self-regulation issues often avoid difficult situations and as a result, many skills are delayed. Occupational Therapists and Speech Language Pathologists can help bridge that gap, focusing on the skills a child needs to be successful. Additionally, Pediatric Occupational Therapists specialize in self-regulation problems and can help to develop a program to improve regulation, while also offering strategies to help a child be more successful at home and school.

If your child is struggling, it’s best to be proactive. Talk to your child’s healthcare provider about your concerns. Therapy can be a great step towards helping your child reach his or her full potential.

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.

Across the world, Major Depressive Disorder (MDD) continues to be a leading source of suffering and disability. MDD causes a staggering burden with the highest morbidity rate in the world, with a great deal of the cost being the indirect expense of loss of productivity. For many people, standard treatment with medications and/or psychotherapy is either not effective or causes serious side effects. New and more effective treatments are needed urgently, and thankfully, medical advancements have been made in recent years. One new form of treatment is SpravatoTM.

Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, talks about this new type of treatment for MDD which he hopes will help many people in the community.

What is SpravatoTM?

SpravatoTM is a new medication for depression (low mood) that is delivered through the nose with a nasal spray. It is an exciting step forward in the treatment of depression and is a valuable addition to the growing list of treatment options. SpravatoTM contains the medication Esketamine, and works differently compared to all other available antidepressants. Usually it is used in addition to traditional antidepressants because this was evaluated as an “add-on” treatment.

Who is a good candidate for this treatment?

SpravatoTM is for individuals who have treatment resistant depression, which is depression that has failed to respond to standard treatment approaches with medications and therapy. In other words, SpravatoTM may be considered if patient’s condition has not improved with two or more medication trials. Usually this is also a requirement by the insurance companies in order to have this treatment approved.

There are instances where use of SpravatoTM would not be appropriate. For example, this is not to be used during pregnancy or by a woman who is breastfeeding. It should not be used by anyone who is allergic to SpravatoTM or any of its ingredients. Patients with a history of bleeding in the brain or any blood vessel disorders should inform their doctor as this treatment may not be right for them. SpravatoTM only treats MDD and is not used for other mental health disorders like anxiety, schizophrenia, PTSD, OCD, etc.

Is it effective?

As of March 2019, SpravatoTM was approved by the Food and Drug Administration for the treatment of depression. It has been evaluated in several trials establishing its effectiveness. Its precursor, Ketamine, has been around for longer and has strong evidence for effectiveness.

What are the side effects?

Even though SpravatoTM was designed to remove side effects of its parent drug Ketamine, it still has some side effects. These may include feeling sleepy and an increase in blood pressure. Due to the potential side effects, treatment must be given in a doctor’s office. For more information on all the potential side effects and whether you would be a good candidate for this treatment, please talk to your healthcare provider.

What should people know before trying this treatment?

Treatment is done in a doctor’s office under physician supervision because there is a requirement that patients are monitored for side effects for at least two hours. In my office, during this time, the patient is sitting in a comfortable reclined chair in a private room, and medical staff will monitor them for side effects like an increase in blood pressure.

There are only two possible dosages of this medication, and if needed, a higher dosage can be given within first week. It is very important to note that the patient will need to make arrangements to have designated driver after receiving treatment. It is not recommended that they drive or operate machinery the rest of the day until they’ve had a restful night’s sleep. If the patient is taking sedating medications, they are advised to avoid them the day of the treatment.

How long do the results last?

The treatment schedule is twice a week for the first month. If the patient is responding well to treatment, it can be decreased to once a week. Eventually, treatments may be decreased to every other week.

Benefits can be seen as quickly as the first day or during the first week. The fast result is a big advantage of this drug because we know that with many antidepressants, we have to wait weeks to months before dosage can be adjusted and real benefits are observed. Unfortunately, the benefits of this medication are short-lived, requiring twice-a-week administration. With time, if the patient responds well, we start seeing longer-term improvement allowing us to decrease the frequency of administration. There is no good data yet as to how long this treatment needs to continue for. Depression is a chronic and recurrent disorder and often we need to continue effective treatments in order to prevent symptoms from returning.

How should patients prepare for the appointment?

You will need to have a psychiatric evaluation by a qualified psychiatrist before this treatment can be recommended for you. When preparing for an appointment with a doctor, make sure you have a complete list of medications that you have tried for treating depression. You should also have a complete list of current medications, whether they are used for psychiatric reasons or not, available to the doctor at the time of appointment. You should know your medical history or have somebody come with you who can help in providing this information.

If you are struggling with depression, or any other mental health concerns, please contact your healthcare provider as help is available. While there is no cure for MDD, by finding the right treatment for you, there is hope to lead a full, happy and productive life.

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.