Dr. David Pagnanelli Jr.

Having arthritis can result in a great deal of pain and can affect the quality of life for those who have the disease. When arthritis is in the feet and ankles it can present a variety of challenges during day-to-day life, including an impact on mobility. The good news is that treatment is available.

Dr. David Pagnanelli Jr. of Keystone Foot and Ankle Center shares some information about how podiatrists can help patients with arthritis, and why seeing a doctor sooner rather than later is so important.

What is arthritis and what causes it?

Arthritis refers to a group of diseases that causes joint pain and swelling. There are more than 100 types of arthritis, but the most common form is Degenerative Arthritis, also known as Osteoarthritis. This arthritis comes into play when your cartilage, which should be smooth and slick to help your joints glide, becomes worn down.

A variety of factors affect one’s risk for developing arthritis and these factors include age, excessive weight, previous injuries and a family history.

How does arthritis affect the feet and ankles?

Everyone wants to walk, but arthritis can make walking difficult. All of your weight is transferred through the bones and joints of your ankles and feet. The excessive strain on these small joints can cause the cartilage to break down and can result in pain with every step you take. The bone on either side of the joint then starts to rub together, causing pain, swelling, stiffness and spurring.

How is arthritis in the feet and ankles treated?

Different types of arthritis are treated in various ways. Early treatment for osteoarthritis of the foot or ankle joints consists of specialized custom orthotics (shoe inserts). These hold your joints in an upright, aligned position during each step to reduce excess pressure and weight in one location on the joint surface. This helps create a more normal and functional walking pattern. We also use NSAIDS (pain relievers) and steroid injections to reduce inflammation and pain as well as bracing and taping to help stabilize the joint.

Surgical intervention is also an option for end-stage arthritis. Depending on the severity of the arthritis, we surgically treat these joints by either simply cleaning up the arthritic spurring, or completely fusing the joint. By completely fusing the joint you eliminate the micro-motion and the sliding of the bone on bone and therefore eliminate the pain. We also can place joint implants for certain joints like the toe joints and the ankle joint. These can only be placed in certain patients who qualify for them.

When is surgery recommended?

When the pain becomes constant and non-invasive treatments have not been sufficient, and/or when there is no more cartilage left in the joint and you begin to create large bone spurs as a result, surgery may be recommended.

Is it important to keep your joints moving when you have arthritis of the foot or ankle?

Although arthritic pain is caused by moving your joints, if you completely stop moving you will add to the stiffness and you will get muscle fatigue and atrophy (loss of muscle mass and strength). It is good to have an exercise program to keep your joints moving but not to the excess that it produces pain. Most patients find that aquatic exercises are the best to alleviate pain and keep joints moving.

What are some tips for living with arthritis of the foot or ankle?

Know your limits and don’t overstress your joints. Try and find a healthy balance of exercise and rest. Also, it’s important that you don’t wait to see a doctor until your pain gets so bad that it hurts with every step. If treated early, your doctor may be able to help you manage your symptoms before they become severe. If you wait until your pain becomes constant, it might be too late for non-invasive treatments and surgery could be needed.

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.

Kyle Ducey

While most people have heard of Autism, there is still a lot of misinformation about the subject. Not all people affected by Autism have the same characteristics, and many people on the spectrum go on to lead productive, independent lives. However, identifying traits of Autism as early as possible is very important.

Kyle Ducey, Certified Registered Nurse Practitioner at Keystone Pediatrics in Chambersburg, sheds some light on the topic in today’s article.

What is Autism Spectrum Disorder?

Autism, or Autism Spectrum Disorder (ASD), refers to a developmental disorder with a wide range of characteristics with varying degrees of severity. The characteristics that define ASD are difficulty in social interaction/social reciprocity, difficulty with communication and restrictive or repetitive patterns of behavior or thoughts. There is not just one classic textbook presentation of Autism, but rather many different subtypes that are affected by a combination of genetic factors and environmental factors.

The characteristics that define ASD run on a spectrum of severity, giving each individual their own unique presentation of strengths and challenges. The ways an individual with ASD learns, thinks, problem-solves and socializes range from highly skilled to severely impaired. Some individuals require significant support to complete their daily activities, while others may need less support and may even eventually live independently.

Autism symptoms are treatable but not curable. Autism is five times more likely to occur in males than females. A diagnosis of ASD is made every 11 minutes in the United States, and 1 in 59 children will be diagnosed with Autism Spectrum Disorder.

Autism is often accompanied and sometimes complicated by conditions such as sensory sensitivity/processing difficulties, gastrointestinal disorders, seizures, sleep disorders, anxiety, ADHD and depression.

When do signs of ASD first appear?

In the United States the most common age at diagnosis is 4 years old. However, the American Academy of Pediatrics recommends screening for Autism at ages 18 months and 2 years at well child exams, using a verified screening tool. A diagnosis of Autism can typically be made by the age of 2 if identified early enough.

One of the most important ways to identify risk factors for Autism is to have your child seen by their health care provider regularly.

Why is it important to identify Autism as early as possible?

Identifying Autism early has been shown to be one of the key predictors of positive outcomes for individuals with Autism. Research has shown that intense early applied behavior analysis (ABA) therapy has shown the best improvement in the child’s core symptoms of Autism. ABA is based on the science of learning and behavior. ABA is considered an evidence-based “best” practice treatment by the US Surgeon General and by the American Psychological Association.

What are some of the common early signs of Autism?

Given that an individual’s outcome has been linked to early diagnosis and early treatment, it is important to know what some of the early signs of Autism may be which parents and providers need to be aware of. These include but are not limited to the following:

Communication

These signs can include:

• Delays in development of spoken language
• Repetitive language
• Lack of useful language
• Inability to initiate or maintain language
• Responding to a question by repeating the question rather than answering it
• Difficulty communicating needs or desires

Social Interactions

These signs can include:

• Displaying inappropriate verbal and/or non-verbal behavior
• Difficulty developing peer relationships
• Lack of social and emotional exchanges
• Preferring not to be touched, held or cuddled
• Trouble understanding feelings or talking about them
• Not sharing interests or achievements with others (such as drawings or toys)

Behavior Patterns

These signs can include:

• Restricted and/or repetitive patterns of behavior
• Difficulty in motor control
• Peculiar attachment to inanimate objects
• Distressed by a change in routine
• Lining up toys
• Head banging
• Rocking back and forth

What are some common signs of Autism in older children?

It is common for an individual with high academic functioning to receive a late diagnosis of Autism. Particularly in girls more than boys, due to girls more often being able to copy neuro-typical behaviors, including verbal and non-verbal communication which may mask their other symptoms of ASD.

Some of the signs an older child could have that may be concerning for Autism are the following:

Difficulty with social interaction and communication. These signs often include problems forming friendships, mistaking social cues or body language, misinterpreting conversations, finding it easier to form friendships online, displaying poor eye contact and expressing that they don’t fit in.

Inflexibility or rigidity of thoughts (‘black and white’ thinking).

Sensory processing difficulties. These often include experiencing sensory overload (finding the noise of school overwhelming), being unable to cope with lines or crowds, sensitivity to touch and having difficulty planning or organizing their work, bag or school day.

Emotional difficulties which often include low self-esteem, difficulty or reluctance to express or label their own emotions, levels of anxiety which seem excessive compared to the situation triggering them, low mood or depression and a desire to withdraw from the outside world.

Having any one of these symptoms by itself does not automatically indicate Autism Spectrum Disorder, but rather, as the name implies, it is a spectrum of multiple symptoms that when combined together can indicate a potential diagnosis of ASD.

What should you do if you are concerned about your child?

If parents are concerned about their child’s development, they should schedule an appointment with their primary care provider’s office to further discuss their concerns. One way that parents can be proactive with their child’s development is to bring their child in for routine physical exams and their provider can perform developmental screenings at that visit to monitor for any areas of concern. And if there is any concern, your provider can refer your child to the appropriate specialist for further evaluation and further intervention and treatment.

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.

Keystone Foot and Ankle Center is accepting new patients! Click here to learn more.

Dr. Rebecca Patterson

In America, healthy eating is not a top priority for most people. The vast majority of Americans are carrying extra weight, and even those who are in a healthy weight range often don’t have the best eating habits. A poor diet can contribute to a variety of health conditions including high blood pressure and cholesterol, heart disease, stroke and even some cancers.

In today’s article, Dr. Rebecca Patterson of Keystone Family Medicine gives some tips for avoiding diets and making healthy eating a part of your everyday lifestyle.

What’s wrong with dieting?

I don’t recommend traditional dieting as there are no quick magic fixes. Most diets promise rapid results by eliminating food groups or having rigid rules that will not be maintainable long-term. Instead, I encourage my patients to make healthy eating part of their lifestyle, and to find a balance they will be able to sustain long-term and feel good about.

One eating plan that I do recommend is the Mediterranean style of eating. It is high in fruits, vegetables, fish, olive oil, nuts and whole grains, and recommends that dairy, red meat and added sugars be consumed only occasionally or in smaller amounts. There is good evidence that following the Mediterranean eating style increases longevity and helps keep inflammation controlled, which is an important part of overall health.  Another eating plan that shows great evidence for longevity and controlled inflammation is a whole-foods, plant-based diet. Studies show that 60% of chronic diseases could be prevented by diet changes that lower inflammation.

Are juices and diet sodas OK to drink?

Juice, even 100% juice, isn’t the healthiest option. Juice has concentrated sugar as the fiber has been removed from the fruit. Many juices have similar amounts of sugar as sodas. Eating a piece of fruit is a much better option than drinking a glass of juice. Diet sodas also aren’t healthy. While they may have no actual sugar, they are loaded with artificial sweeteners which spike insulin. The body has the same reaction to artificial sweeteners as it does to sugar, and the more of it you consume, the more the dopamine centers in your brain will crave it. There are also concerns about how artificial sweeteners affect the body long-term, and studies are currently underway.

No sweetened drinks are healthy, including sweet tea. Instead, opt for water or unsweetened tea. Most people are not drinking enough water. I do not recommend the water flavoring packets or liquids which are available at grocery stores as they contain artificial sweeteners. If you want to add flavor to your water, try a fruit or cucumber slice instead.

Is sugar or salt worse for you?

For most people, lowering their sugar intake is most important. Sugar has been linked to cancer, diabetes, hypertension and more. It is also highly addictive. In research, mice have shown higher levels of addiction to sugar than to cocaine.

Excess salt or sodium intake is not recommended, but unless you have heart conditions, high blood pressure or some other medical concerns it is generally not as big of a problem. However, you should still be mindful about how much salt you are eating. Don’t buy pre-salted foods, limit processed foods (which are often high in sodium) and add salt to meals after cooking instead of before.

What’s the microbiome?

The microbiome, in short, is the bacteria in our guts. This is an exciting area of research showing that proper nutrition may not only be about what we consume, but what our bodies absorb. Everyone’s body absorbs nutrition differently and can be affected by many different factors. In the future, the research that is currently underway may help us better craft eating plans specifically designed for individuals.

What should I keep in mind when trying to change my eating habits?

Healthy eating should focus on what options are available, instead of focusing on restrictions. It’s best to eat fewer foods that are processed and more whole foods that are recognizable without changing their forms. Processed foods do not give our bodies the nutrients we need, and nutrition is the most fundamental part of health and is used for everything our bodies do. Increase your intake of fiber and healthy fats (such as vegetables, fish and nuts), and decrease the amount of sugar, high fructose corn syrup, pre-packaged foods and simple carbs that you eat. (Examples of simple carbohydrates include bagels, donuts, white bread and white pasta). High fructose corn syrup, a type of added sugar, has been linked to the obesity epidemic and like sugar is highly addictive. Foods with preservatives also have a negative effect on many people, and can lead to gastrointestinal issues.

It’s important to keep in mind that it takes a long time to change your eating habits. If you are used to eating a highly-processed or sugar-filled diet, many fruits and vegetables may not taste very good to you at first. It takes a while for your taste buds to adjust, and adding them into your diet gradually may help the transition be easier. Don’t feel like you can never eat your favorite treats again. But keep them as that – an occasional treat – as opposed to eating them every day.

What if I don’t have the time or money to cook healthy meals?

We live in a culture of convenience, and finding the time to eat healthy can feel overwhelming. In today’s society, many people work long hours at multiple jobs, are busy with kids and often have little support. Most people feel they do not have enough time or energy left to prepare healthy meals. However, making small changes can make a big difference. Limiting junk food at home and replacing it with healthier options is a great place to start. Drink water instead of juice or soda and eat real fruit instead of fruit snacks. Instead of sugary breakfast cereals, try yogurt with granola and fruit (make sure you are buying low-sugar products – many yogurts and granolas have added sugars). Swap white pasta for whole-grain pasta. Instead of reaching for cookies, try veggies with hummus or an apple with peanut butter. When you buy fruits or vegetables, it’s helpful to cut them into bite-sized pieces that same day so they are easy to take on-the-go.

As a working mom myself, I find it helpful to plan my meals for the week ahead of time, and to set aside a specific time each week to cook. Those meals can then easily be reheated for a quick, healthy dinner. Allowing your children to be part of this process may encourage them in your new habits. Let them pick which vegetable you’ll have, or assist with simple cooking tasks.

If money is tight, it can be extra tempting to opt for a cheap drive-through meal instead of one with fresh ingredients. However, you don’t have to spend a lot of money to eat healthy foods. Watch for good deals at the store and stock up on foods that you can freeze or can. When you have a day off, cook a large amount of food in advance. Dinner leftovers make great lunches! Frozen fruits and vegetables are often more affordable for produce that is not in-season. For produce that is in-season, farmers markets offer good prices and allow you to support the local economy. Chambersburg has a great outdoor farmers market on Saturday mornings – North Square Farmers Market – which even offers kids tokens to exchange for free produce each week! There are other great markets in Chambersburg and our surrounding towns well, some of which offer weekday and evening hours.

Making the adjustment to healthier eating is crucial to your and your family’s wellbeing. Children often carry their childhood habits into adulthood and eat the same foods they ate growing up. Make time to enjoy your meals together (never in front of the TV), and focus on which healthy foods you really enjoy instead of those which you should limit. If you are looking for some support on your journey to eating healthier, check out a local program called Healthy Eating Adventure (www.healthyeatingadventure.org), a 28-day program which helps people transition to making better nutrition choices.

By gradually changing your eating habits and making a few good choices each day, you can have a healthier and happier tomorrow.

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.

You may have noticed ongoing construction over the past year for Keystone Health’s newest facility. In just over a month, construction will be complete and our newest building will be open!

The 68,000 square foot building is located at 111 Chambers Hill Drive, on the corner of Norland and Fifth avenues in Chambersburg. Several of our current practices will relocate to the new site to allow for expansion so we can better serve the community.

The sites planned for relocation are:

• Keystone Urgent Care
• Keystone Pediatric Dental
• Keystone Pediatric Therapies including Audiology and Speech (which will be renamed Keystone Pediatric Developmental Center)
• Keystone Infectious Diseases, HIV/STD Services, and Keystone Community Outreach (These practices will be combined into one office named Keystone Community Health Services)
• Keystone Administration and Billing

All offices are scheduled to be open for operation in October.

Keep an eye out  for information about an upcoming community open house!

111 Chambers Hill Drive

Keystone Health has earned The Joint Commission’s Gold Seal of Approval ® for Ambulatory Health Care Accreditation by demonstrating continuous compliance with its performance standards. The Gold Seal is a symbol of quality that reflects a health care organization’s commitment to providing safe and quality patient care.

Keystone Health underwent a rigorous, unannounced onsite review in June. During the visit, a team of Joint Commission reviewers evaluated compliance with Ambulatory Health Care Accreditation standards spanning several areas including emergency management, environment of care, infection prevention and control, leadership, medication management, and rights and responsibilities of the individual. The Joint Commission’s standards are developed in consultation with health care experts and providers, measurement experts and patients. They are informed by scientific literature and expert consensus to help health care organizations measure, assess and improve performance. The surveyors also conducted onsite observations and interviews.

“As a private accreditor, The Joint Commission surveys health care organizations to protect the public by identifying deficiencies in care and working with those organizations to correct them as quickly and sustainably as possible,” says Mark Pelletier, RN, MS, chief operating officer, Accreditation and Certification Operations, and chief nursing executive, The Joint Commission. “We commend Keystone Health for its continuous quality improvement efforts in patient safety and quality of care.”

“Keystone Health is pleased to receive accreditation from The Joint Commission, the premier health care quality improvement and accrediting body in the nation,” added Joanne Cochran, President and CEO, Keystone Health. “Staff from across the organization continue to work together to develop and implement approaches that have the potential to improve care for all the residents of our community.”

After finding out a baby is on the way, or when moving to a new town, one of your top priorities may be finding a healthcare provider for your child. Having a doctor or provider that you trust and can go to with any questions or concerns is an important step in keeping your little one healthy. But where do you start?

Dr. Michael Colli, Chief Medical Officer of Keystone Health and Medical Director and Pediatrician at Keystone Pediatrics, shares tips on selecting the provider that’s right for you, and why it’s important for kids to get regular care during the first years of life.

Healthcare Provider Options

There are two types of primary care physicians who treat children. Family doctors and other medical providers at family medicine offices (such as physician assistants and certified registered nurse practitioners) provide care to people of all ages, including babies. After attending medical school, family care physicians do residency training in a variety of specialties where they learn to provide care for all ages. Some people find it convenient to have every member of the family go to the same healthcare location and/or see the same healthcare provider.

Other people prefer to have a pediatrician manage their child’s care. Pediatricians and other providers in a pediatric office specialize in treating babies, kids and teens and only see patients from birth to 18 years old. To become a pediatrician, doctors attend medical school and then complete three additional years of specialized residency training in treating children. This also includes advanced training in the care of critically ill and hospitalized children.

Regular Care Is Important

Even when your child is not sick, it is important that they see their healthcare provider regularly. Well child checks are important, and allow providers to make sure your child is growing and developing properly. Children should be seen at birth, and at ages 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 2 and a half years, 3 years, and then yearly after that. The earlier growth and developmental issues are identified, the earlier testing and treatment can be done which can lead to significant improvements.

Types of Visits

There are three types of appointments—well child checks, acute illness visits and behavioral evaluations. Medical providers can identify and treat many common physical illnesses and complaints, and order testing when needed. They can also evaluate your child for behavioral issues and developmental disorders such as autism spectrum disorder or attention deficit disorders. If your child needs further care from a specialist, your healthcare provider will refer you to the appropriate place.

Finding the Right Provider

If you are expecting a baby, a good way to find great care is to ask your family and friends for their recommendations. You may also consider asking your obstetrician or midwife to recommend a provider. If you are new to the area, there are many options available in Franklin County and the surrounding regions. A simple online search will yield plenty of choices. Decide whether you prefer a family doctor or pediatrician, and what offerings are important to you. Some offices provide evening or weekend hours, or an option to walk in without an appointment.

By finding a healthcare provider that is right for your child and by visiting them regularly, you will be on the right track to helping your child grow up to be a healthy adult.

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.

For more information about Keystone Pediatrics and the Chambersburg Pediatrics Walk-In Program, click here.

For more information about Keystone Family Medicine, click here.