The Keystone Health Employee Spotlight for November shines on Betty Parker from our Billing Department!

Betty is among Keystone’s most tenured employees. She began her career with us in June of 1999 as a part-time receptionist in an office Keystone then had in Dry Run, PA. That location has since closed, but she wanted to continue working for the company.

“In 1999 I was going through medical secretary schooling and did my shadowing at the Dry Run office,” Betty said. “After a couple weeks and toward the end of my course, the office manager there offered me a part-time job as a receptionist. I accepted and here I am 19 years later.”

During that time she has held several different job positions within Keystone including receptionist, medical records technician, data entry technician, collections representative, and now billing representative. Through the years she has always appreciated working for a company that is making a positive impact on our community.

“I’ve learned so much from what Keystone Health stands for and from what Joanne (Cochran) does for our community,” she said. “We offer health care to a lot of people who cannot afford it otherwise.”

On a typical work day Betty keeps busy with posting insurances, assisting patients, resolving issues related to insurance companies and contacting the companies for payment.

“I enjoy working with our patients,” Betty said. “I like to help them understand their billing statements and help them resolve any issues they’re having with their insurance company. I also work with the best group of people. They make it a joy to come to work every day.”

Betty also gets a lot of happiness out of spending time with her family. She lives in Shippensburg with her husband of 37 years, Erick.

“My husband is my best friend and he inspires me to always be me and to reach for whatever I want to achieve,” she said. “We have two beautiful children, Shawnna Lynch and Derek Parker, and two adorable grandchildren. We also have our big boy Maximus, our chocolate lab who we all adore.”

Before moving to Shippensburg Betty and her family lived in Path Valley where her children grew up.

“We waited to move until our children were out of high school so they could graduate with their classmates; that was our promise to them,” she said. “We love living in Shippensburg now. We enjoy walking around our neighborhood and meeting our neighbors. We also enjoy camping with our family, vacationing at the beach, and I love shopping with my daughter and being connected at the hip to my husband. I constantly want to make people happy and have always been like that.”

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

 Join us on Saturday, November 10th, for our 2018 Diabetes Health Fair!

Approximately 7% of Americans are suffering from Major Depressive Disorder (MDD). Unfortunately, this disorder can be debilitating and many people who live with it struggle to find a treatment that works for them which doesn’t also cause unpleasant side effects.

Dr. Irakli Mania, Psychiatrist and Medical Director of Keystone Behavioral Health, has begun providing a new type of treatment to some of his patients – Transcranial Magnetic Stimulation (TMS). While this type of treatment has been deemed safe and effective for years, patients previously had to travel out of the Chambersburg area to receive it. This non-invasive procedure targets the brain directly instead of going through the patient’s bloodstream, and has shown positive results in worldwide studies, and with Mania’s own patients.

If you have been diagnosed with MDD and medications are not working or are causing strong side effects, you may be a good candidate for TMS. In today’s article, Mania answers some frequently asked questions about this type of treatment.

What is Major Depressive Disorder?

Major Depressive Disorder (MDD), also known as clinical depression, is a serious and often chronic condition. Symptoms include a depressed mood, lack of interest in previously enjoyable activities, changes in appetite and weight, and changes in sleep and energy level. It is often accompanied by concentration and memory problems and in some cases can lead to suicide.

Usually MDD is treated with medications and/or psychotherapy. Despite the advances in our ability to recognize this illness and advances in pharmaceuticals and psychotherapeutic techniques, we still have a huge number of individuals who have what we call Treatment Resistant Depression. Their quality of life is very poor. In fact, MDD is one of the leading causes of disability worldwide according to World Health Organization.

What is TMS?        

TMS involves directly stimulating neurons of the brain through the skull. It has been FDA approved for the treatment of MDD since 2008. This is a treatment that is getting a lot of attention and we will soon be able to treat more psychiatric conditions with it. In addition to depression it was recently approved by the FDA for the treatment of Obsessive Compulsive Disorder. It has been successfully used for substance use disorders, anxiety, and many other psychiatric and non-psychiatric conditions.

What’s the treatment like?

TMS is a non-invasive procedure done in a doctor’s office. The patient sits comfortably in a chair and a magnetic coil is placed on his or her head. The patient may feel a tapping sensation on their head during the treatment, which lasts for about 30 minutes. There is no anesthesia or recovery time, and the patient is able to leave right after the procedure without any limitations to driving or activities. In order for the treatment to be effective it has to be done on a daily basis (five days a week) for 4-6 weeks. It may seem like a big commitment to visit a doctor’s office this frequently but often it is well worth the effort. Most people see results within two to four weeks, but some require more time.

Who are good candidates for TMS?

TMS is usually recommended upon failure of one or more antidepressant medications and/or psychotherapy. Also, individuals with MDD who are not able to tolerate medications could be good candidates for this treatment.

If someone has a ferromagnetically sensitive object (metal) in or near their head, TMS therapy is not an option. Examples may include implanted devices like cochlear implants and aneurism clips but also any metal containing tattoo or eyeliner. Of course there are other conditions that a doctor has to evaluate in order to proceed with treatment. For instance, a history of seizures, stroke, or a brain tumor may eliminate someone from TMS treatment.

Does it have side effects?

Side effects for TMS are rare and usually subside within days. TMS has very low dropout rates compared to medications that have side effects. Common side effects of TMS include headache, neck pain, irritation of the stimulation site, and ringing in the ears. They tend to go away within few days of treatment because the patient gets used to the stimulation. On the more severe spectrum there is a risk of seizure, though this is extremely rare (less than 1 in 30,000). This particular side effect is getting more and more rare because of the precautions doctors are taking and the care that TMS teams deliver on a daily basis.

Is it effective?

TMS is a very effective treatment for depression. Rates of success vary from clinic to clinic and from study to study. Response rates are as high as 70% and remission rates (complete absence of symptoms) are as high as 40%. It is important to note that individuals receiving this treatment have treatment resistant depression and the chances of them getting better with other traditional methods are nearing zero. The best predictor of success is the degree of treatment resistance, meaning that if TMS is used earlier the success rates are even higher.

Even though my personal experience with this treatment is limited, with only four patients having undergone the treatment so far, we are proud to report that all four are doing better.

For more information on TMS therapy, call (717) 709-7933.

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.

The Keystone Health Employee Spotlight for October shines on Dr. Jagdeep Kaur, Psychiatrist at Keystone Behavioral Health!

Jagdeep, who is board certified in both general psychiatry and addiction psychiatry, began working at Keystone in July of 2014. She had just graduated with her addiction psychiatry fellowship, and a friend recommended she apply at Keystone.

“Dr. Kawish Garg is a very close friend and he was working at Keystone at that time,” she said. “My daughter, Naaz was an infant and my husband was in Brooklyn, New York doing his pediatric residency training. I did not want to live in a busy city but did not want to be very far from family either. Chambersburg was the perfect location and I decided to join Keystone.”

More than four years later, she’s glad she did.

“My favorite part of my job is seeing my patients doing well and achieving their goals,” she said. “It is hard for me to see them suffering and anything we can do, to alleviate that suffering as a team, is done at Keystone. Seeing patients appreciating these efforts is very fulfilling, and saving lives and saving families makes me very proud.”

Jagdeep spends her work days providing psychiatric and substance abuse medical services to her patients, and then keeps just as busy at home with her family. She lives in Greencastle with her husband, 5-year-old daughter, and 3-year old son. While her days can be hectic, she makes family time a priority and also makes sure to take some time for herself each day.

“I wake up at 5 am every weekday,” she said. “For 20 minutes in the morning I do physical exercise and/or meditation. After dropping off my kids at daycare, I start work at 8 am. I work full time and get off at 5 pm. As you know evenings and mornings are always busy for working moms but I make sure to go to bed on time.”

When she does get some free time, Jagdeep’s hobbies include reading, writing, and time with her children. She also enjoys keeping a balanced diet, getting regular physical activity, and doing meditation to help her stay healthy and active.

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

When some people feel sick or have a minor injury, their first thought is to visit the emergency department at their local hospital. However, there are other options. Urgent care offices are able to treat a variety of illnesses and minor injuries, often more quickly and with less cost to the patient than if the patient would visit an emergency department.

In today’s Take Care article Shannon Fegan, a Certified Physician Assistant at Keystone Urgent Care, explains the difference between urgent cares and emergency departments, and gives some tips about selecting the option that’s right for you.

What are the main differences between an urgent care office and the emergency department?

An urgent care office is designed to treat minor injuries and non-life threatening illnesses, particularly when you are unable to be seen by your PCP (Primary Care Provider) or when it is after your normal PCP’s hours. Emergency departments are for severe injuries and life-threatening illnesses. Typically, wait times are less in an urgent care due to less severe ailments being treated than those seen in an emergency department. Appointments are not needed at urgent cares, and often insurance copays are lower as well.

What types of ailments can be treated at an urgent care office?

Most urgent care centers treat things such as minor fractures (particularly of the wrist, arm, ankle and foot), sprains/strains, cold or flu-like symptoms, seasonal allergies, urinary tract infections, rashes, minor lacerations, minor headaches, ear/sinus pain, nausea/vomiting/diarrhea, eye irritation/swelling/pain and mild asthma symptoms. Chronic health problems should be managed by your PCP and not an urgent care. Urgent care centers typically do not do ongoing follow-up care or routine lab work. Some physical examinations, like school sports physicals, can be done in urgent cares; however, routine yearly physical examinations and routine childhood vaccinations must go through a PCP. Flu shots, however, are given at most urgent care centers.

How should you decide whether to go to the emergency department or an urgent care?

With true emergencies, time is of the essence. Do not delay your care by going to an urgent care first if you are experiencing chest pain, difficulty breathing, signs/symptoms of a stroke, head trauma, loss of consciousness, severe bleeding, fractures where the bone is protruding through the skin, severe abdominal pain (particularly in the lower abdomen), loss of vision or severe headache.

What are some benefits to choosing an urgent care facility for minor health problems?

The majority of patients who go to an urgent care are seen by a provider within 30 minutes of arrival. It is convenient for those who are unable to see their PCP for minor illnesses due to work/school schedules.

What should patients know about insurance and payments before selecting where to seek healthcare?

The copay at urgent care offices is often lower than that of emergency department copays. Most urgent care centers take insurance. If you aren’t certain if your insurance is accepted by the urgent care you are going to visit, call ahead and talk to the staff. They will be able to help you determine if your insurance is accepted. Recognize that because an urgent care office is not a PCP, medical advice is not given over the phone.

Will your wait at the hospital be shorter if you visit an urgent care first?

Unfortunately, I frequently hear from patients that they knew they needed to be in an emergency department but thought if they came to urgent care first, it would mean they wouldn’t have to wait as long in the emergency department. There are many factors that go into the length of time one waits in an emergency department, none of which are impacted by being sent to the emergency department from an urgent care. If you have a serious health issue, as discussed above, do not delay your care; go directly to the emergency department.

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.

September 28 was National Penicillin Allergy Day. Penicillin is the most commonly reported drug allergy. Reactions from penicillin can range from mild to severe. Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, wants to educate the public about penicillin allergies, and shares important information for those who have had past allergic reactions to penicillin or a related drug.

What is penicillin?

Penicillin was discovered by Alexander Fleming in 1928. Ninety years later, it is still one of the most important and commonly prescribed antibiotics. The penicillin family of antibiotics has more than 15 chemically related drugs, including penicillin, amoxicillin, amoxicillin-clavulanate, ampicillin, methicillin, and dicloxacillin that are given to treat many bacterial infections. A penicillin allergy is an abnormal reaction of your immune system to the antibiotic penicillin.

What causes a penicillin allergy?

A penicillin allergy occurs when your immune system mistakes the drug for a harmful substance. It happens when a body reacts to penicillin as if it were an infection instead of an antibiotic. Your immune system needs to be exposed to penicillin at least one time before it can develop sensitivity to it. If sensitivity does develop after your immune system mistakes it for a harmful substance, you will develop an antibody to the drug. Antibodies identify and counteract foreign objects such as bacteria and viruses that enter your body. The next time you take penicillin, these specific antibodies detect it and direct the immune system to attack the substance. There are chemicals that are released by this activity, and they cause the symptoms of an allergic reaction.

Are penicillin allergies common?  

About 10% of the population reports that they are allergic to penicillin. However, most of these patients (90% or more) may not actually be allergic. The majority of people lose their allergy to penicillin over time. Even those who reported a strong reaction in the past, such as anaphylaxis (a severe, potentially life-threatening allergic reaction) may lose their allergy.

Are penicillin allergies genetic?

There is no evidence of penicillin allergies being genetic. Just because a family member is allergic to penicillin or an antibiotic in the penicillin family, you do not need to be scared to take the medication.

What are some of the symptoms of a penicillin allergy?

There are several reactions that can occur immediately or shortly after (usually within one hour of) dosage. These include: hives (multiple raised pink/red areas of the skin that are intensely itchy), tongue, throat and face swelling, shortness of breath, wheezing, sensation of throat closure or choking, change in voice-quality, lightheadedness, racing of the heart, chest pain, a sense of impending doom, and/or loss of consciousness, nausea, vomiting, abdominal cramping and diarrhea.

Reactions that occur later can include a whole body rash similar to measles which occurs five to seven days after starting the antibiotic

What do patients who have a penicillin allergy need to know?

They should be sure that their penicillin allergy or other antibiotic allergy is accurately identified in their medical records. Please make sure the type of reaction is also documented clearly. If the allergy is severe, you should wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency.

Why is it very important to identify and document penicillin allergies accurately?

Penicillin is the most commonly reported drug allergy. Patients who report penicillin allergies tend to receive more expensive and stronger antibiotics, which can lead to significant adverse effects and antibiotic resistance. By identifying patients who are not actually penicillin allergic, we can improve antibiotic prescribing methods and combat the risk of super-bugs like MRSA and C-Diff. Penicillin allergy testing is available and may be beneficial to your future health. 98% of hospitalized patients with a history of penicillin allergies have a negative result when tested.

Know the facts and get tested. Talk to your doctor about penicillin allergy testing.

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.

Joel Desotelle, licensed pediatric occupational therapist and program director of Keystone Pediatric Therapies in Chambersburg, wants the public understand that everyone has value in our community, even those who live with a disability.

Living Up To Standards

In our society, we tend to put individuals with tremendous talent and ability up on a pedestal. At the same time, we often compare ourselves, our children, and others to some unspoken standard. For individuals who live with a disability, such as cognitive or physical challenges, our attention is easily drawn to what these individuals cannot do or even some of the side effects like behaviors commonly seen in a child with autism. Whether gifted or challenged, we are all different and have a purpose in our community.

Ability vs. Disability

Living with a disability can be very challenging. The difficulties a disability presents each day often demand our attention and resources, and so it is easy to focus on an individual’s disability because they stand out. But each individual also has many abilities as well as untapped potential. I have witnessed children with profound cognitive deficits draw amazing pictures, sing like an angel, remember details that would challenge any of us, love their family unconditionally, and so much more. Yes there are challenges, but if our focus is on what these individuals cannot do, it is easy to miss out on what they can do. Furthermore, by seeing people as abled vs. disabled, we rightfully offer each person the dignity they deserve.

Alienation

I work with many families who struggle to go out into the community. They are fearful of what others may think or how to cope with an environment that is overly stimulating and/or not designed for individuals with disabilities. This can leave families staying at home and isolated. These aren’t just fears; I hear stories every day of people staring, criticizing, pointing, and even asking people to leave. Whether a business, an organization or just someone out in the community at a restaurant or shopping, everyone needs to do their part to embrace these challenges and accept those individuals whose lives are enriched by being able to participate in the community without judgment or criticism.

Seek Understanding

Many disabilities are hard to understand. For example, autism is complex and confusing, even for those of us who try to help these individuals. So it is easy to understand why one might misinterpret a child having a meltdown in a store, not realizing that these kids are easily overwhelmed, fixate on objects, misinterpret their surroundings, and process information differently. Our community benefits greatly by educating ourselves and better understanding the disabilities others may live with. Offering help and/or encouragement instead of judgement paves the way for these individuals to feel more accepted, opening up opportunities for each of them to learn and grow, simply by sending the message that “we want you here.”

Invitation To Our Community

Being proactive in developing a community that embraces individuals living with a disability will enrich not only our community, but our own lives as well. Businesses and organizations can be proactive by making doors and hallways wheelchair accessible, but also having a plan or space for our sensory-sensitive kids (sensory-sensitive tables in restaurants, quiet rooms to enable an individual space to decompress, etc). Businesses should also consider creating employment opportunities, while organizations can promote disability-friendly programs. And individuals, whether a relative or someone you see in the community, be patient, understanding, and accepting and together we can create a community where everyone feels welcome.

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.

The Keystone Health Employee Spotlight for September shines on Sue Driver, Outreach Enrollment Navigator!

Sue began working for Keystone in March 2014, and has found fulfillment in working with Keystone’s patients and the public in general.

“What makes me proud of the work I do is that it helps people to have better lives in ways they determine for themselves,” she said. “Being able to help other people is the most personally fulfilling work that I could do. And I am also proud to work at an agency that employs some of the kindest, most caring people I have ever worked with.”

Sue’s job responsibilities make a difference in the community by helping people sign up for health insurance or Keystone’s reduced fee program which ensures they are able to get the healthcare they need. She also connects people to other local resources to meet their daily needs outside of healthcare.

“A typical day for me would include answering calls from patients and the public about getting health insurance and related issues,” she said. “Patients and the public can schedule appointments or walk in. I also get referrals from Keystone Health staff and the community and make referrals to community agencies as needed. On any given day I could help someone complete an application online for Medical Assistance and SNAP (Supplemental Nutrition Assistance Program), for example. My workday involves a lot of phone, computer, and paperwork all related to helping people get health insurance and related services and supports.”

Sue lives in southern Franklin County with her husband, George, their Labrador, Maya, and their four cats. Her favorite hobbies include shopping, reading, watching TV, and attending area events. To stay active and healthy she enjoys going to Zumba classes and taking Maya for walks.

While she’s not originally from Franklin County, she and her husband now call it home.

“We are Pittsburgh area natives but have lived in this area for about 25 years,” she said. “I enjoy the rural character of Franklin County and also that it is in close proximity to a number of urban areas which enables me to have the best of both worlds.”

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

On the occasion of International Overdose Awareness Day, August 31^st, I would like to educate my community about the ill-effects of drug use. We are in the midst of an opioid epidemic. It is costing us lives, but recovery from drug use is possible.

Drug Overdose Deaths in the United States

The rate of drug overdose deaths in the United States is continuing to increase at an alarming rate. Drug poisoning (overdose) deaths include deaths resulting from an unintentional or intentional overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug inadvertently. Drugs involved in drug overdose deaths include methadone, methamphetamine, cocaine, natural and semi-synthetic opioids, heroin, and synthetic opioids other than methadone. According to the  National Vital Statistics System (NVSS) that covers provisional birth, death, marriage, and divorce statistics:

• From 1999 to 2016, more than 630,000 people have died from a drug overdose.
• Provisional data from 2017 presented 72,000 total drug overdose deaths.
• Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid.
• In 2016, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was five times higher than in 1999.
• On average, 115 Americans die every day from an opioid overdose. In Franklin County Pennsylvania, the number of lives lost due to drug overdoses in 2017 was 35. In 2016 the overdose death count was 46.

Below, I have answered some commonly asked questions related to drugs and addiction.

Q: What are opioids?

A: Opioids is a comprehensive term that includes every single substance that stimulates opioid receptors in the human body. These include natural opiates, semisynthetic opioids from natural opiates (oxycodone, heroin, hydrocodone, hydromorphone) and synthetic opioids manufactured from basic chemicals in the lab (methadone, fentanyl etc.).

Q: What is opium?

A: It is specific sticky residue that can be extracted from the opium poppy plant (Papaver somniferum).

Q: What are opiates? A: These are natural components of opium poppy including morphine and codeine.

Q: How do opioids affect the brain and body?

A: Opioid receptors are present in the brain, spinal cord, and gut. In the brain there are highly concentrated areas controlling pain perception, emotion regulation, memory control, breathing control and the pleasure center.

Q: What is addiction?

A: Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuits. Dysfunction in these circuits leads to biological, psychological, social, and spiritual manifestations. Addiction is a brain disease and it presents itself as lack of control over the use of drugs, in spite of having social and relationship problems due to drugs.

Q: Why do people use drugs?

A: People might be using drugs due to many different reasons. They could be curious about drugs and start experimenting with them. There could be social or peer pressure to fit in. Drug use could result from brain disease, chemical coping, or lifestyle choice.   

People use drugs to feel better as these drugs affect the brain’s pleasure center. Feeling depressed, stressed, or anxious could be another reason some use drugs for coping with these emotions. Some people use drugs to improve their performance as they want to get more done in less time.

Q: If drugs are making people feel better, helping them cope with their emotions and improving performance then what is the problem?

A: The problem is the brain changes due to drug use. The good effects of drug use are not lasting as long and the person feels the urge to use high doses to feel the same effects. In the case they don’t use drugs, they start going through withdrawal which is an unpleasant feeling. Due to drug use, a person’s behavior starts changing. They are spending more time looking for the drug, intoxicated, or recovering from the effects of drugs. They are not spending much time with family or friends, may be stealing money to support their drug use, and their functioning is declining. They are often not able to keep a job as they lose control over the drug use, and keep using drugs although it is causing physical, social, legal, and relationship problems. It is not only the person using drugs that suffers from their addiction; their family members and friends are suffering from the consequences as well.

Q: What are the risk factors for overdose and addiction?

A: No one is immune to addiction but still there are associated factors that increase the risk of overdose and addiction, including:

• Taking higher doses of opioids
• Using opioids long-term
• Taking opioids with other substances that affect the respiratory center in the brain e.g., benzodiazepine or alcohol
• Adolescence
• Age of 65 years or older
• Sleep disordered breathing
• Kidney or liver disease
• Psychiatric history
• History of overdose and substance use disorder

Q: Are there any protective factors for addition?

A: Not everyone who experiments with drugs or takes prescribed medications gets addicted. We should not judge anybody based on their medical conditions or medications that they are taking. Factors that can protect people from developing addictions are:

• Good self-control
• Parental monitoring and support
• Positive relationships
• Good grades
• School and drug policies
• Neighborhood resources

Don’t leave drug use untreated as it could have a fatal outcome. Seek help and stay healthy.

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.