November 18-24 is Antibiotic Awareness Week. Antibiotics save countless lives every year, and have been one of the most significant developments in the medical field in the last century. However, using them too frequently or when not needed can have serious consequences. Dr. Raghavendra Tirupathi, Medical Director of Keystone Infectious Diseases, shares some important information about how to protect yourself by using antibiotics safely.

What are antibiotics?

Antibiotics are medicines that help to stop infections caused by bacteria by killing the bacteria or by stopping bacteria from reproducing. Many times when people are sick, they expect their medical provider to prescribe them an antibiotic. For certain types of infections, antibiotics are extremely effective. However, antibiotics can only treat bacterial infections; they do not help infections caused by viruses. If you take antibiotics when they not necessary, it can lead to antibiotic resistance.

What is antibiotic resistance?

Antibiotic resistance is when bacteria change or adapt to the antibiotic, meaning the antibiotic will no longer be helpful against the virus. This is usually caused by using antibiotics too often or when they are not needed.

Using antibiotics responsibly could save your life. When bacteria become resistant to certain antibiotics, there are fewer options to treat deadly infections. Even minor infections can have fatal outcomes when effective antibiotics aren’t available. In the United States, antibiotic resistant bacterial infections lead to 23,000 deaths and more than 2 million illnesses annually.

What causes antibiotic resistance?

Some of the main causes of antibiotic resistance are: patients not taking antibiotics as prescribed or taking someone else’s antibiotics, healthcare providers prescribing antibiotics when they are not needed, patients not finishing their entire dosage of antibiotics, poor infection control in hospitals and clinics, unnecessary antibiotic use in agriculture and poor hygiene and sanitation practices.

How do I know if I need an antibiotic?

If you are ill and think an antibiotic may be necessary, always consult your healthcare provider and let them make that decision. Many common illnesses are caused by viruses, and taking antibiotics for these infections can do harm.

Some common conditions that are caused by bacteria that do require antibiotics are: strep throat, urinary tract infections and whooping cough.

Some common conditions that may require antibiotics are: sinus infections and middle ear infections.

Some common conditions that are caused by viruses and do not require antibiotics are: common colds, runny noses, bronchitis or chest colds in otherwise healthy patients, the flu and sore throats (that are not strep).

What are some ways to feel better when I don’t need antibiotics?

Some people get upset when their provider does not prescribe antibiotics, but he or she is doing that in your best interest when antibiotics will not be helpful. For viral infections, you can try over-the-counter medications (make sure you follow the directions carefully) while getting a lot of rest and drinking plenty of fluids. Upper respiratory infections (including sinus infections, ear infections, colds and bronchitis), can be soothed by using saline nasal spray or drops, avoiding smoking and secondhand smoke, breathing in steam from a hot bowl of water or shower, taking an over-the-counter pain reliever or decongestant and a warm, moist cloth over aching sinuses or ears.

For sore throats, try drinking warm beverages, gargling with salt water, using sore throat spray, and sucking on ice chips, popsicles or lozenges (for those not at risk of choking). For coughs, humidifiers or vaporizers, breathing in steam, lozenges and honey may provide some relief. (Never give honey to a child under 1 year of age.)

What can I do to protect myself from antibiotic resistance?

If your provider does prescribe you antibiotics, make sure you are closely following the directions. Finish the entire dosage, even if you are starting to feel better. Your healthcare provider should prescribe you the shortest period of antibiotics needed. Talk to your doctor if you have any questions or develop side effects to your antibiotics, including diarrhea, as it could be a sign of infection.

To combat antibiotic resistance, people should never share antibiotics, should practice good hygiene (wash your hands frequently, cover coughs, stay home when sick, etc.) and get recommended vaccinations, including the flu vaccine.

If healthcare providers and patients work together to use antibiotics responsibly, we can cut down the number of deaths from resistance and can assure these life-saving medications will be available to future generations. Please do your part in our battle against antibiotic resistance.

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. Carolyn Benenati

On average, one in eight women in the United States will develop breast cancer in their lifetime. Breast cancer is the second-most common cancer in American women with only skin cancer having more diagnosed cases each year.

When you consider these numbers, it can be scary for women to realize there is a good chance that they, or a close friend or relative, will develop the disease. The good news is there are precautions which can be taken to reduce the chance of developing breast cancer, and to catch the cancer early before it spreads.

Dr. Carolyn Benenati, OB/GYN at Keystone Women’s Care, shares some important information all women should know about breast cancer.

Breast self-exams

Adult women should be familiar with what is their “normal” breast. Breast self-awareness makes it possible to detect any changes. These changes would include pain, a lump, nipple discharge (not after stimulation of the breast) and redness of the breasts. Although not all these findings indicate a woman has a cancer, they should seek care with a health care professional if any changes are detected.

Breast self-awareness could include self-breast exams. There are no current recommendations for how often or if self-breast exams should be performed as studies indicate for average-risk women it may not reduce the risk of death associated with breast cancer. But 50% or more breast cancers are detected by women themselves. If a woman is still menstruating, the best time to examine the breast would be the week after her period.

It is best to take your time. Inspect the breast, looking in a mirror with your hands on your hips. Check for any skin changes, change in size of the breasts and dimpling of the skin. Feel for any lumps by using the pads, not tips, of your middle three fingers. Move in small circles, applying different levels of pressure to feel just under the skin and also deeper. You should check the entire area from the collar bone to the breast bone to the armpit to the ribs under the breast.

Mammograms

A mammogram is an x-ray that is used as a screening test for breast cancer, and is covered by most insurance plans. This screening test is used to detect cancer early in women without symptoms to reduce risk of the disease. According to The American College of Obstetricians and Gynecologists and The National Comprehensive Cancer Network, regular mammogram screenings should begin at age 40. Other organizations recommend mammograms should begin at age 45 or 50.

As an OB/GYN, I recommend my patients have annual mammograms starting at 40. In high-risk patients, such as someone who has several family members with breast cancer or a close relative with breast cancer who is younger than 50, earlier screening with mammograms or MRI may be recommended.

Mammograms should be performed until at least age 75. Discontinuation of annual mammograms should take into account the health status and life expectancy of a woman. In healthy older women, it makes sense to continue annual screenings in order to detect any cancer early.

Reducing the risk of breast cancer

Women can also reduce their risk for breast cancer by maintaining a healthy weight (a BMI of 18.5 to 24.9), by getting regular exercise, limiting or avoiding alcohol and breastfeeding if possible.

Women who are at higher risk for breast cancer can undergo genetic testing to identify if they carry a gene that places them not only for higher risk of breast cancer but also other diseases such as ovarian cancer. These high-risk women would include those with a close relative who was diagnosed with breast cancer under age 50 or multiple relatives with cancer. This testing is available at Keystone Women’s Care and most other OB/GYN offices.

Obtaining care when uninsured

If you do not have insurance and would like to have a mammogram, there is a program through the Cumberland Valley Breast Care Alliance (CVBCA) called the MammaGift Project which provides free mammograms to those who are uninsured. For more information about this program, call 717-263-7191. The CVBCA also supports and assists women in our area diagnosed with breast cancer, with health care and other associated costs during treatment.

Breast cancer in men

Though not nearly as common, men can get breast cancer too. About 2,600 men in the United States will be diagnosed with breast cancer each year, and about 500 will die from the disease. If men notice any changes in their chest area, including the changes mentioned above, they should see their healthcare provider as soon as possible.

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. Nana Odoom

If you’re a parent, you likely have a lot on your calendar – doctor’s appointments, kids’ activities, school projects and more. It’s easy to put off taking your child to the dentist when they aren’t having any problems. However, helping your child get in the routine of caring for their teeth each day, including regular visits to the dentist, is a very important step for their future.

Dr. Nana Odoom, Pediatric Dentist at Keystone Dental Care, and her colleague, Dr. Victor Amarteifio, often see children who have dental conditions which could be prevented. In today’s article, she shares what parents can do to help their children have healthy teeth and avoid painful, and sometimes costly, dental problems in the future.

What conditions do pediatric dentists treat?

Pediatric dentists primarily focus on treating toddlers, adolescents and all special needs patients. After four years of dental school to treat not only growing children, but children with additional medical needs and special needs patients of all ages, we receive two to three years of extra training with a great focus on orofacial growth and development. Our training focuses on enhancing our skills to best address all forms of behavioral challenges that a child or a special needs patient may present at a dental office. Those skills include advanced behavior guidance and management techniques, and sedation and treatment in a hospital setting depending on the needs of the patient.

Some of the most common procedures we perform are routine checkups and cleanings, treating caries (cavities), abscesses and swelling. We also see patients for traumatic injuries that may sometimes include needing stitches to the mouth and face as well.

What can parents do to help prevent childhood dental problems?

The best thing you can do is to establish a dental home as early as possible – find a pediatric dentist to see your child for regular care as soon as your child has their first tooth. This dentist will be able to establish a relationship of trust with your child from an early age and get to know them and their needs.

With my patients, I try to remember their hobbies and interests so we have something to talk about when they visit. If your child feels comfortable around his or her dentist, appointments are more enjoyable and less intimidating. If an emergency situation would ever arise, children usually feel much more comfortable being treated by their regular dentist instead of someone they are meeting for the first time.

Nutritional counseling is a major part in preventing cavities from the standpoint of a pediatric dentist. We encourage discontinuing bottle-feeding at 12 months of age.  Not putting your child to sleep with a bottle with anything other than non-flavored water is also beneficial to limiting the rate at which your child can get cavities. Also, cleaning your child’s teeth after night-time feeding is highly recommended. Children should definitely not share utensils with siblings, parents and other caregivers who have had cavities before or have active cavities. Minimizing processed carbohydrate food products helps to decrease your child’s ability to get cavities. Limiting frequent snack intake as well as sugary drinks (flavored water, juice, soda, sport drinks and flavored milk products) during the day will decrease cavity formation in your child.

Cleaning your child’s teeth twice a day with a fluoride-containing toothpaste, especially at night time, will help prevent cavities from forming in their teeth.

Parents can check with their county about water fluoridation in their neighborhood and have a conversation with their dentist to determine if further fluoride supplementation is necessary for their growing child.

What dental habits should parents teach their children?

Parents should start cleaning their child’s teeth as soon as the first tooth appears. They can use a toothbrush or washcloth, or can buy a finger brush which is a small, soft brush designed to fit on the parent’s finger. Even if your baby only has one tooth, you should still clean it. Be consistent with brushing every day.

After brushing their teeth at bedtime, they should not eat anything else and should drink nothing other than water.

As your growing child becomes more independent, parents should follow up afterwards to check if the brushing has been properly done.

What should parents know about taking their child to the dentist?

Contrary to popular belief, you should not wait until your child is 2 years old for their first dental appointment. You should schedule your child’s first dental appointment when his or her first tooth appears, or no later than 12 months of age.

Don’t wait to see a dentist until problems arise. Instead, be proactive. Make caring for your child’s teeth a regular habit, and make time to see their dentist twice a year. By getting into good dental routine, many problems can be prevented.

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.

Starting Monday October 28, Keystone’s newest facility at 111 Chambers Hill Drive (on the corner of Norland and Fifth Avenues in Chambersburg) will be open for business!

The first floor of the building will be operational at that time. The practices on this floor are:

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

In November, Keystone Administration and Keystone Pediatric Dental will move into the second floor of the building.

If you have any questions, you can contact us at 717-709-7900.

111 Chambers Hill Drive

Join us for this FREE event on November 16th, 2019!

Join us and Keystone’s Dr. Tirupathi on October 10th for this educational presentation!

People who live with chronic pain know the impact it can have on their daily lives. Not only does it affect the quality and enjoyment of life, but it can make everyday tasks difficult or impossible. With the opioid crisis continuing to grow, many people are looking for alternative treatment methods.

Dr. Michael Gaudiose of Keystone Family Medicine has seen first-hand the improvement acupuncture, specifically Battlefield Acupuncture, has made in many people’s lives.

Dr. Gaudiose learned Battlefield Acupuncture while serving as a Family Physician at Dunham U.S. Army Clinic and received additional training at Womack Army Medical Center in Fort Bragg, NC. He answers some frequently asked questions about the subject in today’s Take Care article.

What is Battlefield Acupuncture?

Acupuncture has been around for more than 5,000 years. While researchers are still studying to find the exact way acupuncture relieves pain, we do know that all pain is processed in the brain. There is evidence that acupuncture works by suppressing pain transmission signals and by releasing endorphins into the brain to suppress the feeling of pain and disrupt the pain signals.

Battlefield Acupuncture was developed in 2001 by Dr. Richard Niemtzow while on active duty in the United States Air Force. He was looking for an effective way to be able to relieve pain on the battlefield without having to carry a lot of supplies with him. He discovered that a specific sequence of needles, when inserted into the ears, could relieve many types of pain quickly and effectively.

How does it work?

In this type of acupuncture, instead of inserting needles into the part of the body that is in pain, needles are inserted into the surface of the ear. There is scientific evidence that the regions of the ear have a connection to distant body functions, and that that pain relief can be achieved through using ear acupuncture in the correct areas.

Very small needles are inserted into five specific areas of the ear. These needles have a flat head, (similar to a very small nail head), and will stay in your ear until they fall out on their own, usually in two to five days. Pain assessments are taken before and after treatment.

How long does it take to see results?

Some people get results immediately, while others notice their results in the hours and days after treatment. Data shows that 80% of people get at least a 50% reduction in pain level.

How long do the results last?

While some patients receive long-term relief after just one treatment, many require repeat treatments. Most patients will have several days of relief after the first treatment, and after multiple treatments their relief period often becomes longer. Most people report having pain relief for a few days to a month after treatment.

Is it painful?

The needles are so small that pain is not an issue for most patients. You may feel a slight pinch or minor discomfort, but this feeling goes away quickly.

When you leave the office the needles are usually not bothersome, but can become uncomfortable during certain activities such as talking on the phone or sleeping on your side. If they are causing discomfort you can remove them with tweezers or your fingernails.

What have patients said about their experience?

Some patients say they feel better than they have in years, and some have been able to reduce the amount of opioids they take.

I witnessed one patient who walked into the office bent over because of back pain, leaving the office walking upright due to the relief of acupuncture. It is important to note that this treatment does not work for everyone. A small number of people experience no relief after treatment. But in my experience about 90% of patients get at least some results from Battlefield Acupuncture.

Who is a good candidate for Battlefield Acupuncture?

If you experience any type of chronic pain, including migraines, you may benefit from it. People who are pregnant (or might be pregnant), or have a fear of needles are not recommended to undergo this treatment. If you have a bleeding disorder you should discuss this with your provider before deciding to try Battlefield Acupuncture. People who are on active military special mission programs (such as Flight Status) may have restrictions as well.

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. 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.