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Our Friend DEET

For many, DEET is a four letter word and it is something to be avoided at all costs. But short of staying inside, DEET (N,N-Diethyl-meta-toluamide) is our best defense against the biting insects of summer because it masks the scent of CO2 and confuses mosquitoes.

DEET is overwhelmingly considered safe, however, there are varying recommendations for DEET content in bug sprays for certain populations.

Children
The American Association of Pediatrics recommends avoiding DEET containing products on infants 2 months or younger and using a bug repellent containing 10 percent DEET for children older than 2 months.

Pregnant Women
Pregnant women should use bug repellents containing 30 percent or less of DEET because avoiding mosquito transmitted diseases outweighs the minimal risks.

DEET for the Rest of Us
For adult men and women, look for a repellant containing up to 50 percent DEET.  (There are no additional benefits in using a product that has a percentage of DEET higher than 50.)

DEET percentage is not a measure of strength.  It is a measure of how long the product is effective.  A product containing 10 percent DEET needs to be reapplied in 1 to 2 hours, while a product containing 50 percent DEET needs to be reapplied in 4-5 hours.

Additionally, the efficacy of a DEET containing product is impacted by heat and water.  If you are sweating or swimming, you need to apply it more often.  Finally, avoid products that contain both bug repellant and sunscreen because DEET-containing bug repellent can negatively impact the efficacy of sunscreen.

Michele Casey, MD, is the director of Primary Care for WakeMed Physician Practices and a Primary Care Physician atWake Specialty Physicians -Falls Pointe Medical Group

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Recipe for a Healthier Potluck

I will never forget the first potluck I went to at my church several years ago. There was fried chicken, biscuits and potato dishes as far as the eye can see and not a green vegetable in sight, or any other color vegetable for that matter. Of course, being the dietitian in the church, I felt compelled to introduce some variety to this scene of chicken boxes and biscuits. I decided to bring a healthy vegetable every time I attended one of these events and oddly enough, the vegetables are a big hit.

Here are some suggestions for healthy items for your picnic or potluck. A good place to start is to bring a fresh fruit tray or fruit salad. This is always a healthy option and most people really enjoy having some fresh fruit to complement their meal. During this season of the year, many fresh fruits are available making it an easy option as well. Choose various colors and provide a light vanilla or plain yogurt dip.

Vegetables are a great healthy choices and there are so many options to choose from. A raw veggie tray with different colors and textures is always a hit. Hummus or a light dressing makes a great dip. A garden salad with mixed greens, various vegetables with a handful of nuts and berries makes a colorful tasty display.

Try to stay away from the starchy vegetables like corn and potatoes as the main focus in your dish as they are higher in calories. Sauteed vegetables, grilled vegetables and roasted vegetables make a great dish. There are so many vegetables that are great prepared this way including: peppers, eggplant, yellow squash, zucchini squash, onions, mushrooms, broccoli, asparagus and carrots. Many of these vegetables are in season right now and full of flavor so there is little need for seasoning. It is great to make a dish that includes a variety of these vegetables so there is something for everyone to try and taste. Many vegetables are also great as a cold salad, a great alternative to the traditional potato salad or macaroni salad. Cucumbers, tomatoes, green beans, carrots, broccoli and various peas and beans are delicious served as a cold salad.

Meat dishes can also be healthy options, but try to stick with grilled, baked or roasted meats. These preparation methods are healthier and add to the flavor of the meat as well. Stick to the leaner cuts of meat like skinless chicken or turkey breasts, pork tenderloin, London broil, sirloin and top round. Grilled fish is always a great healthy option that is sure to be a hit. Fish is a great source of protein, vitamins and healthy fats that can help protect us from certain cancers and heart disease.
So have some fun enjoying your picnics and potlucks and trying some new healthy dishes that your family and friends just may love. Here are some recipes that may give you a good jump start to trying some new things.  

Roasted Garlic Lemon Broccoli
• 2 heads broccoli, separated into florets
• 2 teaspoons extra-virgin olive oil
• 1 teaspoon sea salt
• 1/2 teaspoon ground black pepper
• 1 clove garlic, minced
• 1/2 teaspoon lemon juice
Directions
1. Preheat the oven to 400 degrees F (200 degrees C).
2. In a large bowl, toss broccoli florets with the extra virgin olive oil, sea salt, pepper and garlic. Spread the broccoli out in an even layer on a baking sheet.
3. Bake in the preheated oven until florets are tender enough to pierce the stems with a fork, 15 to 20 minutes. Remove and transfer to a serving platter. Squeeze lemon juice liberally over the broccoli before serving for a refreshing, tangy finish.

Fruit and Vegetable Salad
• 1 medium green pepper, chopped
• 1 cup chopped celery
• 1 cup shredded cabbage
• 3/4 cup chopped unpeeled red apple
• 1/2 cup seedless red grapes, halved
• 1/4 cup reduced-fat mayonnaise
• 1/4 teaspoon salt
• Lettuce Leaves
Directions
1. In a bowl, combine the first five ingredients. In a small bowl, combine the mayonnaise and salt. Stir into pepper mixture. Cover and refrigerate for at least 1 hour. Serve on lettuce leaves.

Grilled Sesame Chicken
• 1 cup olive oil or vegetable oil
• 1 cup white grape juice
• 1 cup soy sauce
• 1 cup chopped green onions
• 1/3 cup sesame seeds, toasted
• 2 tablespoons ground mustard
• 1 1/2 teaspoons ground ginger
• 2 teaspoons pepper
• 8 cloves garlic, minced
• 12 boneless, skinless chicken breast halves
Directions
1. In a large re sealable plastic bag, combine the first nine ingredients. Remove 1/2 cup for basting; cover and refrigerate. Add chicken to the bag; seal and turn to coat. Refrigerate for 6-8 hours.
2. Drain and discard marinade from chicken. Grill, covered, over medium heat for 6 minutes. Turn and cook 6-8 minutes longer or until meat juices run clear, basting occasionally with the reserved marinade.

Grilled Salmon
• 2 pounds salmon fillets
• 1/2 cup vegetable oil
• 1/2 cup lemon juice
• 4 green onions, thinly sliced
• 3 tablespoons minced fresh parsley
• 1 1/2 teaspoons minced fresh rosemary
• 1/2 teaspoon salt
• 1/8 teaspoon pepper
Directions
1. Place salmon in shallow dish. Combine remaining ingredients and mix well. Set aside 1/4 cup for basting; pour the rest over the salmon. Cover and refrigerate for 30 minutes. Drain, discarding marinade. Grill salmon over medium coals, skin side down, for 15-20 minutes or until fish flakes easily with a fork. Baste occasionally with reserved marinade.

**All of these recipes came from allrecipes.com, one of my favorite websites. 

Julie Paul is a registered dietitian with WakeMed ENERGIZE!, a program to help kids and teens who either have type 2 diabetes or who are at risk of developing type 2 diabetes learn to make healthy lifestyle changes.  Learn more by clicking here.

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Fireworks Injuries Can Happen to You

Fourth of July weekend means loud sounds and bright flashes of fireworks to light up the night.  Although they add enjoyment to countless people’s celebrations, it’s always important to remember proper firework safety because nothing ruins the 4th of July like a trip to the emergency room.

Don’t think it will happen to you? Each and every year WakeMed sees both adult and pediatric patients in our emergency departments with injuries from fireworks.  Fireworks ARE dangerous and should be treated as such.

This year, let’s prevent firework injuries this 4th of July by:

  • NEVER allowing children and adolescents around fireworks alone
  • Making sure to use fireworks properly.  Many injuries are a result of improper use (such as holding the fireworks, etc.).  Always read the warning labels and instructions before use.
  • Having a bucket of water close-by (for used fireworks and for emergencies)
  • Ensuring that the firework is completely finished before getting near it
  • Never using illegal fireworks—they are more likely to cause injury.  (This includes the fireworks your neighbor made the special trip to South Carolina to purchase.)
  • Always protect your eyes— firework accidents can cause permanent burns and blindness

Although fireworks are often used as a fun finish to the 4th of July, just remember that they can have very serious, lasting consequences if used incorrectly or unsupervised.

Samy Saad is an emergency department physician with Wake Emergency Physicians, the physicians group that staffs all five WakeMed emergency departments.

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101 New Beds for Wake County

Fellow citizens of Wake County, as you may be aware three competing hospital systems have submitted applications to develop 101 new beds.  These competing applications were submitted by Rex Healthcare, Novant Health and WakeMed. 

  • Rex proposes to add 11 new beds and a cardiovascular-focused heart tower to its Raleigh Campus as well as build community hospitals in Wake Forest and Holly Springs. 
  • Novant Health has proposed building a 50 bed hospital in Holly Springs.
  • WakeMed is proposing to add 79 new beds to Raleigh Campus and 22 beds to Cary Hospital

Who gets to add these beds is ultimately decided by the state.  The state, through Certificate of Need, manages which hospital systems get to build and what they build.  The process is meant to control healthcare costs and ensure that hospitals do not just add money-making services without doing their fair share of community indigent care.

CON makes sense because healthcare is not a free-market good.    In the United States, most health care providers participate in Medicare and as such are obligated by federal law to provide lifesaving care.  Converting health care to free-market status would mean that a 2 year old with pneumonia would have difficulty receiving care in an emergency department unless they could demonstrate the ability to pay – similar to how a hungry person would have difficulty getting free groceries from a grocery store. A true free market system would neither subsidize nor provide care unless cash were in hand.

Regulations like Certificate of Need ensure that healthcare organizations provide access to care and build facilities in poor as well as rich neighborhoods to ensure access to care for all.  Certificate of Need also gives a helping hand those healthcare organizations that provide the vast majority of charity care. Certificate of Need works – it ensures equal access to health care services and places beds when and where they are needed.

It would be great for every community to have a hospital, including Wake Forest and Holly Springs, but unfortunately it is simply not an efficient way to provide healthcare services. 

Additionally, we have to be careful not to duplicate services that already exist.  A new cardiovascular-focused patient tower at Rex would be the fourth heart center in the Triangle and the second in Wake County.  We ultimately pay the price for these expenditures – isn’t a $278 million price tag to vacate one heart program and move it across town to a new program, as Rex proposes, a bit of a waste? 

The fact is WakeMed provides 80 percent of the charity care in Wake County, operates the most successful heart program in North Carolina, and is driving the need for more beds due to Raleigh Campus’ high occupancy.  Our proposals are also less expensive and can be implemented more quickly.  Isn’t it time we stopped unnecessary health care expenses and focused on cost-effective, efficient, and affordable care?

Stan Taylor is WakeMed vice president of corporate planning.

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Why it Matters that Rex is Owned by the State

When you think of a state-owned hospital, what comes to mind?  For most, it is probably mission – a mission to serve the citizens of our state regardless of the ability to pay.  It is likely a vision of a hospital that adds specialties and services in response to community need, and it is a hospital that helps solve community health issues.

In the Triangle healthcare market, there are two state-owned hospitals; one of which lives up to the assumptions made above and one that does not.  UNC Health Care’s Chapel Hill Hospital looks and acts like a state-owned, publicly supported hospital should.  Rex Healthcare in Wake County does not. 

Wake County deserves a state-owned hospital that does not spend millions of dollars to duplicate services that are already available in Wake County, especially when the duplication threatens the ability of the private, not-for-profit hospital to provide the vast majority (80%) of charity care in the county. And, speaking of indigent care, shouldn’t a state-owned hospital be shouldering more of the indigent care load for the community it serves? 

Unfortunately, the majority of profits generated by Rex don’t support the healthcare needs in Wake County.  These profits are not being reinvested in our community, instead they funneled to Chapel Hill inequitably subsidizing the state’s mission of providing health care to North Carolina’s citizens.  This is happening when there are unmet healthcare needs right here in Wake County.

Additionally, the state of North Carolina should not be using public money via Rex Healthcare to compete with private not-for-profit healthcare systems like WakeMed – especially when that health care system gives back so much to the communities it serves in the form of education, charity care, employment, and so much more.

Competition is not the issue. It is the unfair advantages afforded to state-owned hospitals through higher reimbursement rates and access to capital through the state legislature.

Citizens of Wake County and the state should expect and deserve more from its state-owned hospitals.

To learn more about these issues, please visit www.thewakemedxray.com

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Whooping Cough Making a Comeback

A few weeks ago I was approached by a teacher at an elementary school whose student been coughing for weeks and had been tested for whooping cough.  She was concerned about the other students in the class being exposed to whooping cough, but was quite surprised when I explained that she and her teaching assistant were probably most at risk of becoming infected with whooping cough.

Whooping cough is a highly contagious bacterial disease that causes uncontrollable violent coughing.  The disease is not very well known these days because widespread vaccinations virtually eradicated the disease in the United States years ago. However, whooping cough is making a comeback with 153 cases of confirmed in North Carolina in 2010. 

Most children receive the bordatella pertussis (commonly included in the D-Tap vaccine combination) vaccine at 2 months, 4 months, 6 months, and 18 months.  With each shot, children’s immunity builds to whooping cough, reducing their chances of contracting the disease and reducing the severity of the illness if they do happen to get it. 

Whooping cough boosters previously thought unnecessary are now recommended by physicians.

Up until a few years ago following the 18 month shot you were considered fully vaccinated. However, physicians and public health professionals have learned that the bordatella pertussis vaccine does wear off, and a booster shot between the ages of 10 and 64 is necessary to retain immunity.

A booster shot is especially recommended for teachers, parents, and grandparents – to protect both themselves and the newborn babies and young children who are at most risk of getting very sick and dying from whooping cough.  In fact, more than ½ of babies who get whooping cough will need to be hospitalized and 1 in 100 babies who get whooping cough will die.

Additionally, some parents are choosing to forgo vaccinations for whooping cough and many other diseases due to concerns with vaccine safety.  When parents make the decision not to vaccinate their children for whooping cough or other diseases, they are not only risking the health of their child but of the community at large.

Learn more about whooping cough and protecting you and your family from the disease by contacting your physician or by clicking here.

Robin Carver is the director of infection control and prevention on WakeMed Raleigh Campus.

WakeMed Children’s is dedicated to providing answers to common questions parents have about children’s health and wellbeing.   Learn more by subscribing to WakeMed’s Families First newsletter.  Have a specific question you would like answered?  Post a comment or email us directly.

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Smoky Odor & Hazy Conditions

Several fires in eastern and southeastern North Carolina are producing hazy conditions and smoky odors across the Triangle today, according to www.WRAL.com.

As a result, the N.C. Division of Air Quality has issued a Code Orange Health Notice for Ozone for central North Carolina until 9 pm today. People in sensitive groups – young children, the elderly, anyone with respiratory ailments and people who work/exercise outdoors – should limit their time outdoors.

Many air filtration systems do filter out particulates, however they may not filter out the odor.  Therefore, it is best to try to stay indoors until the smoke clears.

For more information on this weather alert, please visit WRAL.

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N.C. Second in Country for Lightning Strikes. Stay Safe and Plan Ahead for Storms.

Forecast for the next three months: hot, humid, with a chance of thunderstorms.  Summer thunderstorms are not something to be taken lightly – especially in North Carolina where thunderstorms bring danger in the form of lightning, high winds, falling trees and occasional tornadoes.  In fact, North Carolina has the second highest number of lightning strikes in the country every year, and although tornadoes are not frequent in our state they do occur and are very dangerous or even deadly.

Make sure you know what to do if thunderstorms are predicted for your area with plans customized to where you are and what you are doing.  For example, if there is a high probability of severe thunderstorms, playing golf or going for a sail may not be a good idea.  If you are participating in these or any outdoor activities, make sure you have a contingency plan and be prepared to seek safe shelter if a storm does develop.  Hiding under a tree or umbrella until the storm passes is NOT considered a safe or smart contingency plan.

There are many resources available online to help you prepare for storms, including the Red Cross, NOAAs National Weather Service , and Ready.gov.

And, if you are looking for something to do this weekend, join us at StormFest, on Saturday, June 18 from 9 am to 5 pm at the Museum of Natural Sciences. Visitors can become Meteorologist for a Day, watch presentations on Storm Chasing, learn more about preparedness and tour emergency response vehicles and mobile hospital. 

Barb Bisset is the executive director of the WakeMed Emergency Services Insitute.

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Coaches, Check Out Valuable Concussion App

It seems that there’s an app for everything these days – from personal finance to dieting, directions, games, you name it.  Well now, there is even an app available to coaches, athletic trainers and parents who have players on the field to rule out concussion.  A concussion can be very serious, resulting in permanent brain damage or possibly even death depending on severity and treatment of the concussion.

In fact, concussions are rightly now being taken so seriously that just last month the NC House passed the Gfeller-Waller Concussion Awareness Act  113-0.  The bill, which is named for two North Carolina high school football players who died from brain injuries sustained while playing football, focuses on concussion education, signs and symptom identification, emergency action planning, and record-keeping.  It is now awaiting Senate consideration.

Ideally, the best case scenario is to have trained personnel available at the games; however, at many levels of competition, teams simply do not have the funding for this kind of support. The new concussion app developed by Pediatric Neuropsychologist Gerard Gioia at Children’s National Medical Center is a valuable tool for the coaches and parents on the field with the players.  The app, which can be downloaded to any iPhone, Android or Tablet for $3.99, provides some on the spot guidance and even alerts emergency systems with the touch of a button. 

The key to concussion management is to monitor symptoms and respond accordingly.  The app is a good tool to guide coaches, trainers and parents through a series of questions and answers that result in a recommendation.  This recommendation may be to simply sit it out, or to seek medical care.  Positively, the app also addresses one of the biggest obstacles for players, parents and coaches – the need for mental and physical rest.

When everyone is operating with the safety and best interest of the player as their first priority, we are sure to make positive strides in the management of athletes with concussions.  You can purchase the app through the Apple store and Android Market.

Janis V. McLaughlin, PT and Manager of WakeMed Outpatient Rehab and WakeMed Concussion Clinic

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Home Safety Tips for Children

It is a parent’s job to make sure the home environment is as safe as possible, but unfortunately every year more than 2,000 children die in unintentional injuries in the home. Safety devices like smoke alarms and window guards are important, but active supervision by an adult is also key to making sure children stay safe. Baby-proofing is only the first step. Injury risks change as children grow and develop, and parents should regularly reassess the safety of their home to address the most serious risks.

Safe Kids Wake County recommends parents keep these home safety tips in mind:

Preventing Fires & Burns

  • Make sure you have working smoke alarms in every level of your home, outside each sleeping area and in every bedroom. Plan how you would get each child in your home to safety, to help them escape in a fire.  Practice a family fire drill twice a year.
  • Set your water heater at 120 degrees and test the bathwater by running your whole hand and wrist throughout the tub before putting your child in it.

Around Water

  • Always supervise children near water. Never leave young children alone in the bathtub or pool – a child can drown in a matter of seconds.
  • Keep toilet lids closed and lock all doors to bathrooms.
  • Safeguard your pools and hot tubs by making sure your pool has four-sided fencing and a self-closing, self-latching gate that is locked when no adult “water watcher” is on duty. Hot tubs should be covered and locked when not in use.  
  • Install protection to prevent entrapment if you own a pool or hot tub, such as protective measures like anti-entrapment drain covers and safety vacuum release systems.

Around the Home

  • Prevent serious falls by keeping furniture away from windows, installing guards or stops on windows that are not emergency exits, and installing safety gates at the top and the bottom of stairs if you have small children. Never use baby walkers and always use 9 to 12 inches of soft surfacing, such as woodchips, rubber mulch, or pea gravel, under and around playground equipment.
  • Put your baby on his or her back to sleep on a crib that meets all current national safety standards. Remove all pillows, comforters, stuffed toys and other soft products from the crib before putting your baby to sleep.
  • While looking at a room as your child would, ask yourself what looks interesting and what can be reached. Get rid of small items your child can choke on.
  • Keep guns locked, unloaded and where kids cannot reach them. Lock up ammunition in a separate place.

Preventing Poisonings

  • Lock up poisons such as medicine, vitamins, cleaning supplies and pet food. Read labels and follow directions when giving medicine to children.  Post the Poison Center Helpline by every phone: 1-800-222-1222.
  • Make sure you have working carbon monoxide detectors in every sleeping area and on each level of your home. Test them every month and make sure heating systems are vented outside and checked each year.

Be Prepared for Emergencies

  • Be prepared for emergencies and keep emergency numbers by every telephone.
  • Call 911 if your child is choking, collapses, can’t breathe or is having a seizure.
  • Check your first aid kit to make sure it is fully stocked.
  • Make sure babysitters and other caregivers know where to find first aid supplies and how to handle an emergency.

For more safety tips on how to make your home safer for your children, visit www.safekids.org.

Angie Bullock is manager of WakeMed’s Trauma Program and serves as the Safe Kids Wake County Coalition Coordinator.

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