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Is That Cold RSV in Disguise?

Before you dismiss your baby’s sniffles as merely a common cold, consider this: What often appears to be a common cold may in fact be a very common virus called RSV in disguise.

Respiratory syncytial virus (RSV) is a virus that leads to mild, cold-like symptoms in adults and older, healthy children. Unfortunately, RSV can be more serious in young babies, especially to those in certain high-risk groups, and it spreads easily by physical contact.

Premature babies, infants with chronic lung disease, those with weakened immune systems, and those with certain forms of heart disease are most susceptible.  And time of year is notorious for RSV – outbreaks of infections usually begin in the fall and run into the spring. True to form, RSV, which tends to rise every third year, has shown to have infected larger numbers this year than the past two.

This is no reason to panic. In fact, most infants have had this infection by age two.

Be on the lookout, however, for certain symptoms. If a baby isn’t able to feed, is acting lethargic or abnormal, is wheezing, or if their breathing is labored, requiring use of their chest muscles to breathe, the baby should be taken to a primary care physician. At home, RSV can be treated like a regular cold. Use a humidifier, encourage fluids, make use of a bulb suction nasal aspirator to clear mucus before feeding, and make feedings smaller and more frequent, as their appetite may lessen.

In severe RSV cases, an infant may need to be hospitalized in order to receive oxygen, humidified air, and fluids by IV. A ventilator may also be needed.

It is important that RSV is addressed promptly, as it can lead to ear infections, lung failure, and pneumonia.

But of course, an ounce of prevention is worth a pound of cure. Wash your hands—RSV can live for a half an hour or more on hands, keep babies away from those who are sick, and be an advocate for your child—don’t allow strangers to touch your child.

Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness. Additionally, try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child. Finally, common household cleaners can keep the virus, which can also live for up to 5 hours on countertops and for several hours on used tissues, from spreading.

Dr. Karen Chilton, MD, is a WakeMed pediatric intensivist.

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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Debunking Detox Diets

While the idea behind them is catchy—cleanse, start anew, and drop weight fast—detox diets are just another popular, ineffective, and yet harmful form of fad dieting. The sciences do not offer any peer-reviewed research that attests to the safety or effectiveness of these often extreme diets. When considering any strict diet that encourages excessive consumption of water, yellow foods, meat, syrup with juice mixed with strange combinations of spices, remember that any diet that is not balanced should be avoided.

There are healthier, more effective ways to lose weight. Aim for a well-balanced diet. Focus on drinking water and adding fiber. Calorie reduction will come naturally. In addition, getting sufficient amounts of sleep, between 7 and 8 hours a night, is crucial for effective dieting and maintaining energy levels.

Moreover, watch your portions. People often spend more time analyzing what they’re eating with little regard to how much but it’s these little things, done every day that can sabotage a diet. Try to make small changes with a big impact—ones that can be carried out over the long term, very unlike the typical 7-day detox diet that does not offer stable, permanent change. Record your meals and track your progress in a diet diary for 3 days. If you’re honest with yourself, you’ll see where you’re frequently led astray, making self correction easier – whether it’s Friday night alcohol or dessert after dinner that’s adding up for you. iPhone applications and the internet can make calorie-counting and recording very easy. Some of these inlcude caloriecount.about.com, my-calorie-counter.com and livestrong.com/thedailyplate/.

Detox diets are unhealthy and unnecessary because your body detoxes itself every day. In fact, a large role of the kidneys and liver is detoxification. Take care of yourself – limit alcohol, drink plenty of water, have a diet based on fruits and vegetables, lean protein, and whole grains, and get regular exercise to boost weight loss and increase energy levels. While a positive aspect of some detox diets are to promote eating fruits and vegetables and drink ample amounts of water, eating a balanced diet, getting enough sleep, and exercising will provide a foundation for a healthier lifestyle. The end result will be a more satisfying diet plan, and a more confident you.

Interested in learning more about a healthy, sustainable diet? Some insurance plans will pay for visits with a dietitian. Review your specific plan and make an appointment today. To make an appointment with a WakeMed Dietitian, call (919) 350-2358.

Ilsy Chappell, RD, is a clinical dietitian at WakeMed Cary Hospital.

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WTVD Troubleshooter: Rear Facing Seats Until Age 2

Yesterday Rosy Rosenthal, WakeMed Raleigh Campus car seat technician, offered WTVD’s Troubleshooter Diane Wilson information on the new car seat recommendations recently sanctioned by the American Academy of Pediatricians along with the National Highway Traffic Administration.

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Operation Medicine Drop: Clean Out Your Cabinets

This week is Poison Prevention Week and it is also your chance to safely dispose of old or unneeded prescriptions and over-the-counter medications during North Carolina’s second annual Operation Medicine Drop.

Operation Medicine Drop is a statewide blitz of events where the public is invited to drop off medications for safe and secure disposal. A partnership of Safe Kids North Carolina, the North Carolina Department of Insurance, the U.S. Drug Enforcement Agency, the State Bureau of Investigation and other local agencies, Operation Medicine Drop retrieved and destroyed over two million dosages of medications at nearly 200 take-back events in 2010.

Why should you participate in Operation Medicine Drop?

To prevent poisonings: Poisoning from prescription medications is on the rise in North Carolina. Since 1999, approximately 4,500 people in North Carolina have died from prescription drug poisoning, according to the North Carolina Division of Public Health.

To fight drug abuse: Many people think prescription and over-the-counter drugs are safe because they have legitimate uses, but when used improperly, they can be just as dangerous and addictive as illegal substances.

To protect our waterways: Throwing medicines in the garbage or flushing them down the toilet or sink leads to water contamination and harms aquatic life.

There are more than 215 Operation Medicine Drop events scheduled in communities across North Carolina.
Find an Operation Medicine Drop near you by clicking here.

Lynn Eschenbacher is a manager in the Pharmacy on WakeMed Raleigh Campus.

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Uninsured patients and WakeMed

This past weekend Janice Frohman, administrative director of emergency services at WakeMed Health & Hospitals, and Jim Palombaro, M.D., president of Wake Emergency Physicians and of the medical staff at the WakeMed Raleigh Campus, submitted the following op ed about the care of the uninsured to the News & Observer.

Uninsured patients and WakeMed

Almost daily in newspapers across the country, you can find articles, editorials, letters to the editor and op-ed articles written by health policy experts, academics, caregivers and consumers discussing health care reform. When you get to the heart of each of these articles, it all comes down to who is caring for and paying for the un- and underinsured.

The reason for this continued conversation is that there is a significant difference between the services available to the insured and to the underinsured and uninsured. Yet, the uninsured and underinsured, whose ranks continue to grow, remain drastically underserved and misunderstood.

The reality for far too many members of our community is that WakeMed’s five emergency departments serve as the default front door to the health care system. Each day we see heartbreaking situations. For example, uninsured patients who lack access to primary care and who must choose between purchasing medications to manage chronic conditions or putting food on the table. Beyond the obvious tragedy of the dilemma, this dangerous combination frequently lands patients in the hospital with acute, life-threatening illnesses.

The uninsured do not fit a specific mold. They are usually not homeless, do not always have mental illness or substance abuse problems, and increasingly are not exceptionally poor. The uninsured today are more frequently middle-class individuals who have always worked hard and have always been insured, but due to the recession and job loss, extenuating circumstances or the simple inability to afford insurance due to pre-existing conditions, they find themselves uninsured or uninsurable.

At WakeMed, our mission since our founding in 1961 has not changed; for the past 50 years we have been dedicated to providing care to all who seek our services regardless of the ability to pay. Last year WakeMed’s investment in treating the un- and underinsured was $103 million, including $68 million in charity care plus $35 million in unreimbursed Medicaid costs.

As a private not-for-profit, we cover this investment without direct funding from taxpayers, the county or the state, other than Medicaid (which doesn’t come close to covering the cost of care). In fact, not all hospitals receive the same Medicaid reimbursement, and WakeMed currently receives a significantly lower Medicaid reimbursement rate than state-supported hospitals.

Although the cost of delivering on our mission may seem staggering, we take great pride in delivering this care, and we are proud to provide it without discrimination or bias. In fact, up until discharge, when they need to make a referral, the majority of our emergency department physicians and staff do not know or care to determine a patient’s insurance status.

WakeMed continues to serve more than 80 percent of our community’s Medicaid, uninsured and underinsured residents, and we fully anticipate the amount of charity care we provide will continue to increase for the foreseeable future. Insurance status is not and never will be a barrier to care in our emergency departments, but the need in our community is great and growing.

It is therefore time for all of our hospitals to provide their fair share of services to the un- and underinsured. In addition, all of our community hospitals and physicians should receive the same reimbursement from Medicaid and other government-funded programs. It is imperative that Gov. Beverly Perdue and members of the General Assembly work to level the playing field to ensure that all hospitals and physicians that treat Medicaid patients are reimbursed appropriately and in an equitable manner. A level playing field will enable fair competition, ensure appropriate and timely access to care for all members of our community and allow WakeMed to deliver upon its mission and service.

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New pacemaker can take MRI scans

WRAL interviewed Dr. Marc Silver with WakeMed Faculty Physicians – Raleigh Cardiology  about the new Revo pacemaker that is MRI compatible.  This is the first pacemaker that is MRI compatible.  Missed it last night, check it out below.

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Bed Bugs in NC

Last Thursday, Jung Wook Kim, PhD, bed bug specialist with the Division of Environment and Natural Resources presented to hospital staff about the reemerging problem of bed bugs.  Chemicals like DDT virtually eradicated bed beds in the United States but since DDT’s banning in 1972 bed bugs are slowly but surely making a comeback across North America.

While bed bugs are not as prevalent here in North Carolina as they are in New York or other large cities where there are many multi-dwelling apartment complexes, it is important to be aware of this emerging issue.  Bed bugs have been found in our area, and once you have them in your home, they are very difficult to eliminate especially if the infestation become severe.

Bed bugs are aptly named.  They generally live in or around bedding because they are nocturnal and feed on blood.  These traits make the bed the most likely place to find this bug.  A few more fun facts included in Dr. Kim’s presentation about bed bugs include:

  • Bed bugs are initially tiny, but can still be seen with the naked eye.
  • Fed bed bugs are reddish brown and unfed bed bugs are yellow
  • Bed bugs can sometimes travel more than 10 feet to feed
  • Feeding only takes place every three days and lasts for about 10 minutes
  • Female bed bugs lay approximately 500 eggs in their lifetime. Eggs hatch every 7 – 12 days
  • If you have 1 bed bug, you will be bitten 90 times per year
  • Bed bugs have been known to survive 6 to 12 months without feeding

Unlike other insects, both male and female bed bugs bite. Bites are painless because the bed bug administers an anesthetic to its victim. On most people, the bite causes a red bump and can itch.  In severe infestations, anemia can occur as a result of multiple bites. However, people react differently to bed bugs; 54 percent people will have no red, itchy bumps after being bitten, and many bites will not emerge for 7-11 days.  Bites also tend to be in linear groups of three or four.

Although bed bugs are commonly associated with unsanitary conditions, the fact is that despite the best preventive efforts, almost any property can become home to these hitch-hiking pests.  Additionally, contrary to popular belief, bed bugs do NOT carry disease. Check out North Carolina State University’s Department of Entomology web site for more information about bed bug identification and prevention. 

 Also, it might be useful to search the Bed Bug Registry, a free, public database of user-submitted bed bug reports from across the United States and Canada before you travel. This site has collected about 20,000 reports covering 12,000 locations.

Dominique Godfrey-Johnson is a WakeMed Public Health Epidemiologist.

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Whirlwind Tour of an Aortic Aneurysm

What do Lucille Ball, Albert Einstein and John Ritter have in common?  They all died from a ruptured aortic aneurysm

Like peripheral vascular disease, most physicians do not routinely screen for aortic aneurysms.  And for most people this is OK, because they do not have the risk factors for having an aortic aneurysm, making their chances for aortic rupture quite slim.  But for those few individuals who have an aortic aneurysm, it is like walking around with a ticking time bomb in your chest or abdomen because if it ruptures, the result is overwhelmingly death.

Your aorta is the primary blood vessel coming out of the heart.  It is about the size of a garden hose.  Aortic aneurysm affects approximately 6-7 percent of people over age 60.  It is the 10th leading cause of death in men over age 65, but unlike peripheral artery disease, an aortic aneurysm is generally symptom free, making a physical exam almost worthless and diagnosis difficult.  If you have any of the following risk factors, then you are a candidate for screening.

-Are over age 60
-Have ever smoked or used tobacco (the longer you have smoked or used tobacco, the greater the risk)
-Have high blood pressure and/or high cholesterol
-Have been diagnosed with atherosclerosis, which is the build-up of plaque in the arteries
-Are male
-Are white
-Are overweight
-Have a family history of aortic disease
-Have certain rheumatologic conditions like ankylosing spondylitis
-Or a family member were born with an abnormal, or bicuspid, aortic valve

In a physician’s mind if you have an aortic aneurysm, it is similar to having heart disease.  The most important part of treating or preventing aneurysm is to make sure you are living right; eat well, exercise, manage your cholesterol and blood pressure and limit alcohol consumption.  Smoking is the biggest risk factor, and if you have an aortic aneurysm and you continue to smoke, then you may be igniting the bomb in your belly.

Aortic aneurysms are treatable and if they are severe enough can be repaired surgically or in the cath lab using an endovascular repair.  The most important thing is to be screened if you have risk factors for the disease.

Dr. Chris Gring, MD, is an interventional cardiologist with Wake Heart & Vascular Associates.

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Construction Begins on Brier Creek Healthplex

Exciting news for the Brier Creek community. Construction has officially begun on the WakeMed Brier Creek Healthplex located at the corner of US-70 and TW Alexander Blvd.

Like WakeMed’s other stand-alone emergency departments located in North Raleigh and Apex, the Brier Creek Emergency Department will be staffed by the same board certified physicians that serve WakeMed’s five additional emergency departments and Level 1 Trauma Center.

The Brier Creek Healthplex will be the county’s third 24/7 full-service, stand-alone emergency department with 12 private treatment rooms. And laboratory and imaging services, including CT and X-ray, will be available for emergency department patients and outpatient visits.

Construction is slated to be completed by November 2011 and the building will be operational by January 2012. Find more information about Brier Creek Healthplex here.

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NC Seasonal Sensation: Lettuce Recipes

Once again, here are a few recipes straight from the NC’s No Diet Diet – all featuring North Carolina-grown seasonal veggies. Lettuce varieties sprout in early spring and are packed with tons of nutrients like vitamins A, C and K, beta-carotene and folic acid. Not all lettuce is created equal, however, so look for dark green varieties like Romaine, Butter Crunch, Royal Red and even spinach.

Spring Greens

Lettuce varieties sprout in early spring and are packed with tons of nutrients like vitamins A, C and K, beta-carotene and folic acid. Not all lettuce is created equal, however, so look for dark green varieties like Romaine, Butter Crunch, Royal Red and even spinach.

Walnut Vinaigrette Salad
From WakeMed’s HeartSmart Cooking Series, 2009 Serves 8, vinaigrette serving size 1 ½ Tbsp

For the salad
12 cups seasonal lettuce
1 medium tomato or two roma tomatoes, cut into wedges
5 sprigs Italian flat leaf parsley, lightly chopped ½ cup dried cranberries or currant (unsweetened) ½ cup walnuts
Clean and chop the lettuce and place in a large salad bowl. Add the tomato wedges and chopped parsley and toss to combine.
Preheat oven to 325°F. Spread walnuts on a baking sheet and toast in the oven for 5 to 10 minutes or until golden, being careful not to burn them. Remove from oven and let cool.

For the vinaigrette
¼ cup white wine or champagne vinegar
Zest of a lemon
2 Tbsp lemon juice
2 Tbsp walnut oil (Use extra virgin olive oil if walnut oil is unavailable.)
2 Tbsp water
4 Tbsp extra virgin olive oil
Pinch of salt and cracked pepper to taste
Optional: herbs, 1 tsp honey, ½ tsp Dijon mustard, 1 clove garlic

Place vinegar, lemon juice, salt, pepper and optional ingredients in a blender or food processor. Pulse until well combined. With the blender running, slowly add the oil in a thin stream. Pour the vinaigrette into a bowl and wisk in the lemon zest. Drizzle the vinaigrette over the salad and top with the toasted nuts and dried fruit. Try garnishing the salad with a few tablespoons of freshly grated parmesan cheese.

Per serving: 165 calories; 13 g fat; 1 g sat; 6 g monounsaturated fat; 4 g polyunsaturated fat; 0 mg cholesterol; 9 g carbohydrates; 2 g protein; 2.6 g fiber; 90 mg sodium

Grilled Asparagus & Spinach Salad
From WakeMed’s HeartSmart Cooking Series, 2009 Serves 4 to 6
1 large bunch of asparagus
4 cups fresh spinach (preferably baby spinach)
1 Tbsp pine nuts
2 Tbsp extra virgin olive oil plus more for drizzling
2 Tbsp balsamic vinegar
Pinch sea salt
Fresh cracked pepper to taste
½ cups roasted red peppers, chopped
1 cup button or cermini mushrooms

Preheat oven to 325°F. Spread pine nuts on a baking sheet and toast in the oven for 5 to 10 minutes or until golden. Remove from oven and let cool.
Drizzle a small amount of olive oil over asparagus and toss well. Season with a pinch of sea salt and a few grinds of black pepper. Toss well to combine. Place asparagus on a hot grill and cook until lightly charred or to preferred doneness.

Place spinach, mushrooms and roasted red peppers in a large salad bowl. Drizzle about two tablespoon of olive oil, followed by two tablespoons of balsamic vinegar over the salad. Toss well to combine. Top the salad with grilled asparagus and toasted pine nuts.
Per serving: 184 calories; 2.5 g fat, 0 g saturated fat; 1.5 g monounsaturated fat; 120 mg sodium; 12 g carbohydrates

For a complete list of farmers markets, CSA’s, veggie boxes, farm stands and groceries carrying locally grown sources, visit the Community Gardens & Local Foods section of Advocates for Health in Action’s website

Tina Schwebach is a clinical dietician, R.D., at WakeMed Cary Hospital.

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