In today’s society people get 1-5 days of bereavement leave when a particular loved one dies, however grief takes much longer than 1-5 days to get through. No person is the same, and therefore each person’s grief will be as unique as them. Typically, it takes a person 1 year to create his/her “new normal” and to feel better.   The new normal can be defined as a new life style, schedule, or routine that is different from the one utilized while his/her loved one was alive.

 While grieving, people experience several different physical and emotional symptoms. Death is a life-altering event, and therefore the body goes through major changes when a loved one dies. Some of the physical symptoms include but are not limited to: pain, fatigue, low energy, changes in appetite and sleep patterns, irritability, changes in breathing, and tension. Some of the emotional components of grief include but are not limited to: sadness, anxiety, anger, depression, confusion, suicidal feelings, loneliness, shock, and relief.  Another major effect grief has on a person is that a person’s brain can become “foggy.” This means a person may be more forgetful, have a harder time focusing on tasks, and have a lack of energy. During this time it is important to put fewer things on one’s schedule.

 Because grief is different for everyone, the same is true as to what coping skills will help each person tackle his/her grief. Taking care of one’s self is one of the most important things a person can do. This includes eating healthy, resting when possible, and being kind to yourself. Some other coping skills that may help include: talking about the deceased loved one; crying; journaling; creating art, music or poetry; deep breathing; exercise; doing pleasurable activities; and rituals of remembrance.

 Children also grieve, however, their grief looks different than adult grief. Children may become more irritable and have more nightmares. They may also have a hard time leaving their loved ones who are still living. Depending on the age of a child, death may seem like a vacation spot. It is important to talk about the deceased loved one with a child. Children will learn how to grieve by taking cues from their family. It is important to include each child in the funeral process and to discuss death with them.

 It is important to remember a person does not get over grief, a person gets through grief, and this can take a much longer time than one expects it to take. Each person will cope with the loss of a loved one in his or her own unique way and pace, and this is okay. Grief is an individual journey. If you have recently lost a loved one or have never dealt with a loss and are looking for some support, please call Genesis Behavioral at: 412-369-9943, and ask to schedule a grief counseling session with Erin.

Erin O’Donnell, Counselor — Genesis Counseling Center

PLEASE NOTE:  This article is not intended as medical advice.   If you are personally experiencing or have a family member that is experiencing grief and its associated symptoms, please contact Genesis Behavioral at 412.369.9443.

Allergic rhinitis is a prevalent problem throughout the United States. According to the Centers for Disease Control (CDC), 17.9 million American adults were newly diagnosed with hay fever in the year 2010. Allergies are also very common in the pediatric population as well. According to the CDC, 7.1 million children reported allergy symptoms during the year of 2010. In the year 2007, the CDC also reported that 13.4 million visits were made to physician’s offices, emergency rooms, and urgent care centers for allergic rhinitis symptoms.

The symptoms of allergic rhinitis can range from mild to severe. Runny noses, stuffy noses, and watery eyes are just a few of the classic symptoms. Some other common symptoms include itchy eyes, nose, and mouth, fatigue, sneezing, and dark circles under the eyes. Hay fever symptoms most commonly flare up in spring and summer. If left uncontrolled, allergy symptoms can lead to sinus problems, respiratory issues, disruption of sleep, and decreased productivity at school and work.

The culprits of these symptoms are millions of tiny particles called pollen. Pollen is released from grass, trees, and weeds. During the spring, trees are the most common pollinators and during the summer months grasses typically release their pollen. The body recognizes the pollen spores as intruders, thus activating the body’s immune system. The body makes histamine in response to the foreign substance, and it is this chemical that causes the classic allergy symptoms.

There are many ways to treat allergies that include both pharmacological and non-pharmacological treatment options. Many lifestyle modifications can be made to prevent these allergies. The best way to reduce symptoms is to reduce your exposure to pollen. On days with high pollen counts limit outdoor exposure and keep your house and vehicle windows closed. The National Allergy Bureau (NAB) releases the most reliable daily pollen counts for 78 cities throughout the United States including Pittsburgh.  This information is available on-line at www.aaaai.org/global/nab-pollen-counts.aspx. Also, it is important to shower after coming in from outdoors to wash pollen off body and hair.

Multiple pharmacological options exist for treatment and relief. The options you have are over –the-counter medications and prescription medications. The best treatment for long-term relief is immunotherapy, or “allergy shots”.  An allergist can identify specific triggers through allergen testing and then administer regular injections to build up immunity to the specific allergens. There are also many medications that can be used for symptom relief. Runny noses and itching can be treated with antihistamines, such as Benadryl®, Allegra®, Zyrtec®, Claritin®, and Alavert®. Nasal congestion is best treated with decongestant pills and sprays (such as Sudafed®, Astepro® nasal spray, Astelin® nasal spray) and corticosteroid nasal sprays (such as Nasonex®, Flonase®, Rhinocort®). Antihistamines and decongestant pills are available over-the-counter at your local pharmacy, while the corticosteroid and decongestant nasal sprays are only available by prescription.

Allergic rhinitis is a major problem in our area during the spring and summer months and affects many people in all different ways. It is very important to get accurately diagnosed so you can get proper treatment.  If you think you may be suffering from hay fever, then make an appointment with your primary care provider for evaluation, testing, and treatment. With proper treatment, the sun may shine a little brighter, the grass may be a little greener, and the flowers may smell a little sweeter for you this spring and summer!

Kimberley Stark PA-C

Bentz, Grob, Scheri, Woodburn Family Medicine

Please Note:  This information is not to be construed as medical advice.  If you have questions any of the article’’s content, please consult directly with your family practice physician.

The Outpatient Lab Center welcomes patients from other practices and accepts most outside patient insurances.   Results are typically same day or next morning depending on when the draw is performed.

Pricing is competitive and the Lab is easily accessible.

From the North

• Take Perry Highway (State Route 19) south
• From the traffice light at Cumberland Road, continue 1.2 miles south
• The Executive Building is located on the left

Fron the South

• Take Perry Highway (State Route 19) north
• From the traffic light at Sewickley-Oakmont Road, continue .7 miles north
• The Executive Building is located on the right

Handicap parking is available.

So the next time your physician orders testing, please call 412.847.0010.

Blood pressure is a measurement of the resistance in your arteries as your heart pumps blood through your body.  Blood pressure is measured using two numbers; the top number is termed the systolic blood pressure, and the bottom number is termed the diastolic blood pressure.  The systolic number is the measurement of the pressure in the arteries as the heart is pumping.  The diastolic number is the measurement of the pressure in the arteries as the heart is resting in between beats.  Hypertension is the term used to describe high blood pressure.   Blood pressure is considered to be high when it is 140/90 mmHg or above.  Most of the time, there are no symptoms of high blood pressure, therefore you may have high blood pressure and not be aware of it.  If left untreated, high blood pressure can lead to heart disease, stroke, and kidney disease.  Treating blood pressure to keep it less than 140/90 mmHg can help to maintain a healthy heart.    

Cholesterol is a fat that is found in the blood that your body needs to work properly.  Cholesterol is produced naturally by your body and also comes from the foods you eat.  Cholesterol measurements are divided into the “bad” cholesterol, or LDL, and the “good” cholesterol, or HDL.  Bad cholesterol builds in your arteries and becomes plaques that cause atherosclerosis or a narrowing of the arteries.  Good cholesterol helps to remove the bad cholesterol from the blood.  Dyslipidemia is any abnormal cholesterol measurement, most commonly high LDL (“bad”) and low HDL (“good”). Cholesterol is monitored through routine bloodwork.  Cholesterol is considered high when the LDL is greater than 130 mg/dL, and the total cholesterol is greater than 200 mg/dL.  As with hypertension, there are no symptoms of dyslipidemia.  If left untreated, dyslipidemia slowly causes damage to the blood vessels over years.  Treating and maintaining cholesterol below 200 mg/dL can help to maintain a healthy heart.

 Uncontrolled hypertension and abnormal cholesterol levels can lead to coronary artery disease, and ultimately cause a heart attack.  Coronary artery disease is the narrowing or blockage of the blood vessels that supply blood to the heart.  A heart attack occurs when a coronary artery becomes blocked, preventing oxygen from getting to the heart muscle.  The classic symptoms of a heart attack include chest pain or pressure; pain or discomfort in the arms, neck, jaw, or back; and shortness of breath.  Women typically experience more subtle symptoms including unusual fatigue, sleep disturbance, shortness of breath, indigestion, anxiety, weakness, cold sweat, or dizziness.  If you experience any of the above symptoms, it is important to seek medical attention.

There are many ways to promote a healthy heart.  In addition to monitoring and treating high blood pressure and high cholesterol, many lifestyle changes can protect your heart.  Following a healthy diet low in salt, getting regular exercise, maintaining a healthy body weight, quitting smoking, limiting alcohol consumption, and reducing stress all improve your heart health.  Prevention is the most important medicine when it comes to heart disease, so please schedule an appointment with any of our providers to have your blood pressure and cholesterol checked as well as to discuss your other risk factors for developing heart disease.

Rebecca A. Torquato PA-C

Bentz, Grob, Scheri & Woodburn Family Medicine

 Physical activity can be fun and doesn’t have to be done only in a gym.  Exercise can give your family the opportunity to spend time together by walking, hiking or bike riding and becoming healthier while enjoying the outdoors.

 Often we don’t know where to start when deciding to adapt a healthier lifestyle.  Assessing your fitness level is a good place to start.  You can do this by taking your pulse rate before and after a one mile walk, timing how long it takes to walk a mile, keeping track of how many push-ups you can do, how far you can stretch and measuring your waist circumference and body mass index.  Retake your physical assessment every 6 weeks and monitor your progress.

When designing a fitness program consider your goals, go at your own pace, and include different activities to create a balanced routine.  An exercise program should include aerobic activity that increases your heart rate, strengthening exercises and exercises that target your core areas; abdomen, lower back and pelvis.  A proper program should also include balance training, flexibility and stretching exercises.  Remember, a single workout does not need to include all of the above, but should rotate throughout the week. 

Becoming physically active is an important way to feel better, both physically and mentally.  As a general goal, aim for 30 minutes of physical activity each day, change your routine so that you don’t become bored and give up.  Most importantly, always check with your doctor before you start a new exercise program.

Michelle McGrath CRNP

Koman & Kimmell Family Medicine, A Divison of Genesis Medical Associates, Inc.

 As of January this year, Medicare began covering an Annual Wellness Visit (AWV), a new benefit resulting from the Affordable Care Act. The AWV takes place with one’s primary care provider, is covered once every 12 months after the first year of Medicare coverage, and has no deductibles, coinsurance or copayments.

Among other things, the Annual Wellness Visit includes the provider taking your medical history, a health risk assessment, an evaluation of your physical condition, and a screening for cognitive impairment, including depression. It also includes a personalized prevention plan, where the doctor develops a strategy with you to manage your health, including planning the preventive services and screenings you may need over the next 5 to 10 years. The plan helps you take advantage of Medicare’s preventive services, many with no cost-sharing. Also resulting from ACA, eliminating the cost-sharing for many preventive services covered by Medicare marks a major milestone in Medicare’s efforts to keep beneficiaries healthy rather than just pay for treatment when people are sick. Over 800,000 beneficiaries have used the AWV benefit as of June 2011.

The Annual Wellness Visit is different than the Welcome to Medicare visit. The Welcome to Medicare visit is for beneficiaries new to Medicare (see the FAQ below). Neither the AWV nor the Welcome to Medicare visit is a routine physical exam. Both provide you with an opportunity to talk with your doctor about your health concerns. In addition, while the AWV has no cost-sharing, if your doctor performs other services or orders extra testing not included in the AWV during the same appointment, the doctor may claim for those additional services and you may have a copay.

Key publications from Medicare.gov:

FAQ: Frequently Asked Questions

1. What does the Annual Wellness Visit cost?

You pay nothing out of pocket for this visit. However, you may incur a copayment or deductible expense if additional services are performed or ordered by your doctor.

2. When am I eligible for my Annual Wellness Visit?

After you have had Medicare Part B for more than 12 months. If you have had a “Welcome to Medicare” visit within the last 12 months, you must wait 12 months after your Welcome visit to schedule your Annual Wellness Visit.

3. How often can I have my Annual Wellness Visit?

You may have an Annual Wellness Visit once every 12 months.

4. What is covered during the new Annual Wellness Visit?

Your first Annual Wellness Visit will include:

Subsequent Annual Wellness Visits will include:

• measurement of weight, blood pressure, and other measurements deemed appropriate;
• an update to medical and family history;
• an update to the list of providers, suppliers, and medications;
• a review of the initial personal risk assessment;
• detection of any cognitive impairment;
• an updated screening schedule; and,
• a review and update of your list of referral services to help intervene and treat potential health risks.

6. Is the Annual Wellness Visit the same thing as an annual physical exam?

No. An annual physical is a much more extensive physical examination. In addition to collecting a medical history, it may also include: vital signs check, lung exam, head and neck exam, abdominal exam, neurological exam, dermatological exam, and extremities exam. The Annual Wellness Visit is not meant to replace your annual physical.

7. Will I actually see a doctor during the Annual Wellness Visit?

You will see your primary care provider which could be a physician, nurse practitioner or physician assistant. However, most of your time may be spent with an allied health profession, such as a nurse or medical assistant who will gather most of your medical history so that your physician can determine an appropriate preventive health screening plan.

8. What is the difference between the “Welcome to Medicare” visit and the “Annual Wellness Visit”?

• Medicare covers a one-time Welcome to Medicare Visit. (See below for what your provider will cover at this visit.)
• Medicare also covers an Annual Wellness Visit every 12 months. (See above for what your provider will cover during this visit).

9. When am I eligible for my “Welcome to Medicare” visit?

Medicare covers a one-time “Welcome to Medicare” visit within the first 12 months you have Medicare Part B. If you did not receive your Welcome to Medicare visit and have been with Medicare for more than 12 months, you are eligible for your Annual Wellness Visit.

10. What does the “Welcome to Medicare” visit cost?

As of January 2011, you pay nothing out of pocket for this visit.

11. What is covered in the “Welcome to Medicare” visit?

A “Welcome to Medicare” visit includes the following:

• A thorough review of health, education and counseling about the preventive services covered by Medicare and referrals for other care if needed.
• Establishing a schedule for a Medicare screening and preventive services you qualify for over the next 5 to 10 years.
• A review of a medical and social history with attention to risk factors for disease detection.
• A review of an individual for potential depression or other mood disorders.
• A review of the individual for functional ability and level of safety.
• An examination to include an individuals height, weight, blood pressure, visual acuity screen, measurement of body mass index and other factors as deemed appropriate by the examining physician or qualified non-physician practitioner.
• End-of-life planning, upon an individual”””’’s request.
• Education, counseling, and referral based on the results of the review and evaluation services described in the previous five components.
• EKG with interpretation and report.
• Hearing assessment.

12. Do I have to have my “Welcome to Medicare” visit before my Annual Wellness Visit?

No. You do nott have to have a “Welcome to Medicare” visit before getting an Annual Wellness Visit, but if you have the “Welcome to Medicare” visit, you willl have to wait 12 months before you can have your first Annual Wellness Visit.

13. What if I require further tests or screenings?

Medicare covers many screenings for people who are at high risk for certain diseases. During your Annual Wellness Visit, you and your doctor will decide what tests and screenings you need.

14. How do I schedule my Annual Wellness Visit or my “Welcome to Medicare” visit?

To help schedule your Welcome to Medicare visit or determine when you become eligible for your first Medicare Annual Wellness Visit, call your primary care physician.

Many lifestyle factors and medical conditions exist that pose a risk for developing osteoporosis, including but not limited to low calcium and vitamin D intake, tobacco abuse, decreased physical activity, female gender, diabetes, and rheumatoid arthritis. The diagnosis of osteoporosis is through the imaging study known as a DEXA scan, which measures bone mineral density in the hip and spine. The test results are reported with a score and categorized by normal, low bone mass (osteopenia) or osteoporosis.

Various treatment options are available based on patients’ individual score. First, is appropriate calcium and vitamin D intake. The current recommendation is 1200mg per day of calcium and 800-1,000mg of vitamin D. Regular weight bearing exercise, fall prevention, and smoking cessation are all lifestyle changes that patients can initiate on their own. If the diagnosis of osteoporosis is determined, then treatment with prescription medications is recommended. Many different prescription medications are currently available. Patients can take oral medications daily, weekly, or monthly, intravenous medications given once yearly or subcutaneous injections given daily or every six months. Healthcare providers can discuss the appropriate option for their patients depending on the patients’ risk factors as well as previous and current medication use. The goal for treating osteoporosis is to prevent further bone density loss and the prevention of hip and spine fractures.  If treatment with pharmaceuticals is required, it is currently recommended that a DEXA scan should be repeated in two years to evaluate effectiveness.

In the New Year, remember to schedule a yearly physical and if over the age of 65 for women or 70 for men, ask for a referral for a DEXA scan along with your referral for mammograms or colonoscopies!

Lara P. Trushel, PA-C

Schogel and Fardo Family Medicine

COPD is a term that includes chronic bronchitis and emphysema, which is caused primarily by smoking.  Symptoms include shortness of breath, cough, chest tightness, and wheezing.  Extreme weather changes can trigger exacerbations of COPD, which can result in hospitalization.  Breathing cold air can cause more tightening in a COPD patient’s airways and increase bronchospasms, making symptoms worse.  Also, in the winter months, there are more common cold and flu cases, which make COPD patients at a higher risk for developing lung infections, which exacerbates symptoms. 

Here are a few tips to keep healthy and to avoid COPD exacerbations triggered by cold winter weather. 

1. Quit smoking and avoid second hand smoke.  Talk to your healthcare provider for information regarding smoking cessation. 
2. Avoid dust and fumes.  You can check daily air quality levels and air pollution forecasts on local news programs and weather channels.
3. Get vaccinated.  Every COPD patient needs a yearly flu vaccine.  Also, COPD patients should be vaccinated with Pneumovax.  Pneumovax is given every 5 years.  Make sure you are up to date on your vaccinations.
4. Wash your hands frequently
5. Avoid others who have a cold or the flu
6. When outside in the cold weather, use a scarf to cover your nose and mouth to prevent inhaling cold air.

OF course, COPD patients are urged to use their medications, inhalers, and oxygen as prescribed by their doctor, physician assistant, or nurse practitioner.   Seek medical attention if you or a loved one with COPD becomes increasingly more short of breath especially during these cold winter months.

STACIE  LEY, PA-C

Singh & Dayalan Medical Associates

 The management of pain would begin in the acute setting. For example, the patient diagnosed with breast cancer would be provided with a multimodal analgesic regimen that has the goal of preventing and/or reducing the incidence of chronic pain. Factors that can be modified in the acute setting which have been associated with the development of chronic pain postoperatively include the length of time in pain prior to surgery, the coping ability of the patient, the type of surgery performed, treatment with radiation and/or chemotherapy, and adequate postoperative pain control. Nerve damage and subsequently chronic pain may develop after radiation and/or chemotherapy. The pain that may manifest following radiation therapy can appear month to years following treatment. Some studies have shown that up to fifty percent of patients will experience chronic pain post mastectomy. With appropriate treatment the pain that a cancer patient may encounter can be substantially reduced in eighty to ninety percent of cases.

 Another condition that may arise as a result of treatment utilizing surgery or radiation is Complex Regional Pain Syndrome (CRPS), formerly known as Reflex Systemic Dystrophy (RSD). CPRS is a condition in which the patient’s body overreacts to pain. This may be accompanied by skin color and temperature changes in the extremities, sweating differences, and extreme pain in response to non-painful stimuli.

 The best predictor of chronic pain following surgery is the intensity of acute postoperative pain. Our goal as health professionals is to help patients that have been diagnosed with breast cancer deal with all of the aspects of their pain, ranging from the acute postoperative to the chronic, and from nerve pain to CRPS. Options which may be utilized include medication management with opioid and non-opioid treatment, physical and occupational therapy, interventional procedures, and help with coping strategies. Our ultimate goal is to increase the quality of life by decreasing the pain.

 Maria Funair, PA-C

Singh & Dayalan Medical Associates

Behm Family Practice — providing flu vaccine from pediatrics to older adults (age 65+ who should receive high risk flu vaccine.)   Flu shots are given during regular hours of operation including Saturday hours.   Please call office for an appointment time — no walk-ins accepted.

Bentz, Grob, Scheri & Woodburn  — the Perrysville office offers flu vaccine every Tuesday and Thursday from 4:30-5:30 PM beginning September 27 through the month of October.   Will continue through November as needed.  Patient must schedule to receive flu vaccine –  no walk-ins accepted.

The Wexford office will offer flue vaccine starting Monday, September 26 from 8:00-12:00 Noon and Wednesday, October 5 from 1:00-4:00 PM.   It will also be offered October 10 from 8:00-12:00 Noon.  Additional dates will be added as needed.

Heck & Polinski — flu shot clinic scheduled for Monday, September 26 from 9:00-11:00 AM at their WestView office.  

Also available Monday through Friday at both the West View and Troy Hill offices.

Heyl Family Practice – Beginning the week of October 3, Wednesday morning starting at 9:15 AM; Tuesday and Thursday afternoons starting at 1:15 PM

Northern Area Family Medicine — Flu Shot Clinic begins Tuesday, Octoer 18 from 8:30-11:30 AM and 1:00-3:00 PM Monday thru Friday.  Evening and Saturday hours by appointment only.

Koman & Kimmell –  Please contact practice directly

Schogel & Fardo –        Please contact practice directly

Singh & Dayalan — Monday thru Friday 7:00-12:00 Noon and 1:00-5:00 PM.

Zillweger Medical Practice –  Please contact practice directly

If you have any questions specific to the practice at which you are a patient, please call them directly.