Did’ya ever wonder…?

Do you remember the long standing news program 60 Minutes? If you’ve never seen it, you should. If you have, you probably remember the venerable Andy Rooney, who concluded every episode with commentary on a topic of interest. He would always begin his segment by posing a question to the viewing audience by asking them "Did’ya ever wonder…" followed by a witty 5 minute piece.
Well, I recently did a telemedicine consultation on Answer Health on Demand that really made me wonder how many patients wonder about various "simple" health complaints. The patient was concerned about a blistering rash and thought the fluid in them was "infecting" further, causing more of a rash. After looking at the rash, I was able to determine that it was most likely poison ivy. I reassured the patient that the fluid in the blisters would not cause more poison ivy rash and that the only way to get more rash was to get exposed to the oil from the poison ivy plant. Exposure could come from touching more plants, but could also occur from anything with the oil on it, including clothing, gardening equipment, belts, shoelaces, and pets. 
This wondering got me wondering about other things patients wonder about. What follows is a list of simple summer wonderings that we can help to address for you on Answer Health on Demand.
Don’t I need a steroid for my poison ivy?Usually no, unless it’s extensive or on the face. Steroids for poison ivy need to be taken for a relatively long time to help (usually 14 days) and the risks and side effects of steroids usually outweigh the benefits of taking them.
Did I get an infection from this bee sting?Probably not. Bites and stings can cause a localized reaction of redness, swelling, warmth, and tenderness, appearing similar to a skin infection called cellulitis. Local reactions usually begin soon after the sting, will start out larger, and are treated with Benadryl, cold compresses, and over the counter pain medicine. An infection will usually form later, starts small at the site of the sting, and may come with a fever and tenderness.
Am I having an "allergic reaction" to this bite/sting?Probably not. You most likely are having a "localized reaction" (see above). While true allergic reactions can occur, they are much less common. They must involve a reaction distant from the bite or sting and may include a diffuse rash, wheezing, mouth/lip/throat swelling, vomiting, or passing out. These are medical emergencies and must be seen immediately at an ER.
Am I "allergic" to this mosquito bite?Probably not. You are having a "localized reaction" (see above). Various amounts of pain, swelling, and itching can occur in response to mosquito bites also. Our bodies respond to the protein to mosquito puts into our body. This local reaction can be mistaken for an infection (cellulitis) or allergic reaction.
Is that snake poisonous?Maybe (but probably not). The only venomous snake in Michigan is the Massassauga rattlesnake. They are identified by their heart shaped heads, rattler, and vertical pupils. If bitten this is a true emergency and should be seen immediately in an Emergency Department. Don’t apply tourniquets above the bite site, try to suck out the venom, or use any type of device to extract the venom as these don’t work. While other snakes may bite (or try to), the Massassauga rattler is the only venomous Michigan snake.
Do I have a spider bite?Maybe. These usually cause localized reactions. Occasionally a cellulitis may develop requiring antibiotics.
…but I think it was a Brown Recluse spider.Probably not. These are not native to Michigan and generally cannot survive harsh Michigan weather conditions. It’s possible that a Brown Recluse made it here as a passenger on some sort of cargo from the mid-south, but not likely. Regardless, it is possible to be bitten by one, especially around undisturbed wood piles and sheds, attics, and basements. Look for 1/2 inch brown spider with a marking on the back that looks like a fiddle or violin.
…or a Black Widow.Maybe. Black Widow spiders are found throughout Michigan. They prefer to hide, but may bite defensively if found around wood piles, grills, and undisturbed garages. Females are more venomous and larger (1-1.5 inches), and have characteristic red hourglass on their underside. The bite may be sharp, and 2 fang marks might be identified. Immediate pain, redness, and swelling may be followed by muscle cramps, sweats/chills, abdominal pain, and headache. If you suspect a bite, you should seek medical attention right away. If possible bring the creature with you.

And finally… Am I allergic to the sun?
Probably not. You can get a rash from sun exposure, often called "sun poisoning." This is not truly poisoning or an allergy. Sometimes our body can react to sun exposure, especially if it has not been exposed for a while, such as when on spring break. Technically this is polymorphic light eruption, or PMLE. It’s treated by covering the exposed areas, taking a break from the sun, Benadryl, and ibuprofen.

Article source here: Did’ya ever wonder…?


It was an accident… or was it?

"Winter, spring, summer or fall… All you need to do is call…And I’ll be there, yes I will…" Lyrics to one of my favorite songs, performed by both James Taylor and Carole King, could have been written to describe what we do in the world of telemedicine and emergency medicine. Let me back up a few steps to provide the connection.

Do we have more than the four seasons we enjoy yearly in Michigan? If you ask an emergency physician, we have a fifth: Trauma Season. And we’re just settling into it as you read this. As a board certified emergency physician, I completed a residency after medical school specializing in the emergent stabilization of accidents, injuries, and severe acute illnesses. Approximately 30% of the 140 million ER visits this year will be a result of some type of traumatic injury or accident. Fortunately, many such injuries are relatively minor and AHonDemand telemedicine is a convenient and safe way for these to be evaluated.
After 20 years, I’ve come to conclude we have far fewer "accidents" than this number. Most such injuries are the result of poor decision making or "tempting fate." Let me give you an example: I used to get so mad at my kids when they were younger, standing on a swiveling bar stool in our kitchen trying to reach something on a high pantry shelf. If they were to have fallen and had to see me in the ER for a broken limb, stitches, or worse, you might think it was "an accident." I would suggest that it was an "unscheduled planned bad event." An accident is when an asteroid lands on you. A 6-year-old falling from a swiveling stool is destined to happen. Especially when you take into account two other kids playing around the stool, maybe a pet or two in the mix, and the child being careless and hurrying to get what he’s after before mom comes back into the kitchen! My kids are so brainwashed that when they see someone on a bike without a helmet, they would whisper "Psssst… daddy… look at that guy over there. He doesn’t have a helmet on," as if it was a felony.

When you look at events this way, like we do in emergency medicine, you realize that most traumatic accidents and injuries are preventable. Now, I’m not suggesting we live our lives in a bubble. That’s not possible, particularly if we want to enjoy this wonderful world given to us. I am suggesting that we should exercise caution when we can, be thoughtful and intentional about it, and think preventatively. Short cuts, not using available safety equipment, and poor judgement are factors in nearly every "accident" we see. These are all things we have direct control over!
So, use caution, good judgement, and safety equipment (think bike helmets, safety goggles, seat belts, etc.) when available. And when life inevitably happens, be assured the urgent care telemedicine practice of AHonDemand will be there for you. Winter, spring, summer, fall, or trauma season, know that we are available to treat you. You will be evaluated by providers trained specifically for the type of accident or injury you have. Fortunately, most injuries are relatively minor and don’t require much beyond evaluation and reassurance. We can help to determine the extent of injury you may have and in most cases provide reassurance that you don’t need to spend the next 3 hours in the ER at 2am. For those instances where you may need to get seen by another specialist, we can facilitate that, typically as soon as the next day.
So check us out. Explore our website (www.ahondemand.com), get yourself and your family signed up. It only takes about 2 minutes. When life inevitably happens, you’ll be all set to be seen by one of our telemedicine providers who are trained for the type of problem you are facing. Stay healthy!

Article source here: It was an accident… or was it?

Telemedicine: The next healthcare frontier

I just returned from the American Telemedicine Association annual conference, the largest international conference whose focus is on telehealth. The conference brings together healthcare professionals and industry leaders with the mission of transforming healthcare while ensuring quality, equity, and affordability.

I was struck in particular by one presenter, a noted author on societal trends, who said we have reached a tipping point in our existence where greater than 50% of what we do is carried out in "cyberspace." Think about it. Among the things now carried out in virtual fashion are banking, communication, networking, dating and relationships, schooling and education, working, paying bills, and shopping for anything you can imagine. This tipping point is also present in healthcare and growing at a rapid pace. For example, we now access our individual health records online, and in some instances communicate via email with our doctor’s offices. In rural and under-served areas, telemedicine has served for a number of years now as a vital link to advanced healthcare for conditions such as stroke, dermatology, and mental health problems. Would it surprise you to know some surgeries can be done remotely by doctors utilizing computers and robotic equipment?
A bit closer to home, you likely are familiar with the Fitbit or other "wearable technology" that enables you to track a number of your own health and fitness parameters. Why not use such technology to plug-in to your doctor’s office and improve your health? The answer is, we already do! We are currently able to provide remote care via devices that can monitor numerous health parameters such as weight, blood pressure, heart rate and rhythm, and blood sugar. We have remote stethoscopes to listen to hearts and lungs, and a variety of visual aids to look into ears, noses, mouths, and to examine rashes. In addition to the potential for remote surgeries, there are other Star-Trek type devices under development that will eventually allow us to evaluate more complex health parameters remotely.

For now, we are just dipping our toes intothis next frontier of medicine. We are just getting used to the idea of "seeing" our doctor virtually, via telemedicine in an online encounter. It is clear that to balance the demands of escalating healthcare costs and diminished supply, novel efficiencies such as telemedicine will need to be adopted. So what can you do to get more familiar with and promote this next frontier? Let me give you some concrete action items:
Gotowww.AHonDemand.com, explore

the site (including back issues of this blog!), and learn about how we provide urgent care visits online.

Registerwith AHonDemand (it takes 2 minutes!) so when you have a healthcare need, all you need to do is connect with one of our providers.
Discusswith your doctor’s office their plans for integrating telemedicine into their practice.
Askyour friends and family what they know about telemedicine. If you’ve used it already, tell others about it. If they’ve used it, ask them about their experience. You will likely get great reviews from them.
Inquirewith your corporate HR manager or health insurance carrier what their plans are

for integration of telemedicine services into their healthcare benefits plan.

Discusstelemedicine with your government representatives. You likely know someone from school, church, or your neighborhood who works for the government or in public policy. Leverage those relationships to ensure the benefits of telemedicine are on their radar.
Use it!Try it out when you need care!

Article source here: Telemedicine: The next healthcare frontier

Upcoming Events – April 2017

Michigan HR Day
April 19, 2017
Lansing, Michigan
Michigan HR Day is an opportunity for Human Resource Professionals to exchange information, ideas, and experiences. The event will feature a keynote presentation from Matt Jones, titled "HR is a Marathon," followed by a number of breakout sessions. Visit our information booth to learn more about the benefits of offering telemedicine to your employees and enter to win a FitBit!

ATA Annual Conference
April 23, 2017 – April 25, 2017
Orlando, Florida
ATA 2017, Telehealth 2.0: The Transformation Advantage, is the world’s largest telehealth innovation and networking event, focused on how telehealth is transforming healthcare and creating competitive and cost advantages for those leveraging best practices. The featured speakers for Telehealth 2.0 include Patrick J. Kennedy, American Politician and mental health advocate; Thomas L. Friedman, American journalist and author; and Pamela Peele, Chief Analytics Officer of UPMC Insurance Services Division. Find our e-poster in the Exhibit Hall Experience Zone, and see our Executive Director, Barry Brown, present on April 24 from 5:45 to 6:00pm. If you can’t make it to our presentation, click on our e-poster thumbnail above to check it out!

MDAHU Benefit Expo
May 11, 2017
Sterling Heights, Michigan
Hosted by the Metro Detroit Association of Health Underwriters, the 2017 MDAHU Benefits Expo provides a number of featured speakers covering a wide range of topics including everything from boosting productivity to HSA Retirement. Take time to visit our information booth during the exhibitor breakfast and breaks to learn more about how we can help lower healthcare costs.

Article source here: Upcoming Events – April 2017

A Flower a Day Keeps the Antidepressants Away

But, can it really? A play on words of the often repeated phrase "An apple a day keeps the doctor away," could a flower a day be enough to lift some out of depression or keep others from needing antidepressant medication? Researchers at Rutgers University think so. As first reported in the Journal of Evolutionary Psychology in 2005, researchers demonstrated scientifically what we intuitively already know: that flowers make us happy.
The research showed that flowers are indeed a natural mood elevator, that they decrease stress levels, and improve emotional health. Moreover, results revealed that the benefits were not only immediate or when one was in the presence of the flowers. Improved mood, emotional reactions, social behavior, and memory were also demonstrated to be longer term effects.
Is it just a coincidence, then, that the growth of new plants and flowers that accompanies the lifting of winter signals another phenomenon that we also intuitively know: that of "spring fever?" We have long known of seasonal mood variations that affect us. An example you’re likely aware of is seasonal affective disorder (SAD), a depressive mood disorder affecting up to 10% of the population in the winter months.

While scientifically demonstrating the effects of "spring fever" has been more elusive, our intuition tells us it’s real, just as it tells us the "flower effect" and SAD are real. The feeling of euphoria is likely due to the complex interrelationships of our circadian rhythms (our biological clock), the amount of natural light we are exposed to, and hormones produced in our bodies in response to these (and other) factors.
Hopefully you’re recognizing that a number of things can potentially improve our moods that don’t necessarily involve taking medications. We’ve touched on the positive effects of flowers already. We know there are complex changes that accompany the lifting of winter and arrival of spring. For those who suffer from SAD, we know that the use of light therapy can ease depressive symptoms. Other non-pharmacological treatments that have been demonstrated to positively affect mood and ease depressive symptoms include laugh therapy, regular exercise, and appropriate amounts of sleep (approximately 8 hours for adults). Many of these seem remarkably similar to the simple advice our grandparents used to give us!
So, we know our moods are complex, but they can be positively affected by some of the simplest things in life: flowers! Treat yourself (and someone else while you’re at it) to fresh flowers. Place them in a location where you will have repeated exposure on a daily basis, such as your kitchen counter or your desk at work. Add in the other low-cost (or no cost), low-tech interventions discussed above and you should be well on your way to an enhanced sense of well-being.
Source: Haviland-Jones J, Rosario HH, Wilson P, McGuire TR. 2005. An Environmental Approach to Positive Emotion: Flowers. J Evol Psychol. (3): 104-132.

Article source here: A Flower a Day Keeps the Antidepressants Away