Respiratory illnesses are common during the winter months.  As temperatures get colder, people spend more time indoors, making it easier to spread germs.  Respiratory viruses tend to spread better in dry air.  Lower humidity levels indoors can cause dryness and irritation in the respiratory tract.  This makes people more susceptible to developing infections.

Peak Virus Season

Cases of colds, influenza, Covid-19, and RSV (respiratory syncytial virus) all peak during the winter months.  Infections are highest from October to March.  While most people generally recover from these illnesses without issues, respiratory infections can lead to more serious conditions including sinus infections, bronchitis, and pneumonia.  People with asthma, other chronic lung conditions, young children, the elderly, pregnant women, those with compromised immune systems, and people with chronic conditions such as diabetes and heart disease are at higher risk of serious complications from respiratory infections.

Which respiratory infection do I have?

The following are symptoms of common respiratory infections:

• Common cold – Sneezing, runny or stuffy nose, sore throat, sinus pressure, low grade fever
• Influenza (flu) – High fever (100.4 degrees or higher), chills, body aches, headache, cough, sore throat, runny or stuffy nose, fatigue
• Covid-19 – Fever, chills, shortness of breath, cough, body aches, sore throat, fatigue, loss of taste or smell, headache, diarrhea, nausea or vomiting
• RSV – Initial symptoms similar to a cold.  Infants and young children may have trouble breathing and decreased appetite.  Older adults may develop wheezing, pneumonia, or bronchiolitis.

Preventing Infections

Vaccines are available to help protect against flu, Covid-19, and RSV.  Other important preventive steps include washing hands often, particularly when preparing food, eating, after using the bathroom, coughing or sneezing, and after touching dirty surfaces.  Avoid touching your eyes, nose, and mouth with unclean hands.  When possible, stay away from people who have a respiratory infection.

Diagnostic Tests

While there is no diagnostic test for the common cold, other respiratory illnesses do have diagnostic tests.  There are at-home tests for the Covid-19 virus.  A physician or healthcare professional can test for the flu by swabbing a sample from inside the nose or the back of the throat.  Rapid tests for flu can provide results in 30 minutes.  A doctor can test for RSV with a swab test, chest x-rays, and a blood test to check white cell counts.

RMD Primary Care

The physicians at RMD Primary Care are Board Certified in Internal Medicine and Family Medicine.  They provide comprehensive medical care, preventive care, and health maintenance.  Contact our office to schedule an appointment.  

Bronchitis is the inflammation of the airways of the lungs, known as the bronchial tubes.  Acute bronchitis is a common respiratory illness that physicians see often in the winter.  It may develop from a chest cold, flu-like illness, or some other viral respiratory infection.  The acute form of bronchitis is a short-term infection that usually resolves in a few weeks, while chronic bronchitis is an ongoing condition.

Common Symptoms

The following are some common symptoms of acute bronchitis:

• Cough
• Thick mucus which may be clear, yellow, or greenish
• Shortness of breath
• Chest discomfort
• Wheezing
• Fatigue
• Low-grade fever
• Stuffy or runny nose, or post-nasal drip

Other symptoms may include sore throat, body aches, and headache.

What groups are most at risk?

Acute bronchitis can be a serious illness for babies, children, and seniors.  People with other serious health conditions including heart disease, lung disease, asthma, allergies, and those who smoke are also at higher risk of developing serious illness.  Most people recover from acute bronchitis within a week or two, although the cough may last longer.  People with other health problems may need medical treatment for acute bronchitis.

Are antibiotics needed?

Most cases of acute bronchitis are caused by a virus, so antibiotics are not generally effective.  If a bacterial infection is also present, an antibiotic may be prescribed.  Antibiotics may also be helpful in preventing complications, such as pneumonia, for people with other serious health issues.

Treatments

Cough medications may be helpful, particularly at bedtime.  People with allergies, asthma, or COPD may need to use an inhaler to reduce inflammation and keep airways open.  Doctors recommend getting plenty of rest and drinking fluids to stay hydrated.  Fluids help to loosen and thin the mucus, making it easier to cough up.  A humidifier or cool mist vaporizer can relieve stuffiness and open nasal passages.  A hot shower can also open airways.  Fever and body aches can be treated with acetaminophen.

When to Seek Medical Care

These symptoms indicate it’s time to see your doctor:

• Cough that produces bloody mucus
• Fever of 100.4 degrees or higher
• Shortness of breath or trouble breathing
• Symptoms that last more than 3 weeks
• You have repeated bouts of bronchitis

RMD Primary Care

The physicians at RMD Primary Care are Board Certified in Family Medicine and Internal Medicine.  They provide comprehensive medical care, preventive services, and health maintenance.  Contact us to schedule an appointment.

Acid reflux happens when stomach acid leaks back up into the esophagus and throat, causing heartburn and a burning sensation in the chest.  Nearly everyone has experienced it at some time, particularly after eating a large or fatty meal or lying down soon after eating.  Pregnant women sometimes experience bouts of heartburn.  Cases of occasional acid reflux can be treated with over-the-counter antacids.  People suffering with more chronic acid reflux may need to be evaluated by their physician and treated with stronger prescription medication.

Symptoms of Acid Reflux

• Regurgitation – Food or stomach acid backwashes from the stomach to the throat.
• Burning feeling – Stomach acid burns the esophagus, causing a feeling of burning in the stomach, chest, or throat.
• Nausea – Queasiness or loss of appetite.
• Sore throat – Difficulty swallowing; feeling of a lump in the throat.
• Chronic coughing – Related symptoms include hoarseness or wheezing.
• Bad breath – a bad or bitter taste in the mouth.
• Burping or bloating.

Managing Symptoms

Lifestyle and dietary changes may help reduce symptoms. The following are recommendations:

• Eat smaller meals.
• Avoid eating late at night.
• Lose weight.
• Reduce alcohol consumption.
• Quit smoking.

Avoid foods that may act as triggers including spicy foods, fried foods, foods high in fat, acidic foods and drinks, citrus fruits and drinks, carbonated beverages, caffeine, chocolate, peppermint, and alcohol.

Prescription Medications

If lifestyle changes, dietary changes, and over-the-counter medications have not worked, it’s time to see your doctor.  There are prescription medications that can successfully treat acid reflux.

• Proton pump inhibitors – These medications block acid and help heal the esophagus.  Examples include Nexium, Prevacid, Prilosec, and Protonix.
• Prescription strength H-2 blockers – These medications decrease the amount of acid the stomach produces.

Dangers of Not Treating Acid Reflux

Untreated acid reflux can lead to serious health complications.

• Esophagitis – Stomach acid can cause inflammation and scarring of the esophagus.
• Esophageal ulcers
• Narrowing of the esophagus and difficulty swallowing
• Barrett’s esophagus – The lining of the esophagus changes, sometimes leading to cancer.
• Aspiration pneumonia – Acid that is inhaled into the lungs can lead to infection.
• Breathing difficulties and persistent cough
• Worsening of asthma
• Dental Issues – Acid erodes tooth enamel and causes decay.

RMD Primary Care

The physicians at RMD Primary Care urge you to make an appointment if you have acid reflux symptoms several times a week, regularly use over-the-counter medications for heartburn or acid reflux, and are having side effects from those medications.  Contact us to schedule an appointment.

Monthly breast self-examinations were once recommended as a screening tool for breast cancer.  Doctors used to encourage women to perform these exams as a way to become more familiar with the look and feel of their breasts and to notice any changes.  The goal was to help recognize breast disease at an early stage, when it was more successfully treated.  However, breast self-exams have not been shown to be effective in reducing deaths from breast cancer.

Problems with Breast Self-Exams

There are some specific problems in relying on breast self-exams:

• Very small cancers may not be detected through breast self-exams.  Mammograms are much more effective in detecting small cancers before they become large enough to feel.
• More than 40 percent of women have dense breast tissue.  It’s more challenging for women with dense breasts or fibrocystic breasts to feel abnormalities.
• Breast tissue can feel somewhat lumpy.  Many women could not distinguish a difference between lumpy breast tissue and a suspicious lump.

Monthly Breast Self-Exams Not Recommended

Most health professionals no longer recommend breast self-examinations for women’s health.  A mammogram is the primary breast cancer screening tool.  Over the years, mammography has seen significant advances.  Breast imaging has gone from analog to digital, and from 2D images to 3D images.  These improvements now mean that 30 percent more cancers are detected.  The newest guidelines advise women who are at average risk for breast cancer to have a mammogram every other year from age 40 to 70.  However, the American Cancer Society recommends a woman continue to have screenings as long as she is in good health and is expected to live at least ten more years.

However, that doesn’t mean a woman should ignore an obvious change in her breasts.  Any of the following changes should be reported to her physician.

• New lump – a new thickening or firm tissue on the breast or under the arm
• Skin changes on the breast – irritation, redness, dimpling, or puckering
• Nipple changes – a discharge from the nipple; retracted or inverted nipple
• Changes in breast size or shape
• Swelling, discomfort, or persistent pain or tenderness in the breast

Next Steps

October is Breast Cancer Awareness Month.  Women who have not had a breast exam or mammogram in over two years are encouraged to contact their physician and schedule an appointment.

RMD Primary Care encourages women to be proactive in managing their healthcare.  Our physicians offer women’s health appointments as part of our Family Medicine Services.  Contact our office to schedule breast exams, mammogram referrals, and pap smears.

Eating in-season produce is a perfect way to enjoy healthy foods.  Incorporating these foods into your diet provides an excellent variety of vitamins, minerals, antioxidants, and fiber.  Eating healthy also boosts the immune system, helping us to fight off illness.  Fresh seasonal produce is a budget friendly way to stretch your food dollars.

Here are some popular fall produce items that are readily available at grocery stores and local farmers markets.

Apples and Pears

Fall is peak apple and pear season.  These fruits are available at the grocery store, but there may be nearby options to pick your own.  Within a two hour drive north of Atlanta are several apple orchards near Ellijay and Blue Ridge, Georgia.  Picking your own apples can be a fun fall activity for families.  Apples and pears are rich in vitamins, fiber, and antioxidants.  These fruits can be enjoyed raw, used in baking, or cooked.  They are tasty additions to any lunchbox.

Pumpkin

Pumpkin is actually a fruit.  It is high in vitamin A, beta-carotene, and potassium.  Pumpkins can be used in baking or treated like a vegetable in soups and savory dishes.  The seeds are delicious when toasted.  Large, jack o’lantern pumpkins are not ideal for eating.  The smaller varieties of pumpkin are better for cooking since the flesh is denser, smoother, and higher in sugar content. 

Hard Squash

Varieties of winter, or hard squash, include acorn, butternut, Hubbard, turban, and spaghetti squash.  They are all low in calories, and high in vitamins, fiber, and potassium.  Hard squashes can be baked or roasted whole, halved, or cubed.

Other Fall Vegetables

Carrots, parsnips, sweet potatoes, beets, broccoli, cauliflower, and Brussels sprouts are popular autumn vegetables.  There are many ways to prepare them including in soups, stews, and side dishes.  Raw carrots are easy to include in lunch boxes.  Health benefits of these vegetables include being a good source of vitamins A, C, and K, potassium, magnesium, fiber, and antioxidants.

Dark Leafy Greens

Spinach, kale, arugula, and Swiss chard can be mixed with other greens to make a healthy salad.  These greens are packed with fiber, iron, potassium, magnesium, calcium, and folate, a B vitamin that promotes heart health.

Eating Healthy

A healthy diet is key in maintaining a healthy weight.  Following a healthy diet helps to lower blood pressure and cholesterol, and reduces the risk of type 2 diabetes.  The physicians at RMD Primary Care are happy to answer questions about weight loss and a healthy diet.  Contact us to schedule an appointment.

Immunizations can save lives and protect against serious diseases.  Even if people do contract an illness despite being vaccinated, symptoms are less severe.  Yet many people do not get important vaccinations.  August is National Immunization Awareness Month, a good time to assess whether your vaccines are current.

At RMD Primary Care, we believe quality health begins with preventative care and health maintenance.  Our doctors can help keep children and adults healthy by offering recommended vaccines.

Childhood Immunizations

The state of Georgia recommends a number of vaccines for children from preschool to college.  Many vaccines are required for school attendance.  Children should begin to receive their first vaccines during infancy (birth to 15 months).  These include vaccines for RSV, Hepatitis B, Rotavirus, DTaP (diphtheria, tetanus, and acellular pertussis), Hib, pneumococcal conjugate, inactivated poliovirus, Covid-19, and Influenza.  Some of the above vaccines are given as a series of injections.  Toddlers should receive vaccines for MMR (measles, mumps, rubella), Hepatitis A, and Varicella (chickenpox).  Boosters of some vaccines should be given during childhood.  Your child’s doctor or the local health department has the required vaccine forms for school attendance.

Students entering 7^th grade are required to have an additional dose of DTaP and one dose of meningococcal conjugate (for bacterial meningitis).  Students entering 11^th grade are required to have a meningococcal booster shot.  Georgia does allow for religious objections with a completed special form.

Adult Immunizations

Vaccines shouldn’t stop after childhood.  Adults may receive some vaccines annually, such as Influenza and Covid-19.  An RSV vaccine should be given to pregnant women and adults after age 60, if at risk from severe respiratory illness.

The DTaP vaccine booster can be given every 10 years for adults.  Two doses of Varicella vaccine should be given to adults born in 1980 or later, if they’ve never had chickenpox.  The Shingrex (RZV) series of two vaccines can help prevent shingles.  Adults aged 65 and older should receive vaccines to prevent pneumonia – PCV15 and PCV20, as well as PPSV23.  These vaccines protect against different types of bacterial pneumonia.  They are particularly important for seniors with lung disease, heart disease, diabetes, and kidney disease.

Next Steps

RMD Primary Care provides General Practice, Family Medicine, and Medical Weight Loss Services.  Our doctors can answer questions about specific vaccines your family may need.  Some factors that may impact your need for vaccinations include age, overall health, and travel plans.  Visiting certain countries may expose people to additional diseases, which might mean they need more vaccines before they travel.  Contact us to schedule a vaccine appointment. 

Regular healthcare visits with their primary care physician are important for women of all ages.  At these visits, the healthcare provider can screen for a variety of health issues, provide preventive care services, update vaccines, assess risks for potential medical problems, and recommend healthy lifestyle choices.  As people age, it’s more likely they will develop medical issues.  Just because there have been no past problems doesn’t mean changes won’t occur that will impact our future health.  The following are some of the health screenings that are recommended for older women.

Blood Pressure Checks

There are often no symptoms with high blood pressure, so it’s important to have periodic checks.  Those with high blood pressure are at increased risk for heart attacks and strokes.  High blood pressure forces the heart to work harder to pump blood through the body.  Women who have diabetes, heart disease, kidney disease, or are overweight need more frequent screenings.

Breast Cancer Screenings

It’s recommended that women get a mammogram every 1-2 years until age 75.  Breast cancer that is detected early is more likely to be successfully treated.  3D mammography is more precise and may particularly benefit women who have dense breast tissue.

Osteoporosis Screening

Osteoporosis is a disease in which bones become brittle, fragile, and more prone to breakage.  Early stages of osteoporosis usually have no visible symptoms.  Women aged 65 and older should have a bone density test to assess their risk.  Post menopausal women are at higher risk for bone loss, which contributes to fractures of the hip, wrist, and spinal vertebrae.

Colorectal Cancer Screening

Women should be screened for colorectal cancer until age 75.  Several types of screening tests are available including stool tests, flexible sigmoidoscopy, and colonoscopy.  These screenings should be repeated periodically, depending on the type of test.  Women who have ulcerative colitis, polyps, or a family history of colorectal cancer will need more frequent screenings.

Cholesterol Screening

Coronary artery disease is the leading cause of death for women.  A woman’s risk for developing coronary artery disease increases after menopause.  Simple blood tests performed in the physician’s office can identify high cholesterol and high triglyceride levels, which can raise the risk for coronary artery disease.

Next Steps

RMD Primary Care treats many women’s health issues.  Our physicians can make referrals for mammograms, bone density tests, and colonoscopies.  Contact our office to schedule an appointment.    

A bone density scan assesses a person’s risk for osteoporosis, a disease that affects approximately 10 million Americans.  Osteoporosis causes a loss of minerals from the bones, leaving them brittle and vulnerable to fractures.  The condition becomes more common with age, and many people don’t know they have osteoporosis until they break a bone.  Old bone breaks down more quickly than new bone can be made.

Osteoporosis can affect both women and men; however, it is a common women’s health issue.  A bone density, or DEXA scan, is the imaging test that is used to diagnose osteoporosis.  The National Institutes of Health recommends women have a bone density scan at age 65.  Then they should be rescreened in 2-3 years, if their results are good.  Some doctors may recommend women aged 64 and under receive a bone density scan after going through menopause, since reduced levels of estrogen is a risk factor for osteoporosis. 

Many physicians don’t recommend a DEXA scan for men until age 70, unless they’ve had a vertebral bone fracture, osteopenia of the spine, other broken bones, or additional risk factors.  The National Osteoporosis Foundation recommends a DEXA scan for anyone over age 50 who breaks a bone.

Risk Factors for Osteoporosis

The most common risk factors for developing osteoporosis are age, post-menopausal female, small body frame, and a family history of the condition.  Some medications pose risk factors including long-term use of cortisone, prednisone, thyroid hormone medications, anti-seizure drugs, and some cancer drugs.  People having primary hyperthyroidism are also at higher risk.

Common Bone Fractures

Those with osteoporosis most commonly fracture a wrist, hip, or spinal vertebrae.  There is no cure for osteoporosis, but medications can help slow down the rate of bone loss.  Periodic bone density scans help doctors monitor the progression of the disease and evaluate how well the osteoporosis medication is working.

Test Preparation

No special preparation is needed before a DEXA scan except to stop taking calcium supplements 24 hours before the test. The scan is a low dose x-ray that is totally painless.  The patient will lie on their back on a padded table while the machine moves over the body.  The entire process takes 15-30 minutes.  The scan will be read by a radiologist, and a report is sent to the referring physician.

Will insurance pay for the test?

Medicare Part B covers a bone density scan for women once every 24 months, and more often if medically necessary.  A person may qualify for more frequent tests if they have any of the following conditions, which could lead to decreased bone density:

• Rheumatoid arthritis
• Chronic kidney disease
• Overactive parathyroid gland or other hormonal imbalance
• Diabetes
• Organ transplant

Medicare will cover the test for men who have had a vertebral fracture or osteopenia of the spine.  Many private health insurance companies also cover DEXA scans.

Next Steps

RMD Primary Care treats many common women’s health issues, such as osteoporosis.  Our physicians can make a referral for a bone density scan.  Contact our office to schedule an appointment.     

May is Skin Cancer Prevention and Awareness Month, a good time to review some basic facts about skin cancer.  Although skin cancer is the most common cancer diagnosis in the U.S., many cases could be prevented with proper skin protection.  When found in the early stages, skin cancer is very treatable.

Common Types of Skin Cancer

• Basal Cell Carcinoma – the most common type of skin cancer.  Often appears as a shiny raised spot that can be mistaken for a pimple, sore, or scar.  The slow growing spot doesn’t heal and sometimes bleeds.  May crust over.  Usually non-life-threatening.
• Squamous Cell Carcinoma – lesions may look like rough, reddish scaly areas or an open sore.  May also resemble a wart or a brown age spot.  Slow growing and usually non-life threatening, but can grow deep and spread to other parts of the body.
• Melanoma – the most dangerous and deadly type of skin cancer.  May resemble a mole that looks asymmetrical and has irregular borders.  May also be a new pigmented growth that may be brown, tan, black, red, or pink in color.  Spots can change as they grow and may itch, bleed, or feel painful.  Melanoma grows quickly and can spread to other organs.

Rare Types of Skin Cancer

• Merkel Cell Carcinoma – More likely in people over age 50.  Is aggressive and can spread.
• Sebaceous Carcinoma – Often begins as a tumor on the eyelid, but can develop in any sebaceous gland.  Is aggressive and may spread.
• Dermatofibrosarcoma Protuberans – May resemble a deep pimple or rough patch.  Begins in the middle layer of skin.  Slow growing and seldom spreads.

Protection and Prevention

Most skin cancer is preventable with proper protection.  When outdoors, wear a broad-spectrum sunscreen with an SPF of 30 or higher.  Reapply every two hours and after swimming or sweating.  This provides protection from the sun’s harmful UVA and UVB rays.  Wear protective clothing including long-sleeved shirts, a wide-brimmed hat, and sunglasses.  Avoid peak sun hours between 10am and 2pm, when the sun’s rays are the strongest.  Use sunscreen even on cloudy days.  Avoid tanning beds, since they use UV light.

Rod MD Primary Care

Your primary care physician may be the first to notice potential skin cancers.  A patient may call a particular spot to the attention of their primary doctor during a routine physical exam.  The primary doctor will often refer the patient to a dermatologist for a follow up and biopsy.

The physicians at RMD Primary Care can perform in-office mole biopsies and excisions and send them to a lab for diagnosis.  We provide continuing and comprehensive medical care and preventive services.  Contact us to schedule an appointment.

According to the CDC, more than 130 million Americans visit emergency rooms each year.  Some of the most common reasons for a trip to the emergency room include chest pain, stomach or abdominal pain, stroke symptoms, difficulty breathing, seizures, falls, concussions, broken bones, and other injuries or traumas.  After being evaluated by a physician, diagnostic tests such as blood work, x-rays, or CT scans may be ordered.  The patient will receive appropriate care based on the evaluation.  If discharged, the person will be advised to follow up with their personal physician.

Why is a follow up with your own doctor important?  The following are some of the primary reasons to follow up a trip to the emergency room with a visit to your primary care physician.

Continuity of Care

Your personal physician has your medical history and a record of your past care.  This physician is equipped to provide continuity of care in treating your medical conditions.  The patient should describe the symptoms that led them to seek emergency care and bring their hospital discharge papers, as well as any new medications, to their follow up doctor visit.

Management of Chronic Medical Conditions

The primary care physician can determine whether the patient may need a referral to a specialist.  The primary care physician should always be apprised of any changes in conditions, to help manage overall healthcare.  They can determine whether any new medications are compatible with existing medications the patient is taking.

Determine Whether Additional Tests are Needed

Some test results from the ER may indicate the need for follow up testing.  This is especially important if a new medication has been prescribed.  The primary care physician will be able to monitor the patient for any complications that may arise.

Risk of Subsequent Hospitalizations Reduced

Studies have shown that patients with chronic diseases are at higher risk of repeat hospitalization, or even death, if they do not see their personal physician or specialist within 30 days after discharge from the ER.  This is especially true of patients suffering from heart disease, diabetes, or chronic lung disease.  A prompt follow up visit with their own physician may be critical to their care management.

Next Steps

Patients should not assume the hospital will notify their personal physician about the emergency room visit.  It’s always appropriate for the patient to call their own doctor within a few days of their trip to the emergency room.  RMD Primary Care physicians are Board Certified in Family Medicine and Internal Medicine.  They are qualified to provide continuing and comprehensive medical care, health maintenance, and preventive services.  Contact us to schedule an appointment.