For a safe, comfortable ride

 Proper use of car safety seats can help keep children safe.

 Here are a few important tips from the National Highway Traffic Safety Administration (NHTSA) and theAmericanAcademyof Pediatrics:

• Select a car seat based on your child’s age and size, and choose a seat that fits in your vehicle.  Use it every time.
• Always follow your specific car seat manufacturer’s instructions.  Read the vehicle owner’s manual to learn how to install the car seat.  Check height and weight limits.

• Infants and toddlers:  Use a rear-facing seat until they are two years of age or until they reach the highest weight or height allowed by their car seat manufacturer.

• Toddlers and preschoolers:  For children two years of age or older, or those younger than two years of age who have outgrown the rear-facing weight or height limit for their car safety seat, use a forward facing car seat with a harness until they reach the highest weight or height allowed by their car safety manufacturer.

• School-aged children:  If child’s weight or height is above the forward facing limit for their car seat use a belt positioning booster seat until the vehicle seat belt fits properly.  This typically occurs when the child reaches 4’9” tall and between 8 to 12 years of age.

 If you have any questions about installing a child safety seat, or would like to find the nearest Child Passenger Safety (CPS) technician who is trained to install your child seat correctly, call the NHTSA Vehicle Safety Hotline at 1.888.327.4236.  Or, log on to www.nhsta.gov.

 Educational Resource by Merck & Co., Inc.

Home blood pressure monitors are used to diagnose high blood pressure and to evaluate treatment and control of high blood pressure (BP). They can be used to confirm “white coat” (BP high only in the doctor’s office) and “masked” hypertension (BP normal in doctor’s office/high outside). BP that is higher outside the office is particularly risky. BP measurements performed at home with a validated electronic blood pressure cuff (Omron™ and others) predict heart attacks and strokes better than office BP readings, and home measurement improves blood pressure control in people on blood pressure pills, because it gives patients and their families a sense of more control over their care.

It is easy to perform and most patients with high blood pressure should perform HBPM.

Use a validated oscillometric, automatic devices such as an Omron™ upper arm device. If your upper arm is more than 12 inches around you need a large adult cuff, (noted on box). A complete list of approved, validated monitors is available online at dableducational.org. Costco and Sam’s Club sell validated Omron BP monitors for $66.00. The monitors usually last about 5 years unless dropped.

If you have a very large upper arm, your doctor may recommend a wrist blood pressure monitor again, Omron, or other validated devices.

After you get your device, bring it to the office to use to check against your doctor’s device and make sure you know how to take your own BP. When measuring your BP measure each arm and from then on use the arm with the higher BP reading.

Technique: rest for 4 minutes, sit with your back supported, arm at the level of the heart, feet on the floor (a kitchen chair at a kitchen table works well). Measure BP twice in the morning (just let the cuff deflate and count to 10 in between readings), before pills and breakfast, and twice in the evening, after dinner or before bedtime for 7 days in a row. WRITE DOWN OR GRAPH ALL YOUR READINGS. Your doctor will then have about 30 readings to look at, instead of one or two from the office, and he/she will review them with you.

Goal blood pressure at home should be a bit lower than in the office-

If you have hypertension without kidney disease or diabetes, 2010 data suggest a reading less than 135/85 both morning and evening is optimal. If you have kidney disease it probably should be should be less than 130/80 both times.

We are not sure about people with diabetes without kidney disease; for now we recommend less than 130/80.
Check with your doctor- if you are over age 80, your blood pressure may need to be a bit higher. If you have orthostatic hypotension (BP lower in the standing position) your doctor may have you measure your blood pressure standing rather than sitting. If your doctor is trying to exclude white coat hypertension the blood pressure level to exclude it is lower. Blood pressure at home should be less than 125/76 morning and evening. (Most people without high blood pressure have readings less than that at home).

Report any blood pressures more than 160 systolic or less than 110 systolic immediately to your doctor.

If you have any questions or concerns please contact your Providence Medical Group Family Medicine or Internal Medicine Primary Care Physician.

Submitted by:
Susan Steigerwalt MD
Providence Heart Institute
248-849-2000

 Malaria is a disease produced by organisms belonging to the genus plasmodium.  It is present in tropical and subtropical regions, including much of sub-Saharan Africa, Asia and the Americas.  The disease is produced by the multiplication of malaria parasites inside the red blood cells, causing the typical symptoms of fever, headache and in more severe cases progressing to coma and death.  Malaria is transmitted by female mosquitoes of the genus anopheles, and much of the prevention is aimed to the elimination and avoidance of mosquito bites.

 Each year, there are more than 225 million cases of malaria killing around 781,000 people according to the World Health Organization.  The majority of these deaths are of young children in sub-Saharan Africa.  Malaria is commonly associated with poverty and can be a major obstacle for economic development in certain parts of the world.

 Methods used to prevent malaria or to protect individuals in areas where malaria is endemic, include prophylactic drugs, mosquito, eradication, and the prevention of mosquito bites, using DEET insect repellent and mosquito nets.  Many drugs, most of which are used for the treatment of malaria, can be taken as a prevention as well.  They include mefloquine, doxycycline, and the combination of atovaquone and proguanil hydrochloride (malarone).  The choice of drugs depends on which drugs the parasites in the area are resistant to as well as side effects and other considerations.  The Bill and Melinda Gates Foundation is actively contributing to vaccine research and to find a cure for malaria. 

 Our TravelCare clinic has given advice to travelers to malaria endemic and epidemic areas with a great deal of success, in which over the years we have not had any cases of the disease in returning travelers.

 Dr. Vilma Drelichman

• heart attack symptoms (pressure, fullness, squeezing or pain in center of chest; tightness, burning or aching under breastbone; chest pain with lightheadedness)
• stroke symptoms (sudden weakness or numbness of face, arm or leg on one side; sudden dimness or loss of vision, particularly in one eye, loss of speech, trouble talking or understanding speech; sudden severe headache; unexplained dizziness)
• shortness of breath
• sudden or severe pain
• uncontrolled bleeding
• coughing or vomiting blood
• severe or persistent vomiting or diarrhea
• poisoning or suspected drug overdose (if possible, call poison control for immediate treatment advice)
• suicidal/homicidal thoughts or actions
• serious burns or cuts
• broken bones
• neck or head injury
• seizure
• temperature of 103^o or greater
• severe/worsening reaction to insect bite/sting or medication

For non life-threatening illness or injury contact your PMG Family Medicine, Internal Medicine or Pediatrician for advice as to when/where to receive care.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Some of the risk factors are:

·          Age over 50

·          Personal history of colorectal polyps, inflammatory bowel disease or family history of colon cancer

·          African American or Jews of Eastern European descent (Ashkenazi Jews)

·          Diet high in red meat and processed meat (hot dogs and some luncheon meats)

·          Physical inactivity and obesity

·          Smoking and heavy alcohol use

·          Type 2 diabetes

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below:

·          Flexible sigmoidoscopy every 5 years*

·          Colonoscopy every 10 years

·          Double-contrast barium enema every 5 years*

·          CT colonography (virtual colonoscopy) every 5 years

·          Fecal occult blood test (FOBT) every year Fecal immunochemical test (FIT) every year

·          Stool DNA test (sDNA), interval uncertain

Colorectal cancer may cause one or more of the symptoms below. If you have any of the following you should see your doctor:

·          A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days

·          A feeling that you need to have a bowel movement that is not relieved by doing so

·          Rectal bleeding, dark stools, or blood in the stool (often, though, the stool will look normal)

·          Cramping or abdominal (stomach area) pain

·          Weakness and fatigue

·          Unintended weight loss

Most of these symptoms are more likely to be caused by conditions other than colorectal cancer, such as infection, hemorrhoids, or inflammatory bowel disease. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Info taken from American Cancer Society website

Did you know that heart disease is the No. 1 killer of women in Detroit and Michigan? Many women don’t take the time to care for their heart, even though more than one woman in three has some form of heart disease. It goes without saying that men also need to assess their lifestyles for heart health. Take a moment to review the following risk factors and do a brief self-assessment:

• Cholesterol levels
• Blood pressure
• Smoking
• Physical activity
• Obesity
• Diabetes
• Stress
• Alcohol
• Family history

How many of these risk factors do you have? How many can you do something about? For example, take a half-hour walk every day – the benefits from something so simple will surprise you.

If you’re not sure about your risks or have other heart concerns the Internal Medicine, Family Medicine Physicians in the Providence Medical Group will be glad to assist you. With offices from Warren to Brighton, there is a Primary Care Physician near you.

  I was thinking about this as I was thinking of buying some sugary delights and chocolate for the grandkids. I went online and did some research. I thought these were some interesting facts from Sugar, Inc:

 Everyone is trying to eat healthier and, in many cases, lose weight.  Knowing what we are putting in our mouths before we eat it sometimes helps us make better choices.  After seeing this info, I decided to get the grandkids a small non-edible gift instead!

 If you are struggling to lose weight, get in better shape or just figure out what are healthier food choices for your family, the Internal Medicine, Family Medicine and Pediatricians in the Providence Medical Group, PC will be glad to get you going in the right direction.  With offices from Warren to Brighton, there is a Primary Care Physician near you.

Cholesterol can’t dissolve in the blood. It is transported to and from the cells by special carriers called lipoproteins. There are several kinds, but the two most important ones are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL or “bad” cholesterol levels should be 100 mg/dl or less if you don’t have heart disease. If you do have heart disease your level should be below 70mg/dl. Too much LDL can clog arteries to the heart and brain leading to heart attack and/or stroke.

HDL or “good” cholesterol helps remove “bad” cholesterol from your body. Men should have greater than 40mg/dl levels and women greater than 50 mg/dl.

Triglycerides are a type of fat in your bloodstream that is used as energy. Too high a level is not healthy. Normal levels should be less than 150mg/dl

Total Cholesterol is the total of all the cholesterol in your body. It should be less than 200 mg/dl (below 180 mg/dl is even better).

Cholesterol and triglyceride levels that are too high can be corrected with diet, exercise and medications. See your Primary Care Physician to determine what your best course of treatment should be.

Some of content from American Heart Association, Novo Nordisk and Merck literature.

Are you ever confused about all the terms that are used relating to your diabetes? Many patients say that they are, especially if a term has more than one abbreviation.

 For instance, do you know the difference between a Fasting Blood Sugar (FBS), a Fasting Blood Glucose (FBG)  and a Fasting Plasma Glucose (FPG)? In fact, they are all the same thing in which a test that tells how much “sugar” (glucose) is in your blood stream before you have eaten anything.  The normal range for a fasting blood sugar is below 100. 

Another test that often confuses patients is the hemoglobin A1C, also known as (are you ready?) HbA1c, A1C, glycosylated hemoglobin, glycohemoglobin or glycated hemoglobin!

The HbA1C is a blood test that tells your average blood sugar over a 2-3 month time period. What you ate the night before the HbA1c blood test does not affect the result. The test can be done at any time of the day in a lab using a sample of blood from your arm. You do not need to be fasting to have an HbA1c blood test done and it is usually done every 3-6 months. People without diabetes will have an HbA1c below 6.

The difference between the 2 types of tests is this. The FBS (FBG or FPG) tells you what your blood sugar is at one moment in time (the time the blood is drawn). The HbA1c lets you see how your blood sugars have averaged over the last couple of months. Increasing HbA1c numbers may indicate a need for a change in medication, diet or activity level. Your Primary Care Physician or Specialist will evaluate this with you and come up with an action plan that will help you achieve better control of your blood sugar.