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Smoke Exposure Dangers: What You Need To Know

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On the afternoon of November 28, 2017, a fire broke out in Salem, Ohio (where I live) at the former Salem China Company building. As of this evening, the fire was still going. (Check out this link from WKBN Youngstown for the latest information. Photo above courtesy of WKBN). Via social media, I've been receiving a lot of questions about all the smoke in the air around town. 

Photo courtesy of The Salem News

Photo courtesy of The Salem News

Here are Four Things To Keep In Mind About Smoke Exposure

  • What are symptoms of smoke exposure: Symptoms to look out for include Cough, Shortness of Breath, Hoarseness, Noisy Breathing, Eye Irritation, Abnormal Skin Color, Headache, Confusion
  • Beware if you have past or current lung problems: For those already with lung disease like asthma, COPD, emphysema, or others, you are at a higher risk of breathing problems when exposed to any kind of smoke - like those from fires. Take your prescription lung medication as scheduled and make sure you have your rescue medication if needed.
  • Check on young children and the elderly: Especially those young and old are prone to lung symptoms when exposed to smoke. If they start to report any symptoms above, don't ignore them.
  • See your doctor sooner rather than later: Even though you are halfway across town, your lungs could still be affected by the smoke in the air. Even though it may be the day after the fire as you read this, your lungs could still be affected by the smoke in the air around town. If you think you're having difficulty with breathing or anything else, I encourage you to check with your doctor, you'll be glad you did....

American Cancer Society: Great American Smokeout

I'm always looking for fun opportunities to encourage my patients to stop smoking - other than my nagging of them during office appointments. Every year, one week before Thanksgiving is that opportunity called "The Great American Smokeout" that is promoted by the American Cancer Society. 

There is great information on The American Cancer Society website like Health Risks of Smoking Tobacco, Health Risks of Secondhand Smoke, Keeping Your Kids Tobacco Free, and other resources. This blog post will take you to the next step in preparing you for your quit day, maybe The Great American Smokeout day. (also, tweet about it using #GASO hashtag)

Prepare For Your Quit Day: Here are some steps to help you get ready for your quit day

  • Pick the date and mark it on your calendar
  • Tell friends and family about your quit day
  • Get rid of all your cigarettes
  • Practice saying, "No thank you, I don't smoke"
  • Set up a support system to help you

On Your Quit Day: Some steps on your Quit Day checklist

  • Avoid situations and people associated with smoking
  • Stay Busy - Try walking or other activities and hobbies
  • Change your routine: Take a different route to work, etc
  • Drink lots of water, and no alcohol
  • Do Not Smoke - Not even one puff

In addition to reaching out to friends and family for support, I also encourage you to contact your Family Physician for further assistance, especially when it comes to options for possible nicotine substitutes. Thanks to WKBN-TV for posting the story, "The Great American Smokeout: National Intervention encourages smokers to quit." I also wanted to share with you similar TV interviews back from 2010 and 2011 below. Dr. Mike Sevilla works at the Family Practice Center of Salem in Salem, Ohio.

#FMRevolution Weekend Update

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On Saturday, October 21, 2017, I had a fun Facebook Live with our friends Dr. Kim Yu and Dr. Alex McDonald. Alex gave us a live report following his day's activities at the California Medical Association meeting. Kim gave us an update on her Family Medicine relief effort for Puerto Rico following Hurricane Maria. Kim and I also talk about supporting children with allergies during Halloween and Trick-or-Treat, We also talk about some upcoming events for the American Academy of Family Physicians.

There are many ways to check out the show. Above in the blog post, you can listen to the audio podcast from our Facebook Live. You can also download the audio file at this link. In addition, I encourage you to subscribe to my audio podcast on iTunes at this link.

To check out the videos associated with the FB live show, check out the videos below. I've broken down some of the segments in the video below. In addition, I encourage you to check out my youtube channel for more of my videos.

Safe Halloween Tips

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It's hard to believe that Halloween is right around the corner. In my office this week. there's been a lot of excitement with my pediatric patients, and their parents, in what their costumes will be for Halloween. Now, before you start planning those Fall and Halloween parties and Trick-Or-Treat, the Centers for Disease Control and Prevention outlines thirteen tips to make your festivities fun and healthy. The full list is on the CDC website, but I'll outline just a few below.

Halloween Health and Safety Tips

  • Avoid trick-or-treating alone: Walk in groups or with trusted adult
  • Reflective Tape: Fasten reflective tape to costumes and bags to help drivers see you
  • Beware of Choking Hazards: Examine all treats for choking hazards and tampering before eating
  • Flashlight: Hold a flashlight while trick-or-treating to help you see and others see you
  • Look Both Ways before crossing the street. Use crosswalks whenever possible
  • Wear well-fitting masks, costumes and shoes to avoid blocked vision, trips and falls
  • Eat only factory-wrapped treats: Avoid eating homemade treats made by strangers
  • Tobacco Free Events: Make your Halloween activities Smoke Free and tobacco free events

Family Medicine Helping Puerto Rico

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The plight of Puerto Rico has been broadcast daily since Category 4 Hurricane Maria slammed into the island less than 2 weeks ago. The Family Medicine community has been proactive in the relief effort, even before Maria hit Puerto Rico.

Our friend and colleague Dr. Kim Yu has been in contact with the Puerto Rico Academy of Family (PRAFP)  Physicians and has helped organize an effort and a campaign to raise money for electric generators for the people there, especially since it's been reported that 95% of people in Puerto Rico are still without power. The goal is 60 generators, since this year marks the 60th anniversary of the PRAFP. As of this posting, we have already reached 20 generators!

On Saturday, September 30, 2017, we broadcast a Facebook Live with Kim Yu, Alex McDonald, and myself to raise awareness for this fundraising campaign, and for Kim to share some of the stories that are happening in Puerto Rico right now. Please contribute to this link right now, and thanks to our colleagues at the Indiana Academy of Family Physicians for setting this up: https://www.in-afp.org/give

Included in the video segments below include a statement from Dr. Carlos Cestero who is the President of the Puerto Rico Academy of Family Physicians read by Kim Yu. How did Kim get started in this effort? She answers that question in a video below. In addition to raising funds for generators, Kim talks about other things that you can do to help Puerto Rico, including volunteering your physician skills on site in Puerto Rico. If you'd like more information on any of this, please reach out to Kim Yu on twitter at @DrKKYu

Also in the program, we talked about National Primary Care Week which is taking place now from October 1-7, 2017. In addition, we talked about lighter topics like the origins of Alex McDonald's twitter name, and how much fun we had at the recent AAFP Family Medicine Experience conference. Below, I broke down last night's video into shorter segments for your review and enjoyment. Please share this post with friends and colleagues to continue to raise awareness and to continue to raise funds for the people of Puerto Rico!

Raising Breast Cancer Awareness

Just this week, actress Julia Louis-Dreyfus, best known for her roles in the TV shows "Veep" and "Seinfeld," announced that she was diagnosed with breast cancer. She wrote on twitter, "1 in 8 women get breast cancer. Today, I am the one."

The month of October is also National Breast Cancer Awareness month, and I'll be doing my part to remind my patients and to remind my community about the importance of talking about this illness. Here are some facts about breast cancer and here are some risk factors to keep in mind from the American Cancer Society and the National Breast Cancer Foundation.

Breast Cancer Facts

  • 1 in 8 lifetime risk of getting breast cancer
  • Breast cancer is the 2nd leading cause of cancer death in women
  • Over 250,000 new cases of breast cancer in women in 2017
  • About 40,000 women will die from breast cancer in 2017
  • More than 3.1 million breast cancer survivors in USA

Breast Cancer Risk Factors

  • About 60-70% patients have no risk factors
  • Genetic Risk
  • Lack of Physical Activity
  • Poor Diet
  • Overweight/obesity
  • Drinking Alcohol

There are so many other topics to mention, especially about testing, diagnosis, and treatment. But, the most important things at this point are to know the facts, and to know your risks. In addition to reviewing the information above, I encourage you to visit your Family Physician and/or your personal medical provider.

Addendum: Thanks to WKBN-TV for posting the article on the interview: "Importance of Recognition during Breast Cancer Awareness Month

One Hurricane Irma Story

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As I write this, Hurricane Irma has not quite made landfall yet. However, the winds in Southern Florida and the Florida keys have already started to ramp up in speed and intensity. I wanted to try to get a sense of how it was going down there, so I reached out to a Family Physician friend of mine.

Dr. Ajoy Kumar practices Family Medicine in the Tampa, Florida area. And, as we recorded this interview at around 10:45am Eastern time on Saturday, September 9, 2017 - Hurricane Irma has not made landfall yet, and was forecast to arrive in the Tampa area in around 24-48 hours.

In our conversation, Dr. Kumar talked about the emotion that he is going through, and the sense of emotion going on both in the hospital and in the community. He also talked about how his experience working in developing countries have prepared him for this urgent situation. Finally, he speaks on how Family Medicine and Family Physicians are uniquely qualified to perform in these leadership positions.

There is an audio podcast above that you can both listen to and also download. For those who have access to iTunes podcasts, I encourage you to download the podcast from iTunes at this link. Finally, check out our youtube conversation both below and at this link. Stay safe, Dr. Kumar and all of our friends in Florida!

One Hurricane Harvey Story

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Not only is Dr. Troy Fiesinger a Family Physician, but he is also a long time resident of the Houston, Texas area. Something interesting I saw on my Facebook feed was Dr. Troy posting news and updates from the Houston area. So, I reached out to him to see if he would be interested and available to share his story. I was honored that he shared his story exclusively with me, and we conducted a Facebook Live interview less than a week following landfall of the storm.

In the links below, I have made available an audio file for you to listen to you from my The Dr. Mike Sevilla Podcast. In addition, I tried to edit our 60 minute interview into smaller portions which make things easier to you to digest. 

Finally, I encourage you to donate to whatever charity you choose. For me, I recommend the American Academy of Family Physicians (AAFP) Foundation. I look forward to talking with Dr. Troy more at the upcoming AAFP Family Medicine Experience conference (#AAFPFMX on twitter).

New Rules For Acute Pain Prescribing in Ohio

A few hours ago, the State Medical Board of Ohio announced new prescribing rules for opioid pain medications in the treatment of acute pain. These rules will take effect beginning on August 31, 2017. These new rules do not apply to the treatment of chronic pain.

Rules for prescribing for acute pain:

  • No more than seven days of opioids can be prescribed to adults
  • No more than five days of opioids can be prescribed to minors, unless written permission from parent/guardian
  • Can prescribe beyond day supply limits only if documented in medical record
  • Total morphine equivalent dose (MED) cannot exceed 30 MED per day
  • New rules do not apply to opioids prescribed for cancer care, palliative care, and hospice care

The State of Ohio Board of Pharmacy has a table of MED doses at this link. I also encourage you to check out the State Medical Board of Ohio links to Acute Pain Rules: Definitions, General Provisions, Prescribing of opioid analgesics for acute pain.

What does this mean? I know our "friends in Columbus" want physicians to write less opioid medication, but this is not the way to do it. Family Physicians like me will be more scared to write for opioid medications for my patients who will need it. Will I have to bring back my patients every seven days? According to the State Medical Board, when does acute pain transition to chronic pain?

In my opinion, these new rules will not help the opioid problem in Ohio. The unintended consequence will be that it will worsen the problem. Back in the 1990s, physicians were forced to address "Pain As The Fifth Vital Sign," which forced physicians to prescribe more opioid medication. Now, with the current opioid crisis, we are being legislated to write less. Will this drive patients to obtaining illegal opioids? The answer is yes, because you see it in the news everyday, especially here in Ohio.

What's the answer to the opioid problem in Ohio and across the country? I know it's complicated, but blaming doctors and putting more restrictions on physicians may get you some political points and help get/keep you elected. Meanwhile, according to the Columbus Dispatch, 4149 Ohioans died from unintentional drug overdoses in 2016, which is a 36 percent leap from the previous year. Plus, 2017 is on track to outpace last year's numbers. When are Ohioans themselves going to stand up and say that enough is enough?

Concussions & CTE

This week, many schools around the state will be getting back to school, and this ultimately means the beginning of high school football season. Through the summer, I've been performing a lot of sports physicals and back to school physicals, and an important topic that I bring up is concussions.

According to our friends at FamilyDoctor.org, a concussion is a type of Traumatic Brain Injury which is defined as a sudden damage to your head. Many associate football with concussions, but other sports including soccer, can also result in concussions. And, the Ohio High School Athletic Association has rules for athletes determined to have concussions.

Signs and Symptoms of Concussion:

  • Loss Of Consciousness
  • Headache
  • Confusion or Memory Problems
  • Dizziness or Balance Problems

OHSAA Rules For Athletes With Concussions:

  • Unable to return to play the same day, under no circumstances
  • For return to play, required to have written authorization from a physician (MD or DO) or certified athletic trainer

There has been a lot in the press about CTE, or Chronic Traumatic Encephalopathy. Symptoms generally appear 8-10 years after an athlete experiences repeated concussions. It is generally believed that CTE occurs in four stages.

Stages of CTE: Chronic Traumatic Encephalopathy

  • Stage 1: Disorientation, dizziness, headaches
  • Stage 2: Memory loss, erratic behavior, poor judgement
  • Stage 3/4: Dementia, movement disorders, tremors, suicidality

Back to school is always an exciting time. But, as school sports progresses, make sure your review the signs and symptoms of concussion. And, as always, if any questions, please reach out to your Family Physician.