Listen Up For Ear Infection Advice! - Yankton Medical Clinic
Dr. YoungTalks Zika VirusWhat Exactly isPre-Diabetes?Waking Upto Hip andShoulderPain?Listen up forEar InfectionAdvice!www.yanktonmedicalclinic.com 605-665-78411
For more information or to schedule anappointment please call 605-665-1722.Taking the StingOut of SummerWritten by Board Certified DermatologistJames W. Young, DO, FAOCDFirst, A Frank TalkThe treatment is symptomatic – rest, fluids,from venom). Susceptible individuals must carry anAbout Zika Virus.acetaminophen. Having the infection likely results inepinephrine auto injector. Many diseases are transmittedimmunity. The big consequences of this infection are theby bites-malaria, plague, Lyme, West Nile and Zika arebirth defects of skull size and brain of infant, so it cannotjust a few examples.Zika is new to the spotlight, but it was first reportedfrom Uganda in 1947. It is spread by mosquito bite. It hasbeen isolated from semen, and it is currently unknownhow long the virus stays in semen, but it is felt to persistlonger in semen than blood. Men who have traveled toareas where Zika is endemic should wear condoms orabstain from sex with women who are or could becomebe overemphasized how important prevention is if youare pregnant or trying to conceive! Much misinformationMost bites and stings result in redness, swelling, itchingis floating about. Check reputable resources such as youror pain. Wasp and bee stings can be severe and lifephysician or www.cdc.gov/zika.threatening. Ant bites frequently cause pustules/pimples.Spider bites are rare and may cause blisters or necroticpregnant. To prevent mosquito bites, wear long sleevesIt’s Sunscreen SeasonSummer into Fall.and long pants. Try to stay indoors or behind window‘Tis the season! From mid-March to the end of Octoberand door screens. Sleep under a mosquito net. Wear(here) or year round (closer to the equator or highinsect repellent, being careful to follow the directions!Seek medical help if you experience symptoms beyondaltitudes) protect yourself! Just like there is no safeAlways apply sunscreen first, then insect repellent. Speakthe site of the injury, which could include hives. If shortexposure to tobacco, there is no safe sun exposure. I’veto your pediatrician or family physician about protectingheard the arguments – get your vitamin D from a pill,your child. Clothing and gear treated with permethrinminimum of 600 I.U. daily. Clothing helps with longcan be quite useful.sleeves and pants and broad brimmed hats, but nearlyMost people infected with Zika do not know it. Themost common symptoms are fever, rash, joint pain, andconjunctivitis but muscle pain and headache are alsocommon. The virus incubation period is not known but90% of skin cancers occur on face, neck and hands,which is where sunscreen comes in. Sun exposure is peak9:30am to 4:30pm, so if possible defer outdoor activityto earlier or later. Let’s face it, that’s not always practical.If you have to be outdoors protect your exposed skin.felt to be a week or less. Symptoms usually last a fewUltraviolet A rays penetrate deeper and cause wrinklesdays. Travel history is vital! Mention any recent traveland tanning. Ultraviolet B rays are higher energy andhistory to treating physicians. If you are pregnant andburn. Both can cause skin cancer.develop rash or fever, or the above symptoms, consultwith the physician providing obstetrical care.and reapplied every couple of hours (particularly ifsweating or swimming). Guidelines are one ounce(shot glass full) of sunscreen covers exposed skin.Apply evenly, directly into your skin and keepSo much care, so close to home. symptoms.of breath call 9-1-1. If the area looks infected – warm,fever, red streaks, pus – seek help. If you have severesymptoms such as a history of wheezing, chest pain/tightness, shortness of breath, fainting, weakness, throatclosing-call 9-1-1 or go to the nearest emergency room.Good first aid for bites and stings includes carefullyremoving the stinger, by scraping along the skin, NOTgrabbing and squeezing. Using ice ten minutes perhour, or a cool compress often is soothing. Topicalcorticosteroids twice daily for a week can reduceredness and itching. Topical anesthetics can be useful,Broad spectrum sunscreen blocks both UVA and UVB. Itshould be applied 20-30 minutes before sun exposure,2(black scab) ulcerations and occasionally systemicbut it is possible to develop an allergy to them. Oralantihistamines may help a person sleep, but have alimited role in the absence of hives. If tender, takeacetaminophen or ibuprofen. Calamine lotion can dry upsomething that is weeping. Most of these will resolve inyour skin safe out there!a few days.How to TreatBites and Stings.As always, your physician is an excellent source ofMost insects don’t bite or sting unlessyour service to answer questions on these or otherprovoked (the exception are mosquitoes,skin, hair, and nail questions. We want you to have alice, or bed bugs which are after a bloodsafe and enjoyable summer into the fall, so please wearmeal). Stings can be fatal (usually anaphylaxissunscreen!information. The Department of Dermatology is at
For more information or to schedule anappointment please call 605-665-8910.Pre-Diabetes Diagnosis?It’s Time for Action!A Q&A wit h Board Certified Family Medicine P hysicianMcKenzie Hanson, MDQ: My doctor tells meI am pre-diabetic.What does that mean?A: It means that your blood sugar level is higher thannormal, but not yet high enough to be classified as type(such as during intense exercise or with fasting) andwhen you are sleeping.Q: How do I get my blood sugarsto return to normal?2 diabetes. It is a warning sign. Without intervention,A: This is the challenging part, since in order to preventpre-diabetes is likely to become type 2 diabetes in 10or delay diabetes, you need to change your eating habitsyears or less if you don’t make some lifestyle changes.and activity level. The good news is that just a 5 to 10It is an opportunity for you to improve your health.percent weight loss can make a huge difference. Thattranslates into 10 to 20 pounds for someone who weighsQ: How can I tell ifI am pre-diabetic?200 pounds.A: Often, there are no signs or symptoms. It is mostso exercising can lower your blood sugar level. Alsolead to weight loss. You can use a simple journal or do anoften diagnosed based on blood tests. If you have awhen you exercise, your body doesn’t need as muchonline search for health and fitness apps. There are manyhistory of high blood pressure, high cholesterol or haveinsulin to transport the sugar. Since your body isn’t usinga strong family history then you should definitely beinsulin well when you have pre-diabetes, a lower insulinscreened. Typically, you would have this screening doneresistance is a very good thing.Diets that are well studied and have proven long-For diet, focus on fruits, vegetables and whole grains andterm outcomes would be Weight Watchers and thehealthy sources of protein such as lean cuts of meat thatMediterranean diet. The Mediterranean diet emphasizesare grilled or baked, nuts such as cashews and almonds,eating primarily plant-based foods, such as fruitsat your annual wellness exam. Be sure to share familyhistory with your physician.Q: What causes pre-diabetes?Exercise alone causes your body to uses more glucose,and beans.that are free, such as MyFitnessPal.and vegetables, whole grains, legumes and nuts. TheA. The exact cause of pre-diabetes is unknown. YourYou may also benefit from a medication called metforminbody either doesn’t make enough insulin or it doesn’tif you are considered by your doctor to be very high riskuse it well (that’s called insulin resistance), leading tofor developing type 2 diabetes. It works by keeping thea higher-than-normal blood sugar (glucose) level. Soliver from making more glucose when you don’t needinstead of sugar fueling your body, it builds up in yourit, thereby keeping your blood glucose level in a betterTheir website (choosemyplate.gov) also has tips andblood stream. Most of the sugar in your body comesrange.online resources.Q: So my doctor tells me I need tolose weight and exercise more.What are resources to help me?As a doctor, I do my best in educating and empoweringmade with white flour. However, your body’s liver isA: Studies show that just the act of recording what youeasy to change. Find what motivates you – and act on italso a source of sugar. It makes sugar in times of stressare eating and what kind of activities you are doing cantoday!government has moved away from the food pyramidand instead is recommending portion sizes andcombinations of food based on the concept of a plate.from the foods you eat, specifically foods that containcarbohydrates. Any food that contains carbohydratescan affect your blood sugar levels, not just sweet foods.The highest levels of carbohydrates come from foodssuch as cereal, potatoes, white bread, or anythingReferences: www.endocrineweb.com & www.mayoclinic.orgpatients, but when it comes to your health it is up to you.Much of this information is not new to us, but it is notwww.yanktonmedicalclinic.com 605-665-78413
Family MedicineDavid J. Barnes, MD*605-665-8910convenientcareJennifer McGinnis, CNP, MSNMeredith Hunhoff, CNP, MSNDaniel J. Megard, MD*Robert J. Neumayr, MD, PhD†Ashley Reiner, MPAS, PA-CAmy M. Eichfeld, MD, FACOG*Robert T. Ferrell, MD, FACOG*Jill F. Sternquist, MD, FACOG*Randolph Heisinger, MD, FAAP*Dawn M. Larson, MD*April K. Willman, MD, FAAP*David W. Withrow, MD, FAAP*PediatricsFamily medicineFamily medicineFamily medicineFamily medicineMatthew D. Krell, MD, FAAP*William J. Dendinger, MD*Charles C. Yelverton, MD*Michelle Chaussee, MPAS, PA-CAmy Fluit, MPAS, PA-C McKenzie Hanson, MD*605-665-8910Carrissa Pietz, MD*605-665-8910Scott A. Weber, DO*605-665-8910Family & Sports Medicine605-665-8910605-665-7841Internal MedicineSusan E. Fanta, MD*605-665-1082John J. Frank, MD*605-665-1082Tyler Hanson, 2Internal Medicine obstetrics / GynecologyDenise Taggart, MPAS, PA-C605-665-1082Curtis M. Adams, MD*605-665-5538Kevin Bray, MD, 05-665-5538605-665-5538vermillionmedical clinic 605-624-86434So much care, so close to home. 605-624-8643605-624-8643605-624-8643605-624-8643
Provider DirectorySo much care, so close to home.cardiology* Board Certified † B oard Eligible* Board Certified†Board EligibleWill C. Hurley, MD, FACC*dermatologySpecialty CareTim Irwin, MD, FACC*605-664-2741605-664-2741Ear, Nose & throatJames Young, DO, FAOCD*Patrick J. Collison, MD*605-665-1722605-665-1722General SurgeryaudiologyJason R. Howe,MS, FAAA, CCC-A605-665-1722NephrologyLuke C. Serck, MD*Mary Milroy, MD, FACS*605-664-2742605-664-2742Specializing in Breast SurgeryByron S. Nielsen, MD*605-665-1082Orthopedic Surgery Brent Adams, MD, ABOS* 605-665-1722Jeremy Kudera, MD, ABOS*605-665-1722pulmonologyL ori A. Hansen,MD, FACP, FACCP*605-665-1152Jim Frerk, MPAS, PA-C605-665-1722RadiologyMichael P. Pietila,MD, FCCP, FACP*605-665-1152Pulmonology/Critical Care Will R. Eidsness, MD*605-665-7841GastroenterologyGeneral SurgerySteve H. Gutnik,MD, FACP*, AssociateRyan J. Garry, MD, FACS* 605-665-1722605-664-2742Jesse L. Kampshoff, MD*605-664-2742Oncology / HematologyMax L. Farver, MD*Mary Lee Villanueva, MD*Internal Medicine,Specializing in Oncology/HematologyPhysical Medicine & RehabDawn Lauer, MPAS, PA-CJudith R. Peterson, MD*605-665-1722605-665-1722RheumatologyLeann Bassing, MD*605-665-1722605-665-1722Whitney Delforge, CNP, MSN605-665-1722605-665-1152UrologyGeorge R. Fournier, Jr.,MD, FACS*605-664-2742Christopher A. Hathaway,MD, PhD*605-664-2742www.yanktonmedicalclinic.com 605-665-78415
For more information or to schedule anappointment please call 605-665-1722.Your Hip and Shoulder StiffnessMay Need Attention.Written by Board Certified RheumatologistLeann Bassing, MDWhat is PolymyalgiaRheumatica (PMR)?How is it diagnosed?Prednisone is so effective in treating PMR that we expectPolymyalgia Rheumatica is a diagnosis based largelyPolymyalgia Rheumatica, or PMR, is an uncommon buton the patient’s symptoms, age, inflammatory bloodimportant to recognize cause of pain and stiffness thattests, and response to appropriate treatment. Althoughaffects the muscles of the shoulder girdle and hip girdle.no single blood test can confirm or rule out PMR, mostThis means the muscle groups involved are those inpatients with active PMR will have elevated inflammationthe upper arms and the upper thighs, in a symmetrictests, including an elevated ESR (erythrocytepattern affecting both sides. The discomfort of PMRsedimentation rate) and CRP (C-reactive protein). Evenincludes moderate to severe muscle stiffness in thesemore important, is the patient’s expected response toareas especially in the mornings, typically significantthe medication used to treat PMR (read on for moreenough to cause some difficulty raising the arms abovebelow).suddenly, with some patients able to pinpoint the veryday their symptoms started.the patient who truly has PMR to experience nearcomplete resolution of symptoms within the first fewdoses of the medication. If symptoms do not resolve,then a reconsideration of the diagnosis is a next possiblestep. However, I never take lightly the use of Prednisone,and neither should the patient. I try to always discusswith patients the potential risks of medications, andwhen it comes to chronic (more than three months)Prednisone use, this includes possible risks for bonehealth (Osteoporosis), increased risk for infections,one’s head in an effort to comb hair or get dressed. Oftentimes, this severe muscle stiffness and pain will begintreat inflammatory conditions, especially PMR. In fact,Who typically getsdiagnosed with PMR?hyperglycemia (elevated blood sugars), potential weightgain, and possible changes in mood, among otherthings. Of course, most patients do not experiencePeople younger than age 50 (and most often thosethese things; however, we monitor for side effects orless than 60 years of age) do not develop PMR. Theintolerance to any medication.reason for this predilection is unknown, however it is animportant component when appropriately diagnosingthe condition. Again, symptoms of muscle aches andImportant informationto consider:pains can be relatively nonspecific and are much morecommonly due to other entities (Thyroid dysfunction,Polymyalgia Rheumatica is not the most common causeFibromyalgia, viral illness, deconditioning, and the listof muscle pain or stiffness; however it is an importantgoes on), therefore an appropriate evaluation by apossibility to consider when evaluating a patient withprimary provider or rheumatologist is important.these symptoms, especially older patients. A thoroughhistory and physical examination are important in theHow is it treated?process of making a diagnosis of PMR, and appropriatetreatment should essentially resolve the moderate toThere is only one proven treatment for PMR, and thatis with oral corticosteroids (Prednisone) starting at amoderate dose, and then decreasing very slowly - usuallyover the course of many months. I often tell patientssevere symptoms of muscle pain and stiffness. Closemonitoring of a patient with PMR diagnosis is imperativein order to recognize and help limit potential side effectsto treatment.Prednisone is both a good and a bad medication. There6So much care, so close to home. are several positive things about this therapy, namely itsCall your physician if you are experiencing the type ofability to quickly and effectivelystiffness or pain described. We are here to help.
Ear Infections& Antibiotics:What to Know?Ear infections, also known as acute otitis media (AOM),are the most common reason children are brought tothe doctor every year. Though rarely severe, these nastyillnesses and the pain associated with them cause quitea bit of distress for children and their parents. So whenshould your child be seen by your pediatrician and whattreatment should you expect? Here’s a brief introductionto what your doctor is thinking about when he or sheAntibiotic TherapyObservationToxic-appearing childFever 102.2 FEar pain for 48 hoursWell-appearing childNo Fever or Fever 102.2 FEar pain for 48 hoursAmerican Academy of Pediatrics, Clinical Practice Guidelines: The Diagnosis and Management of Acute Otitis Media, 2013.UpToDate, Acute Otitis Media: Epidemiology, Microbiology, Clinical Manifestations, and Complications, 2016.sees your child for an ear infection.Acute otitis media, is an infection in the middle ear. Thisspace is separated from the external ear by the eardrum,and is connected to the throat and nasal passages bythe eustachian tube. Because the only entrance to themiddle ear is the eustachian tube, problems arise when itis closed off. Inflammation in the upper respiratory tract,like during a cold, has the potential to narrow or closethis tube. When the middle ear continues to make fluidas it normally does, it has no way to drain. This buildupof fluid is a breeding ground for the viruses and bacteriathat are already present in these spaces. Their growthcauses more inflammation with greater fluid secretionand ultimately, an increase in pressure in the middleear. This increase in pressure is what causes the painassociated with ear infections.Image from www.medicinenet.compneumococcal, HiB, and annual influenza vaccines, havesymptoms. However, the risks and potential side effectshelped to reduce the frequency of ear infections due toattributed to antibiotic use include diarrhea, diapersome of these organisms.dermatitis, and allergic reactions to the medication.Additionally, overuse of antibiotics can lead to increasedChildren with ear infections can present with a varietybacterial resistance, resulting in future difficultyof symptoms. Ear pain is an important symptom, whichtreating bacterial infections. Antibiotic therapy ofmay be demonstrated by young children tugging at orAOM does not provide pain relief in the first 24 hours,holding the ear. A fever (100.4 or greater) is also typicallyand pain may even persist 3 to 7 days after antibioticpresent, along with increased fussiness or decreasedinitiation. However, pain-relievers such as ibuprofen andactivity. Some additional signs are hearing loss,acetaminophen help to relieve pain associated with AOMdecreased appetite, vomiting and diarrhea.and should be used whether or not antibiotic therapy isAs a parent, when should you bring your child tothe pediatrician for ear pain? In accordance with theThe initial observation option primarily manages AOMAmerican Academy of Pediatrics, we suggest thatwith symptomatic pain relief. Antibiotic therapy isall children under the age of 2 years be seen by aconsidered later on only if the child’s condition worsenspediatrician if they have symptoms of ear infection, asat any time or does not show improvement withinmentioned above. For older children 2-17 years old, we48-72 hours after diagnosis. Joint decision-making andrecommend only coming into the clinic if they have oneconversations between the parent and physician isor more of the following: moderate to severe ear pain,critical, and a plan must be in place to ensure adequateear pain for at least 48 hours, or a temperature of 102.2 follow-up and initiation of antibiotics if symptoms failor greater. If your child has had any drainage of fluid fromto improve after 1-2 days. Initial observation results inthe ears or has had worsening of symptoms, you shoulddecreased use of antibiotics, decreased side effects ofalso seek medical care. A child with mild ear pain for lessantibiotics, and decreased potential for developmentthan 48 hours and a temperature of less than 102.2 mayof bacterial resistance. Many cases of AOM are viral innot require medical attention or antibiotics.nature, and antibiotics will therefore not always result inIn the 2-17 year old age group, uncomplicated AOM canSeveral viruses and bacteria are typically to blame forprescribed.be treated two ways: immediate antibiotic therapy ora more rapid resolution of symptoms because antibioticsdo not treat viral illnesses. However, there is the chancethat a child will still require antibiotics later on if theear infections. Many microbes are present naturally ininitial observation. Antibiotic therapy requires immediatethe middle ear, but their overgrowth is what can resulttreatment of AOM with prescribed antibiotics at thein infection. Recent research has found that most eartime of diagnosis by the physician. The benefits to thisTherefore, we encourage you as parents to ask questionsinfections are caused by viruses. Certain bacteria are alsostrategy include only a slight increased likelihood ofand have discussions with your pediatrician on whatcommon. Fortunately, childhood vaccines, such as themore rapid resolution of AOM and its associatedinitial treatment option is best for your child.symptoms worsen or don’t improve.Written by Universit y of South Dakota Sanford School of Medicine Medical StudentsDavid Christianson, Laura Rasmussen, Ashley Schmidt, Nicole West, Sharleen Yuanwww.yanktonmedicalclinic.com 605-665-78417
605-665-78411104 West 8th Street Yankton, SD 57078www.YanktonMedicalClinic.comOn call orwe’re there.Weekdays5 – 9pmWeekendsNoon – 5pmNo appointments necessary.Checklist for aHealt hy School YearCall now to make an appointment!33 Kindergarten PhysicalSchedule now to be first in line before the summer rush! Screenings, shots andphysicals are required before your child can start school.Sports PhysicalGet in the game! Parents and guardians need to fill out forms in advanceof sports physicals. Don’t get sidelined by waiting too long. Plan now andavoid conflicts with summer sports camps, vacations and family reunions.36th Grade Vaccinations New this year!Follow the rules or no school! Contact your doctor now to talk about therequired immunizations for incoming 6th graders. In sports? You cancombine this with your sports physical – but you must complete forms inadvance.So much care, so close to home. Call now to bookyour appointment.101 South Plum Street, Vermillion, SD 570691104 West 8th Street, Yankton, SD icalclinic.com605-624-8643605-665-7841
Kevin Bray, MD, FACOG* 605-665-5538 Amy M. Eichfeld, MD, FACOG* 605-665-5538 David W. Withrow, MD, FAAP* 605-665-5538 Robert T. Ferrell, MD, FACOG* 605-665-5538 Matthew D. Krell, MD, FAAP* 605-624-8643 William J. Dendinger, MD* 605-624-8643 Charles C. Yelverton, MD* 605-624-8643 Michelle Chaussee, MPAS, PA-C 605-624-8643 Amy Fluit, MPAS, PA-C .
Furuncle of external ear. H60.00 Abscess of external ear, unspecified ear. H60.01 Abscess of right external ear. H60.02 Abscess of left external ear. H60.03 Abscess of external ear, bilateral. H60.1 Cellulitis of external ear. Cellulitis of auricle Cellulitis of external auditory canal. H60.10 Cellulitis of external ear, unspecified ear
Middle Ear Infection (Otitis Media) Overview: Middle ear infection is one of the most common illnesses among children. It is often caused by a bacterial or viral infection. Discharge from the ear is a symptom that requires immediate doctor visit. A child with frequent ear infections may need a hearing test, testing speech skills or others .
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Care of Ear Cleaning Equipment 7. Ear Cleaning Equipment Single-use [(e.g. Tips (Elephant Ear Washer tips , Otoclear tips)], Syringes) Multi-patient reusable Patient owned or dedicated to a single patient (e.g. Elephant Ear Washer or Rhino Ear Washer ) (e.g. Elephant Ear Washer , Rhi
H53.10 Unspecified subjective visual disturbances H53.1 1 Day blindness Ear Diseases H61 .20 Impacfed cerumen, unspecified ear H61 .2t Impacted cerumen, right ear H6t 22 Impacted cerumen left ear H61 23 Impacted cerumen bilatera H60.00 Abscess of external ear, unspecified ear H60.01 Abscess of right external ear
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Hotell För hotell anges de tre klasserna A/B, C och D. Det betyder att den "normala" standarden C är acceptabel men att motiven för en högre standard är starka. Ljudklass C motsvarar de tidigare normkraven för hotell, ljudklass A/B motsvarar kraven för moderna hotell med hög standard och ljudklass D kan användas vid
