Tips for Getting Children with Special Needs Vaccinated

By Troy Nelson, MD, pediatrician and medical director at DMG Children’s Rehabilitative Services

special needs vaccine

Whether it’s childhood immunizations or vaccinations for the flu or COVID-19, getting a vaccine is an anxiety-causing process for many children.  If your child has special needs or a complex medical condition, getting vaccinations can be more stressful for both you and your child.

Here’s some tips for supporting children with special needs getting vaccinated.

Before the appointment:

  • Ask for an appointment on a day and time that is not busy in your pediatrician’s office.
  • See if your child’s provider recommends pre-medicating with an over-the-counter pain reliever or using a topical numbing cream or spray.
  • Be honest with your child and explain to them what will be happening. For some children, it might be appropriate to prepare a couple days in advance; for others it might be the day of the appointment.
  • If possible, ask if your child can receive their vaccination in the car instead of going into the clinic.

Day of and during the appointment:

  • Try to remain calm before and during the appointment. Children pick up on nervous or anxious energy, especially from their family. If you are calm, your child is more likely to remain calm.
  • Bring your child’s favorite stuffed animal or doll with them for comfort.
  • If your child has a favorite provider, nurse, or medical assistant at your pediatrician’s office, ask for that person to be present to support your child.
  • Ask that your child be vaccinated in a quiet exam room, away from noise, the waiting area, and other people.
  • If appropriate, encourage your child to take some deep breaths.
  • If able, help your child relax by asking them to shake their arms and legs in a silly way.
  • Walk around with your child after the vaccination to distract them instead of sitting.
  • If multiple vaccinations are being administered, ask the provider to take a break in-between if it will help your child.
  • Reassure your child that they will be fine, and you and the provider will be there to support them.
  • Reward your child. If your child is having more than one vaccination in a single appointment, you may want to reward them after each vaccination with a sticker or other small item they like.

As pediatricians, our goal at DMG CRS’ primary care clinic is to make every child’s appointment positive and comforting.  Partnering with parents or guardians is key to this goal and making your child feel confident and safe with their medical providers.  We’re here to listen and support you in managing your child’s health and wellness.

The Importance and Safety of Childhood Vaccinations

By Pamela Murphy, MD, pediatrician in the Spina Bifida Clinic at DMG Children’s Rehabilitative Services

childhood vaccinations


As a pediatrician, I am asked frequently about childhood vaccinations. Are they safe? Do they cause one disease while trying to prevent another? As a parent or guardian, it’s our responsibility to provide safe care for our children and asking questions and getting the facts from credible sources are part of that responsibility.

U.S. public health officials and physicians have been combating misconceptions about vaccine safety for more than twenty years. Despite these efforts, childhood immunization rates have fallen in the past two decades resulting in resurgences of vaccine-preventable diseases such as whooping cough (pertussis) and measles. For example, in 2010, California saw more cases of whooping cough than any year since 1947, according to research published by the American Academy of Pediatrics.

August is Immunization Awareness Month. Let’s look at what childhood vaccinations are recommended when and address the most common misinformation about childhood vaccinations.

Recommended Childhood Vaccinations

The Centers for Disease Control and Prevention (CDC) has easy to review children’s vaccines schedules by age group on their website.  All the vaccinations listed below are available at DMG CRS’ primary care clinic.

Early Childhood: Birth to Age 6

  • Chickenpox/varicella
  • Hepatitis A
  • Hepatitis B
  • Diphtheria, tetanus, and pertussis (DTaP)
  • Haemophilus influenzae type b (Hib)
  • Influenza (flu): recommended annually from age six months and on
  • Measles, mumps, and rubella (MMR)
  • Pneumococcal conjugate disease (PCV13)
  • Polio (IPV)
  • Rotavirus (RV)

Children: Ages 7-18

In addition to any vaccines missed that were recommended during early childhood, the CDC recommends the following vaccines for kids ages 7-18:

  • Flu (annually)
  • Human papillomavirus (HPV)
  • Meningococcal conjugate (MenACWY)
  • Tdap (the DTaP booster)

If your child has certain health conditions that put them at increased risk for serious diseases, your pediatrician may also recommend the following vaccinations be administered:

  • Pneumococcal
  • Serogroup B meningococcal (MenB)

COVID-19 Vaccine

The CDC also recommends children ages six months and older receive the COVID-19 vaccination, and children ages five and older also get the booster. The COVID-19 vaccination is not available at DMG CRS. For more information on COVID-19 vaccinations for children, including locations providing these vaccinations, visit the Maricopa County Public Health website.

Childhood Vaccinations: Debunking the Myths

 According to, the following are the top three myths about childhood vaccinations.


Myth #1: Vaccines increase the risk of autism.

This hypothesis originated in 1997 from study by a British surgeon who concluded that the MMR vaccine was increasing autism in children in the United Kingdom. The article “has since been completely discredited due to serious procedural errors, undisclosed financial conflicts of interest, and ethical violations.” The physician author lost his medical license, and the paper was retracted.

Myth #2: Infant immune systems can’t handle so many vaccines.

The cells in the immune system are constantly being replenished, making it near impossible for a baby’s immune system to be overwhelmed by immunizations. In fact, babies are exposed to numerous bacteria and viruses every day; vaccines are minor in comparison.

Myth #3: Natural immunity is better than vaccine-acquired immunity.

While in some cases, catching a disease and getting sick (i.e., “natural immunity”) results in a stronger immunity to the disease than a vaccination, the risks outweigh the benefits. For example, if a child were to catch the measles, they would face a one in 500 chance of death from symptoms; in contrast, having a severe allergic reaction to the MMR vaccine is less than one-in-a-million according to the CDC.


As families travel more, especially internationally, the risk of contracting vaccine-preventable diseases increases. Even if the disease is not prevalent in the United States, it may be in other countries. COVID-19 gave us a strong example of how quickly a virus can spread from one continent to the next.

DMG Children’s Rehabilitative Services’ (DMG CRS) primary care clinic specializes in medical care of all children. We know that, especially if your child has a complex condition, getting vaccinations can be challenging and concerning. Your child may have increased anxiety resulting from their medical conditions making getting immunizations even more scary for them. You may have questions about how vaccinations fit into your child’s therapy plan. Our pediatric primary care providers are here to answer your questions and provide compassionate, experienced, and individualized care to support the health of your child and your family.

Discover DMG Children’s Rehabilitative Services

More than 25 medical specialties in one location. DMG Children’s was specifically designed to make it easy for pediatric patients- regardless of mobility or condition- to receive care.

Benefits of Breastfeeding for You and Your Baby

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

mother and baby


The baby formula shortage in the United States has prompted the need to find solutions to decrease the risk of a shortage impacting the country again. According to a recent article by NPR, often overlooked in the race to fill the gap is the most natural alternative: mother’s milk.

The American Academy of Pediatrics (AAP) recommends “exclusive breastfeeding for about six months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for one year or longer as mutually desired by mother and infant.” Despite this recommendation, 2018 data published by the Centers for Disease Control and Prevention (CDC) revealed that only one in four babies born in the United States met this target; in Arizona, 50 to 60 percent of babies met this target.

So, why do mothers stop breastfeeding? According to the CDC, how long a mother breastfeeds is impacted by:

  • Issues with lactation and latching
  • Concerns about infant nutrition and weight
  • Mother’s concern about taking medications while breastfeeding
  • Unsupportive work policies and lack of parental leave
  • Cultural norms and lack of family support
  • Unsupportive hospital practices and policies

The Surgeon General’s Call to Action to Support Breastfeeding as well as medical experts in women’s health and pediatrics continue to push education about the benefits of breastfeeding. Let’s look at the benefits to you and your baby.

Benefits of Breastfeeding for Mom

According to, an AAP website, breastfeeding provides emotional, mental and physical health benefits to a mother, including:

Release of good hormones: During breastfeeding, hormones such as prolactin and oxytocin are released which produce peaceful, nurturing, and relaxing sensations that promote bonding with your infant.

Quicker uterus recovery: Oxytocin, released during breastfeeding, helps return the uterus to its regular size more quickly and can reduce postpartum bleeding.

Potential reduced risk of disease: Some studies have found that breastfeeding may reduce the risk of developing breast and ovarian cancers, cardiovascular disease, rheumatoid arthritis, and type 2 diabetes.

Natural contraception: Exclusive breastfeeding delays the return of the mother’s menstrual period, which can help extend the time between pregnancies.

Less expense: Formula can cost four to ten dollars a day or $1460-$3650 annually.

Ease of preparation:  Human milk directly from the mother is the right temperature, so no taking time to warm bottles of formula.

Ease of travel:  Whether you are going out to run an errand or for the day, no need to bring a bag of temperature-controlled formula.

Environmentally friendly: You get the satisfaction of knowing you are not contributing baby formula cans and packaging to landfills.

Benefits of Breastfeeding for Your Baby

Breast milk provides a baby with ideal nutrition and supports growth and development. According to the CDC, the benefits of breast milk for your baby include:

The best source of nutrition for most babies, because as the baby grows, the mother’s milk will change to meet the baby’s needs.

Shared antibodies from the mother with her baby

Supports proper brain development through docosahexaenoic acid (DHA), a polyunsaturated fatty acid found in breast milk

Helps protect babies against some short- and long-term illnesses and diseases and decreases the risk of:

  • Allergies
  • Asthma
  • Ear infections
  • Obesity
  • Sudden infant death syndrome (SIDS)
  • Stomach viruses or illnesses
  • Type 1 diabetes

If you have questions about breastfeeding or want more information, please contact your women’s health provider or pediatrician. We’re here to help you make the right decision for you and your baby and provide the support and resources needed for you to care for your newborn.

Top Five Causes of Death in Men

By Richard Fowler, MD, internal medicine physician

father and son talking about health

Did you know that in 1920, women outlived men by one year, and today, the Centers for Disease Control and Prevention (CDC) reports that women survive men by five or more years?  June is Men’s Health Month and a good time to examine the primary causes of death in men and how to decrease your risks.

According to the Men’s Health Network (MHN), the top five killers of men are:

Heart Disease

Heart disease is the leading cause of death among men and women, but twice as many men die of cardiovascular diseases.  According to the American Heart Association, heart disease tends to manifest itself about ten years earlier in men vs. women.

Risk factors include:

  • Diabetes
  • Family history
  • High blood pressure
  • High cholesterol
  • Physical inactivity
  • Obesity/overweight
  • Smoking

Did you know 90 percent of heart disease is due to lifestyle? 80 percent of heart disease is preventable with six healthy lifestyle modifications:

  • Nutrition/diet
  • Physical activity
  • Smoking/substance cessation
  • Stress management
  • Compliance with prescribed medication(s)
  • Sleep


Like heart disease, stroke incidents are higher among men vs. women.  According to the American Stroke Association, the incidence rate of stroke is 1.25 times greater in men than women. Many of the risk factors associated with strokes mirror that of heart disease and include:

  • Hypertension
  • Increasing age
  • Race: African-Americans have the greater risk than whites.
  • Gender: Stroke is more common in men than in women until age 75.
  • Personal history of stroke or a transient ischemic attack (TIA, or ministroke)
  • Diabetes
  • High cholesterol
  • Heart disease
  • Smoking, including secondhand smoke
  • Physical inactivity
  • Obesity
  • Alcohol and substance abuse 

Suicide and Depression

According to reports by MHN, men are four times more likely to commit suicide compared to women, partially because of underdiagnosed depression in men. More than six million men have depression each year, according to the National Institute of Mental Health.

Signs of depression in men are often different than women, which may contribute to family and friends not helping to identify it.  Instead of sadness, depression in men may present as:

  • Anger
  • Aggression
  • Work “burnout”
  • Risk-taking behavior
  • Midlife crisis
  • Alcohol and substance abuse

Lung Cancer

Did you know lung cancer is the leading cancer cause of death among men and women?  While rates of lung cancer have been declining since the 1980s, tobacco products remain the number one cause of lung cancer.  Unfortunately, with the introduction of e-cigarettes and “vaping,” new risk factors have been introduced.

Other risk factors include:

  • Secondhand smoke
  • Exposure to asbestos or radon
  • Personal history
  • Air pollution

Prostate Cancer

Prostate cancer is the most common cancer found in men but is treatable is found early.  Unfortunately, prostate cancer symptoms are generally not visible until it has spread to other parts of the body, making it the second deadliest cancer in men.

The key to early detection is annual screening.  The American Cancer Society recommends a prostate-specific antigen (PSA) blood test and digital rectal exam be completed annually for healthy men starting at age 50 or older. Men who are at high risk should begin testing earlier.

Prostate cancer is most common in North America and Northwestern Europe. Other risk factors include:

  • Increasing age
  • High-fat diet including a lot of red meat and high-fat dairy products and not enough fruits and vegetables

Fortunately, steps can be taken to reduce one’s risk of these diseases, and decreasing your risk starts with getting established with a primary care provider and getting annual wellness exams and appropriate screenings.

Mental Health and Your Child

By Megan Aros-O’Malley, PhD, pediatric psychologist at DMG Children’s Rehabilitative Services


May is Mental Health Awareness Month. Unfortunately, children in the United States are currently facing a mental health crisis. Data from the Centers for Disease Control and Prevention (CDC) indicate that one in five children has a mental or behavioral health condition such as anxiety, depression, attention-deficit/hyperactivity disorder, autism spectrum disorder, or disruptive behavior disorder. However, only about 20 percent of these children received care from a mental health provider.

Parents are often the first to recognize that their child is struggling emotionally and/or behaviorally. A few signs that a mental health difficulty could be arising include (but are not limited to):

  • Persistent worries or anxiety
  • Persistent behavioral acting out, aggression, or disobedience
  • Hyperactivity or constant movement beyond regular playing
  • Difficulty paying attention
  • Marked decline in school performance
  • Inability to cope with setbacks and problems
  • Severe mood swings
  • Threatening to kill or harm oneself and/or self-injury
  • Strange thoughts, beliefs, or unusual behaviors

Untreated mental health conditions can have many short- and long-term impacts on children’s development, social and behavioral functioning, and home and school life.

Fortunately, help exists. DMG Children’s Rehabilitative Services (DMG CRS) Behavioral Health clinic has pediatric psychologists and counselors available to meet the mental health needs of children of all ages. DMG CRS behavioral health providers collaborate with families to develop a comprehensive treatment plan that can include services such as consultation, psychotherapy, and/or psychological testing. Furthermore, with more than 25 pediatric medical specialties on-site, DMG CRS behavioral health providers are skilled at partnering with other pediatric specialists to provide whole-child care that incorporates physical and mental health domains.

Four Types of Food that Increase Your Risk of Type II Diabetes

By Misty Cox, FNP-C, WHNP, family nurse practitioner



November is National Diabetes Month, and the timing is perfect as the holiday season means a lot of food and celebrations. The holidays are busy and many of us get out of healthy routines such as exercise, eating a balanced diet, and more.

Type 2 diabetes, unfortunately, does not take the holiday season off, so here’s four types of foods to avoid or moderate your intake of this holiday season and throughout the year. These four food types increase your risk of type 2 diabetes:

Heavily processed carbohydrates

Foods made with white flour, white sugar, and white rice are low in bran, fiber, vitamins, and minerals; examples include breads, muffins, cakes, crackers, and pasta. According to a 2007 study published in the Journal of the American Medical Association (JAMA), a diet high in heavily processed carbohydrates increased the risk of type 2 diabetes by 21 percent compared to those who ate a whole foods-rich diet.

Drinks sweetened with sugar

Sodas, sweet tea, fruit drinks, and lemonade can lead to weight gain and increase your risk of getting type 2 diabetes. Having just two sugar-sweetened drinks per day can increase your risk of type 2 diabetes by as much as 26 percent, according to a 2010 study by the American Diabetes Association. Water is the best substitute and has many health benefits for your body.

Saturated and trans fats

Saturated fats are found in dairy products such as butter, whole milk, cream, and cheese as well as fatty meats. Trans fats are tied to fried foods (fast food restaurants, “bar” food) and packaged baked goods. Some healthy alternatives include:

  • Snacking on nuts, not sweets
  • Eating lean meats and/or poultry, and removing the skin
  • Avoiding salad dressings such as blue cheese, ranch and thousand island and using olive oil and balsamic vinegar instead
  • Cooking and baking with olive or canola oils

Red meats and processed meats

Processed meats such as hot dogs, bacon, and deli meats have higher levels of sodium and nitrites, which put you at not only higher risk of type 2 diabetes but heart disease. A study shared in the American Journal of Clinical Nutrition found that a three ounce serving of red meat daily increased the risk of type 2 diabetes by 19 percent, and a serving of less than three ounces of processed meats increased the risk by more than 50 percent. Protein is essential to your health so switch to wild caught fish, like salmon, or organic poultry like chicken or eggs combined with vegetables to optimize your meal plan.

Prediabetes is alarmingly prevalent. Did you know one of three Americans is prediabetic? Your best defense is getting information on your risk factors and how to optimize your lifestyle to decrease your risks. We primary care providers (PCP) are here to help. If you have not had your annual wellness exam, schedule it, and talk with your PCP about your health goals.

What You Need to Know about Ovarian Cancer

By Dana Putman, FNP-C, family nurse practitioner

Group of happy women


September is Ovarian Cancer Awareness Month.  According to the American Cancer Society, more than 20,000 women will receive an ovarian cancer diagnosis in 2021, and nearly 14,000 women will die from this form of female reproductive system cancer.

Fortunately, the rate at which women have been diagnosed with ovarian cancers has been decreasing slowly in the past 20 years. Driving awareness and empowering women with the knowledge of how to decrease their risks and identify ovarian cancer symptoms early has helped significantly.

Did you know there are more than 30 types of ovarian cancer?

According to the American Cancer Society, 85 to 90 percent of ovarian cancers originate from epithelial cells, which cover the outer surface of the ovary. About 52 percent of all epithelial ovarian cancers are serous carcinomas.

What are the risk factors for epithelial ovarian cancers?

Because epithelial ovarian cancers are the most common, let’s take a closer look at risk factors for these types of ovarian cancers.

Getting older – The risk of getting ovarian cancer increases with age, unless a woman has had her ovaries removed.  Most women diagnosed with ovarian cancer have completed menopause and are age 63 or older.

Being overweight or obese – Women with a Body Mass Index (BMI) of 30 or higher have a higher risk of developing many cancers, not just ovarian cancer. In addition, obesity can negatively impact a woman’s chance of surviving ovarian cancer.

Having children later or not having a full-term pregnancy – Women who have their first full-term pregnancy after age 35 or who never carried a pregnancy to term have a higher risk of ovarian cancer.

Having a family history of breast, colorectal or ovarian cancer – If one’s mother, sister or daughter has had ovarian cancer, the risk is higher. Increased of risk of ovarian cancer can also come from the father’s side of the family.  In addition, breast and colorectal cancers can be caused by an inherited mutation (change) in certain genes that cause a family cancer syndrome that increases the risk of ovarian cancer. To learn more about family cancer syndromes and gene mutations, visit the American Cancer Society website.

Using fertility treatment – In vitro fertilization (IVF) has been linked to increased risk of ovarian cancer, while some types of fertility drugs have not. If you are considering or have had fertility treatments, speak with your women’s health physician about your risk factors.

Having had breast cancer – A family history of breast cancer may be linked to inherited mutation in the BRCA1 or BRCA2 genes, which are also linked to ovarian cancer.

Smoking – While smoking is not directly linked to ovarian cancer, it has been linked to an increased overall risk of developing some form of cancer.

What decreases the risk of ovarian cancer?

While some of the risk factors are not within our control, decreasing the risk of ovarian cancer is to some extent.  However, a woman must make the right personal and life choices for her and her family, so some or all these options may or may not be chosen.

Pregnancy – Women who have carried a baby to full-term by the age of 26 have a lower risk of ovarian cancer. The risk goes down with each full-term pregnancy.

Breast feeding – Breast feeding may reduce the risk of ovarian cancer even further.

Birth control – Using oral contraceptives (birth control pills) decreases the risk of ovarian cancer; the longer oral contraceptives are used, the more the risk decreases. According to the American Cancer Society, tubal ligation (having fallopian tubes tied) and short use of intrauterine devices (IUDs) have also been associated with a lower risk of ovarian cancer.

Hysterectomy – Removing the uterus without removing the ovaries reduces the risk of ovarian cancer by more than 30 percent.

Your first step in reducing your risk of ovarian cancer is getting an annual well-woman exam.  During this exam, you will share your medical history as well as that of your family, discuss your methods of birth control, receive a physical examination, and discuss your health goals.  We are here to help you understand your risks and create a care and lifestyle plan to support you in living the life you choose.

What Immunizations Does Your Family Need?

by Misty Cox, FNP-C, WHNP-BC, Family Nurse Practitioner

Arizona family


Do you know anyone who has recently had Haemophilus influenzae type b (Hib)? Do you know what Hib is?  Probably not in both cases.  Affecting mostly children under five years-old, Hib is a disease that can seriously damage a child’s immune system and cause brain damage, hearing loss, or even death.  According for the Centers for Disease Control and Prevention (CDC), before the four dose vaccine was available, approximately 20,000 children were affected by Hibs annually.

Hib is just one of many diseases we rarely encounter any longer thanks to vaccines.  More than 16 diseases can be prevented or decreased in severity if vaccines are proactively administered.  The most current example is COVID-19 and associated variants, including delta.

August is Immunization Awareness Month, so let’s review vaccines recommended throughout our lifetimes.

Please consult your primary care provider (PCP) for more information on recommended vaccines, timing, number of doses and when to receive based on medical history, risks, and other factors.

Childhood Vaccinations

The CDC has easy to review children’s vaccines schedules by age group on their website.

Early Childhood: Birth to Age 6

  • Chickenpox/varicella
  • Hepatitis A
  • Hepatitis B
  • Diphtheria, tetanus, and whooping cough/pertussis (DTaP)
  • Hib
  • Influenza (flu): recommended annually from age six months and on
  • Measles, mumps, and rubella (MMR)
  • Pneumococcal conjugate disease (PCV13)
  • Polio (IPV)
  • Rotavirus (RV)

Children: Ages 7-18

In addition to any vaccines missed that were recommended during early childhood, the CDC recommends the following vaccines for kids ages 7-18:

  • Flu (annually)
  • Human papillomavirus (HPV)
  • Meningococcal conjugate (MenACWY)
  • Tdap (the DTaP booster)

If your child has certain health conditions that put them at an increased risk for serious diseases, your PCP may also recommend the following vaccinations be administered:

  • Pneumococcal
  • Serogroup B meningococcal (MenB)


Adult Vaccinations

The CDC also provides information to adults to help adults understand what vaccinations are recommended based on age, lifestyle, medical conditions, and more.

Young Adults: Ages 19-26

  • Flu: recommended annually
  • HPV, if not previously received
  • Tdap, if not previously received

Adults: Age 50+

  • Flu: recommended annually
  • PCV13: recommended for all adults with a condition that weakens the immune system, cerebrospinal fluid leak, or cochlear implant
  • Pneumococcal polysaccharide vaccine (PPSV23): protects against serious pneumococcal disease, including meningitis and bloodstream infections and is recommended for all adults age 65 and older

If you have one of the following medical conditions, talk with your PCP about additional vaccinations that may be recommended to decrease your risk of serious illness and complications.

  • Asplenia
  • Asthma
  • Diabetes Type 1 and/or Type 2
  • Heart disease, stroke, or other cardiovascular disease
  • HIV
  • Kidney/renal disease
  • Liver disease
  • Lung disease
  • Weakened immune system

Adults: Special Groups

If you fall into one of the following categories, additional vaccinations may be recommended.  Consult the CDC website for more information or speak with your PCP.

COVID-19 Vaccination

The COVID-19 vaccine is highly recommended to fight against the coronavirus and variants, like delta.  This vaccine is now available for everyone age 12 and older.  For the most current information on the COVID-19 vaccine, please visit the CDC website.

If you have questions about what vaccinations you and your family need, DMG primary care providers (PCP) are here for you. To find a DMG PCP at a location near you, click here. We’re here to support the health of you, your family, and the entire community.

UV Safety for You and Your Dog

By Misty Cox, FNP-C, WHNP, family nurse practitioner

couple outdoors with their dog


July is UV Safety Month, and in Arizona, protecting ourselves and those we love against the harmful rays of the sun is even more important.  Did you know Arizona has more sunny days per year than California and Florida?

If you’re like me, you enjoy the outdoors, especially when you can enjoy it with someone you love. In my case, that “someone” is often my dog, Alfred.   Alfred and I can regularly be seen taking long, brisk walks together.

As a primary care provider and a “pet parent,” I’d like to share tips to protect you and your four-legged friend from the harmful rays of the sun.  First, let’s check out some facts about skin cancer for humans and canines.

Facts about Skin Cancer

According to the American Cancer Society:

  • Skin cancer is the most common form of cancer in the United States.
  • Melanoma is among the top five cancer types diagnosed in Arizona.
  • Incidence of melanoma are increasing in Arizona at a slightly higher rate than that of the United States as a whole.

According to the American Kennel Club (AKC):

  • Skin tumors are the most commonly diagnosed tumors in dogs.
  • Too much exposure to the sun is one of the top causes of skin cancer in dogs.
  • Malignant melanoma is one of the most common skin cancers in dogs.
  • Malignant melanoma in dogs grow quickly and have a high risk of spreading to other organs.

UV Safety Tips for You and Your Dog

Surprisingly, how we protect ourselves from harmful UV rays also apply to our dogs, with some minor adjustments.

Stay in the shade

Heading to the lake, beach or park this summer and taking your dog along?  Be certain to bring a large umbrella to provide shade for you, your family and dog.  Some parks have covered areas for picnics and gatherings; be certain to check the park’s website ahead of time to see if these spaces need to be reserved.

Wear protective clothing and accessories

If you are going to be out in the sun, wear certified UV protective clothing (and a wide brim hat), which can be purchased online or at most sporting goods stores.  Believe it or not, UV protective shirts are available for dogs, too.  In addition, remember if the pavement or ground is too hot for your bare feet, it’s too hot for your dog’s paws; if your dog will not tolerate paw protectors, do not walk him if you cannot put your hand or foot on the pavement or ground comfortably for 30 seconds.

Wear sunglasses

Sunglasses protect the eyes from UV rays and reduce the risk of cataracts and skin cancer in or on the tender skin around the eye for both humans and canines.  If your dog likes to have his head out the window when in the car, sunglasses can also protect his eyes from wind and debris. Just like with humans, companies that are dedicated to making eyewear for dogs are plentiful; just do a Web search to find the dog goggles (“doggles”) that work for your dog.

Apply and reapply sunscreen

The American Academy of Dermatology recommends that we use a sunscreen with an SPF of 30 or higher and be certain your sunscreen is not expired; most sunscreens have a shelf life of three years.

Similarly, the AKC recommends a sunscreen with an SPF of 30 or higher for dogs.  As dogs will often lick their skin, a sunscreen specifically made for canines should be used as some ingredients in human formulas are toxic for dogs.

For both you and your dog, sunscreen should be applied about 20 minutes before going outdoors and reapplied if you get wet or every two to three hours.


  • misty cox and her dog

    Here’s Misty Cox and her dog

Why Men Need to Get Annual Wellness Exams and Why They Don’t

By Misty Cox, FNP-C, WHNP, family nurse practitioner

Mature Male Friends Socializing In Backyard Together


According to a study by the Cleveland Clinic, nearly 60 percent of men do not regularly see a doctor for preventive care; instead, these men only seek a medical specialist when they are seriously ill. Of those surveyed, three in five men get annual physicals.  When asked what they regularly talk about, only seven percent said their health.  

Did you know men die an average of five years sooner than women?  Perhaps the fact that, according to the Centers for Disease Control and Prevention (CDC), women are 33 percent more likely than men to see a medical provider is one reason why. 

June is Men’s Health Month so let’s get to the bottom of why men are less likely to seek preventive care, how you can help the men in your life, and what men’s health screenings are recommended.

Why are men less likely to seek medical care?

An online survey commissioned by Orlando Health revealed the following reasons men do not seek medical care, with the first two being the most reported:

  • Too busy
  • Afraid of what medical condition might be discovered 
  • Not “sick enough”
  • Discomfort of the exam (i.e., prostate checks, testicular exams, colon cancer screenings, etc.)

A survey by Cleveland Clinic revealed that 19 percent of men will seek medical care to get their significant other or a loved one to “stop nagging them” about it.  

What screenings should men get and when?

Depending on age, family medical history, lifestyle, and more, a primary care provider (PCP) will recommend the following screenings and potentially other tests to support the health of a male patient. 

Blood pressure screening

Regular blood pressure screening enables early detection of pre-hypertension and/or high blood pressure, a leading cause of heart issues and stroke. 

Cholesterol level test

Men need regular cholesterol testing at age 35; those with a higher risk factor should begin testing as early as age 20. Like blood pressure issues, high cholesterol can lead to heart attacks and/or stroke if not detected early and managed through diet, exercise, and/or medication.

Colorectal exam

Both men and women should begin colorectal screenings at age 50.  Based on family history and other risks, a PCP may recommend these screenings begin earlier.

Diabetes screening

Starting at age 45, healthy men should begin diabetes screenings every three years. Testing may begin earlier for those with higher risk factors, including high cholesterol or blood pressure.

Glaucoma test

Eye tests for glaucoma are based on age and personal risk.  Generally, men should be tested as follows:

  • Under the age of 40: Every two to four years
  • Age 40-64: Every one to three years
  • Age 65+ Every six to 12 months

Prostate exam

Prostate cancer is second only to skin cancer as the most common form of cancer in American men.  The American Cancer Society recommends men discuss prostate cancer screening with their PCP to make an informed decision.  Prostate cancer screening may be recommended as follows:

  • Age 50 for men at average risk with a life expectancy of >10 years
  • Age 45 for men at high risk, including African Americans and men who have a father or brother diagnosed with prostate cancer under the age of 65
  • Age 40 for men at higher risk due to having more than one first degree relative (i.e., father, brothers) who had prostate cancer at an early age

Skin cancer screening

Skin cancer is one of the top cancers found in men.  Annual screenings are recommended and may be increased in frequency if skin cancer or pre-cancerous cells are found.

Testicular cancer exam

Most testicular cancers can be detected early, so a testicular exam should be part of a man’s annual health screening.

Stroke Awareness and Prevention

By Richard Fowler, MD, internal medicine physician

stroke awareness


According to the Centers for Disease Control and Prevention (CDC), nearly 800,000 people in the United States annually have a stroke, and the majority of these are first-time occurrences.  Additional striking statistics from the CDC include:

  • Every 40 seconds someone has a stroke.
  • Every four minutes a person dies of a stroke.
  • One in every six deaths from cardiovascular disease is due to a stroke.
  • One in every four people who experience a stroke have had a stroke in the past.
  • Stroke is the leading cause of disability.
  • Stroke reduces mobility in >50 percent of stroke survivors ages 65 and older.

Did you know May is National Stroke Month?

Strokes can occur at any age; in fact, according to the CDC, 34% of people hospitalized in one year due to stroke were under the age of 65.  So, it’s important for all of us to be aware of how to prevent strokes.

Causes of Stroke

Leading causes of stroke include:

  • Advancing age
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Obesity
  • Prior stroke/transient ischemic attack (TIA)
  • Smoking

According to the American Heart Association, one in three Americans has one of these conditions or habits.

Signs and Symptoms of Stroke

Early action is important to surviving a stroke and decreasing the long-term impacts. According to the CDC, patients who arrive at the emergency room within three hours of their first symptoms often have less disability three months after a stroke than those who received delayed care.

Unfortunately, many people do not recognize all the signs and symptoms of a stroke.  In fact, the CDC reports that in one survey, only 38 percent of respondents were aware of all major symptoms and knew to call 9-1-1 when someone was having a stroke.

While most people recognize sudden numbness on one side as a sign of a stroke, below are other signs and symptoms of a stroke.  Note that all these signs or symptoms occur suddenly.

  • Confusion, trouble speaking, or difficulty understanding speech
  • Dizziness, lack of coordination, loss of balance or trouble walking
  • Severe headache with no known cause
  • Trouble seeing in one or both eyes

F.A.S.T. to Save Lives

If you recognize signs or symptoms of a stroke in someone, follow these steps:

f.a.s.t diagram

How Telehealth Can Help You Help Your Child

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

telehealth family


A March 2021 survey found that 61 percent of respondents had used telehealth vs. less than 20 percent in March 2020.  The COVID-19 pandemic created a need for a safe way to visit with a medical provider to get non-emergent medical care, and telehealth was the answer.  At District Medical Group (DMG), including DMG Children’s Rehabilitative Services (DMG CRS), we offer telehealth appointments and have encouraged patients to use this technology to continue care for themselves and their families.

While many of our DMG CRS patients have complex conditions, telehealth can still be used to support ongoing treatment and ensure our young patients remain healthy and on course with prescribed treatment plans during the COVID-19 pandemic and beyond.

Here’s some ways telehealth is being used at DMG CRS to support the health of our pediatric patients and support their families:

Intake Appointments for New Patients

While we love to meet new patients and their families in-person, their health and safety is our number one priority.  Fortunately, through a telehealth meeting, we can gather all needed information about our new patient, understand the family’s health and wellness goals for their child, and begin development of a multi-specialty treatment plan. We can also get to know your child and you through these telephone visits.

Consultations with Specialty Providers

Like intake appointments, when a new pediatric specialist is being engaged to support your child’s health, a consultation between you and the DMG CRS medical specialist can usually be completed through a telehealth appointment.  As all clinics within DMG CRS use the same electronic medical records (EMR) system, the new DMG CRS medical specialist can easily view your child’s medical history and discuss next steps with you.

As well, if you have a regular follow-up scheduled with a DMG CRS specialty physician who has been treating your child, it may be able to be completed through a telehealth appointment. Through a telehealth appointment, your child’s DMG CRS physician and you can determine if an in-person visit is needed based on how your child is doing on his/her treatment plan.

Behavioral Health Visits

Because a physical examination is not needed, behavioral health visits are among the easiest to facilitate through telehealth.  COVID-19 has been stressful for people of all ages, including children. That’s why maintaining scheduled visits for your child with his/her DMG CRS behavioral health specialist is important.

Primary Care for Minor Illnesses or Injuries

If your child has a minor scrape or bruise that is concerning you or woke up with a cough, mild fever, or other non-emergent symptoms, contact the primary care clinic at DMG CRS to see if a telehealth visit is appropriate.  In some cases, minor symptoms can be easily diagnosed and treatment prescribed without an in-person examination.

Reengaging with Your Child’s Providers

If you missed regular medical appointments for your child during the COVID-19 pandemic, a telehealth appointment is a good way to reengage your child’s medical provider(s).  Through a telehealth visit, you can provide medical updates so the DMG CRS physician can determine your child’s present health status and make appropriate referrals.

The health, wellbeing and safety of your family is our number one priority.  At DMG CRS, we’re here for you providing options to ensure your child’s treatment plan stays on-track and support you in helping your child live a happy and healthy life.

The Advantages of Walk-in Healthcare at a Primary Care Clinic

By Michelle Martin, APRN, FNP-C, family nurse practitioner

walk-in health care


A 2017 Harris Poll study revealed 66 percent of respondents said they would seek healthcare from sources other than their primary care provider (PCP) such as urgent care clinics or retail pharmacy clinics. 43 percent of these patients cited the “inability to schedule a non-urgent appointment within the same week” as the top reason they would seek medical attention from someone other than their PCP.

To address this gap, more primary care clinics are offering walk-in health care in addition to same day and scheduled appointments.

Benefits of Walk-in Health Services at a PCP Location

Access to medical records:
What many patients do not realize is that medical records resulting from appointments at other medical providers are not automatically shared with the patient’s PCP.

In this same Harris Poll , 65 percent of respondents said they assumed their PCPs would receive updates on their urgent care visits.  In fact, the patient must request in writing with a signature that the urgent care, retail pharmacy clinic or other medical provider send the patient’s medical notes from the appointment to the patient’s PCP. The only possible exception is if the urgent care is owned by the same health system as the primary care clinic and a single electronic health records (EHR) system is used at all locations.

Ease of scheduling follow-up:
“Follow up with your PCP” is a standard among discharge instructions for patients seeking urgent or walk in health services.  Seeking walk-in care at your PCP’s office enables you to schedule any needed follow-up appointments at the time initial help is received; no need to make additional phone calls or go online to schedule an appointment once you get home.

Less potential exposure to illnesses:
Because most patients at the PCP’s office have scheduled appointments many of which are for preventive healthcare (wellness exams, allergy management, etc.), you are likely less exposed to patients with contagious illnesses. While all healthcare facilities- including urgent cares and retail clinics- are likely following strict protocols during COVID-19 to maintain social distancing and sanitary measures, outside of a pandemic, many people seeking urgent care are ill or injured and sitting near each other in the waiting area or lobby.

Expanded hours:
Some PCP locations that offer walk-in health services offer Saturday hours in addition to being open Monday-Friday. In some cases, PCP locations also have extended hours Monday-Friday, opening earlier and staying open later to support walk-in care.

We encourage you to seek the attention you need when you need it.

Remember, if you have a medical emergency, call 911 or have someone take you immediately to a local hospital’s emergency department (ED).  If your PCP does not offer walk-in healthcare or is not open when you have a non-emergent medical illness or injury, urgent care or retail clinics are an option; these locations are generally open seven days a week, including evenings and are staffed by licensed medical providers.  Be certain to follow up with your PCP if you receive care anywhere besides his/her office.


Early Intervention for Infants and Toddlers with Developmental Disabilities

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

child with development disabilities


March is Developmental Disabilities Month.  According to the Centers for Disease Control and Prevention (CDC), the United States has experienced an increase in children with developmental disabilities.  Developmental disabilities would include:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder (ASD)
  • Cerebral palsy
  • Moderate-to-profound hearing loss
  • Learning disability
  • Intellectual disability (ID)
  • Recurrent seizures in the past 12 months
  • Stuttering or stammering in the past 12 months
  • Visual impairment
  • Any other developmental delay

The same CDC study also revealed that some groups of children were more likely to have a developmental disability than others, such as:

  • Boys compared to girls
  • Non-Hispanic white and non-Hispanic black children compared to Hispanic children or non-Hispanic children of other races
  • Children living in rural areas compared to children living in urban areas
  • Children with public health insurance compared to uninsured children and children with private insurance

The CDC found that 17 percent of children 3–17 years-old had a developmental disability, and this percentage increased over the two time periods compared (2009–2011 and 2015–2017).  Specifically, diagnoses increased for ADHD, ASD and ID.

One of the potential reasons for the documented increase is improved awareness, screening, diagnosis, and service accessibility. Healthcare providers and parents/guardians are having more conversations about symptoms (called “developmental delays”) of developmental disabilities early, allowing for improved diagnosis and early intervention.

What is a “Developmental Delay?”

Parents or guardians are in the best position to detect a developmental delay in an infant or toddler.  Developmental delays fall into five categories:

  • Adaptive development: The ability level of a child related to age-appropriate life skills, such as self-care (feeding, dressing, etc.)
  • Cognitive development: How children think, explore and figure things out, including knowledge and understanding and problem solving
  • Communication development: The skills to understand and express thoughts, feelings, and information
  • Physical development: Motor skills defined as children’s abilities to use and control their bodies, including vision and hearing
  • Social or emotional development: how children start to understand who they are, what they are feeling and what to expect when interacting with others

If you sense a developmental delay in your child, surface your concerns to your child’s primary care provider (PCP) immediately.  Your child’s PCP will assess your child through a developmental screening and engage the right specialists and support, as needed, to optimize early intervention.

Benefits of Early Intervention

“Early intervention” describes services and support that help babies and toddlers (from birth to three years of age, in most cases) with developmental delays or disabilities. Early intervention may include speech therapy, physical therapy, behavioral health support and other types of medical services based on the needs of the child and family.

According to the CDC, intervention is likely to be more effective when it is provided earlier in life because:

  • Connections in a baby’s brain are most adaptable in the first three years of life.
  • Services can change a child’s developmental path and improve outcomes for children and their families.
  • Families are better able to meet their child’s needs at an early age and throughout their lives.

As the largest multi-specialty interdisciplinary clinic (MSIC) in Maricopa County, DMG CRS provides all needed medical and support services in one place so your child’s treatment plan is managed through a single medical record.  If you have questions about your child’s development at any age, please contact us to schedule an appointment with a pediatrician or the appropriate pediatric specialist.

7 Tips to Help You Prevent Cancer

By Richard Fowler, MD, internal medicine physician

prevent cancer


Did you know that you make choices every day that impact your risk of cancer?  Research shows that approximately 50 percent of cancer cases are preventable with knowledge and early detection being key.

February is Cancer Prevention Month, and below are seven tips to help you decrease your risk of cancer.

Don’t use tobacco products and/or subject yourself to secondhand smoke.

While smoking is most associated with lung cancer, bladder, breast, cervical, colorectal, esophageal, mouth and throat cancers have also been linked to tobacco use.

Protect your skin from the sun.

Did you know that in Arizona 85-90 percent of the 365 days in the year are sunny?  While our attractive climate makes enjoying the great outdoors inviting, the risk of skin cancer, including melanoma, is greater.  Skin cancer is not only the most common form of cancer in the United States, but it’s also one of the most preventable.  Be certain to protect your skin from the sun’s ultraviolet radiation using a sunscreen of 30 SPF or higher and reapply every two hours.

Eat (and drink) healthy.

A balanced diet that includes plenty of beans, fruits, vegetables, and whole grains and limits red meat is recommended to improve your overall health and decrease the risk of cancer as well as other conditions such as cardiovascular disease.  In addition, delete processed meats from your diet, and limit alcohol consumption to no more than two drinks daily if you are a man, and one for a woman.  Alcohol consumption increases your risk of breast, colorectal and liver cancers.

Maintain physical activity and a healthy weight.

Exercise has numerous health benefits, including decreasing stress, increasing energy and positive attitude, supporting a healthy weight, and strengthening the immune system. Did you know a minimum of 30 minutes of physical activity daily can also decrease your risk of cancer? Lack of exercise and obesity have been linked to breast and colorectal cancers, and some evidence has revealed a connection to lung and pancreatic cancers.

Practice safe sex.

High-risk strains of the human papillomavirus (HPV), which is spread through skin-to-skin contact during anal, oral, and vaginal sex, have increasingly been found to cause many types of cancer, including liver cancer. Use protection during sex, know your partner’s sexual history, and limit your number of partners.

Get the HPV and hepatitis vaccinations.

Certain viruses have been linked to cancer but can be prevented through vaccinations. For example, approximately one-third of liver cancers are connected to hepatitis B (HBV) and hepatitis C (HCV) viruses.  Vaccinations are available and recommended for certain age and/or risk groups; speak with your primary care provider (PCP) to determine if vaccinations are appropriate based on your age, risks, and other factors.

Get regular cancer screenings and annual exams.

If you do not have a PCP, find one and not only schedule an annual exam but share your complete medical history as well as that of your family.  Your PCP will partner with you to assess your risk of cancer and other diseases, schedule appropriate screenings such as a mammogram, PAP smear, and/or colonoscopy, and design a health and wellness plan that is right for you.

To find a District Medical Group PCP near you, click here.


COVID-19 Pandemic and Your Heart Health

By Ivan Filner, DO, family medicine physician

couple cuddling on couch


Whether you have had COVID-19 or not, the pandemic may have impacted your heart health or that of a loved one.  February is American Heart Month, and a great time for all of us to learn more about heart disease and factors that increase our risks, some of which were exacerbated by the pandemic.

Did you know that according to the American Heart Association, heart disease is:

  • The number one killer of Americans?
  • Diagnosed in about one of three women annually?
  • Increased 171 percent worldwide in the past decade?
  • Preventable in most cases?

Indirect Impacts of COVID-19

Studies by the American College of Cardiology have highlighted the indirect impacts of the COVID-19 pandemic on the heart health of people of all ages.

Delay in seeking care due to fear of contracting COVID-19

While the best way to avoid getting COVID-19 is to stay home, some people with symptoms of stroke or heart attack are not seeking or are delaying getting medical care, resulting in increased heart-related mortalities.  In addition, annual wellness exams and/or regular check-ups have been by patients to mitigate the risk of contracting the coronavirus.

Weight gain, aka “quarantine 15”

With many services, like gyms, closed and people encouraged to stay home, eating increased and activity decreased for many of us resulting in the addition of “pandemic pounds.”  An increase in body fat is directly related to cardiovascular disease.

Decline in mental and/or emotional health

A Kaiser Family Foundation (KFF) poll found that 53 percent of adults in the United States reported their mental health had been negatively impacted by the pandemic due to increased worry and stress.  In discussing the “head-heart connection” with the American Heart Association, Nieca Goldberg, MD, medical director for the Joan H. Tisch Center for Women’s Health at New York University’s Langone Medical Center, shared, “Stress can increase hormones like adrenaline and cortisol, and can impact your blood pressure and heart rate.”

Increase in alcohol and/or substance abuse

Of those responding to the KFF poll, 12 percent reported increased alcohol consumption and/or substance use.  Drinking more than three servings of alcohol per day leads to a level of toxic substances in the blood that directly increases the risk of heart attack. As well, according to the American Heart Association, “most illegal drugs can have adverse cardiovascular effects, ranging from abnormal heart rate to heart attacks.”

If you’ve been impacted by any of the above, schedule an appointment with A DMG primary care provider.  Together, we can develop a care plan to get you back on the road to optimal health.


Share the Love, and Partner Up to Lose Weight

By Brett Willden, DO, family medicine physician

couple jogging in nature


Have you gained the “quarantine 15?”  If you have, chances are your partner has put on some pandemic pounds as well.  According to the National Institute of Health (NIH), an individual’s weight loss or weight gain is strongly affected by one’s romantic partner; in fact, having an obese spouse increases one’s own risk for obesity by 43 percent.

The good news is pursuing weight loss together will increase your chances of achieving your goals.  A recent European Society of Cardiology study presentation found couples who hold each other accountable for healthy lifestyle changes had a better shot at shedding that quarantine 15 compared to control groups that tried affecting change on their own.

February is American Heart Month, and, of course, Valentine’s Day is February 14th.  What better way to improve your heart health and show your love for each other than starting your weight loss journey together?

Here’s some tips for a successful weight loss partnership:

Recognize your differences.
Men and women gain and lose weight in different areas of the body as well as in different ways.  For example, the way metabolism works is different in men and women; water retention impacting weight is also a primary difference between the sexes.  Speak with your primary care provider (PCP) to understand your differences so you can each support and empathize with each other as well as have realistic expectations.

Plan meals together.
Decreasing calories does not have to mean going hungry or eating foods you don’t like.  Plan your meals, shop for ingredients, and cook meals together to increase the enjoyment and benefits of your weight loss journey.

Get active together.
For some, “exercise” is a dreaded word. Plan ways to get active that you can do together, so the focus becomes on time together- something you like doing- instead of exercise.  For example, take your dog for long walks together; sign up for dance lessons, karate, or another activity in which you are both interested together.

Hold each other accountable thoughtfully.
Be a cheerleader for your partner, not a cynic. Putting a person down, pestering or criticizing are not optimal ways to provide support and hold your partner accountable. Keeping a journal of what you eat and your activity levels is often recommended as part of a weight loss program; share your journals with each other, talk about what worked and what did not that day, and identify solutions together.

Communicate with each other.
As you begin your weight loss journey together, share with each other your concerns, vulnerabilities, etc.  Talk about what causes you to overeat, so you can support each other along the way as those instigators show up.  For example, “emotional eating” is common, and a stressful day can ignite a desire to eat more and/or choose “comfort” foods.  Understanding these areas of vulnerability will help each of you be aware and support each other during those challenges.



What You Need to Know about Cervical Cancer

By Dana Putman, FNP-C, family nurse practitioner

group of women


Did you know January is Cervical Cancer Awareness Month? According to the American Cancer Society, cervical cancer is one of the most common causes of cancer death among women; however, cervical cancer is highly preventable and treatable.  With the increased use of Pap test screening, the death rate has dropped but has remained consistent for the past 10 years.

What is cervical cancer and how do you get it?

Cervical cancer occurs in the cells of the cervix, which is the lower part of the uterus that connects to the vagina.  Strains of the human papillomavirus (HPV), a sexually transmitted disease (STD), play a role in causing most cervical cancer. In a small percentage of women, HPV survives for years and contributes to the process that causes cervical cells to become cancerous.

What are the symptoms of cervical cancer?

In its early stages, cervical cancer often has no signs or symptoms.  In more advanced stages, cervical cancer symptoms may include:

  • Pain during intercourse or pelvic pain
  • Vaginal bleeding after intercourse, between periods or after menopause
  • Watery, bloody vaginal discharge that may be heavy and have a foul odor

Can I prevent cervical cancer?

As with many diseases, screening, and early detection and diagnosis are key to optimal health outcomes. You can reduce your risk of cervical cancer by:

  • Having screening tests, including a Pap test as part of your annual well-woman exam
  • Practicing safe sex by using condoms to decrease the risk of STDs
  • Receiving the HPV vaccine to protect yourself against HPV infection

Screening can prevent most cervical cancers by finding abnormal cervical cell changes (pre-cancers) so that they can be treated before they have a chance to turn into a cervical cancer.  Most cervical cancers are found in women who have never had a Pap test or who have not had one recently.

Who is most at risk for cervical cancer?

As with many diseases, risk factors for cervical cancer include things within your control as well as factors you cannot control.  To decrease your risk of cervical cancer, focus on making changes to those factors you can possibly change.

  • HPV infection: HPV is the most important risk factor for cervical cancer and is a group of more than 150 related viruses that are spread through skin-to-skin contact. Decrease your risk of certain types of HPV infection by getting the HPV vaccine. As well, understand the signs and symptoms of HPV infections and seek medical treatment immediately.
  • Sexual history and activity: HPV is a sexually-transmitted disease so those who begin having sex at a young age, have many sexual partners, and/or have a sexual partner who has HPV or who has many sexual partners increase their risk of getting HPV, the leading cause of cervical cancer.
  • Smoking: Women who smoke are about twice as likely to get cervical cancer.
  • Weakened immune system: The immune system is critical to killing cancer cells and/or slowing their growth. Women with HIV, autoimmune diseases, and/or who have had an organ transplant are at higher risk of cervical cancer.
  • Chlamydia infection: Chlamydia is a bacteria that is sexually transmitted and can infect the reproductive system. Some studies have shown a higher risk of cervical cancer in women with chlamydia as it may help HPV grow.
  • Long term use of birth control pills: Research suggests that birth control pills or oral contraceptives (OC) increase the risk of cervical cancer the longer the woman takes OCs; however, the risk decreases again after the OCs are stopped and returns to normal many years after stopping. IUDs may be a viable birth control option.
  • Multiple full-term pregnancies: Studies have suggested that women who have had three or more full-term pregnancies have an increased risk of developing cervical cancer due to hormonal changes during pregnancy possibly making these women more susceptible to HPV infection and/or cancer growth.
  • Young age at first full-term pregnancy: Women whose first full-term pregnancy was at age 20 or younger are more susceptible to cervical cancer than women age 25 older.
  • Diet low in fruits and vegetables
  • Diethylstilbestrol (DES): DES is a hormonal drug that was given to some women to avoid miscarriages; DES was used primarily from 1938 to 1971. A woman whose mother took DES is not at a higher risk of cervical cancer.
  • Family history of cervical cancer

We’re here to help you understand cervical cancer and control your risk factors. For more information about cervical cancer or the HPV vaccination or to schedule your annual well-woman exam and screening, please contact a DMG primary care provider.

COVID-19 and Kids’ Mental Health

By Melissa Meyer, DNP, PMHNP-BC, child psychiatry specialist at DMG Children’s Rehabilitative Services

family in kitchen

2020 has been a year like no other, especially for children.  Kids have had to completely change their routines, including:

  • Attending school from home (“virtual learning”)
  • Limiting and/or eliminating in-person social activities
  • Limit extracurricular activities, such as team sports, clubs, etc.

All the above activities are critical to providing balance to a child’s life, and without these options, children, like many adults, may be feeling isolated.  And to top it off, we don’t know when things will change and return to “normal.”  As a result, children may feel increased stress, fear, anger, hopelessness, anxiety and may experience depression.

Depending on how old your child is, he or she may deal and/or reveal these emotions in different ways.  Adolescents and young adults may try to hide their struggles because of fear, shame, or a sense of responsibility to avoid burdening others. Younger children may not know how to talk about these feelings but may show changes in their behavior or development.

Here’s some tips for supporting your child through these uncertain times and helping them deal with these confusing emotions.

  1. Check in with your child often. Ask him or her how he or she is feeling and be (age appropriately) open in sharing how the changes brought on by the pandemic are impacting you.  The goal is for your child to know that his or her feelings are not “strange,” and people of all ages are having these emotions.  At the same time, you want to share empathy and confidence with your child.
  2. Watch and listen for signs that your child is struggling.
    1. Younger children: Bedwetting; fussiness, tantrums or hitting; difficulty sleeping; taking steps backward in development; stomach issues such as nausea or loose stool; and/or separation anxiety
    2. Adolescents: Challenges sleeping; changes in mood or increased moodiness; decreased appetite and/or weight loss; less interest in activities previously enjoyed, including texting and video chatting; issues remembering things; less interest and/or apathy for academics and schoolwork; use of alcohol or drugs or new risky behavior; talk or interest in suicide; and/or lack of personal hygiene
  3. Stay in touch with your child’s primary care provider (PCP) or pediatrician through telephone, patient portals, and/or in-person or telehealth visits. He/she can do basic depression evaluations and help you determine if additional support is needed, be it counseling/therapy, medication, or other tools or activities to help your child.

DMG Children’s Rehabilitative Services has behavioral health providers to support children of all ages.  As a parent,you’re not alone; healthcare providers are here to support the health of your child and your entire family.