Stroke Awareness and Prevention

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By Richard Fowler, MD, internal medicine physician

stroke awareness

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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

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

telehealth family

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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

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

walk-in health care

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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

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

child with development disabilities

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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

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By Richard Fowler, MD, internal medicine physician

prevent cancer

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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

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By Ivan Filner, DO, family medicine physician

couple cuddling on couch

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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

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By Brett Willden, DO, family medicine physician

couple jogging in nature

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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

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By Dana Putman, FNP-C, family nurse practitioner

group of women

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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

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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.

Healthy Weight, Diabetes and Your Child

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By Troy Nelson, MD, Medical Director at DMG Children’s Rehabilitative Services

children outdoors

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Did you know November was American Diabetes Month?  According to the American Diabetes Association, more than 34 million people in the United States have diabetes, and more than seven million of those people are undiagnosed. About 210,000 Americans under age 20 are estimated to have diagnosed diabetes.

Type 1 Diabetes: Diagnosed at Younger Ages

According to the Centers for Disease Control and Prevention (CDC), type 1 diabetes accounts for approximately 5-10% of diabetes cases in the United States.  Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults.

Type 2 Diabetes: Increasing Pediatric Cases

Type 2 diabetes is the most common type and is generally diagnosed in middle age or older.  However, the incidence is on the rise in children because more children are becoming obese.  Being overweight or obese increases the risk of developing type 2 diabetes, regardless of age.

Symptoms of Type 2 Diabetes in Children

Your child may develop type 2 diabetes so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up, which is why regular well-child exams are important.

Symptoms of type 2 diabetes in your child may include:

• Blurry vision
• Darkened areas of skin, especially around the neck and armpits
• Fatigue
• Frequent urination
• Increased thirst

Type 2 Diabetes Risk Factors in Children

• Age and sex: Many children develop type 2 diabetes in their early teens. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
• Family history
• Inactivity
• Overweight, especially in the abdomen
• Pre-term birth (before 39-42 weeks)
• Race or ethnicity: Black, Hispanic, American Indian, and Asian American people are more likely to develop type 2 diabetes

Preventing and Managing Pediatric Type 2 Diabetes

You can help decrease the risk of your child getting type 2 diabetes as well as help manage it if your child has been diagnosed.

• Get an annual well-child exam with your child’s pediatrician or family medicine provider.
• Eat healthy foods as a family; encourage your child to participate in meal planning and preparation.
• Ensure your child gets plenty of physical activity; identify activities you can do as a family, like hiking or walking the dog.
• Help your child maintain a healthy weight.

DMG Children’s Rehabilitative Services includes pediatric and young adult providers,  endocrinologists and nutritionists to support your child and your family.  We are committed to educating you and your child and developing treatment plans to optimize your child’s health and long-term wellness.

 

Supporting Your Kids through Holiday Stress

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

family at Christmas

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The holidays are a time of peace, love, joy, and family, but it’s also a time where schedules are irregular, routines are disrupted, meals are heavier, and sugar abounds.  For children of all ages, these changes can be difficult; if the child has depression, anxiety, an eating disorder, attention deficit disorder (ADHD) or other emotional or behavioral health challenges, the holidays can compound the issue.

Did you know?

  • Depression and anxiety: According to a 2019 study published in the Journal of Pediatrics, about 1.9 million children ages 3 to 17 years have been diagnosed with depression, and 4.4 million have been diagnosed with an anxiety disorder.
  • ADHD: Nearly 6.1 million kids ages 2 to 17 have been diagnosed with ADHD, according to a 2018 study in the Journal of Clinical Child & Adolescent Psychology.

If your child suffers with emotional or mental health issues, here’s some tips to help you child and your family decrease the stress and impact of the holidays:

  • Communicate plans: With each activity or outing, let the child know what will be happening ahead of time- who will be there, how long you will be staying, what food to expect, etc.  Knowing what will be happening will help decrease anxiety.
  • Share feelings: If you are feeling stressed, tired, or anxious, share your feelings with the child.  He or she will take comfort in knowing that even adults get nervous and stressed during the holidays.
  • Maintain a sleep schedule: Everyone in the family will benefit from a good night’s rest, especially children. According to the American Academy of Sleep Medicine, kids with mental health issues need adequate sleep; for teens, 8 to 10 hours per night is recommended.
  • Manage screen and device time: When adults are busy, it’s easy for children of all ages to occupy themselves with television, video games, and social media. However, too much “technology time” has proven to negatively impact sleep as well as contribute to depression.
  • Keep medication schedules: If a child takes medication, ensure he or she continues to take it at the same time each day.
  • Watch sugar intake: Help keep the child’s diet balanced with regular nutritious meals and limit sweets and sugar-filled drinks, especially before bedtime.

Most importantly, be aware of the child’s mood and listen to him or her.  The child or teen make need some downtime in between the hustle and bustle of the holidays.  Allow time in the family’s schedule for everyone to decompress, so each member of your family can enjoy the spirit of the holidays.

What’s the Connection between Healthy Weight and Diabetes?

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By Brett Willden, DO, family medicine physician

overweight family near the water

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Did you know November is American Diabetes Month?  According to the American Diabetes Association, more than 34 million people in the United States have diabetes, and more than seven million of those people are undiagnosed.  

There are two types of diabetes, type 1 and type 2, and in both cases, healthy weight management is important.  However, why weight management is important is different.

Type 1 Diabetes 

According to the Centers for Disease Control and Prevention (CDC), type 1 diabetes accounts for approximately 5-10 percent of diabetes cases in the United States.  Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults.

Like type 2, increased thirst and urination are common symptoms of type 1 diabetes.  Undiagnosed or untreated, type 1 diabetes can cause weight loss.  

Unlike type 2, developing type 1 diabetes is not related to being overweight, but keeping a healthy weight is important. Too much fat tissue can make it hard for insulin to work properly, leading to both higher insulin needs and trouble controlling blood sugar.

Type 2 Diabetes 

Type 2 diabetes is the most common and is generally diagnosed middle age or older.  Being overweight or obese increases your risk for developing type 2 diabetes, regardless of age.  As well, if you have type 2 diabetes, weight gain complicates the condition as it makes blood sugar levels even harder to control.

Healthy Weight Management

Many primary care providers (PCP) treat patients with diabetes and other chronic conditions, as well as help patients understand how to live a healthy lifestyle to decrease their risks of diabetes and other diseases.  Our goal, as PCPs, is to identify treatment plans that are achievable based on the patient’s lifestyle.  Talk with your PCP about identifying a weight loss program that’s right for you, your lifestyle, and weight loss goals.  And remember, weight management is a long-term lifestyle- not a short-term fix.

Dental Health in Children: Get the Facts

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By Lyn Hughes, dental hygienist, DMG Children’s Rehabilitative Services

parent and doctor showing young child how to brush teeth

October is Dental Hygiene Month, which is somewhat ironic as Halloween, the day of the year where children probably get more candy than ever, is also in October.  So, why not take this month to talk to your children about the importance of taking care of their teeth?

Getting your children into healthy dental habits now can save them time and pain and give them advantages throughout their lives.  According to the Centers for Disease and Control and Prevention (CDC), children who have poor oral health often miss more school and receive lower grades than children who don’t.

Did you know cavities are one of the most common childhood diseases in the United States?

When untreated, tooth decay can cause pain and infections which can lead to problems with eating, speaking, playing, and learning.

The CDC also shares these facts about cavities in children:

  • 20 percent of children ages 5-11 and 13 percent of adolescents have at least one untreated cavity.
  • Children ages 5-19 from low income households are more than twice as likely to have untreated tooth decay.
  • About one-third of cavities in baby teeth can be prevented by a fluoride varnish.
  • Dental sealants applied to the surfaces of back teeth can prevent 80 percent of cavities.

Beginning dental care when your child is a baby is a great first step towards optimal dental health.  Schedule your child’s first pediatric dental care appointment at the age of one to spot signs of early problems.  We’ll help you identify good at-home dental habits to engage your child in taking care of his or her pearly whites for a lifetime.

What Is Pediatric Physical Therapy?

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By Linda Thunn, DPT, physical therapist at DMG Children’s Rehabilitative Services

young child receiving physical therapy

Did you know October is National Physical Therapy Month?  Each year during October, the physical therapy team at DMG Children’s Rehabilitative Services (DMG CRS) supports the Spina Bifida Association of Arizona through their annual Walk-N-Roll® fundraiser.  The team is passionate about serving patients I and outside of the clinic.

What do pediatric physical therapists do?

Pediatric physical therapists provide services for children with developmental disabilities from birth to 21 years-old; in addition, the team provides support and education to the patient’s family.  At DMG CRS, our goal is to develop, restore and/or improve mobility to enhance quality of life for the child and his/her family.

Pediatric physical therapy benefits children and their families and/or caregivers by promoting activity and participation in everyday routines, increasing functional independence, improving strength and endurance, facilitating motor development and mobility, and easing the challenges of daily caregiving.

The team has also begun serving adults with disabilities who may benefit from the services specifically available through DMG CRS.

DMG CRS physical therapists treat patients one-on-one in the physical therapy and rehabilitation clinic at DMG CRS as well as serve patients being treated at other DMG CRS clinics such as:

DMG CRS physical therapists also perform equipment evaluations, trialing each child in specialized equipment before ordering it to determine what works best. Types of equipment evaluations provided include:

  • Adaptive seating
  • Adaptive car seats
  • Forearm crutches
  • Gait trainers
  • Standers
  • Walkers
  • Wheelchairs

Additional Content

For more information on DMG CRS equipment evaluation services, watch this video.

For additional information on  the services offered by DMG CRS physical therapists, view this video.

 

Detecting Breast Cancer Early

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By Faith Cutrona, FNP-C, family nurse practitioner

happy group of people in front of brick wall

Contents:

October is Breast Cancer Awareness Month, and as a primary care provider and woman, sharing information to help women understand the importance of early detection is the most important care I provide.  The more each patient is educated, the greater the chance that she will get regular exams so breast cancer- or another disease- can be caught early.

Did You Know?

According to the American Cancer Society, breast cancer……

  • Is the second most common cancer in women in the United States. The first is skin cancer. The average risk of a woman developing breast cancer sometime in her life is about 13 percent.
  • Typically has no symptoms when the tumor is small and most easily treated.
  • Impacted approximately 268,000 women in 2019.
  • Risk increases with age.
  • Survival rate drops to less than 30 percent if the cancer has spread (aka “metastasizes”) outside of the breast to other organs in the body.

Early Detection: What You Need to Do

Remember, if detected early, the breast cancer survival rate greatly increases.  Women who get breast cancer screenings decrease their chance of dying from breast cancer by 30 percent.  Breast cancer screening saves lives, and getting an annual mammography is the single most important thing a woman can do to lessen her chances of dying from breast cancer. Mammography can detect cancer at early stages before a lump can be felt or symptoms are experienced.  

An annual mammography is recommended for women age 40 and older and may be recommended sooner if the patient has had cancer or if a history of cancer is in the family.  Understanding and sharing your complete family medical history with your primary care provider (PCP), therefore, is critical.  In addition to annual mammography, your PCP will also recommend you do self-exams of your breasts at-home and can help you understand how to do these exams.

Screening Mammography: What to Expect

A breast screening are also called  a “screening mammogram,” which is the type of mammogram ordered when the patient has no symptoms and/or signs of changes in breast tissue.  A mammography is a fast procedure (about 20 minutes), and discomfort is minimal for most women. During a mammography, a low-energy x-ray is used to examine the breast for early signs of breast cancer.  The small amount of radiation the patient is potentially exposed to is so small that the benefits outweigh the risk.

3D mammography is being used increasingly, especially for women with dense breast tissue. FDA-approved, 3D mammography takes pictures of thin “slices” of the breast from different angles, and computer software is used to reconstruct an image.  In contrast, a standard mammography takes a single image.

Changes in the Breast: What Next?

If changes in one or both breasts are detected, a diagnostic mammogram will be ordered.  Changes in breast include:

  • Changes in skin texture of the breast
  • Inversion in the nipple
  • Nipple discharge
  • Pain in the breast
  • Palpated lump

If breast cancer is detected early, a mastectomy or total breast removal can be avoided.  Localized cancers can be managed through other treatments, which may include a lumpectomy, radiation and/or chemotherapy.

The key is early detection.  Schedule your annual exam with your PCP today, and include breast screenings in your wellness plan.

Healthy Aging: Tips for Your Health

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By Lauren Lambert, FNP-C, family nurse practitioner

couple running the forest

Contents:

First introduced when baby boomers began turning 50, September is Healthy Aging Month.  While September marks “back-to-school” for children, we adults can use this time to learn some new lessons to support our overall health and wellbeing.

As a primary care provider (PCP), I support the health and wellbeing of adult patients, and each patient is different.  However, one thing remains the same: our health is dependent on physical, emotional, and mental wellbeing.  Here’s some tips to support each of these areas for healthy aging.

Preventive medical exams

Stay on top of your annual wellness exams and screenings.  As we age, the types of screenings recommended change and include:

  • Diabetes testing: Begins at age 45 and should be completed every three years
  • Colon cancer screening: Should begin no later than age 50 and be done every five years
  • Osteoporosis screenings: Should start no later than age 65
  • Blood pressure readings: Should be taken annually, beginning at age 45
  • Vision and balance: To prevent falls resulting in hip fractures, traumatic brain injuries or even death, both your vision and balance should be checked at least annually.

For all the above, if you have a personal or family history, your physician may recommend tests or screenings begin earlier or be done more frequently.

Physical activity

Staying active is exercise for your body and brain and helps reduce stress.

  • Exercise: Exercise daily. Choose an activity you like so you look forward to doing it.
  • Balance: Identify an activity that helps you maintain balance and flexibility, like yoga, to decrease your risk of falls.  Your PCP can also provide exercises to improve your balance.

Socialize

See old friends as well as make new ones; socializing is great for the brain and supports emotional wellbeing.  In addition, you may find others with whom to enjoy exercising and new activities.

  • Volunteer: Most of us have a ton of life experience, which can enrich the lives of others. Find a cause that speaks to you and volunteer your time and skills to help others.
  • Play cards or board games: Games keep our minds sharp and provide a great way to socialize and meet new people.

Sleep

Getting the right amount of sleep is important throughout our lives.  As we get older, ensuring we get enough sleep- but not excessive- is important to refresh our bodies and minds.

Prostate Cancer Awareness

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By Richard Fowler, MD, internal medicine physician

prostate cancer awareness

Contents:

Each year, more than 160,000 men in the United States are diagnosed with prostate cancer, and approximately 19 percent die from it.  Prostate cancer is the second leading cancer-related cause of death among men.  To raise awareness and early detection, September is designated as Prostate Cancer Awareness Month.

Five facts about prostate cancer:

  1. Prostate cancer is typically slow-growing, making early detection more likely if the patient sees his physician for regular exams and screenings.
  2. Older men are more likely to get prostate cancer. About 60 percent of cases are in men age 65 and older.
  3. African-American men are more likely to develop prostate cancer than white or Hispanic men; Asian men have a lower risk.
  4. Major risk factors are genetics and family history. Studies examining the link between prostate cancer and a diet high in red meat, chemical exposures including smoking, sexually transmitted infections and having had a vasectomy have produced conflicting results.

Screening

The American Cancer Society recommends that at age 50, men discuss the risks and benefits of screening with their physician.  African American men and those with a family history of prostate cancer should have this discussion at age 40-45.  Screening includes two tests one of which is a blood test and the other a digital rectal exam.

Symptoms

Early stage prostate cancer may cause few or no symptoms.  As this cancer progresses and tumors grow, symptoms may include:

  • Blood in the urine or semen
  • Difficulty getting an erection
  • Difficulty urinating
  • Pain in the lower back and hips

As the cancer spreads and/or metastasizes, other symptoms, like bone pain, may occur.  Treatment is dependent on the stage of the cancer and may include medications, surgery, radiation, chemotherapy, hormone therapy, and/or other options.

Talk with your primary care physician for more information on prostate cancer and your risks.

Newborn Screenings: What You Need to Know

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

Newborn Baby

Did you know September is Newborn Screening Awareness Month?  Newborn screening allows identification and treatment of a disease before symptoms even emerge.  A newborn may appear healthy, but still have a serious condition that cannot be seen.  If left untreated, these conditions can lead to slow growth, blindness and/or intellectual disability, and may be life threatening. Early detection and treatment can help prevent these serious problems, which is why newborn screening is critical.

Based on published research by Dr. Robert Guthrie in 1963, newborn screenings have evolved with newborns now being screened for more than 25 conditions within days of birth; screenings involve just a few drops of blood.  According to the National Institute of Health, newborn screening detects a treatable condition in about 1 in 300 babies born each year, a total of about 12,500 cases each year. In Arizona, approximately 100 babies annually are found to have a serious condition identified through newborn screening.

Providers in Arizona are required by law to order newborn screening tests for all newborns.  Arizona requires newborns to be screened twice to help ensure accuracy, as some conditions are easier to detect on a subsequent screen.  In addition, approximately 98 percent of all infants born in Arizona are screened for hearing loss prior to hospital discharge.  The first screening sample will be taken before the newborn leaves the hospital and the second will be taken between 5-10 days after birth, or at the first well-baby visit, whichever comes first. For those newborns born at home, the healthcare provider present at the birth will collect the first screen.

At DMG Children’s Rehabilitative Services (DMG CRS), we provide specialized treatment for newborns for which a condition was detected during screening.  Our goal is to provide most medical specialties and services in one location by physicians and staff that work exclusively with children.  With early detection, intervention, and treatment, we can partner with you and your family to enable your baby to thrive to the maximum of his or her abilities.

UV Safety for Motorcyclists

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By Ivan Filner, DO, family medicine physician

Dr. Fillner on a MotorcycleAnyone who knows Dr. Filner knows that when he is not caring for patients, he can be found riding his Harley. In Arizona, we are fortunate to have many great months for long rides due to Arizona having more sunny days (85-90 percent per year) than almost all other states. In fact, we have more sunny days per year than California and Florida.

Have you ever heard the saying, “For every strength, there is a weakness?” This “law of opposites” applies to our good fortune in having so many sun-drenched days. The downside is more exposure to ultraviolet (UV) rays, which can result in premature aging of the skin and worse- skin cancer. Even on sunny days in winter, UV rays are just as harmful.

As a motorcycle rider, we wear protective gear from head-to-toe, so why would we need to worry about excessive UV ray exposure? Even with a full face helmet, parts of the face- primarily the nose, cheeks and lips- are exposed for longer than you think…long enough to put you at risk of a severe sunburn, which can lead to skin cancer, including melanoma.

Fortunately, protecting yourself from dangerous UV rays while riding is easy. Follow these tips year-round to ensure you’re riding for a long time to come.

1. Protect your face, neck, ears, and other exposed skin

Carry a small tube of sunscreen with an SPF of 30 or more in your jacket pocket, tank bag or panniers, and re-apply every two hours during your ride. If your sleeves do not quite meet your gloves, put sunscreen on your wrists.

2. Shield your lips

As your lips are also vulnerable to skin cancer, use a lip balm with an SPF of 30 (but no less than 15) and, like sunscreen, reapply throughout your ride.

3. Safeguard your eyes

Did you know melanoma can occur in your eyes? While they may be a bit more expensive, choose sunglasses that provide 100 percent UV protection, or UV 400 protection.

4. Protect the back of your neck

In addition to sunscreen, a light neck sock with an SPF rating is a good way to protect the back of your neck (and parts of your face), especially for sports bike riders who are bent over.

When many of us stop during our ride, we take off some gear, leaving more of our skin exposed to the sun. Be certain to apply sunscreen to those areas. A sunburn and/or the start of melanoma only take minutes, especially when in direct sun during our beautiful Arizona days.

We’re Here for You…Safely

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doctor with gloves and face mask

Valued DMG Patient:

As part of the District Medical Group (DMG) family, we want to ensure you know we are here for you. Throughout the COVID-19 pandemic, DMG locations across the Valley have remained open to support the health of our patients.

We understand you may have concerns about leaving your home right now, especially if you or a family member is not feeling well and needs medical care. We are employing safety measures recommended by the Centers for Disease Control and Prevention (CDC) to protect you and your family as well as our staff, including:

  • Safe screening practices for all patients and families prior to an in-person office visit
  • Availability of telehealth appointments, as appropriate, so you can meet with your DMG provider safely and securely from home
  • Enhanced office cleaning and personal protection procedures, with hand sanitizer readily available in our locations
  • Social distancing measures at check-in, checkout and in our waiting rooms, including rapidly moving patients that are sick to a private room
  • Use of masks and face shields by all providers and staff while caring for our patients
  • Providing cloth facial coverings to patients and any required family member entering the clinics without a cloth masks

Whether you or a family member needs to visit a DMG primary care location for preventive care (i.e. annual exams, screenings or vaccines), treatment of seasonal allergies or illness, behavioral health support, or management of a chronic or complex condition, we are here for you, providing a safe, clean environment. Our DMG primary care and behavioral health locations are open and available for in-person and telehealth appointments.

Contact the desired location to get the care you need when you need it:

 

Behavioral Health

DMG Desert Horizon Integrative Medicine
840 E. McKellips Rd., Ste. 110
Mesa, AZ 85203
(602) 470-5520

 

Internal Medicine

District Medical Group- East Mesa
(formerly Arizona Center for Internal Medicine)
6315 E. Main St., Ste. 4
Mesa, AZ 85205
(480) 830-4164

 

Family Practice

District Medical Group- Anthem*
(formerly Choice Medical Walk-in)
3624 W. Anthem Wy.
Anthem, AZ 85086
(623) 434-5748

District Medical Group- Lake Pleasant*
(formerly Choice Medical Walk-in)
10144 W. Lake Pleasant Pkwy., Ste. 1110
Peoria, AZ 85382
(623) 434-5748

*Walk-in care available at these locations

District Medical Group- Arrowhead
(formerly M&M Medical)
15182 N. 75th Ave.
Peoria AZ 85381
(623) 487-3334

 

For more information on each location’s hours of operations, services, and providers, visit DMGAZ.org. If you have any concerns, do not hesitate to call us. You are part of the DMG family, and we are here for you.

Sincerely,
David Wisinger, MD
Chief Medical Officer
District Medical Group