HAND WASHINGAmy Movius MDThe influenza season was rough this year, filling Maine hospitals to capacity. Warnings about new “superbugs” are in the media nationally and abroad. Several schools across the country (including our neighbor Vermont) have temporarily shut down because of rampant stomach flu, which is making the rounds locally as well. How do you keep yourself healthy?? Wash your hands!Hand Washing is the single most important thing you can do to prevent illness. Most of us use our hands constantly. Infection (germs) can be transferred to our hands by everything we touch. This infection can then be transferred into our bodies by touching our eyes or nose or mouth. Of course, if you already have an infection you can likewise spread it to everything you touch. These germs can then be picked up by others and so the infection goes around and around. It is estimated hand washing with soap could prevent 1 out of 3 cases of childhood diarrhea and 1 out of 6 cases of childhood respiratory infection worldwide (2,3).People tend to think they are more conscientious about hand washing than they really are. One study found that, even though over 90% of adults reported always washing their hands after using a public restroom, only about 4 out of 5 were actually doing it. In middle and high schools, less than 60% of girls and 50% of boys were observed to clean their hands after using school restrooms. People routinely admit to less hand washing after using their home bathrooms. Hand washing can dry and chap the skin. If skin irritation becomes a problem, pick a mild soap and moisturize after each washing. Sometimes there is no washing facility nearby. Keeping waterless soap or sanitizer (at least 60% alcohol) available is an alternative in this circumstance.Below is a list for when and how you should wash your hands – and gently remind others to do so if needed.Before: Eating After: Using the bathroom (or diaper changing) Blowing nose/coughing/sneezing Touching animals Touching pet food/treats Touching garbage Outdoor activitiesBefore and After: Preparing or serving food Taking care of a cut or wound Visiting/caring for anyone who’s sick How: Use any type of soap and warm running water Wash all of your hands: front and back, fingers, nails, wrists Wash for at least 20 seconds, or two rounds of “happy birthday” Rinse well and pat hands dry with a clean towel Use paper towels to turn faucets and door handles in public bathrooms1. www.cdc.gov/handwashing/ – Cached2. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008 Jan 23:(1):CD004265.3. Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan:8(1):97-104. >
MARCH IS COLORECTAL CANCER SCREENING MONTHBy: Dr. Joan PellegriniColorectal cancer (CRC) is the second most common cause of cancer (excluding skin cancers) and cancer deaths in Maine. The good news is that it may be somewhat preventable. Over the last 20 years there has been a national effort to increase the number of people being screened for this disease. Also over the last 20 years there has been a decline in the death rate from CRC. It is felt that this is partly due to more people being screened for CRC. Screening allows precancerous polyps to be found and removed before they develop into cancer. CRC starts from a small precancerous polyp which can be removed at the time of colonoscopy. If this polyp is not removed, then it becomes a cancer. Even if it is cancerous, it is better to remove it when it is still small because the procedure can be easier and there is less chance of spread to other organs. Once CRC has spread outside of the colon then chemotherapy and radiation may be needed and this makes the treatment more complicated. If CRC is found in an early stage the survival is about 75% over 5 years. The 5 year survival is much less if CRC is not found until it has already spread to other organs or lymph nodes.Screening includes a physical exam, blood work, a digital rectal exam and imaging of the colon. It is recommended that screening including a colonoscopy start at age 50 years (for those without a family history). Unfortunately, only about half of the people who should be screened are screened. In Maine there are several obstacles to being screened: no primary care provider, no insurance, fear of the test and the results, denial, ignorance of the seriousness of CRC, embarrassment, lack of time, difficulty traveling to location for colonoscopy. The CDC (Centers for Disease Control and Prevention) recognizes that it can help with some of these obstacles. Maine CDC has funding for the CRC screening program to defray the costs of colonoscopy for someone without insurance or someone whose insurance may not cover the costs of a screening colonoscopy. For more information:
Why CPR is so important?By- Dr. Anthony NgEach year in the United States, roughly 360,000 people of all ages suffer non-traumatic sudden cardiac arrest with nine out of ten victims dying. Sudden cardiac arrest is the leading cause of death among adults over the age of 40 in the United States and other countries. According to the American Heart Association, about 88% of sudden cardiac event occurs in the home. The number of sudden cardiac arrest deaths does not take into account other individuals who die from cardiac arrest as a result of variety of injuries or illness, including electrical shock, heart attacks or drowning. One often thinks that in all these instances, the more rapid first responders arrive to help, the higher the survival rate. However, the most important predictor of survival is whether or not cardio-pulmonary resuscitation, or CPR, is performed on the individual with cardiac arrest. Effective bystander CPR can double or triple survival rate. Sadly, the American Heart Association noted that 70 percent of Americans may feel helpless to act during a cardiac emergency because they either do not know how to administer CPR.CPR is a manual procedure that ensures the heart is still pumping and the lungs are putting oxygen into the blood in the event that the heart stops. This procedure ensures that the heart and brain are not deprived of oxygen. Who should take CPR? Often, many assume that only health care workers or emergency personnel take CPR. However, many more in the community can benefit from learning CPR. Most certainly individuals who are caring for someone with a medical condition should be taking CPR classes. Additionally, individuals who interact with the public on a regular basis should take CPR. Both adults and teenagers can take the class. CPR is taught by the American Heart Association and the American Red Cross through various agencies, including hospitals, schools and community agencies. It is often free to low cost. It is half to full day depending of the class. CPR class also teaches one to use Automated External Defibrillators or AED’s. AED is a portable electronic device that diagnoses cardiac rhythm disturbances in a person with cardiac arrest and is able to treat the person with electrical therapy, allowing the heart to return to its regular rhythm. AED’s are now available in many public places. However, it should only be used by someone trained to use it safely and effectively.CPR teaches not only immediate intervention for adults with cardiac arrest, but it also teaches someone to perform child and infant CPR. Additionally CPR classes teach one how to deal with choking in both adults and children. In 2009, almost 1,100 children under 14 died from unintentional choking and in 2010, close to 17,000 children were treated in emergency rooms for unintentional choking. Some of these children suffer long term sequelae from the choking. This is why it is so important that adults, such as parents, teachers, and child care workers take the class. CPR certification is often good from one to several years depending on the course. As most individuals may not need to use CPR between certification, it is important that individuals take refresher class. While one hopes never having the need to use CPR, knowing how to do CPR effectively is probably one of the most effective public health interventions. With increase number of the public knowing this skill, many lives can be saved. American Heart Associationhttp://www.heart.org/HEARTORG/CPRAndECC/CommunityCPRandFirstAid/Community-CPR-First-Aid_UCM_001123_SubHomePage.jspAmerican Red Crosshttp://www.redcross.org/take-a-class
Teaching Our Children and OurselvesBy- Dr. David PrescottIn tonight’s State of the Union address, the President will reportedly talk about our national struggle to cope with gun violence. Given the wide range of viewpoints, debates concerning the best strategies for reducing violence will likely continue for weeks and months. Watching and hearing about violent events is troubling for most people. Psychologists have helped identify strategies for coping with violent events in the short term, as well as strategies for the longer term issue of raising our children to deal with anger and frustration in non-violent ways. Not surprisingly, adult behavior and role modeling play a large role in how children learn to deal with these issues. The Short Term: Coping with Violence or Exposure to ViolenceWhether people are directly impacted by a violent event, or witness violence through news and other mass media, working through the feelings takes time. Any one of the following strategies can help people cope more effectively: Â· Honor Your Feelings: Remember that it is common to have a range of emotions after a traumatic incident. You may experience intense stress similar to the effects of a physical injury. For example, you may feel exhausted, sore or off balance.Â· Strive for balance. When a tragedy occurs, it’s easy to become overwhelmed and have a negative or pessimistic outlook. Balance that viewpoint by reminding yourself of people and events which are meaningful and comforting, even encouraging. Striving for balance empowers you and allows for a healthier perspective on yourself and the world around you.Â· Turn it off and take a break. You may want to keep informed, but try to limit the amount of news you take in whether it’s from the Internet, television, newspapers or magazines. While getting the news informs you, being overexposed to it can actually increase your stress. The images can be very powerful in reawakening your feeling of distress. Â· Help others or do something productive. Locate resources in your community on ways that you can help people who have been affected by this incident, or have other needs. Helping someone else often has the benefit of making you feel better.The Long Term: Teaching Gentleness To Our ChildrenHow can parents help to teach their children to behave in a compassionate caring manner? Social scientific research suggests that even at young ages, children have the capacity to empathize with the feelings of others, and to help others in need. Part of raising children who don’t use violence to cope with anger or frustration is nurturing these tendencies. Here are some strategies that parents and other adults can use to help teach children to act with compassion: Â· Lead By Example: What most inspires a child to grow up caring about others is the caring that the child receives. That nurturing is itself a perfect role model for children. Experts point out that when children feel they have a secure base at home, they’re more likely to venture out and pay attention to others.Â· Choose Books that Illustrate Compassion and Caring: Particularly for young children, books that illustrate compassion and caring help children learn about these behaviors. For older children, make sure that the books promote realistic characters who deal with everyday struggles in a caring manner. Â· Limit television and movies which promote violence: Research from the National Institute of Mental Health found that children tend to imitate behavior they see on television. For this reason, you may want to limit their viewing of violent programs and encourage them to watch shows that promote ideas about caring and helping.For More Information: American Psychological Association www.apa.org/helpcenter
By- Dr. Jonathan WoodThis month, the American Academy of Pediatrics* published its first Practice Guideline on the management of newly diagnosed Type 2 diabetes mellitus (T2DM) in children and adolescents. This comes in the wake of increasing prevalence of Type 2 diabetes in children, a phenomenon attributed to the epidemic of childhood obesity in North America.This publication is intended for professionals caring for children with this disease. But, as is usual in the US, the public wants to know about such publications and hopes to understand their significance. This requires (1) knowing the definitions of some key terms and (2) understanding the benefits and limitations of publications such as Practice Guidelines. Neither of these tasks is simple.Two important definitions:1. Diabetes Mellitus (DM): The word “diabetes” is derived from both Latin and Greek and essentially means to “pass through.” This alludes to the prominent of symptom seen in all forms of DM: increased urination. The word “mellitus” is derived from Latin and essentially means, “honey sweet.” Again, this comes from the fact that high blood glucose (sugar) results in high urine glucose. If tasted, which early diagnosticians did, the urine would be sweet.Confusion comes when people equate all forms of “diabetes”. There are three distinct, different diseases:Type 1 DM – previously known as “juvenile onset DM” (a misnomer, because it is not strictly age dependent) or “insulin-dependent DM” (also a misnomer given that other forms can come to require treatment with insulin). Type 1 DM (T1DM) typically does occur in children and adolescents. And it involves the loss of the pancreatic cells that produce insulin: hence T1DM always requires insulin shots. Type II DM – previously known as “adult onset DM” or “non-insulin-dependent DM,” both misnomers for the same reasons noted above. The main problem in T2DM is insulin resistance, meaning the body does not respond to insulin properly. This often is a complication of obesity and the exact mechanisms are not known. Hence, typically the first approach is to modify behaviors and use medicines that directly reduce blood sugar independent of the insulin mechanism. Sometimes, in T2DM, there is a relative lack of insulin later in the disease and extra insulin (shots) is used in the treatment.Note: at diagnosis, it is sometime difficult to distinguish between Type I and Type II DM. It will become clear quite quickly, but sometimes the final label needs to wait and during this time there can be overlap of treatment types.Gestational DM – a transient form diabetes seen in some pregnancies. It is similar to T2DM in that is involves insulin resistance, but it is typically transient and resolves after the pregnancy. That said, it is dangerous to both mother and baby, so it should be treated. Woman who have gestational DM have a higher than usual incidence of developing T2DM later in life.2. Practice Guideline: A practice guideline is just that: a guideline. Â· It is not a set of rules, nor is it a standard which all must follow. A professional society or group of experts in the field typically puts it together.Â· The guideline attempts to pull together all the evidence on the chosen subject. The evidence is then “graded” on its quality and validity. If there is no evidence, then “expert opinion” is often invoked.Â· The best guidelines detail specific questions or issues to “answer”. They then issue a statement based on the graded evidence. Typically, the statements “for” or “against” the issue in question are also given levels of strength. (e.g. strong recommendation, recommendation, option, no recommendation)Potential Problems:Â· When practice guidelines are seen as dictums, rules that must be followed.Â· When practitioners (or patients) fail to appreciate the strength of the recommendation or the grading of the evidence that led to this recommendation. This is particularly important in pediatric practice guidelines, because the volume and quality of evidence is frequently lacking in pediatrics. (but that is a topic for another WABI pieceâ€¦) Â· When a guideline is applied to a disease (or a patient) for which the guideline does not fit. Although this seems like an unlikely circumstance, it happens frequently and it can lead to a poor outcome.What is the point? What about the AAP’s T2DM Practice Guideline?The AAP’s Practice Guideline has all the qualities you would want in a guideline, as outlined above. Â· Most importantly, it raises awareness of the true increase in T2DM among youth in the US. Â· It has an excellent section on definitions to help avoid confusion like those outlined above. Â· It explains the evidence grading system and subsequent recommendation strategy. Â· It identifies six (6) clear issues and offers clear “action statements”: two Strong Recommendations and four Options.The strongest recommendations are centered on making the diagnosis of T2DM accurately and starting treatment promptly. In the most dramatic presentations, treatment may include insulin, despite my definitions above. But usually the treatment of T2DM stresses lifestyle modification (nutrition and physical activity) and initiating oral medicines to control glucose levels.The AAP’s new Practice Guideline on Type II Diabetes Mellitus is a good one. Patients and practitioners alike will benefit from the teaching it offeres and its judicious application to this increasingly prevalent disease.* This guideline was published with support from the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics.
By- Anthony Ng, MDDomestic abuse is a public health crisis that has recently gained more attention. In a report from the US Preventative Services Task Force (USPSTF), published in the recent Annals of Internal Medicine, it recommended that all women of childbearing age be screened for abuse, and women who screen positive should be provided or referred to intervention services. A survey from CDC in 2011 which interviewed about 16500 adults in 2010 showed 1 in 3 women was a victim of domestic violence. It is suspected that this number may actually on the low side as there may be widespread under-reporting of abuse. Last year, domestic violence accounted for almost half of all homicide cases in the state of Maine. Domestic abuse comes in many forms. They may include not only physical abuse, but also sexual and emotional abuses, intimidation, stalking and even economic deprivation. Additionally, while this report focused on women of childbearing age, it is important to recognize that domestic violence also known as spousal abuse or intimate partner violence (ITF) can occur in any person including males. Domestic abuse is often under-reported. Reasons may include victims minimizing the abuse. There may be stigma to being identified as a victim of domestic abuse. Such abuses can occur in all walks of life. Some victims may fear reporting domestic abuse may lead to more abuse and violence or perhaps abandonment from the abusers. Some victims may actually blame themselves for the abuse, thinking it is their fault for the abuse. There may also be under-detection and screening for domestic abuse. Lastly, there may not be enough resources in communities, such as shelters for victims, to address the issue of domestic abuse even when such abuses are identified. Domestic abuse is not limited to women. Males are also at risk of domestic abuse. However the data in this group remains sparse. It is widely under-reported with stigma likely being a major reason. There are some identifiable risk factors for abuse. They include individuals with physical or emotional disabilities being victims, young age, substance abuse, marital conflict and instability, economic and work stress. Domestic abuse can lead to significant physical and emotional concerns. Victims of domestic abuse can lead to increased risk of physical injuries and illnesses. It can also lead to depression, anxiety, post traumatic stress disorder and substance abuse. To intervene in domestic abuse, the approach needs to be from multiple avenues. First, there needs to be greater education to communities of the extent of the problem of domestic abuse. It is a major health problem that needs early recognition so that intervention can be effective. Identifying the risk factors and stress that can cause and worsen domestic abuse would be paramount. For example, if a couple is experiencing marital stress or stress from economic hardships, counseling early on may prevent domestic abuse. Better screening is needed, especially by primary care physicians. According to the recent USPTSF guidelines, primary care physicians are strongly encouraged to screen closely for signs of domestic abuse. This may include asking for stress at home and further questioning about psychological distress, as well as repeated physical injuries. For victims of domestic abuse, there are some shelters that are available. In the Bangor area, Spruce Run is a shelter for victims of domestic abuse and violence. In some instances, law enforcement may also need to be involved to protect the victims.Domestic abuse is a major health problem in Maine and the United States. It can lead to a rippling of other health and mental health problems if not treated. Greater awareness and early interventions can help both the abuser and the victim. So, don’t be surprised if your doctor starts to ask more questions about the presence of domestic abuse. Resources:Spruce Run Tel: 1-800-863-9909Website: http://www.sprucerun.net/Maine Department of Health and Human ServicesTel: 1-866-834-4357 (HELP)Center for Disease Control on Intimate Partner ViolenceWebsite: http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.htmlMaine Office of Attorney GeneralWebsite: http://www.maine.gov/ag/children_families/domestic_violence.htmlMaine Coalition to End Domestic ViolenceWebsite: http://mcedv.org/
Health Watch â€“ January 22, 2013Dr. David Prescott â€“ Eastern Maine Medical Center Behavioral MedicineHow Many People Are Able to Stick with New Habits? It has been exactly three weeks since the start of the New Year. For many of us, the New Year means taking a moment to reflect on those things we would like to change in 2013. But wait a moment! How are those resolutions coming along? If you are having trouble developing a new positive habit, you are not alone. Surveys suggest that about 60% of people who set a personal goal to make a positive change in their life have given up 6 months later. So, take a bit of comfort that making lifestyle changes doesnâ€™t happen automatically. How long is the list of things you would like to change about yourself?: Psychologists have found that one common problem with resolutions to make our lives better is that our list is too long. Changing one habit or incorporating one new thing into each day presents a big enough challenge. Trying to change many things at once can lead to frustration and giving up. If you resolved to make yourself a better or healthier person, did you focus on one small, but achievable step? Increasing Your Odds of Success: These 5 strategies can help make a new habit or routine a permanent part of your life: 1. Change one behavior at a time. Unhealthy behaviors develop over the course of time, so replacing unhealthy behaviors with healthy ones requires time. Many people run into problems when they try to change too much too fast. To improve your success, focus on one goal or change at a time. As new healthy behaviors become a habit, try to add another goal that works toward the overall change youâ€™re striving for.2. Start small. After youâ€™ve identified realistic short-term and long-term goals, break down your goals into small, manageable steps. It may sound overly simple, but change leads to more change. If you would like to eat healthier, consider as a goal for the week replacing dessert with a healthier option, like fruit or yogurt. At the end of the week, youâ€™ll feel successful knowing you met your goal.3. Make a plan that will stick. Your plan is a map that will guide you on this journey of change. You can even think of it as an adventure. When making your plan, be specific. Want to exercise more? Detail the time of day when you can take walks and how long youâ€™ll walk. Write everything down, and ask yourself if youâ€™re confident that these activities and goals are realistic for you. If not, start with smaller steps. Post your plan where youâ€™ll most often see it as a reminder. Donâ€™t underestimate the impact of simply putting your plan on a piece of paper where you see it several times a day. 4. Involve a buddy. Whether it be a friend, co-worker or family member, someone else on your journey will keep you motivated and accountable. Perhaps it can be someone who will go to the gym with you or someone who is also trying to stop smoking. Talk about what you are doing. Consider joining a support group. Having someone with whom to share your struggles and successes makes the work easier and the mission less intimidating.5. Ask for support. Accepting help from those who care about you and will listen strengthens your resilience and commitment. If you feel overwhelmed or unable to meet your goals on your own, consider seeking help from a psychologist. Psychologists are uniquely trained to understand the connection between the mind and body, as well as the factors that promote behavior change. Asking for help doesnâ€™t mean a lifetime of therapy: even just a few sessions can help you examine and set attainable goals or address the emotional issues that may be getting in your way.Thanks to the American Psychological Association for help with this feature. For more information, go to www.apa.org/helpcenter.Or visit Acadia Hospitalâ€™s website at www.acadiahospital.org.
One terrible day last week, four snowmobilers plunged into Rangeley Lake. The body of just one of them has been found. TV5 Health Advisor Dr. Amy Movius joined Jim Morris on TV5 News at 5 with advice to help keep snow sledding safe.
The holidays are an exciting and memorable time for everyone. The following tips may help keep you and your family safe while enjoying this special season.Christmas TreesFor many households, putting up a Christmas tree is a major event. When picking a precut tree, choose one with branches than bend (not break) and with needles that do not easily pull off. These indicate that it is fresher. The trunk of a fresh tree will have a sticky trunk butt and cutting a little more of the trunk off will exposes fresher wood which will absorb water better. Be sure to keep the tree stand full of water. Otherwise, even the freshest tree will dry out quickly.Keep Christmas trees away from any heat source – this includes fireplaces, radiators, wood stoves or portable heaters.If you use an artificial tree, make sure it is labeled â€œfire resistantâ€.DecorationsLIGHTS are the star of holiday decorations. Check all of your lights, even if brand new. All the bulbs should be in working order and there should be no loose sockets/cracked areas/other defects. Outdoor lights should be certified for this use. Metal and lights do not mix! This means no lights should be used on metal Christmas trees and no metal should be used to hang lights, such as staples or nails. There are noncombustible hooks or insulated staples available just for safely hanging decorative lights. Although coming home to twinkling lights seems charming, it is not safe to leave them on in an empty house, so please turn off all decorative lights when you are not homeLIGHTED CANDLES are also traditional for many but should be carefully kept away from any trees or other greenery. Candle holders must be non-flammable and only placed on secure surfaces where they will not be knocked over. ORNAMENTS should also be flame resistant or non-combustible. Ornaments that are small, sharp, breakable, or have removable parts should be well out of the reach of children. The same is true of ornaments that look like candy or other treats.WrappingFor many people, especially children, the most exciting part of the season is opening presents. While the wrapping paper is being ripped off, someone needs to remain vigilant and keep track of the discarded paper, bags, bows and ribbons as they can become fire, choking and suffocation hazards. It is important to never burn wrapping paper, bows or ribbons in fireplaces: they can ignite suddenly and burn intensely.Especially for ChildrenVisiting friends and relatives or having visitors can be the most meaningful part of the holidays. It may also require some extra planning to keep small children safe. Other homes may not be childproofed, and though it can be socially awkward, asking your hosts to temporarily adjust their homes during the visit is essential. Likewise, visitors may themselves need to be â€œchildproofedâ€! Attention to how personal belongings are handled, such as purses and luggage â€“ which may contain medication or choking hazards â€“ is a must. Monitoring and directing visitor behavior with food and drink is necessary also. Another potentially touchy subject is the gifts your children may receive from well-meaning loved ones. All toys given should be age appropriate. If not, you will need to remove it from your childâ€™s possession. No items with an electrical cord are appropriate for children under 10. Also, no items with strings or cords are appropriate for infants or young toddlers. Swallowing button batteries and magnets can be deadly. Besides being found in some toys, button batteries are also found in items ranging from musical greeting cards to hearing aids. All of us at EMMC want you have the most wonderful holiday season possible! Hopefully, these safety tips will help you enjoy the seasonal festivities with confidence and peace of mind. For more details visit the American Academy of Pediatrics Website 2012 Holiday Safety Tips. Referenceaap.org 2012 Holiday Safety Tips
By- Dr. Anthony NgEmergency rooms are great community resources to help provide medical care to anyone in crisis. However, emergency rooms have now become a crisis in itself as many emergency rooms around the country are inundated with patients. There are a variety of reasons to why emergency rooms are getting busier. They may include a lack of community health resources for people to get care in a timely manner or there are insufficient inpatient beds for patients who need hospitalization, just to name a few. As a result of emergency rooms getting busy, people are waiting longer to be seen. Some people even leave the emergency room before they are actually seen due to the long wait. For some others, they don’t even bother going to emergency room at all when they are really sick because of concerns of long wait in the emergency room, as well as to how they will pay for the visit. As chaotic and stressful an emergency room visit may be, there will be times when a visit to the emergency room is necessary. However, there are few things one can do to make the visit less stressful so that one can get the care they need. The most important time to prepare for any emergency room visit is actually before the emergency happens, especially for individuals with illnesses. If one has an illness, whether it is an acute or chronic condition, one should discuss with the health providers to what conditions would necessitate a visit to the emergency room and what can be handled by contacting the health care provider directly. An alternative to emergency room is walk in center or urgent care centers which many hospitals offer for less emergent medical concerns. One should ensure that they have enough medications for their medical condition. A trip to the emergency room is not necessary to obtain medication refills. These can be obtained by contacting your regular health providers ahead of you running out of the medication. Also, before you go to the emergency room, you should prepare an updated list of contact information of your regular health providers, emergency contacts, allergies, past and current medical conditions and current medications that can be easily produced for the emergency room provider. This will help ensure they are fully aware of your current health status. You can also keep a copy of this information in your wallet or purse so it is readily available. You should also check with your health insurance carrier to your financial responsibilities such as copayment for emergency room visits. Often many patients learned too late after an emergency room visit that their insurance plan did not fully cover the visit and they incur additional stress trying to figure out how to pay for their visit. Understanding what happens to you when you visit an emergency room can help lessen some of the stress of a visit. While you are in the emergency room, you may be asked multiple questions by different staff members. While the questions may seem redundant and frustrating to you, the questions are meant to get as accurate information as possible about your emergent health needs so you can get the best help. This information also is important to help the emergency room staff determine the priority of patients to be seen. As there are limited resources in the emergency room, sometimes health providers there must see the sickest first. For example, someone with a heart attack or a major trauma will require more emergent response than someone with a less severe medical condition. This is why sometimes one may experience that another patient who arrived after you may be seen before you. Lastly, it is important that you allow communication between the emergency room health provider and your regular health provider to ensure good coordination of your care, not only at the time of the emergency room visit but also in regards to your follow up care with your regular health provider. A visit to the emergency room can be extremely stressful to a person. With some important steps that you can take and some awareness, you can help lessen the stress and your experience to ensure that you get the best health care during your emergency room visit.
Coping With Anniversaries of Traumatic EventsHealthy Living â€“ December 4, 2012Dr. David Prescott â€“ Eastern Maine Medical Center Behavioral MedicineWhy are Anniversaries of Traumatic Events so Difficult? Living through a difficult time takes energy and hard work. Most people wish that once they make it through a difficult time it will be behind them forever. Unfortunately, people who experience the loss of a loved one, extreme personal hardship, or a traumatic event often relive parts of that experience on anniversaries of the event. This can be especially upsetting when the anniversary occurs during the traditional holiday season. Common Reactions on Anniversaries of Traumatic Events Anniversaries of traumatic events may be associated with a variety of difficult memories and feelings. Common experiences on an anniversary include: â€¢ Extreme anxiety or apprehension as the anniversary approaches. â€¢ Repeated memories of the event, or a renewed clearity of memories that had begun to fade. â€¢ General feeling of sadness or depression. â€¢ Sensitivity to reminders of the event. â€¢ Difficulty sleeping or having dreams about the event. â€¢ Impaired concentration or trouble focusing. â€¢ Unexpected outbursts of anger or irritabilityDifficult Events that Occur around the Holidays: For some people, the traditional holiday season is also the anniversary of a personal loss or traumatic event. This can lead to feeling left out or detached from others who do not share your experience. In most cases, it is important to honor your true feelings at the moment, and avoid trying to pretend that you feel upbeat or joyous. Over time, unhappy anniversaries tend to fade in their intensity. Most psychologists agree that grieving and sadness are part of healing, and that if allowed to take its course, recovery from a traumatic event occurs in most people over time. Strategies for Coping with Anniversaries of Traumatic Eventsâ€¢ Recognize and acknowledge feelings you may experience. Understand that your feelings are part of the recovery process.â€¢ Find healthy ways to cope with your distress. Share memories and feelings with someone you trust or just spend time with friends and family. Activities that allow your mind to focus on something other than these memories are a good coping strategy for some people. Contemplative activities like reading, thinking or just taking a walk are also a good approach. â€¢ Avoid reactions that become part of the problem such as drinking or using drugs. Sometimes, progress in healing from a traumatic event can occur simply by avoiding coping strategies that lead to bigger problems. Excessive drinking or using drugs usually make the problem worse in the long run. â€¢ Engage in an activity that honors lost loved ones. You may want to plant a tree in their memory, make a donation to their favorite charity, participate in activities your loved one would have enjoyed or share happy memories with others. Consider volunteering: you may find that helping others actually helps you. â€¢ Use your support system. Reach out to friends and family. Donâ€™t isolate yourself. For More Information: American Psychological Association Help Center (www.apa.org/helpcenter)
By- Dr. Joan Marie PellegriniBecause I am a surgeon, I often have to talk to my patients about managing pain both before and after surgery. As such, I discuss using over the counter (OTC) pain medications with my patients. Many of my patients are confused about how to use the medications and what are the side effects. I also find that many of them think that Tylenol and Motrin are the same. Acetaminophen: This is also known by its trade name as Tylenol. It is sold as just acetaminophen but can also be found in many other OTC medications such as cold/flu remedies and arthritis medications. It is commonly combined with a narcotic as a prescription medication (such as Percocet, Vicodin, etc). It is extremely important to know if your medication has acetaminophen in it and how much is in it because of the risk of taking too much. The maximum dose is 4000 mg a day. The usual dose for an adult is 325-650 mg every 4 hours. Taking too much can lead to severe liver damage. It is not known exactly how this medication works to reduce pain and fever. It can be safely combined with anti-inflammatories and narcotics. It does not usually affect kidney function nor does it cause hypertension often. Also, it does not cause bleeding and is safe to use if you are on blood thinners.Ibuprofen: This is often known by the trade name Motrin. It is an anti-inflammatory and is in the class of medications known as NSAIDs (non-steroidal anti-inflammatory drugs). Other medications in this class are aspirin, Naprosyn (also known as Aleve), and meloxicam (prescription only). Like acetaminophen, there are many different brands of the same medication in the pharmacy and therefore it is important to read the ingredients to know what is in the medication. NSAIDs can cause hypertension, fluid retention, and bleeding disorders. They also can affect the kidney and should not be used in people with kidney disease or on blood thinners. Long-term high dose use of NSAIDs can damage the liver. Ibuprofen has a maximal adult dose of 2400 mg a day. Almost all OTC ibuprofen tablets come as 200 mg. Therefore, the maximum dose is 2 pills (400 mg) every 4 hours, 3 pills (600 mg) every 6 hours, or 4 pills (800 mg) every 8 hours. The prescription strength of 800 mg is just one pill that acts the same as taking 4 pills of the OTC brand. Since aspirin, ibuprofen, and Naprosyn are in the same class these medications should not be combined.If the patient is healthy and on no medications, then a combination of acetaminophen and ibuprofen may be quite effective for pain control. When you talk to your doctor about your pain medication, make sure you write down exactly what you are taking. Also make sure you write down whether you can take acetaminophen or ibuprofen or both and how much your doctor recommends. Neither of these medications causes the side effects that are common with narcotics such as constipation, sleepiness, respiratory depression, or addiction.
By- Dr. David PrescottLack of Willpower is the Number One Barrier to Positive Health Behavior Change: Many people can identify changes in their behavior which would improve their health or mental health. For example, getting support from others rather than staying isolated can help reduce depression. Improving poor eating habits can lower cholesterol or improve your diabetes. Reducing excessive alcohol use will result in better overall health. However, the number one barrier cited by Americans to making positive behavior change is lack of self-discipline. Self-discipline is not entirely pre-determined at birth. By focusing on certain key factors, you can improve your own willpower and self-discipline. The Marshmallow Experiment: Delay of Gratification Really Does Pay Off: Researchers at Columbia University wanted to study how early children can begin to delay gratification, which is a key component of self-discipline. They offered 4-year olds a treat (a single marshmallow) immediately, or told them that if they could wait a few minutes, they would get more than one marshmallow. But more importantly, they kept track of these 4-year olds until they were teenagers. Those teenagers who had been most able to delay gratification had, on average, higher SAT scores, better ability to handle stress, and better ability to plan. Research Supports the Idea that Willpower Wears Down: As people try to change unhealthy behaviors, they often report that the make an initial change, for example not smoking, but that over time stress wears them down. Psychology research actually suggests that this is true! One key to maintaining a healthy behavior is to try to strengthen your willpower. Tips for Building Up Your Willpower: Â· Avoid temptations. In the marshmallow study described above, children who stared at the treat were less likely to resist it than those who closed their eyes, turned away or distracted themselves. “Out of sight, out of mind” works when you’re studying, too. When you need to focus, turn off your phone, sign out of email and eliminate any other distractions from your environment.Â· Make a plan. Having a plan in place may help you resist temptations without having to draw on your willpower, research www.tandfonline.com/doi/abs/10.1080/01443410.2010.506003 suggests. Decide ahead of time how you will react to situations that are likely to foil your resolve. If you need to spend the weekend studying, for example, you might tell yourself, “If someone invites me out, I’ll suggest a Sunday night outing as a reward for studying.”Â· Think you can. How you think about willpower itself is also important. In one study pss.sagepub.com/content/21/11/1686 , researchers found that people who think willpower is a limited resource are more likely to have willpower problems than those who don’t think of it as easily exhausted.Â· Fuel your willpower. Your brain runs on glucose, or blood sugar. But exerting self-control can leave brain cells consuming glucose at a fast pace. Feeding your brain may help restore your willpower, research www.ncbi.nlm.nih.gov/pubmed/17279852 suggests. Eating regular meals can keep your blood-sugar levels on an even keel and may help refuel your run-down willpower.Â· Focus on one goal at a time. The evidence suggests that making a list of New Year’s resolutions isn’t a great idea. That’s because having your willpower become depleted in one realm may reduce willpower in other realms. Instead of trying to adopt better study habits, exercise more and quit smoking all at the same time, take your goals one by one. Once a good habit becomes routine, you no longer need to draw as much on your willpower to maintain it.FOR MORE INFORMATION: American Psychological Association: www.apa.org/helpcenter
Using the Holiday to Reinforce Year-Round Health and Safety HabitsBy- Dr. Jonathan WoodThis year, consider using Halloween as an opportunity to discuss a number of global health and safety issues with your children. Yes, several pointed issues certainly all apply to the day itself. But this is also an opportunity to reinforce with your kids that the lessons of Halloween are worth applying to their lives every day of the year.Dental HealthCavities develop as a result of carbohydrates (sugars) and the associated acids produced bathing the teeth. The total time and frequency of exposure is the key, not necessarily the amount of sugar. The acids remain in the mouth for approx 20 min after a snack or meal. This knowledge supports a number of healthy habits, Halloween-related or not:Â· Candies or foods that bath the mouth for long periods (lollipops, dense sticky candies, etc) engender the greatest riskÂ· Eating at proscribed meal and snack times, rather than “grazing”, will result in a healthier dental environmentÂ· Timing your Halloween candy consumption to around meals will reduce the associated risk of cavitiesÂ· Suggesting that kids eat little bits at a time and spread their candy consumption out over time will paradoxically increase their cavity riskEvening and Nighttime SafetyAs your kids prepare to wander the neighborhoods this year, use the holiday to remind them about pedestrian safety. It is especially important to stress that the driver visibility is at its worst during dusk, the time when many trick-or-treaters are out and about.Â· Help your children choose costumes that offer adequate vision and mobilityÂ· Consider reflective costumes or at least adding some stick-on reflector materialÂ· Flashlights! One hand for the candy bag, one hand for the flashlightâ€¦!Â· Review basic road crossing safety and stress the fact that these principles apply year ’roundÂ· Use sidewalks whenever possible.Food AllergiesFor kids with food allergies, Halloween is a good time to review some of the principles of awareness and avoidance. Â· Teach label reading to confirm that ingredients are acceptableÂ· Use the time to review the signs and symptoms of allergic reactions due to inadvertent exposureÂ· Be aware that “trick-or-treat” size candies occasionally do not contain the exact same ingredients as the full size versionGeneral Healthy Behaviors and Global Safety Issues Â· With wood stoves fired up and with Jack-o-lanterns on porches, Halloween offers a context for reviewing fire safety. Also, consider fire safety when choosing costumes.Â· Carving pumpkins offers a setting in which to review knife safety with small children and adolescents alike.Â· Use Halloween to gently review stranger safety. Use the trick-or-treating experience to reinforce simple things like not getting in cars with strangers and not going into strangers’ homes unaccompanied. Halloween can be used to emphasize that most people are good people with good intentions, but that this doesn’t negate the value of prudence and being careful.Â· Use Halloween to talk about peer pressure and mob mentality. For example, reinforce the difference between “tricks” and vandalism. Especially with older kids and adolescents, Halloween can offer an environment for trouble making. Prepare your kids with the means to identify and avoid inappropriate situations. Offering “scripts” for extracting themselves can be very helpful. Most important, discuss simple common sense with your kids. Nothing will serve them better than that! So, arm those kids with essential Halloween equipment (safe costume, good shoes, candy receptacle, flashlight, cell phone) and some common sense. They’ll have fun, learn some things along the way, and have plenty of year ’round good.
By: Dr. Anthony NgFor those who have had shingles before, it is a very painful and uncomfortable experience. There are many others who have yet to have it and may wonder what it is and what can one do about it. Herpes Zoster, or more commonly known as shingles, is essentially a reactivated viral infection caused by Varicella Zoster. This is the same virus that causes chicken pox. It usually happens to 2 in every 10 people in their lifetimes. Shingles is a painful blistering illness that while it can occur in anyone with a history of chicken pox, it is more likely to occur in individuals over 60 years old. A person, adult or child with no history of having chicken pox or having received the chicken pox vaccine, can contract chicken pox if they come into contact with the shingles rashes when there are vesicles in the skin. Shingles often starts with one sided pain and unusual feelings such as tingling, pins and needles like, numbing and even burning. They may start in one spot and then spread to other areas that are covered by a particular nerve. The pain and numbing can be extremely painful and they usually precede the appearance of any skin rashes. The rashes usually start as reddish patches and then progress to small blisters, sometimes even looking like pimples. The blisters can break. They may have some wetness to them and forming small sores. These sores will dry and crust over, sometimes remaining for 2 to 3 weeks. Shingle rashes may affect a narrow area from the spine to the front of the belly or chest. They can also appear on the face, near the mouth, eyes and ears. Additional symptoms of shingles may include abdominal pain, fever and chills, headaches and swollen glands. If the rash affects the face, there may also be muscle weakness such as drooping eyelids, loss of eye motion and taste problems. The diagnosis of shingles is often done from history and a physical exam by your health care provider. Blood test is rarely needed. Seeking treatment early is the best way to deal with an outbreak of shingles. If one notices possible signs of shingles, they should contact their health provider immediately. The earlier treatment is initiated, such as within 72 hours of outbreak of symptoms, the sooner the symptoms will remit with less discomfort and less risk of complications. Treatment likely would include being prescribed a course of oral antiviral medication, such as acyclovir, famciclovir and valacyclovir, lasting about a week. Sometimes low dose steroids may be prescribed to help lessen the swelling and pain. Over the counter medications in general can help with most discomfort of shingles. Cool compresses can help relieve some of the skin discomfort. An important consideration when one has shingles is to avoid contacting others with no history of chicken pox or vaccine and more importantly, when there is oozing from the blisters of a shingles rash. Someone with shingles should also avoid any contact with pregnant women.It is important to not scratch the rashes as they may worsen the sores. Keep any open sores clean to prevent bacterial infection. If shingles rashes affect the face and eyes, an eye exam by an ophthalmologist may be needed to make sure the virus does not affect the eye. Untreated virus in the eye can potentially lead to blindness. Most shingles resolve by 2 to 3 weeks but some residue nerve discomfort may persist. Shingles can recur but for many, it usually does not. For some, a condition called postherpetic neuralgia may develop. This is when the nerve that was affected has been damaged. This postherpetic neuralgia is pain in the area where the shingles occur and can last for months and even years. This is more likely to occur in individuals over 60 years old. It is unclear what would cause someone to have a shingles outbreak. Injuries, being older than 50 years old, recent medication, illness or stress have all been implicated as reasons for a person have an outbreak of shingles. There is a shingles vaccine which is currently approved for people over 50 years old, though CDC is recommending those over 60 years old receiving the vaccine. This is not the same as a chickenpox vaccine as it is more potent. Side effects for this vaccine may include redness and tenderness at injection site, swelling and headaches. Not all insurance would cover this vaccine so one would need to check with their insurance carrier prior to getting the vaccine. With the shingles vaccine, it lessens the risk of developing shingles or decreases its severity and chances of complications if one does develop shingles. The vaccine offers protection for about 6 years. Shingles is a viral condition that can be very painful and uncomfortable and with potentially serious complications. However, early recognition and treatment will often lead to minimal long term effects. References:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/ Accessed Oct 16,2012.Resources:CDC: http://www.cdc.gov/shingles/index.htmlMayo Clinic: http://www.mayoclinic.com/health/shingles/DS00098
By- Dr. Joan Marie PellegriniHardly a week goes by that we do not read about some part of Maine’s narcotic problem. This is a really complex problem. As a surgeon, I prescribe narcotics frequently. The vast majority of patients use as little narcotic as possible. However, there are a few patients who require much longer pain management and may even live with chronic pain. I have noticed that most patients are rather uneducated about non-narcotic options for pain control.The goal of pain management is to reduce the pain enough to allow us to function properly. The goal is not necessarily to completely get rid of all pain. Also, if the pain is due to an acute injury or event, then we need to understand that our expectations should be different during the early course of healing versus the end of the healing phase. Narcotics are certainly quite effective for controlling pain. However, this effectiveness is not without consequences. Narcotics cause drowsiness, slowed motor control, decreased balance, potential for addiction, constipation, difficulty urinating, and respiratory depression. In short, narcotics are a very dangerous class of drugs.There are non-narcotic drugs such as acetaminophen, NSAIDs, tramadol, anti-depressants, anti-convulsants, etc. Acetaminophen is quite safe as long as one does not have liver disease and is careful not to exceed the maximum dose. NSAIDs are anti-inflammatories that are most useful for acute pain and inflammatory disorders. They also are useful as an adjunct to other therapies. They can be dangerous though in that they can cause bleeding, hypertension, kidney disease, fluid retention, stomach damage, and other potentially serious side effects.I have compiled a list of non-pharmacologic techniques for reducing pain. Many of these ideas came from an article that you can access on WebMD.â€¢Exercise: it is a catch-22. Pain makes us not want to move yet inactivity worsens pain. If you live with chronic pain, this becomes exceedingly important. It may not be anything more that gentle yoga excises or walking or swimming. The most important aspect is to move all the joints and muscles and maintain good balance. You may need to start with a physical therapist or personal trainer.â€¢Breathing and relaxation: get into a comfortable position and concentrate on slow, deep breaths. You may even use imagery or soothing tapes of various sounds (ocean, rain, music, etc). Focus on muscle relaxation and not on the pain or the day’s stresses.â€¢Avoid alcohol: alcohol can have a relaxing effect and makes us feel good. However, it will also interfere with sleep. Our sleep is less deep and we can wake up more frequently.â€¢Quit smoking: the chemicals in tobacco will slow healing and will reduce blood supply to an injured area.â€¢Eat healthy. Whole grains, fruit, and vegetables provide many disease fighting nutrients. Over time, our bodies will be able heal chronically injured areas.â€¢Journal: keep track of your level of pain, what activities you did during the day, foods you ate, and level/type of stress. Your doctor may be able to help you learn what some of the triggers are for your pain.â€¢Find a distraction: anything to take your mind off of the pain. Take a class, help a neighbor, find a project.â€¢Accupuncture: this is becoming more accepted and the good news is that because of this, there may be a specialist near you.â€¢Find a massage therapist who does myofascial release. I personally find this very helpful. Unfortunately, it can be painful when it is being done and it is a bit expensive (it is generally not covered by insurance).â€¢Find a sauna/ steam room/ hot tub that you may use. Whole body heat will loosen joints and muscles and make stretching more effective.â€¢Investigate if you have depression and treat it. Depression can cause pain and will certainly worsen any pre-existing pain.â€¢Try singing: this will also help with breathing exercises and relaxation. Along this same line is dancing which helps with movement and balance.â€¢Biofeedback: this is started with an instructor who measures a muscle’s level of tension. The patient then is taught various relaxation techniques and can see the results of the muscle relaxing.â€¢Invasive pain management: a pain specialist may inject certain ares. There are also stimulators that can be implanted. These specialists have many other techniques they may use.â€¢Get a pet: not just any pet. Studies show that petting a cat or dog will lower our blood pressure and our pain level. They also distract us.
TV5 Health Advisor Dr. Erik Steele joined Jim Morris on TV5 News at 5 to talk about meningitis, bacterial meningitis and prevention.
By- Dr. David PrescottSuicide Prevention Efforts Highlighted by U.S. Army: Last week, the United States Army conducted a suicide prevention stand down to focus its efforts on promoting good health, reducing the risk of suicide, and training soldiers in resilience. As has been publicized and acknowledged by the Army, 120 deaths by suicide have occurred in 2012, with another 67 under investigation. Family, Friends and Colleagues are Often the Gateway to Help: One interesting fact was highlighted in the Army’s careful attention to this problem. In the majority of cases where a person considering suicide was identified and helped, the person at risk first talked to a friend, colleague, or family member. Friends and families were able to assist the person considering suicide in obtaining professional help. Thus, early recognition by non-professionals appears to be a critical link in preventing suicides. Suicide Prevention in Maine: In the last year that data are available (2009), Maine had a rate of 15.4 suicides per 100,000 people each year, which is above the national average of 13.7. Maine’s Department of Health and Human Services has put significant effort into suicide prevention in general and youth suicide prevention in particular. Information is available at http://maine.gov/suicide.Possible Warning Signs of Suicide: There is no sure way to predict who is at highest risk for suicide. But, some frequent signs include: Â· Change in Mood or Behavior: Significant changes in a person’s mood or behavior may signify a broader psychological problem. Depression is the mood change most closely associated with suicide. Changes like this shouldn’t be ignored, but should be talked about, preferably with a counselor or mental health professional.Â· Talking about suicide or death: Most people who attempt suicide have talked about it. Becoming preoccupied with suicide or death is often a warning sign of increased risk. Â· Loss, breakup, or high stress event: One factor which increases risk for suicide is a significant loss, such as a relationship breakup. Or, a high stress event such as not getting into a preferred college, bad grades, or trouble with the law is often associated with an increase in thought of suicide. Â· Substance use: Using alcohol or drugs impairs judgment and decision making. Many suicides occur while people are using, or have recently been using such substances. Steps to Take: Talk about suicide, or any of the warning signs, should be taken seriously and brought to a mental health professional. Some steps to keep in mind include: If someone talks about suicide, help them find professional assistance: Counseling and psychotherapy can help work through a moment of crisis, but also resolve some of the problems which contribute to increased risk for suicide. Reduce or eliminate substance use: One step in reducing risk for suicide is to reduce use of alcohol or other substances. Take away ready access to weapons or pills: Families are often asked to help by removing weapons or pills from ready access. In many cases, not having a means available helps the person think the problem through in a different way. Find hope: One key to resolving preoccupation with suicide is to help a person find hope. Often, friends and family can help people keep a sense of realistic hope while problems are worked through. Adult Crisis Line: 1-888-568-1112Youth Crisis Line: 1-800-499-9130Maine Youth Suicide Prevention: http://maine.gov/suicideNational Suicide Prevention Hotline: 1-800-273-TALK (8255)
Psychotherapy is a relationship between a mental health professional and a client that involves talking about problems and concerns in a specific way. Based on scientific research about how to best help people deal with problems like depression, stress, or anger, psychotherapy provides effective long term benefit to over 75% of people who complete a relatively small number of sessions. Most people feel better in as few as 6-12 sessions. How Do I Know if I would be Helped by Psychotherapy? One important question to ask yourself if you are considering starting psychotherapy, is whether problems in your life have gotten better on their own, or through the help of family or friends. If not, for example if you have felt depressed or helpless for several weeks or months, or if you worry so much that you have trouble concentrating on things other than your problems, you would probably benefit from psychotherapy. Myths about Psychotherapy: Many people have inaccurate beliefs about what occurs in psychotherapy, and about its potential benefits. Common myths include: Â· Myth: Psychotherapy is no different from talking with friends: Professional mental health counselors, like psychologists, have learned what types of relationships and what types of self-understanding lead to long term changes that make us feel better. Support from friends is important, but psychotherapy focuses on specific patterns of thinking and behaving that often need to be changed. Â· Myth: Being in Psychotherapy Means that I am Crazy: About 1 in 5 people have a diagnosable mental health problem. Most of these people are not “crazy.” In fact, mental health problems are relatively common. Â· Myth: Psychotherapy is Nothing More than Blowing Off Steam: While being able to talk freely is an important part of psychotherapy, effective treatment is more than just venting. Psychologists and other psychotherapists listen for certain styles of thinking and behaving which actually perpetuate many of our problems. By helping you find alternative ways of thinking and acting, you will begin to improve your mental, and often your physical health. What Happens in Psychotherapy? Most people are quite nervous and more than a little apprehensive before their first meeting with a psychologist or other psychotherapist. What is said when you meet with a psychotherapist is confidential, unless you give permission for your therapist to talk to someone else, like your primary care doctor, about your treatment. Usually, people meet with their therapist once a week, or once every other week, until they begin to make progress. Typical topics during the first few visits include: Â· Telling the Psychotherapist What Brought You Here at This Time: Most people start psychotherapy when they are having particularly difficult struggles. It will be important for your therapist to understand what makes this time so challenging. Â· What Do You Hope to Gain from Psychotherapy? Psychotherapy works best when the therapist and client mutually agree on the goals. You will have an opportunity to tell your therapist what you hope psychotherapy can do for you. Â· Patience and Focus on Lasting Change: One of the primary benefits of psychotherapy is that the changes you make tend to last even after therapy starts. This may make the entire process slower than you wish, but the benefit is that changes in self-understanding, behavior, and attitudes can last a lifetime. For more information:Understanding Psychotherapy and How It Works: http://www.apa.org/helpcenter/understanding-psychotherapy.aspxVideo Clips on Psychotherapy: http://www.apa.org/helpcenter/psychotherapy-works.aspx