Deciding when your child is just a little under the weather and when your child should go to the pediatrician is an age-old question for parents. Dr. Yaser Freij, a pediatric physician with Springfield Clinic Taylorville, provides some guidelines. Q. When should parents call when it comes to fever? A. A sudden onset of high fever (102 degrees and higher) is one of the most common reasons to call or seek pediatric advice or visit. Lower fevers may still be serious, and you can call your pediatrician if you are concerned. Q. When is vomiting serious? A. Repeated, frequent vomiting over several hours, especially with copious amounts, may result in dehydration. If more body fluids are lost with accompanying diarrhea, the fluid balance/dehydration may become critical, requiring urgent attention. Call your pediatrician, or after hours go to the emergency room at the hospital or prompt care facility. Q. When should you seek a pediatrician when the child is coughing? A. When a cough is frequent, persistent and associated with a high fever, a visit to the pediatric office should be urgent. This is especially true if the infant or child has signs of significant respiratory distress like rapid and shallow breathing, grunting, wheezing audible to the ear or stridor. Q. What about trouble breathing? A. Trouble breathing can lead to respiratory failure, which may follow a quick course or more time. However, the ultimate outcome of unattended respiratory failure is failure of vital organs and death. Therefore, situations like severe asthma, spasmodic croup or foreign body aspirations are true emergencies in which parents should seek help immediately. In my practice, these patients can be seen anytime during office hours. No appointments needed. Q. When should parents take dehydration seriously? A. (When there is) any lack of voiding urine for more than 12 hours, dry mouth or being very thirsty despite vomiting. The parent might also see poor circulation that includes cold, mottled skin that feels like dough. They might be drowsy, sleepy, be limp, and any or all of these signs are serious. Parents are encouraged to seek help even when in doubt. Q. What if your child is hard to wake up? A. Parents are advised to call and have the child assessed immediately. In past years, when bacterial meningitis has occurred, immediately seeking a physician was the best course of action. Presently, the vaccines have about eliminated them, but still give children immediate attention. Q. When should parents check with pediatricians involving a rash? A. Very few, if any, rashes are serious. However, they are annoying to children and parents. In the summer, rashes include poison ivy, and bug bites or sunburn are an issue if they become infected. Sometimes urticaria or hives are a problem. Lately, a resurgence of skin abscesses due to methicillin-resistant staphylococcus aureus (MRSA) has been seen. Yet, most of the time there is no need to seek urgent care when it comes to rashes. If you have questions or are concerned about a rash, call your physician or pediatrician for answers. Q. What are some other situations when parents should call a pediatrician? A. Most of these situations relate to sudden problems: trauma, accidents, ingestions (accidental or intentional). Q. Where can someone go for more information? A. I direct my patients and parents to reliable sources such as aap.org (American Academy of Pediatrics) or nih.gov (National Institutes of Health). Parents should be aware that there are websites that intentionally mislead (like anti-vaccine sites). Parents are always encouraged to share what they read.
Dr. Yaser Freij is a pediatric physician with Springfield Clinic Taylorville.
MINNEAPOLIS - Dr. Dan Fulton and his wife, Lois, talk about stress quite a bit.He's a third-year medical resident; she's a physical therapist. In addition to raising two daughters, 3 years and 9 months, the couple is chipping away at about $173,000 in student debt from medical school."We have an agreement that I can't log in from home," said Fulton, 30, a resident in internal medicine at Hennepin County Medical Center in Minneapolis. "It means that at times at the end of a long day I have to stay at work and finish up reports. But when I'm home, I'm home."Finding ways to keep a lid on the pressure is becoming ever more difficult for doctors-in-training, according to a new Mayo Clinic study.Large numbers are burned out, depressed and becoming increasingly cynical about their work. They're deep in debt and finding it impossible to balance work and life.Most jarring, according to the study of more than 16,000 U.S. graduate medical students, is that the stress is making it harder for residents to learn needed skills. The Mayo Clinic researcher who worked on the report warns that downplaying the signs could lead to mistakes and poor patient care."This isn't just a woe-is-me, look at those doctors complaining about how hard their medical training is," said Dr. Colin West, a general internist who co-directs the Mayo Clinic Department of Medicine Program on Physician Well-Being. "This actually has an impact on what we're providing to patients throughout the health-care system."The results, published last month in the Journal of the American Medical Association, are the first to draw connections between distress, debt and medical knowledge. The researchers used scores from tests taken each year by nearly every internal medicine resident in the country and added questions about burnout, work-life balance and other measures of well-being.More than half of the internal medicine residents, about 52 percent, reported some symptom of burnout. Nearly 46 percent complained of being emotionally exhausted, and 3 in 10 showed signs of cynicism, lack of empathy or callous feelings on the job.The report also found that those with more than $200,000 in debt had test scores 5 percent lower than their debt-free peers. Today's medical school graduate leaves school with an average of $160,000 in student loans.
'The right stress with the right support'Medical leaders have known for years that young doctors are under stress, with previous reports focusing on individual hospitals and training centers. Those results helped spawn industry regulations in 2003 that now limit residents to an average of 80 hours a week averaged over a four-week period. New rules came into effect in July aimed at interns - doctors in their first year of residency - that limits them to 16 hours in a single shift. The Mayo report indicates that reducing hours may not be sufficient or the best approach."You reduce the work hours, maybe fatigue gets better," West said. "But even after you've helped with that, we're still seeing these national numbers of high rates of burnout, high rates of quality of life concerns. What are we going to do on a national basis to address those issues? That's a dialogue that's really in its infancy."Medical experts say there's a certain amount of stress medical residents need to experience to become good at making quick decisions in high-pressure situations, and to get as much hands-on training as possible.But the combination of the debt load and the stress is affecting the number of students choosing to become family doctors. Specialty medicine offers bigger paychecks and fewer midnight calls at home than primary care doctors get."When you graduate from medical school with well into the six figures of debt, that is a motivating factor for what specialty of medicine residents and medical students go into," said Dr. David Hilden, who works with medical residents and students at HCMC.Hilden points to his own experience. He was a primary care doctor for six years, but got out "largely because of burnout." Two years ago, he became a hospitalist, where he sees patients at HCMC."A family doctor might see 20 patients or more before lunch and the same after lunch," he said."And that's only a fraction of the actual work involved. You'll spend an equal amount of time doing the charting and the billing and the followup of lab results and the phone calls for that patient.""You never feel caught up," he added. "The pressures of the clock are extreme."Fulton said staff physicians and resident fellows can help residents deal with the pressure and try to anticipate signs of stress."People don't always get better," he said. "As a physician, it's hard to see that and walk through that with them. The more that happens, the more burned out you start to feel."West said he hopes this research, which documents the problem on a nationwide scale, will turnthe focus away from documenting the problem to looking for solutions. The end game is providing better medical care."There's a balance," West said. "You've got to have the right stress with the right support so you promote the best growth for the trainee. We're not at that point right now."
Photo one: Richard Sennott/Minneapolis Star Tribune/MCT -- Dr. David Hilden, right, burned out as a family physician, but now works as a hospitalist. He sat during patient reviews with a group of medical students and residents in Minneapolis, Minn.
Photo two: Richard Sennott/Minneapolis Star Tribune/MCT -- Dr. David Hilden, left,talks with Dr. Dan Fulton, resident physician, about his patient roster.
Finding a doctor, whether you need a primary care physician or a specialist for a certain disease or condition, can be one of the toughest decisions to make. How do you know if you're picking a quality doctor?
According to Carolyn Clancy, director for the Agency of Healthcare Research and Quality, finding a doctor is "a little bit like picking a spouse - you have to find someone you can work with."
Here are her tips for finding the right one and making sure you're getting the most out of your doctor's visits: Make the most of your first visit. At your first visit, make sure you can communicate well with the doctor. Clancy says good communication is the most important thing. Bring a list of questions with you. Write them down so you remember everything. Also, make sure the practice is well organized. When you need referrals or information from your doctor, you want to make sure the office can efficiently deal with it. Do your research. While there is no universal clearinghouse for finding a doctor, Clancy says many states have information about doctors online. What should you look for? Find out whether a doctor is board certified in his/her specialty (which is not a requirement, but nice to know) and whether there have been any disciplinary proceedings or judgments against him or her. Also, ask friends and family for recommendations. Be familiar with your medical history. Make sure you tell your doctor about your medical history and bring a list of medications you are taking, both prescription and over-the-counter. Ask questions about side effects of any medications you are prescribed. Ask your doctor about any recommended procedures and whether they are necessary or can be delayed. Know what you're looking for. While recommendations are good to have, make sure the criteria of what you are looking for in a doctor match up with the criteria of the person who is recommending that doctor to you. If you value someone with a no-nonsense attitude, while a family member values someone a little warm and fuzzier, you might not get what you're looking for. Don't overlook the details. Clancy says there are many things people don't think about but should ?before selecting a doctor. This includes knowing whether your doctor is covered by your insurance. You should also make sure your doctor has admitting privileges at the hospital you prefer to go to. Other things to consider: Is your doctor's office good at reaching the physician after hours? Can you get preliminary medical advice over the phone? Can you reach your doctor via email if that's your preferred mode of communication?
Photo: GateHouse News Service- Stethoscope
Some questions consumers may have about listeria in cantaloupes.
Q: What is listeria?
A: Listeria is a hardy bacteria found in soil and water that can be carried by animals. It is often found in processed meats because it can contaminate a processing facility and stay there for a long period of time. It is also common in unpasteurized cheeses and unpasteurized milk. It is less common in produce like cantaloupe, but there have been a couple of other listeria outbreaks in fruits and vegetables in recent years. When a person contracts the disease, it can cause fever, muscle aches, gastrointestinal symptoms and even death. One in five people who have listeria can die.
Q: Am I at risk?
A: Listeria generally only affects the elderly, people with compromised immune systems, pregnant women and newborns whose mothers were infected before birth. The median age of victims in this outbreak is 78 years old. Healthy, younger adults and most children can usually consume listeria with no ill effects or mild illness.
Q: So can I eat cantaloupe?
A: You should avoid cantaloupe from Jensen Farms, the Colorado grower that distributed the tainted fruit.
Q: How do I know if I have a cantaloupe from Jensen Farms?
A: The recalled cantaloupe may be labeled "Colorado Grown," ''Distributed by Frontera Produce," ''Jensenfarms.com" or "Sweet Rocky Fords." It may also be labeled "USA." Not all of the recalled cantaloupes are labeled with a sticker, the Food and Drug Administration said, so it may be hard to tell. Neither the government nor Jensen Farms has released a list of retailers who sold the fruit, so health officials advise consumers ask retailers about the origin of their cantaloupe.
Q: I think I may have had one of the contaminated cantaloupes in my home. But I'm not sure. What should I do?
A: The government's motto is "when in doubt, throw it out." And if you think you had tainted fruit in your home, clean and sanitize all surfaces it may have touched.
Q: I scrub all of my fruits and vegetables before I eat them. So I am okay, right?
A: Scrubbing is never a bad idea, but it may not rid produce of all contaminants, especially on cantaloupe which has a thick, rough skin with a lot of places for pathogens to hide. Health officials think people may have been sickened when people cut into their cantaloupes, bringing listeria on the outside of the fruit to the inside. If you think you may have a tainted cantaloupe in your house, the best recourse is to throw it out.
Q: It looks like the cantaloupes weren't even shipped to my state. Should I still be concerned?
A: The FDA said Jensen Farms shipped to 25 states, but it may have been resold in other states. Illnesses have been discovered in several states where cantaloupes weren't shipped, including in Maryland where a person died.
Q: Why have there been so many deaths?
A: Listeria is less well-known than other pathogens like salmonella and E. coli, which cause many more illnesses in tainted food every year. But listeria is more deadly. One in five people who contract it can die.
Q: When is this outbreak going to be over?
A: FDA and CDC officials said Wednesday that they expect the number of illnesses and even deaths to rise through October. Listeria has an incubation period of a month or more, so people who ate contaminated fruit last week may not see illnesses until next month.
Photo: AP/Ed Andrieski -- Cantaloupes rot in the afternoon heat on a field on the Jensen Farms near Holly, Colo., on Wednesday, Sept. 28, 2011. Federal health officials said Wednesday more illnesses and possibly more deaths may be linked to an outbreak of listeria in cantaloupe in coming weeks.
Games to promote exercise and healthy eating were on the menu during Thursday's health fair for Head Start families and teachers.
The event was sponsored by Southern Illinois University School of Medicine and Springfield Urban League Head Start and coincided with National Childhood Obesity Month, which ends today. The event was held at St. Cabrini Head Start, 1024 E. Milton St.
"We're here to educate and have a little fun at the same time," said Dr. Dave Steward of the SIU School of Medicine.
SIU medical students and other health professionals from the school set up 10 booths to educate the Head Start families about different medical issues. The topics included nutrition, hand washing, women's health, skin cancer prevention, choking prevention and body mass index screenings.
The adults led games that taught children about the health foods they should reach for when they get hungry.
Monica Turner said her three kids, ages 9, 6 and 4, do a pretty good job when it comes to eating right. The family has cut down on fatty foods, and there are some strict rules in place when it comes to snacks.
"They only get candy bars if they go to a birthday party. I don't buy candy bars or potato chips," Turner said.
Turner, who is 28, said she came to the fair to get information on cervical cancer.
"They had information at two different booths. It was very helpful," Turner said.
On the subject of healthy eating, Steward said it's not hard to get the message out, but getting people to follow through and change their eating habits is different.
"It's hard when families are struggling economically. It's hard to change your household habits when you're working hard to just get by," Steward said.
Thursday's event was co-organized by SIU School of Medicine's program, The Springfield Collaborative for Active Child Health, which is partnering with eight Head Start programs in the area to educate children and their families about the importance of healthy nutrition and regular physical activity.
John Reynolds can be reached at 788-1524.
Copyright 2011 The State Journal-Register. Some rights reserved
St. John's Hospital and the American Cancer Society kicked off their sixth annual "Real Men Wear Pink" campaign Thursday to stress the importance of annual mammograms and early detection of breast cancer.
The campaign, which uses local residents in advertisements, encourages men from central Illinois to wear pink on Fridays in October to remind the women in their lives to get annual mammograms.
The "Real Men" who will be featured in this year's campaign are: Dick Corkery, a St. John's board member; Mike Sosa, St. John's food and nutrition director; Jeff Hofmann, WFMB-AM news director; Dr. Tommy Ibrahim, a Hospital Sisters Health System hospitalist; Richard Woo, a breast cancer researcher at Southern Illinois University School of Medicine; Dr. Timothy Gillison, a Springfield Clinic oncologist; Mark Bate, president and chief executive of Nudo Products; Steve Whitton, a breast-cancer survivor; and TC Christian, publisher and CEO of Pure News USA.
A schedule of awareness-raising events is available at http://tinyurl.com/648j4jb.
Information about cancer society programs and events is available at 523-4503 or at www.illinoiscancerhelp.org.
The second annual Be Aware Women's Fair will run from 9 a.m. until 2 p.m. on Saturday, Oct. 15. A $4 admission covers all exhibits, health screenings, demonstrations and entertainment.
"Because we recognize that women are often taking care of the health of everyone else in their families, including their children, partners and parents, we want them to be able to take some time for themselves at Memorial's Be Aware Women's Fair," said Tiffany Lowers, Memorial Medical Center's manager of Memorial's Outpatient Imaging Center at Baylis and chair of the Be Aware Women's Fair organizing committee.
More than 100 exhibits will be available for women to browse, covering topics such as clothing, finance, fitness, health, beauty, massage, fashion, home decoration, education and nutrition.
A grand-prize drawing will be held at the conclusion of the Be Aware Women's Fair. A complete list of the prizes is on the Be Aware Women's Fair website.
Breakfast items will be available to purchase. Box lunches will also be available for $7.75.
Demonstrations will be held at several exhibitor booths. They include:
Photography by Sara Gleckler at 9:45 a.m.
Oil portraits by Kimberly K. Magawon at 9:45 a.m. and 1:15 p.m.
Project CPR at 10:15 a.m. and 1 p.m.
Cooking with Memorial Medical Center's Food and Nutrition Services at 10:45 a.m. and 1:30 p.m.
Floral arrangements at 10:15 a.m. and 1:15 p.m.
Cupcake decorating by Carolyn Coziahr at 11:15 a.m. and 1 p.m.
Plastic surgery Q&A by Dr. Jennifer Lee at 9:15 a.m. and 1:30 p.m.
The American Cancer Society will hold its annual Making Strides Against Breast Cancer Walk that same day at the Illinois State Fairgrounds. All women who are registered walkers will be able to show their Making Strides sticker for free admission to Memorial's Be Aware Women's Fair.
Registration begins at 7:30 a.m. at the Commodities Pavilion, just west of the Grandstand. The walk begins at 9 a.m. at the pavilion and goes through the Department of Natural Resources area.
Proceeds from Memorial's Be Aware Women's Fair will go toward a mammography patient assistance fund. Free "mocktails" will be served at stations throughout the Orr Building, and women can choose to contribute to a tip jar; tips will go toward the assistance fund.
"This fund will support women who may need additional tests after receiving a positive result from a mammogram but cannot afford the associated expenses," Lowers said.
Events scheduled for the entertainment stage are: a Zumba dance fitness demonstration at 9:30 a.m., a belly-dancing performance at 10:30 a.m. and a fashion show at 11:30 a.m. Stevens DJ Service will provide music and will emcee the events on the entertainment stage.
The three women randomly chosen for the Be Aware Women's Fair Super Survivor makeover will be announced at 12:30 p.m. More than 30 nominations were received for the first year of the Super Survivor makeover. People were asked to nominate a breast cancer survivor whose cancer journey has been an inspiration to others.
Health screenings will include blood pressure, cholesterol, body fat, body mass index, bone density, blood sugar, spine health, depression, lung function and oral cancer screenings.
Other health initiatives include fitness evaluations from Memorial's SportsCare, stroke risk assessments by Memorial's Stroke Center, information on self-breast exams and skin cancer, electronic foot scans by the Springfield Running Center, and varicose vein screenings from Memorial Interventional Radiology Clinic.
For more information or a coupon for $1 off the admission price can be found at BeAwareWomensFair.com.
CHICAGO - Billboards could be the latest tools to help the disabled in Illinois find jobs in a tough economy.
It's the latest phase of a public awareness campaign by the Illinois Department of Human Services' Division of Rehabilitation Services. The statewide campaign starts Oct.1.
The campaign is aimed at employers and disabled people who are looking for work. The goal is to let them know the state has resources available to help. The agency already has done radio and TV spots about its vocational rehabilitation services.
The agency's John Marchioro says last year they helped 4,600 people with disabilities get jobs in Illinois.
He says the billboard campaign is aimed at the widest possible audience because "anybody out there knows somebody who has a disability."
Illinois education and transportation officials are encouraging schools to participate in the upcoming International Walk to School Day.
More than 140 Illinois schools have registered for the Oct. 5 event so far.
The day began as a community demonstration in Chicago and has grown into a worldwide event celebrating its 15th year.
The slogan for this year's international event, "Hike it. Bike it. I like it!" was chosen after an online contest. The winner came from a suburban Chicago elementary school.
Participating schools are asked to instruct students on the basics of pedestrian and bicycle safety.
CHICAGO -- A patient who predicted he wouldn't survive a move from a now-closed Illinois charity hospital has died three weeks after his transfer to a nursing home, family and friends said Thursday.
The death of Michael Yanul, 58, who had muscular dystrophy and breathed with a ventilator, raises questions about how Cook County managed patient transfers while closing the hospital in Chicago's south suburbs.
Facing a multimillion-dollar budget deficit, Cook County converted Oak Forest Hospital to an outpatient center in August to save money. Earlier this year, protesters opposed to closing the hospital carried Yanul's photo, enlarged to poster size, to several public hearings. They said they wanted officials to see the face of patients who would be most affected.
The last nine patients, including Yanul, were moved into private homes and other health care facilities by the end of August.
Yanul, who had been cared for at Oak Forest for 17 years, moved into a nursing home chosen by his family Aug. 31. Yanul's brother, Tom Yanul, said he died Sept. 20 of pneumonia and a blood infection.
Cook County Health spokeswoman Marisa Kollias said the county has "an elite team" that makes sure transfers go smoothly. Following standard practice in the health care system, the county is not officially tracking patients after the transfers, Kollias said.
"Cook County Health and Hospitals System is extremely saddened by the death of Mr. Yanul," she said.
Tom Yanul has filed a complaint about the nursing home with the Illinois Department of Public Health. He said Oak Lawn Respiratory and Rehab broke promises for how Michael Yanul would be cared for, lacked needed equipment such as a heated humidifier for Yanul's ventilator and didn't educate staff about Yanul's needs.
A phone message left for the Oak Lawn nursing home's administrator wasn't immediately returned.
Transferring ventilator patients requires detailed planning, including making sure the new facility has similar equipment, said Steven Sittig, a respiratory therapist and pediatric transport clinical specialist at Mayo Clinic in Rochester, Minn. Sittig chairs the transport specialty section of the American Association for Respiratory Care.
"The logistics of it are very complex. It goes beyond the normal discharge planning," Sittig said. "As the sending facility, you make sure all the fine points of the patient's care are relayed on, such as the need for active humidification, the time and involvement for (tracheostomy tube) care, ventilator settings and that the staff is knowledgeable of the ventilator and how to troubleshoot it."
Juanita Gibbs, a friend of Yanul's, was highly involved in his care for many years. She said Yanul loved the care he received at the now-closed hospital and predicted he would die if he had to move.
"He didn't want to be moved because he knew the outcome," Gibbs said. "He said he was signing his death warrant."
Yanul told The Associated Press in April that he was "devastated" to think Oak Forest might close: "The doctors and nurses here have kept me alive. I can't breathe on my own."
Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson