Weighing In On the Holidays

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The “holiday season” is synonymous to many of us with the “eating season”. If COVID hasn’t been enough to promote sedentary weight gain already, we have this to look forward to next.   Starting at Thanksgiving, our feeding frenzy extends relentlessly through Christmas and New Year’s, and continues to perpetuate all the way through the football playoffs into the February Super Bowl.  And every holiday deserves a feast!  Not just the holiday dinners, but also the endless numbers of seasonal snacks and treats at home and the workplace all contribute to the caloric avalanche we experience through the winter months.   No wonder it is not a surprise that most people gain the most weight every year in the month of December.   They also commonly do not lose all of those acquired winter pounds.  Maintaining just two of those extra pounds each season makes you twenty pounds heavier in a decade.

The answer is, of course, calories.  Some fun facts are that, on average, the adult male needs 2500 calories to maintain his current weight.  The average female needs only 2000 calories per day.  It only takes an extra 500 calories each day to gain a pound every week.  Imagine that the typical holiday dinner alone packs a usual 3000 calories, and with appetizers and drinks may top 4500 calories for just that meal and up to 7000 for the day.  “Not bad”, you say.  “There are only a couple of excessive meals during that season in which I indulge”.

However, add the onslaught of holiday snacks, those extra calories may be easy to accrue.  A couple of calorie counts for example: a slice of pumpkin pie is 279, slice of pecan is 532, cherry pie is 304 and apple pie alamode is 414 calories.  Not a pie person?  How about cookies, then.  Each sugar cookie from Subway is 220 calories.  Beer is anywhere from 64 calories in the ultralight to 200 for a hearty IPA.  Wine may range anywhere from 110 to 300 calories per glass depending on sweetness and alcohol content.  If you are considering the playoff parties, a serving of beef nachos is 430 calories, a chili cheese hotdog is 340, one pork rib is 370 and a half dozen chicken wings is 616 calories (www.calorieking.com).

The point is not so much the specific calorie count, but rather the ready availability of “extracurricular” food and treats in which we mindlessly and consistently indulge.  Adding this onslaught of calories consumed throughout the “season”, one could readily pack on two, five or even ten extra pounds this year.

Your awareness of these points may make it easier not to go overboard this year.  Some tips include limiting your choices to eating only your favorite foods.  You do not have to try one of everything.  Serve yourself smaller portions, as most holiday foods are rich and should readily fill you up.  Only eat one helping at a service.  If you feel you must have more, drink a big glass of water and set your timer for twenty minutes.  It is likely by then that meal has caught up, and you will not be hungry for a second helping.  Finally, eat slowly, taste every bite and enjoy these special treats.  Celebrate the holidays and enjoy your time with family and friends.  With social distancing and COVID precautions, of course.

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season 2020-2021 – It’s that Time of Year Again

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In the pandemic of COVID-19, health care has a new face given limitations on access of medical services and products.  Although social distancing and health hygiene is at an all-time high, we still need to beware of the impact of the influenza season looming this winter.  With personal awareness there may be less opportunity for influenza, but it will still be present and potentially deadly in combination with COVID. Here is some disease information that you should know.

Influenza is a respiratory infection that causes fever, cough, sore throat, and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  Although these complaints are similar to the common cold, the severity is typically much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to impact a workplace or school from a single source.  Influenza can cause complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young, similar to the COVID-19.  However, anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.  Fortunately, there is treatment for influenza with early intervention, unlike COVID.

A severe outbreak may commonly last up to eight weeks regionally and can often infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendation from the CDC for the 2020-2021 season again includes trivalent and quadrivalent injectable vaccines.  This year vaccines have been updated to match the expected circulating viruses and are provided as the inactivated influenza vaccine (IIV), the live attenuated nasal spray (LAIV4) and the recombinant influenza vaccine (RIV).

For those interested, the updated protections for this year’s likely infections include:

Egg-based H1N1: A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus.

Cell/recombinant H1N1: A/Hawaii/70/2019 (H1N1)pdm09-like virus.

Egg-based H3N2:  A/Hong Kong/2671/2019 (H3N2)-like virus.

Cell/recombinant H3N2:  A/Hong Kong/2671/2019 (H3N2)-like virus.

B-Victoria lineage: B/Washington/02/2019 (B/Victoria lineage)-like virus.

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are usually readily available at county health clinics, most retail pharmacies, and many family doctor offices.  Nobody knows when the flu will show up in any community, but is often seen as early as October.  Of course, the sooner the administration, the more effective the immunization for the entire influenza season which may go well into the spring.  It can take up to two full weeks to acquire immunity from the shot.  Now is the time to prevent the flu!  Immunize, and do not let the flu get YOU!

Bradford Croft, DO

East Flagstaff Family Medicine

Go With the Flow

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There is a lot of public awareness regarding heart attack and stroke.  Lesser known may be the presentation of vascular disease other than the heart or brain, commonly referred to as peripheral vascular disease or PVD.  Blood vessels may narrow, spasm or obstruct in arteries or veins.  Often seen in legs, PVD commonly presents as pain and fatigue, especially during exercise, and may improve with rest.  Arms and internal organs can be also be affected.  A large percentage of this disease is specific to the arteries, known as peripheral artery disease, or PAD.  Both terms commonly may refer to the same condition.   According to the CDC, over 8.5 million people over 60 have PAD in the United States.

Two different situations occur to develop vascular blockage.  Hardening of the arteries or atherosclerosis develops from plaques or blockages that slowly build up over time.  As vessels slowly narrow, circulation is diminished.  If the plaque ruptures or clots, there is an immediate and complete blockage of the vessel causing acute symptoms.   When this occurs in the heart or brain, the result is a heart attack or stroke.  With PVD, muscles demand higher oxygen during exertion, but the inability to provide adequate circulation results in pain and spasm.  In some situations, a blood vessel that is otherwise undamaged may go into spasm and prevent circulation with similar outcomes.  This can occur from exposure to cold temperatures, vibrating machines or tools, emotional stress or drugs that cause vessel spasm, such as some stimulants.  There are diseases that greatly contribute to the development of PVD.  Those individuals who have high blood pressure, high cholesterol and diabetes are at much greater risk of PVD.  Smokers are at great risk as well from the damaging effects of smoking harming the blood vessels over time.  Just the ageing process alone is a risk to those over sixty.

Common symptoms of PVD known as claudication may be the spasm, aches and fatigue of exertion, but sometimes may occur during sleep.  Over time, there may be a noticeable reduction in the growth of hair on the legs.  Thin or pale skin may develop as well, leading to the development of sores or ulcers that will not heal.  Discoloration or blueish skin, especially fingers or toes may become evident.  With continued diminishing blood flow, tissues may subsequently die leading to gangrene and amputation.   An acute blockage results in significant pain along with a cold, pulseless and pale or blue skin.  This is a medical emergency and needs immediate attention.

There are multiple ways to evaluate for PVD.  Doppler ultrasound measures the sound waves from the blood flow in arteries and veins and can determine compromises.  Ankle-brachial index, or ABI, compares the blood pressures of the upper and lower extremities.  As blood pressures are generally consistent throughout the body, a difference between extremities can indicate PVD.  Angiography injects contrast into the blood vessels and can visualize narrowing or obstruction in the arteries.  Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA) are also radiology studies that image vessels to visualize disease.

The main goals of care are to stop the disease and manage the pain.  Treatment may initially involve diet, increased exercise, weight loss and stop smoking.  Management of underlying chronic disease is critical.  There are various medications that may be appropriate as early treatment.  In more severe cases, surgical intervention may be necessary to open and re-establish blood flow in the obstructed vessel.  Early diagnosis is critical.  Symptoms of PVD?  Contact your primary care provider as soon as possible!

Bradford Croft, DO

East Flagstaff Family Medicine

Cabin Fever Redefined

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“Extreme irritability and restlessness from living in isolation or a confined indoor area for a prolonged time”, says Webster.  If this definition strikes a familiar feeling, you may have fallen under the spell of “cabin fever”.  Although not a true medical disease, it is a common aberration of human nature resulting from prolonged boredom and lack of social stimulation.

Prior to COVID-19, this scenario may have been a subplot in a Jack London short story. For those living in Flagstaff, it could have come from experiencing a longer than expected, snowed-in weekend in northern Arizona.  But with the current COVD-19 pandemic, many of us have participated in self quarantine and social isolation as doing our part to address this disease.  As we all deal with our day-to-day anxieties in our own way, once we add the additional stressors of this rampant disease and subsequent societal compromises, our coping mechanisms may begin to break down.

Not everyone will experience the same symptoms from this syndrome.  Commonly, complaints of intense irritability or restlessness are reported.  Physical symptoms of lethargy, fatigue and frequent napping with difficult awakening are not uncommon.  Psychological issues include depression and sadness, difficulty with thinking, and feelings of hopelessness.  Sometimes the stress is reflected in anger and lack of patience with those in close household proximity, such as spouse and children, and in multi-generational households, even parents or other relatives.  Initially innocuous for most, cabin fever left unbridled may evolve to extreme emotional and psychological imbalance that may require professional help.

As we continue to navigate the changing waters of the COVID-19 social recommendations by our national medical experts as well as the guidelines or requirements by our governments, we once again may be held to voluntary or mandatory health and socioeconomic restrictions.  Taking active steps to counter our adverse feelings early on may go a long way for each of us to maintain better emotional control.

If you shelter at home or need to self-quarantine, getting out of the house for even a short time while maintaining social distancing may be helpful.  Exposure to sunlight will help autoregulate your natural endocrine cycles.  Exercise will help produce endorphins, your body’s natural stress reliever.  Planning for some alternative regular exertion, such as an indoor exercise or following an online program are accessible to most, if not all of us.

Avoid the temptation of junk foods, as well as ongoing snacking and grazing thru the day.  Maintaining a regular, well-balanced diet will help preserve energy levels and motivation.  Stay away from high fat and high sugar foods.  Satisfy adequate hydration by drinking at least 64 oz of water daily.  Avoiding caffeine may be beneficial.  Regular sleep / wake cycles are also supportive.  Avoid ‘all-nighters’ and maintaining a regular wake up time will go a long way to preserve your proper circadian balance.

Mindless TV and binge-watching programs are a relative vacuum of mental effort.  Stimulate your brain with puzzles such as crossword or sudoku, playing board games or reading books are much more beneficial activities that will keep your mind in gear.  Make some reasonable goal during your time at home.  Going thru that closet or listing some easy but long-overdue home fixit chores will lead to a sense of satisfaction with each achievement.   Set your daily requirement of at least one hurdle to cross that provides some sense of fulfilment.

Hopefully, we as a society will be able to stabilize and control our health future without significant socioeconomic isolation again.  Yet should we head down that path, keep these suggestions in mind as we shelter at home and self-quarantine once more.  Please be responsible to all of us: yourself, your family, and your neighbor as we fight for wellness together.

Bradford Croft, DO

East Flagstaff Family Medicine

An Eye Out for Trouble

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There are an estimated 2.4 million eye injuries in the United States annually.  Injury leading to blindness or impaired vision are potential outcomes of eye trauma.   Up to 90% of this trauma should be essentially preventable with proactive eye protection.

As there are many individuals wearing corrective glasses or contacts, these do not offer protection from eye trauma.  Your specific eye protection depends on your activity, from protests to paintball.  In fact, the presence of glasses or contacts may further impact eye damage.   Protective eyewear should be made from polycarbonate, as it resists shattering and can provide UV protection.

The most basic form of eye protection is the use of goggles.  This safeguard includes security from impact, dust and chemical splash and protects the entire eye.   Every household should have at least one set of eye protection, as many home projects or repairs put one at risk of eye trauma.   For most projects around the home, standard ANSI approved eye protection is reasonable.   They should be marked on the lens or frame with “ANSI Z87.1” to assure your protection meets the standards.   This may include goggles, safety glasses or face shields.  If you work in an environment with hazardous chemicals or substances, flying debris or small particles, or projectiles of any kind, you should be making proper use of protective eyewear.   Most hardware stores carry appropriate inventory.

Sports related eye protection is specific to each activity.  The American Society for Testing and Materials (ASTM) has set standards for specific sports to prevent eye trauma associated with common trauma etiologies.  As reported by the American Academy of Ophthalmology, these are some specific eye safety standards for the following sports:

ASTM F803 – eye protection for racquet sports, lacrosse, field hockey, baseball and basketball

ASTM F515 – eye and face protection for hockey players

ASTM F1776 – eye protection for paintball sports

ASTM F1587 – head and face protection for hockey goaltenders

ASTM F659 – high impact resistance eye protection for Alpine skiing

For activities needing eye protection in an outdoor environment involving water or snow, make sure that there is the additional UV protection included in the device.

Work environments are evaluated by the Occupational Safety and Health Administration (OSHA).  Your human resources department should know if you have any specific requirements for your job.  Commonly, the OSHA standard require the same ANSI-certified eye protection that you should use at home.  Some guidelines for the type of protection depend on the hazard.  Safety glasses with side protection or side shields protect around flying objects, particles or dust.  Goggles are best for total protection for those handling chemicals.  There are specially designed glasses, goggles, face shields or helmets working with hazardous radiation, welding, lasers or fiber optics.  Many employers who have these exposures innate to employment will have eyewash stations strategic to the plant layout.

More information can found at https://www.osha.gov/SLTC/eyefaceprotection/. This website provides an overview of OSHA requirements, including standards, hazards and solutions and additional resources.  https://blog.ansi.org/2020/03/ansi-z87-1-eye-face-protection-standard-isea/#gref provides additional resources regarding the device standards.  Prevention is the watchword for eye protection, as trauma can happen literally in the blink of an eye.

Bradford Croft, DO

East Flagstaff Family Medicine

TESTING…One….Two…Three

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We continue to be bombarded by media and hearsay about COVID-19 testing.  Hopefully this information may help offer some guidance regarding the testing issues and some direction for you to consider personal testing.  There are two types of COVID 19 tests available at this time, the molecular testing for active disease and the antibody test for the exposure to or recovery from the disease.

The molecular test looks for active disease.  This involves taking a cotton swab of one nostril for about a five second duration.  This sample is then sent to the lab to undergo a polymerase chain reaction (PCR).  This testing checks for the presence of the genetic material of the virus.  A positive PCR test identifies the presence of two specific SARS-CoV-2 genes.

If there is only one gene present, the test is reported as an inconclusive result.  This testing can only diagnose a current active case of COVID-19.  Common symptoms include a cough and/or shortness of breath.  At least two additional symptoms including fever/chills, muscle pain, headache, sore throat and loss of taste or smell are suspicious of disease.  Some individuals may have only a few or no symptoms whatsoever, but still be actively infected.   Negative test during the presence of acute respiratory symptoms indicates that the illness is not COVID-19.

False negative testing may occur if the test is collected too early in the exposure of the disease.  The usual period from catching the infection to developing symptoms averages 5-6 days, but may be up to 14 days.  During the “pre-symptomatic” period, some individuals may be actively spreading the infection.

At this writing, the only way to access local molecular testing is with a physician order through the Coconino County Health Department.  The collection sites for testing are at Fort Tuthill and their King Street building, but schedules may vary.  For more information and updates, visit www.coconino.az.gov/2294/COVID-19-Information.

Coronavirus COVID-19 SARS-CoV-2 Antibody IgG testing may show individuals who have recovered from exposure to COVID-19. This test searches for the presence of specific antibodies that the body has produced to fight the virus.  A blood sample is needed to run this test, and there are a number of commercial labs producing these serologic tests.  This testing should not be considered until at least ten days or longer after symptoms develop, as it can take one to three weeks for the body to develop antibodies.

A positive test shows that antibodies are present, a negative indicates no antibodies present.  There are some questions that arise about such testing.  By recent reports, some of these lab tests may be up to thirty percent inaccurate.  False positives may indicate antibodies, but may not be specific to SARS-CoV-2 as there are other common Coronaviruses including HKU1, NL63, OC43 and 229E.  There is also no distinction as to recovering from a present COVID-19 infection or a previous common non-SARS-CoV-2.

One needs to use some care in interpreting the value of antibody testing.  There is no assurance that antibody positive individuals may continue to be resistant to future exposures.  Or, if positive, for what longevity may their resistance be present.  That said, the presence or absence of antibodies should not be used to definitively diagnose or exclude COVID-19 infection or designate the status of infection.  Be careful about using these test results alone to make health related decisions.  Because of these problems, some medical clinics are not offering this test to their patients.  Consult your health care provider for guidance regarding testing during these challenging times.

Bradford Croft, DO

East Flagstaff Family Medicine

Not Virtually Impossible

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When I look back to when I was an 8-year-old boy thinking while talking on the phone to friends and family how amazing it would be to see their faces as we talked. At the time I never thought this was a realistic proposition for the general public. Now here we are in 2020 and you can have a comprehensive remote audio and visual visit with your medical provider via telemedicine! 

 

According to CMS (Centers for Medicare and Medicaid Services), telemedicine or telehealth refers to the exchange of information from one site to another through electronic communication to improve a patient’s health. Its use involves any interactive audio and visual telecommunications system that allows real-time communication between a medical provider and the patient at a remote site, such as a patient’s home, place of work, or even automobile. 

 

Telemedicine has become far more prevalent in the last few years. Its beginning dates back at least 70 years. In the 1940s and 1950s physicians in Pennsylvania and Canada started to send radiology images to other sites via telephone lines for shared care of patients. The first use of audio and visual telehealth dates back to 1959-1965 when the University of Nebraska established a two-way television for use in educating medical students and video consults with patients in a state hospital. In many rural areas of the US where certain medical specialties may not be available within a reasonable geographic traveling distance, telemedicine can help bridge the gap via a provider-to-provider consult or a provider-to-patient visit. 

 

Though telemedicine has been in use for a number of years, its use has increased significantly by providers in a great variety of medical specialties recently due to the current COVID-19 pandemic. As it has been strongly encouraged to stay at home as much as possible to prevent the spread of the virus, telemedicine provides an invaluable way to be able to communicate with your medical provider regarding any chronic or acute medical condition that needs treatment.  

 

As one may imagine, there can be some limitations to receiving care via telemedicine vs. an in-person visit. One is not able to provide hands-on listening to heart and lungs or examine a spine or extremity. However, with many chronic and acute conditions, an adequate examination may be performed with face-to-face telecommunications. During these very unusual conditions that the COVID-19 pandemic has presented, the benefits obtained by not delaying care with your medical provider for any medical condition that may present itself greatly outweighs any limitations that this mode of treatment may have.  

 

You will want to schedule a telemedicine appointment with one of your healthcare providers soon.  We highly recommend taking advantage of this technology to have such a visit with your doctor, nurse practitioner, or physician assistant while in the comfort of your own home.  All insurances now recognize and reimburse these visits.  There is no special equipment needed other that a smartphone or desktop/laptop or tablet that has a video camera and microphone.  If you need any assistance, offices are more than ready to help.  Hope to see you soon.   

Andy Conboy, PA -C

East Flagstaff Family Medicine

 

Going Viral

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As global economics sagged late in February, the worldwide impact of the Wuhan Corona virus (Covid-19) illness becomes apparent.  Having initially been localized to China since the discovery of the infection December 2019, there evolves a worldwide surge of infection with documented cases in all continents except Antarctica by the end of February.  At this writing, there are more than 82,000 cases and 2,800 deaths.  Some infections are easily spread with the ability of global travel as highly virulent strains.  Other infections may take their human toll as they may be extraordinarily deadly.  With the jury not yet back on Covid-19, the World Health Organization (WHO) and Center for Disease Control (CDC) can only attempt at this time to limit the spread with national and international cooperation.

Border closures and quarantine may initially be the preferred steps to prevent the entry of disease.  Once the illness becomes apparent in communities, the challenge becomes much greater. Consideration of work and school closures, restrictions of public events, self-imposed isolation of individuals who are ill may be collaboratively helpful.  The health care provisions to treat this disease are supportive treatments at best, as there is yet definitive treatment or immunization for this virus.  As reflected in the stock market changes, these can as well have significant economic impact for both health care costs and the worldwide economy as well.

If we need to put this epidemic in proportion, we should look at pandemics of the past century.  The Flu Pandemic of 1918 became a worldwide outbreak over two years, infecting one third of the world population and killing up to 500 million people with a mortality rate of up to 20%.  Perhaps with the development of modern medicine, no other epidemics have eclipsed this toll in the modern world.  Yet.

The Asian Flu of 1956 spread from SE Asia thru the US, killing 2 million.  The Hong Kong Flu killed one million from SE Asia thru Europe, Australia and the United States in 1968.  Other diseases have provided their epidemic influence over years and centuries, but may not have the impact to the “modern” world as we know it.  Those diseases that have influenced history include cholera, bubonic plague and smallpox.  Not to ignore their presence at this time, as they are persistently lurking.  A good example of this scenario is the current control of Ebola. The human to human contact is not easily spread, but up to 80% lethal once transmitted.

Concern for Covid-19 transmission has a few concerns.  Standard face masks may protect you from transmission of the virus. Covering coughs and sneezes with masks can minimize the aerosol spread.  The virus is highly contagious, although over eighty percent of the cases are mild, the remaining infections can be severe.   That said, the virus is spread from infected human contact, so preventive measures are important.  Avoidance of those already coughing and sneezing is commonsense.  Inactivation of potentially contaminated surfaces may be achieved with cleaning agents containing hydrogen peroxide, ethanol or bleach.  A common habit that many of us have involves touching eyes, nose, and mouth without any awareness of the action.  This single contact is the most likely way to inoculate yourself with the viral contamination on your hands.  Make an extra effort to keep hands away from face.  Which leads to the single most important prevention:  hand washing.   Frequent use of an alcohol based hand cleaner or twenty seconds minimum with soap and warm water are ideal. So if we can’t treat it, let’s beat it!

Bradford Croft, DO

East Flagstaff Family Medicine

What You Should Know about Coronavirus

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With the increasing concern of COVID-19 in our communities, our first and foremost concern is for the health and safety of our patients and our people. We want you to know what you can do to prepare for the coronavirus at home and if you need to visit a healthcare center.

What you should know
• COVID-19 is a respiratory disease caused by a novel (new) coronavirus that was first detected in China. It is now being spread from person to person in multiple locations across the U.S.
• Health experts are still learning the details. Currently it is thought to spread:
o Between people who are in close contact with one another (within about 6 feet).
o Via respiratory droplets produced when an infected person coughs or sneezes.

Personal precautions
Here are a few tips to help prevent infection:
• Wash your hands often with warm, soapy water for at least 20 seconds and/or use hand sanitizer.
• Cough into your elbow. Cover your mouth and nose with flexed arm or tissue when coughing and sneezing. Clean hands with hand sanitizer or wash hands thoroughly after.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect high touch areas such as desks, doorknobs, keyboards, phones, etc.

Medical care
• If you are sick and have a fever, or signs of cough/flu/pneumonia, shortness of breath, or other respiratory conditions please stay home from work or school.
• Call your primary care provider before traveling to a care center to understand the appropriate plan of care if you know you have been exposed to somebody with the COVID-19 virus or if you have a fever above 100.4 associated with a cough.
• Consider a telephone visit for simple illness if possible.
• If you arrive at a care center with respiratory symptoms, ask for a mask to wear.

More information and resources
• For all that you need to know, including travel advisories: www.cdc.gov/coronavirus/index.html
• For specific questions, see the CDC’s FAQ section: www.cdc.gov/coronavirus/2019-ncov/faq.html
• For information about COVID-19 in your state, search your state’s health department, which works with the CDC to monitor and implement all recommendations: www.cdc.gov/public…/healthdirectories/healthdepartments.html

Say Again??

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Have you ever experienced difficulty in hearing after a night at a concert?  Have you had an exposure to a sudden loud noise that caused reduced hearing in one or both ears for any period of time?   How about a buzzing or ringing in your ears after noise exposure?  If any of those rings a bell (which you may or may not be able to hear), you may be experiencing Noise Induced Hearing Loss (NIHL).  In fact, about fifteen percent of Americans between twenty and seventy may have hearing loss from exposure to noise at work or in leisure activities according to the National Institute of Deafness, https://www.nidcd.nih.gov/.

There is not one simple situation that causes NIHL.  The damage to hearing after loud noise exposures may not be immediately apparent.  Commonly it is a subtle, progressive damage caused by repeated exposure to loud noises, many times from varying sources over years.  The individual may not even be aware until family members or friends point out the concern.  The repeated damage from loud noise even from short exposures over time may progress to permanent loss.  It is important to wear hearing protection when you anticipate such exposures.

Excessive noise exposure in the workplace is readily recognized as a potential hazard for as many as 30 million Americans.  Employers are required by law to evaluate and monitor noise exposure levels that identifies workers at risk.  The threshold to provide an OSHA Hearing Conservation Program is that of 85 decibels (dB) or above averaged over an eight hour day. But as damage may also occur accruing from sporadic and intermittent noise, the range of exposure must be monitored from 80 dB to 130 dB.  Employers must provide hearing protection in the workplace for these individuals, the type and extent of such can be calculated from the average noise exposure level.  Baseline and annual hearing tests must also be provided to these individuals to assure adherence to the Hearing Conservation Program, that progressive hearing loss does not occur.  Prevention is paramount, as NIHL is progressive and permanent.

Although the higher pitches of hearing (frequency) are usually the first lost, it is the volume (amplitude), of sound, measured in decibels (dB), that causes damage.  Examples of common volumes are: whisper at three feet = 30 dB, conversation at three feet = 60 dB, vacuum cleaner at three feet = 70dB, busy road at fifteen feet = 80 dB, diesel truck at thirty feet = 90 dB, concert three feet from a speaker = 100dB, chainsaw at three feet = 110dB, ambulance siren at 100 feet = 130 dB.  The OSHA standard for the work environment is 85 dB averaged over eight hours of exposure.  For every three dB of volume increase, the “safe” exposure time is cut in half.  At 88 dB, the limit of exposure is now cut to four hours before hearing will become further damaged.

As the work environment is only responsible for about eight hours of our daily living (for most of us), consider the cumulative effect of noise exposure throughout the twenty-four hour day.  What is the “safe” level of noise exposure then?  According to hyperacusisresearch.org the only evidence-based safe noise level for hearing is a surprisingly low 70 dB when it is averaged over twenty-four hours.  Consider personal hearing protection when working with power tools or at sporting events.  You may want to turn down the volume on your headphones or earbuds.  At maximum volume, you may be generating 100 dB volume, loud enough to begin causing hearing damage at only fifteen minutes of exposure per day. Additional information on NIHL may be obtained from the Occupational Safety and Health Administration link: https://www.osha.gov/Publications/osha3074.pdf  or your PCP.

Bradford Croft, DO

East Flagstaff Family Medicine