“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

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

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

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

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

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.

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

In addition to St. Valentine, February helps to remind us of other things that impact the heart. Multiple factors can influence your risk of heart disease that include several health conditions, your lifestyle, age and family history.   It is important to know your risk factors as some can be changed, others cannot.  As heart disease is still the number one killer of both men and women in the US, these are issues that should truly be taken to heart.

According to the Center for Disease Control, almost half of the US population have at least one of three main risk factors of cardiovascular disease: high blood pressure, elevated cholesterol and smoking.  High blood pressure can silently damage the heart, kidneys and brain among other systems over time.  When the damage comes, its first symptom will usually be a heart attack, kidney failure or stroke.   As there are rarely any physical complaints associated with untreated hypertension, the only way to determine the problem is to check your blood pressure.  If elevated, treatments may include lifestyle changes as well as medication.

Cholesterol is a natural substance in the body, but with elevated levels may cause deposits in the blood vessels over time.  As these plaques occur, circulation can be compromised to organ systems, again leading to damage to brain, heart and kidneys.  And again, its first symptom may present as a stroke, heart attack or kidney failure.  The two major cholesterol subgroups include HDL (good cholesterol), the higher the better, and LDL (bad cholesterol), better lower.  Depending on risk factors, the goals for the cholesterol components may vary among individuals.  A simple blood test can determine your values and imply your risk.

Smoking is well known to increase the negative effects of both hypertension and hyperlipidemia.  The effects of nicotine, either smoking or vaping, will further heighten blood vessel resistance, contributing to worsening hypertension and vascular damage.  High cholesterol will be adversely affected by further lowering HDL, further increasing plaque formation.

Diabetes will compound the likelihood of cardiovascular death.  Management of diabetes is critical to decreasing the risk of cardiovascular disease.  The impact of obesity further worsens adverse cholesterol and elevates blood pressure.  Poor dietary habits, sedentary lifestyle, excessive alcohol intake and uncontrolled anger or stress all are additional contributors as risk factors.  As difficult as it may be, however, all of these risks can be modified and improved with lifestyle and medical intervention.

Some risk factors can’t be changed including family history (following genetic blueprints), age (risk increases with age), gender (males more likely than females, but the odds equilibrate after menopause), and race (African American, Native American and Hispanic American are at higher risk than Caucasian).  Even though these risks cannot be changed, the spectrum and contribution of the additional treatable risks can be addressed and monitored over time to improve the outcomes and minimize the cardiovascular consequences.  If you are not aware if you have any of these risk factors, this would be the month to visit with your primary care provider for screening.  If you do have any of these risk factors, this would be the month to visit with your primary care provider for treatment.  Take it to heart.

Bradford Croft, DO

East Flagstaff Family Medicine

Over ten million Americans suffer from vision loss secondary to macular degeneration, more than glaucoma and cataracts combined.  The retina is the back lining of the eye, responsible to receive images projected by the lens.  The central portion, or macula, is where the ability to focus central vision occurs.   As that lining deteriorates, the ability to read, recognize faces or colors, drive a car and see objects in fine detail becomes compromised.   In the early changes of macular degeneration, the individual may not yet be aware there are any changes in vision.  As the disease progresses, there may be wavy or blurred vision.  With additional change, there becomes a loss of the center of the visual field.  Imagine looking at a photograph with the center of the picture erased.

Macular degeneration is a little known disease, but research continues.  There is evidence that lifestyle, genetics and environment all contribute to the development.  People with a family history are at greater risk.  Whites are also at greater likelihood than Blacks or Hispanics/Latinos. Those with light colored eyes are more prevalent, as are those with long term UV exposure over time without protection.   Those with cardiovascular disease, overweight, eat high fat diet or are females are at greater risk.  Smoking doubles the risk of macular degeneration.  The threat increases with aging, particularly over age 60.

Because the disease most commonly occurs with age, it is referred to as Age-related Macular Degeneration (AMD).  The early stage of AMD may not be evident to the patient.  A careful eye exam may identify the initial presence of drusen, the degenerative deposits found in the retina as the disease is diagnosed.  Intermediate AMD develops as the number and size of drusen increase, which may provide some degree of visual changes, but still may not necessarily be apparent to the individual.  A comprehensive eye exam along with additional testing should show larger and increasing drusen or changes in the retinal pigment.  Late AMD has established apparent vision loss.  There is another form of macular degeneration known as Stargardt disease. This type is genetic in nature and commonly presents in young individuals, earning the name of early onset or juvenile macular degeneration.

Dry degeneration (atrophic) is far the more common type of macular degeneration (85-90%) while the balance is wet degeneration (exudative).  Although both are problems, the wet form is a much more aggressive form of the disease.  Dry degeneration involves the proliferation of drusen, where eventually the macular cells will thin and die, causing loss of central vision.  Wet degeneration involves overgrowth of blood vessels in the eye, causing bleeding and fluid in the retina, eventually causing scarring and vision loss.

At this time, macular degeneration is an incurable disease.  There are opportunities to reduce your risk and slow the progression once diagnosed.  Risk reduction may include exercise, diet changes, protecting your eyes from UV exposure and not smoking.  Regular eye examinations may be the single most important factor in intervention, especially if you have risk factors or a family history of macular degeneration.

Bradford Croft, DO

East Flagstaff Family Medicine

As of end-October 2019, there have been 1888 lung injury cases associated with the use of e-cigarettes, with thirty-seven confirmed deaths in 24 states.   There are some common findings that are associated with lung damage from e-cigs or vaping, but there are many variables that may contribute to the damage.  All patients reported the use of vaping as a common denominator.  Both the exclusive use of nicotine in some patients along with the combined use of nicotine with THC have been reported by others.  According to the CDC, the latest national and state findings suggest that products containing THC, especially those obtained off the street or other informal sources are linked to most of the cases and play a major role in the outbreak.  But as some patients had reported only using nicotine and still experienced lung damage, nicotine should not be excluded as playing a role as an antagonist as well.

To date, the FDA and the CDC have not isolated specific agents producing the lung injuries in these cases.  There may be multiple substances that are contributing to the outbreaks as many product sources continue to be investigated.  As there are currently no ingredient requirements or contaminant controls imposed on vaping fluids, there are no required quality guidelines or measures imposed on manufactures at this time.  Home based fluids can be exceptionally risky, particularly those with THC.

The CDC data reports seventy percent of e-cigarette/vaping lung injury (EVALI) patients are male.  The median age of patients is 24, ranging from 13 to 75 years old, with 79% of patients under 35.  Of 864 patients with established disease report using the following within three months from the onset of their disease:  86% with THC containing products, 34% exclusively THC, 64% with nicotine containing products and 11% exclusively nicotine.  Listing patients by age group category: 14% of patients are under 18 years old, 40% are 18 to 24, 25% are 25 to 34, and 21% are 35 or older.

Symptoms of EVALI can be very nonspecific and vague.  Listed complaints of the disease include cough, shortness of breath, or chest pain; nausea, vomiting, abdominal pain, or diarrhea; fever, chills, or weight loss.  The onset of symptoms can be as brief as a few days after exposure, others have taken weeks to develop.  A common acknowledgement is that lung infections do not appear to be the underlying cause of symptoms, rather it is the vaping products themselves.

As you would expect, the CDC recommendations include not using vaping or e-cig products, especially those that contain THC.  Given no product quality controls, you may reconsider buying any type of commercial products, especially off the street.  If you are using vaping as an alternative to smoking, please do not go back to cigarettes.  Consider using FDA approved nicotine replacement therapies.  If you are trying to quit tobacco products and need assistance, contact your health care provider.  The Arizona program ASHLINE is a free nicotine cessation program at www.ashline.org  and has a helpline 24/7 to get started at 1-800-55-66-222.  For youth or adults with marijuana addiction, support and treatment is available through the Substance Abuse and Mental Health Services Administration (SAMHSA) Flagstaff Office at (928) 774-7128.

Should you need additional support or information regarding vaping or e-cigarettes, search https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html or contact your health care provider.  The urgent message regarding vaping – don’t start, quit if you do!

Bradford Croft, DO

East Flagstaff Family Medicine