An Apple Per Day

Burn Care

2010-05-11T13:04:00.000-07:00

Thermal Burns: Most of these burns are from hot water, hot drinks, hot grease, heating grates, and cigarettes. Usually the burn is first degree (reddened skin without blisters) or second degree (with blisters). Neither of these leaves scars. Second-degree burns take up to 3 weeks to heal. A third-degree burn is deep and leaves areas of scarred skin. During healing it usually needs a skin graft to prevent bad scarring.

Chemical Burns: These burns are from lye, acids, caustic cleaning agents, or other tissue-damaging chemicals splashed on the skin. They usually heal like a sunburn in about a week. These burns always need to be evaluated by a physician.

Electrical Burns: These burns originate from a source of electricity such as an electrical outlet. These burns can cause permanent disfigurement of the face, mouth or hands. They always need to be evaluated by a physician.

FIRST AID
Thermal burns. Immediately (don’t take time to remove clothing) put the burned part in cold tap water or pour cold tap water over it for 10 minutes. If you are outside, the nearest garden hose should be used. This will lessen the depth of the burn and relieve pain. If the burned area is large, cover it loosely with a clean sheet. The covering will keep the burn clean and reduce the pain.

Chemical burns. Remove all contaminated clothing and rinse off the exposed body parts. Instructions for treating burns may be found on the container. If so, follow them. If not, wash away the chemical with large amounts of water for at least 20 minutes. Don’t rub the skin during the rinse. Don’t apply any burn ointment because washing it off will cause pain. The best way to do the rinse is in a tub or shower. If the burn area is large, cover it loosely with a clean, damp sheet.

Electrical burns. If the electrical current is controlled by a wall switch, turn it off. If not, pull the child away using a non-conductive material such as a board or wooden chair. Do not use bare hands. If the child is not breathing, call 911 and start CPR.

HOME CARE
Treatment. General measures for caring for a burn include keeping the area clean. Soaking in a tub or applying warm compresses at least once a day may be recommended by your physician. During this time, all the dead skin from the area should be gently removed.

BURNS
Children usually require the burned area to be bandaged if the area is subject to being bumped or rubbed. An antibiotic cream called Silvadene is usually recommended, and is applied before the area is bandaged. Many burns will need to be seen daily by the physician for bandage changes and debridement.

Pain. For pain, give acetaminophen every 4 hours or ibuprofen every 6 hours for at least 24 hours. Burns can be very painful, and sometimes the physician will prescribe a pain medicine. It may be necessary to give the pain medication one hour before changing the bandages or going to see the doctor.

Diet. If the child has an extensive burn, try to increase the protein intake while the healing progresses. Proteins are the “building blocks” needed for repair. High-protein foods include meat, poultry, fish, eggs, milk, cheese and beans.

CALL YOUR CHILD’S PHYSICIAN IMMEDIATELY IF:
• Child develops a fever of 101.5°F.
• Pus accumulates in the burned area.
• There is pain, redness or swelling in the tissue surrounding the burned area.

NOTIFY YOUR PHYSICIAN IF:
• The burn starts to look infected.
• The burn isn’t healed within 10 days.
• You feel your child is getting worse.
• You have other questions or concerns.

Bee Stings

2010-05-10T13:53:00.000-07:00

Stings by honey bees, bumble bees, wasps, or yellow jackets are frightening. Over 95% of stings are by yellow jackets. These stings cause immediate, painful red bumps. The pain is usually better in 2 hours. However, the swelling may increase for 24 - 48 hours. Multiple stings (more than 10) can cause vomiting, diarrhea, a headache, and fever. These symptoms are caused by a toxic reaction to the large amount of venom in so many stings. They are not the symptoms of an allergic reaction. Allergic reactions cause difficulty breathing, difficulty swallowing, passing out, hives, or swelling in skin areas other than where the sting occurred.

HOME CARE Treatment. If you see a little black dot in the area of the sting, the stinger may still be in the skin. (Only honey bees leave their stingers.) Remove the stinger by scraping it off. If only a small fragment remains, it will come out on its own. Then rub each sting for 20 minutes with a cotton ball soaked in meat tenderizer and water, or with a slurry of ground-up aspirin tablets. (Avoid the area around the eye.) This will neutralize the venom and relieve the pain. If you do not have any meat tenderizer, apply an aluminum-based deodorant or a baking soda solution for 20 minutes. If it still hurts, massage with an ice cube for 10 minutes. Give acetaminophen or ibuprofen immediately for relief of pain and burning.

Prevention. Some bee stings can be prevented by avoiding gardens and orchards and by not going barefoot. Insect repellents do not protect against these stinging insects.

CALL YOUR PHYSICIAN IMMEDIATELY (or CALL 911) IF BREATHING OR SWALLOWING IS DIFFICULT.

NOTIFY YOUR PHYSICIAN IF:
• The swelling continues to spread after 24 hours.
• Swelling of the hand or foot spreads past the wrist or ankle.
• You have other questions or concerns.

Poison Ivy

2010-05-07T13:16:00.000-07:00

With spring here, many people have started to get poison ivy. Here is some information on the appearance, cause, course, treatment, contagiousness, and prevention of poison ivy. We've also included recommendations on when to call your doctor.

Signs and Appearance:
• Redness and blisters
• Eruptions on exposed body surfaces (e.g., hands)
• Shapes like streaks or patches
• Extreme itchiness
• Onset 1-2 days after the patient was in a forest of field
CAUSE
Poison Ivy, poison oak and poison sumac cause the same
type of rash, and are found throughout the United States.
More the 50% of people are sensitive to the oil of these
plants.
EXPECTED COURSE
Poison Ivy usually lasts 2 weeks. Treatment reduces the
symptoms but doesn’t cure the disease. The best approach is
prevention. The sores should be dried up and no longer itchy
in 10-14 days. In the meantime, cut your child’s fingernails
short and encourage him not to scratch himself.
HOME TREATMENT
• Cool soaks. Soak the involved area in cold water or
massage it with an ice cube for 20 minutes as often as
necessary. Then let it air dry. This will reduce the
itching.
• Steroid creams. If applied early, a steroid cream
applied to the skin can significantly reduce the itching.
• Antihistamine. A non-prescription product such as
Benadryl taken orally also helps reduce itching.
CONTAGIOUSNESS
The fluid from the sores is not contagious. However,
anything that has the poison ivy plant oil on it can cause the
rash for about a week. This includes the shoes and clothes
the patient last wore into the poison ivy area, as well as any
pets that may have the oil in their fur. Be sure to wash them
off with soap and water. The rash usually begins 1 -2 days
after contact.

PREVENTION
Learn to recognize these plants. Otherwise, avoid all plants
with three large shiny, green leaves. Wear long pants when
walking through areas that may contain poison ivy. If you
think there has been contact, wash the exposed areas of skin
with soap several times. Do this as soon as possible, because
after 1 hour it is of little value in preventing absorption of
the oil.
CALL YOUR PHYSICIAN IMMEDIATELY IF:
• the face, eyelids, or lips become involved
• the itching interferes with sleep
• any large blisters develop
• the rash becomes open and oozing
• signs of other infection, such as pus or soft yellow
scabs are seen
• you have other concerns or questions

Apple Per Day - Allergies

2010-05-07T05:51:00.000-07:00

Hello, welcome to the newest video in the Apple Per Day series, exclusively from Righttime Medical Care. In the latest installment, Dr. Graw discusses allergies, primarily of the outdoor kind, what to do to prevent them, and how to respond in the event that allergies may become an issue.

In springtime, when the first blossom occurs on a tree or a flower erupts, those of us who are allergic start to experience the symptoms of allergies. The symptoms can occur through the summer when the grass pollens erupt and into the fall with ragweed, and might not stop until winter when the first hard freeze occurs.

Winter allergens include dust, dust mites, and mold. Spring allergies are primarily associated with flowers and tree pollen.

Spring allergy symptoms are pretty easy to recognize – the sneezy, itchy, scratchy symptoms we all know. Most people complain of itchy and burning eyes, sniffing and sneezing and nose scratching. Some people may develop wheezing and coughing symptoms. You may even develop a crease on your knows or bags under your eyes from all of the congestion.

When the symptoms persists and are not improving with home remedies like over the counter antihistamines and eye drops, its time to see your physician. The physician will try to determine which allergen is causing the problem – is it an early spring blossom, a grass pollen, ragweed or all of them? They may use a skin prick test or complicated, but very modernized and easy to interpret, blood tests to determine the allergen responsible for your symptoms.

The number one treatment for allergies is avoidance. Your doctor may tell you to move to another part of the county. Obviously, that’s not practical. Secondly, they may recommend testing and evaluation of an allergy shot regiment. They will describe that to you and it can be life saving and important to take those allergy shots if you are severely affected.

What can you do to avoid allergies? If the pollen is heavy and can be seen on your dark car, you should probably close the windows, stay indoors with the windows shut and run your air conditioning. If you go outside, use cool compresses on your eyes if they are itching, try over the counter eye drops with antihistamines, try an antihistamine that makes you less drowsy and do not try to drive until you have taken the first dose and have determined if it will make you sleepy. Finally, sleep in an environment where you do not have the pollen continually bathing into the nasal mucosa, which can be stimulated by the allergens to cause the release of chemical mediators that lead to the other symptoms of itching, sneezing and coughing.

Apple Per Day - Special Edition: Concussions

2010-04-23T06:41:00.000-07:00

Hello, welcome to the newest video in the Apple Per Day series, exclusively from Righttime Medical Care. In the latest installment, Dr. Graw presents a special extended edition video discussing the dangers of concussions, and what can be done to prevent them, and what steps should be taken if you think one may be occuring.

Apple Per Day: Sports Injuries

2010-04-23T06:36:00.000-07:00

Hello, welcome to the newest video in the Apple Per Day series, exclusively from Righttime Medical Care. In the latest installment, Dr. Graw discusses typical sports injuries, what to do to prevent them, and how to respond in the event that some may occur.

For additional information, please see our "special edition" video specializing solely in concussions: http://www.youtube.com/watch?v=cV6Ez1uXbns&feature=related

Insect Bites and Stings

2010-03-26T06:58:00.000-07:00

Apple Per Day - Lacerations

2009-12-11T12:08:00.001-08:00

Dr. Graw discusses lacerations, how you can get them, how to quickly assess severity, and how to make a tourniquet to reduce blood loss. Stay Healthy and be careful with those sharp objects!

Anyone can cut themselves around the house – cutting and chopping food, stepping on broken glass, working with tools in the yard, etc. It can be pretty scary if you don’t know how to deal with a cut.

When you’ve sustained a laceration its important to know where your arteries are located. Your arteries always run from your heart out to your extremities. If the bleeding is in your hands, feet, knees or ankles, you can recognize that by putting pressure on a blood vessel proximal, or closer, to your heart, you can cut down on the bleeding.

There are many places on the body that we worry much more about a laceration. The ones we worry about are superficial lacerations on the sides of the finger, the wrists, the elbows, on the top of the feet, the knees, in the groin area near the top of your thighs. The other place we worry about is on the neck and on the skull.

When you sustain a cut you may need a tourniquet to reduce the bleeding. Try a belt – wrap it around your arm of leg and tighten it up. It will reduce the bleeding until emergency personnel can get to the scene to take care of you. Remember to release the tourniquet now and then – you can’t leave it on forever or the limb may go dead.

If you have a cut that continues to bleed despite pressure and the tourniquet, it is time to go to the hospital. Always call 911 in times of emergency. On the other hand, if you have a minor cut that has stopped bleeding but is still gaping open, we may be able to help you at Righttime Medical Care. Go to an urgent care center and let them suture the wound so that it won’t get infected.

Apple Per Day - Orthopedic Trauma

2009-11-20T11:41:00.000-08:00

Dr. Graw discusses broken bones, sprains, dislocations, and severe bruises. How they are different, how they are caused, and how to get treatment.

At Righttime Medical Care, we see many patients with injuries. Many people wonder – what has happened to me? Frequently we will see a bruise, sprain, dislocation, or a fracture of a bone. Simply looking at a bruise or distortion does not indicate whether it is sprained or fractured. We often need to use our Mini C Arm x-ray machine to take an image of the limb. Thankfully, our mini c-arm is 1/100th of the radiation exposure of a traditional x-ray machine.

There are many causes for these types of injuries – as you get older, you can slip and fall, trip on a step, or twist your ankle on the dance floor. When you are young, children learning to walk will fall with outstretched hands or develop a nurse maid’s elbow by being dragged around by their wrist and dropping their weight, causing their elbow to be dislocated. Many times in sports, children will sustain injuries – football, lacrosse, soccer, etc. We see lots of broken legs, separated shoulders, fractured clavicles, injured elbows, and fractured wrists. These occur from rough housing around the house and/or sports injuries with unintended consequences.

So what is the difference between bruises, sprains, dislocations, and fractures?

A bruise is a big blue lump or swelling under the skin. A bruise comes when you hit somebody or you fall against a step or wall.

A sprain is when those fragile ligaments and muscles get teased past their normal point of function – like cables on a bridge – made up of millions tiny fibers that get stretched too far and break.

A dislocation is when your joint doesn’t work just right – it keeps popping out of the socket. Any joint in your body can pop out of its socket. It can happen in your elbow, as occurs frequently in children.

A fracture is a broken bone. A minimum broken bone is when it’s just cracked, often called a green stick fracture. Or you can have a dislocated fracture. Or you can have a fracture that goes out through the skin, which is clearly a much more severe type of fracture.

When do you need to see a doctor? If you have an injury that is associated with a severe amount of pain, or a loss of function, a finger that cant move, an elbow that cant flex, or a leg that cant bear weight, or a failure to improve with home remedies, you should come to an urgent care center for evaluation to ensure that there is no severe underlying injury.

When you come to a Righttime Medical Care Center, what can you expect if you have a bruise or broken bone? First of all, we can evaluate the type of injury – if you have a very severe injury – dislocated bone or fracture perforating the skin – that type of injury should be taken care of by an orthopedic specialist and we can refer you to one. Most injuries that come to a Righttime Medical Care Center are minor sprains and fractures. We will put you in a splint, give you pain medicine, recommend what you can do to rehabilitate the joint, and refer you to your physician for follow up. In short, if it’s a minor fracture we can splint it right at an urgent care center – for example the fingers and feet. If it’s a major fracture of your elbow, wrist, or leg, eventually you will have to see an orthopedist.

Apple Per Day - H1N1 Vaccine

2009-10-26T08:54:00.001-07:00

In this Special Edition of Apple Per Day, Dr. Graw will answer many common questions about the H1N1 Vaccine. Is it safe? Is the mist safe? Who should get it first? Who is at risk? Where can I get it? Why are some doctors not offering it? Should I get the seasonal flu vaccine too and can I get them simultaneously? How did they make the H1N1 vaccine and why has it taken so long? Will Nighttime Care Centers offer it?

Do you have more questions? Leave a comment. We will look at every single one and do our best to get you an answer. Stay Healthy!

Apple Per Day - Ear Infection

2009-10-24T05:25:00.000-07:00

Today's Apple Per Day is about Ear Infection. Dr. Graw discusses causes, symptoms, home remedies and relief, when to see a doctor, and what to do if you can't get to your doctor. Stay tuned for our next video where we answer many questions and concerns about the H1N1 vaccine. Stay Healthy!

Ear Infections are called Otitis Media in clinical terminology. Sometimes this can be confused Otitis externa, or swimmer’s ear, when it burns and itches on the outside of the ear. Otitis Media is an infection in the middle ear, the chamber connecting the outer ear and the throat through the Eustachian tube.

The symptoms are: pain associated with irritability in small infants. Children may also find it difficult to eat and swallow and they may poke at the ear. If you elevate the head, you may find the symptoms improve.

In older patients, people complain of "fullness" in the ear, an inability to clear the Eustachian tube, and a stuffiness that results from the upper respiratory congestion in the nose and around the Eustachian tube. Most of the symptoms in older folks are related to inflammation in the adenoids and tonsils or because of an infection in the Eustachian tube. The Eustachian tube being closed creates negative pressure in the middle ear. The ear drum gets sucked in. When the air can pass through the Eustachian tube, the ear drum will pop back to a neutral position and you will feel relieved. As the Eustachian tube remains closed, the air is absorbed into the soft tissues, the ear drum will be sucked in and you will feel like you have to clear the space again. Many people will hold their nose and try to blow air to pop their ear drum out. That is only a temporarily resolution and probably will not permanently open up the Eustachian tube.

Ear infections are commonly cause by secondary complication of upper respiratory tract infections. The number one invader is a virus and requires no special treatment. Secondary complications of bacteria are far less frequent and will require an antibiotic. Other organisms like fungi do not invade the middle ear space.

When there is negative pressure on the middle ear, fluid will be drawn into the middle ear space like a warm bowl of broth, waiting to be infected. It takes one swallow with an infected Eustachian tube and a hundred germs will pass from the throat up into the middle ear space. That warm bowl of broth will be a welcoming environment to perpetuate the growth of those bacteria or viruses.

There are some home remedies to relieve the symptoms. Over the counter medicine like Tylenol and Motrin can relive the pain. Suctioning the mucus from the nose, particularly in small infants, allows the pressure to equilibrate around the Eustachian tube which allows them to swallow and eat better. Keeping the upper airway soft and open using saline and suctioning following the saline will help relieve the symptoms and pressure. In older patients, the use of short courses of neosynephrine or afrin will help relieve the pressure around the Eustachian tube. Gargling hot salt water may decrease the swelling in the throat, allowing you to swallow easier and freeing the Eustachian tube opening so that the pressure can be equilibrtated more easily.

In years past, it was not uncommon that people believed that every ear infection required antibiotic treatement. It is now known that the majority of ear infections will respond to time. That means that if I look at an infected ear today it might be perfect tomorrow whether they get an antibiotic or not. Providers are now counseled to be very reserved with the use of broad spectrum antibiotics to treat middle ear infections if they are not caused by bacteria. Speak with your provider, understand if it’s a virus or bacteria causing the ear infection, find out what you can do to clear the virus or bacteria. Once the mechanical fluid blocking the passage ways to the Eustachian tube is removed, the ear symptoms may resolve.

It is possible for a viral ear infection to become complicated by a secondary bacterial infection. You may have a secondary infection if the symptoms progress, particularly in young children, or if they are associated with a high fever or a thick pussy nose and drainage from the throat.

For symptoms that are progressive of middle ear pain or upper respiratory tract infection, you should see your primary care provider. When you can't see your primary care provider, reach out for Righttime Medical Care at www.myRighttime.com

Apple Per Day - Sore Throat

2009-10-19T10:07:00.000-07:00

In this Apple Per Day, Dr. Graw talks about Sore Throat, various causes, symptoms, treatment options, home care, prevention techniques, and when to see a doctor. Subscribe for an update when the next video on Ear Infections is available. Stay Healthy!

Sore throat is a common clinical presentation for many illnesses. It can come from dry air while your sleeping, it can be caused by a viral infection, or by that dreaded worry – strep. Most viral infections are not associated with the symptoms of Strep – high fever, chills, headache, stomach ache, lethargy. Instead, most sore throats are associated with an irritating dryness and burning, particularly when you wake up in the morning. These symptoms can be treated with over-the-counter medications and gargling hot salt water.

The complications of strep include: cardiac disease, heart murmurs, heart failure, rheumatoid arthritis, and kidney infection can be prevented if Strep is treated within the first nine days of its appearance.

The symptoms most associated with sore throat are burning, dryness, and aches in the pharynx (hence the name Pharyngitis). These symptoms are usually easily remedied by Tylenol or Motrin, gargling hot salt water, and keeping your nasal airway open. Try opening your airway through the night and sleeping with your head elevated while running a cool mist humidifier in the room.

Families, particularly on the East Coast, are likely to have several bouts of sore throat and upper respiratory infections through the year. It’s estimated that %20 of children are incubating viral infections at any one time. When you have a sore throat, you want to ensure that there are no secondary infections – streptococcal, otitis media ear infection, or post nasal drip leading to bronchitis. If those don’t occur, it is safe to return to work and school, however, be cautious sneeze into a tissue, dispose of the tissues properly, cough into your elbow, wash your hands, don’t touch your face, do not share water bottles and cups, and avoid direct contact with those who have a sore throat.

When you see your doctor, he/she will likely take a strep culture. If that strep culture is positive, he/she will choose an antibiotic and course of treatment, which he/she thinks is best for you. If your strep test is negative, don’t plead with your doctor for an antibiotic. There is no antibiotic that will improve a viral sore throat infection. In some cases, patients may be treated with an antibiotic for a secondary complication. Although your mother may have told you “you always get better with penicillin”, that is not the case with viral infections – you would have gotten better without the penicillin.

Be sure not to ignore those symptoms of progression – difficulty swallowing, high fever, severe pain. Be sure to reach out for your primary care provider if you are worried. You will never go to the doctor’s office too many times but you may miss the one critical time if you deny the symptoms. If you can’t see your primary care provider, look for Righttime Medical Care at www.MyRighttime.com or call 888-808-6483 for an appointment.

Apple Per Day - Pink Eye

2009-10-10T07:31:00.001-07:00

Dr. Robert Graw Jr M.D., founder of Righttime Medical Care, discusses pink eye symptoms, causes, treatment and homecare options, prevention, and when you should see your doctor. Check back regularly for apple per day videos.

Pink Eye is a common name for conjunctivitis. The symptoms and signs of pink eye are redness, itching, burning, sensitivity to light, and often a pussy drainage from the corner of the eye. Any of these symptoms should direct you to your provider if you don’t respond easily to cool compresses or flushing of the eye.

Pink Eye is named for its appearance. We all have seen patients or friends who have a red/pink swollen appearance to their eye. Some people are confused by what pink eye really represents. Pink eye refers to viral conjunctivitis. A virus is a non-bacterial infection that does not respond to antibiotics, such as those used for strep and pneumonia. Viral conjunctivitis is the kind of infection that spreads rapidly in school and work. Is conjunctivitis contagious? Yes it is. How do you prevent it? You prevent it by not exposing yourself and your saliva to others.

Many patients who have pink eye will also have a clear runny nose and be sniffing. This usually indicates that allergens from the air have entered through the nasal passage and the conjunctiva of the eye to cause itchiness and be irritation. This is cause allergic pink eye and there is no specific treatment or worry when you have this type of pink eye.

If your pink eye does not clear up in a day or two, your physician may prescribe eye drops for the itching. They may also may prescribe an antibiotic to prevent secondary infection when you have viral conjunctivitis.

Most schools have a policy that students can not return to school until they have seen a doctor and have received medication to treat the pink eye. As we’ve discussed, viral and allergic conjunctivitis do not require special treatment. As long as the conjunctivitis is not contagious, the student should be able to return to school.

Pink eye is no more contagious that a runny nose or a cough. Its important that you don’t touch your face and then touch others. When you have a cold or cough, you should cover your mouth by coughing into your elbow so you don’t get germs all over your hands. Pink eye is similar. Once you have pink eye, you are just as contagious as you would be with a viral upper-respiratory infection. The use of antibiotics does not make you any less contagious.

In the workplace, you should be able to return to work with pink eye as long as you use good hygiene, don’t touch your face and touch others, wash your hands well between contacting things like keyboards, calculators, phone, etc.

It is safe to go to work when you have pink eye. Pink eye usually lasts 3-7 days and if there are no complications, it usually resolves itself without intervention and/or medication.

If your symptoms do not improve or get worse, reach out for your primary care provider. If you can not reach your provider, reach out for Righttime Medical Care at www.MyRighttime.com

Apple Per Day - Swine Flu H1N1

2009-10-09T07:05:00.001-07:00

In this Apple Per Day, Dr. Graw discusses H1N1 (Swine Flu) symptoms, treatment options, home care, returning to work and school guidelines, and when to see a doctor. If you are unable to reach you doctor, you can contact us at nighttime.com. Stay tuned for more Apple Per Day videos. Stay Healthy!

Welcome!

2009-08-21T08:12:00.000-07:00

Welcome to the Apple-Per-Day blog! This blog is provided as a public service from Nighttime Medical Care. With this blog, we hope to offer daily tips for you to stay healthy so you can enjoy your life and keep the doctor away as much as possible.

We will also keep you up to date on current events so that you can quickly adapt and be prepared for the ever-changing landscape of health care.

Our mission is to empower individuals to take ownership over their own health and live better healthier lives.

We know that despite the best efforts to stay healthy, everyone gets sick and injured sometimes. We'd like to let you know that our Nighttime Medical Care Centers are open 365 days a year from 11am until midnight to treat your urgent care needs. If you ever need us, please visit nighttime.com to make an appointment or call 888-808-6483.