Integra Insights - Issue 01 - December 2022

Integra Insights “as they should be” INSIDE THIS ISSUE:

Stay Healthy this Christmas Dealing with Eczema During Winter Navigate a High-risk Pregnancy Is Your Child Sick all the Time?

New Patient Records App PLUS MUCH MORE...

December 2022 Integra Healthcare | www.integra.ky

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Introductory message...

And just like that, we have reached the last month of 2022.

We hope you’re enjoying December so far and welcome to the first installment of Integra’s digital magazine! We have lots of updates, articles, information and advice within Integra and the wider healthcare world. The topics range from tackling the increase in flu cases, advice for staying safe and healthy over the holiday season and some informative resources and articles for each one of our specialties. We hope you enjoy reading and on behalf of the whole team here at Integra, we want to wish you a very Merry Christmas and a Happy New Year!

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Contents Communication Update, Preferences & Permissions

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Cover Over Christmas Period

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Changes to Out-of-Hours Paediatric Cover and Telephone

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Chief Medical Officer says ‘No Cause For Concern’ over imported Dengue Case

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Flu Now Rampant in the US

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Covid-19 Updates

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Chronic Diseases & The Importance of Early Detection

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Know Your Screenings

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Top Tips to Stay Safe and Healthy this Christmas

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Skin Cancer in the Cayman Islands

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Recognising Skin Conditions on Different Skin Tones

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Dealing with Eczema in Changing Weather

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Polycystic Ovary Syndrome (PCOS) - The Signs and Symptoms

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Recognising Menopause Symptoms

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Navigating a High-risk Pregnancy at Integra

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Choosing Your Paediatrician - Parental Rights

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Increased Strep A Infections In Children: What You Need to Know

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Why is My Child Sick All The Time?

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Fever Advice Sheet

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Featured Physician - Madhavi Manoharan

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Insurance: What Happens After You Leave?

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Cayman First

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Contact Us

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Staff Directory

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Patient Records App

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Integra Healthcare | www.integra.ky

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About Mailing: Communication Update, Preferences & Permissions Dear All It’s amazing to think that around 20% of the whole Cayman Islands population is now registered with Integra Healthcare Ltd, so firstly, thank you, thank you, thank you for the trust you place in use to assist with keeping you in tip top shape.

It also means we have to communicate better too. We are frequently exposed to comments like “oh, I didn’t realise you had a fertility specialist”, or “I didn’t realise you treated XYZ” and at the same time, all of our doctors are exposed to the problems caused by patients accessing unreliable, non-evidence-based information and spurious advice, which abounds on the internet. But everybody is different and because we are required by law to retain health records, it means people can remain in our system long after they have left the Island.

Historically, we have struggled with providing preference options that don’t also interfere with operational practice emails like appointment reminders etc. To address this, and provide you with far more choice, quite rightly, we have adopted a new Customer Relationship Management system that allows us to separate operational and functional communications from health information, notices about new services and doctors etc. And this is the first Integra Insights ‘short magazine’ from that system.

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We’re excited, because it means we can serve you far better, keep you informed and educate too. It will be issued monthly, so it’s enough but not overwhelming, and always close enough to the health issues of the day.

So, firstly, we hope you enjoy the inaugural edition. If you have moved on or just don’t wish to be included, simply unsubscribe to these (from the email) and you can do so knowing it won’t affect your normal practice emails and notifications. If you have unsubscribed to a previous system, we obviously apologise but hope you understand our desire to get this permanently right for you, which this is designed to achieve.

Welcome, once more, to Integra Insights, health information and communication… as it should be.

Warmest Regards

Andrew Vincent

Director & Data Guardian Privacy Policy

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Cookies Policy

C L I N I C - W I D E A NH NEOAULT NC H EAMLEENRTTSS

Cover Over Christmas Period For babies and children...

Please see below Integra’s holiday hours: » Saturday 24th December (Christmas Eve) - 9am - 1pm

Out of hours, one of our paediatricians will always be reached on (345) 326-4370 (for which a telephone consultation fee may be chargeable).

» Monday 26th December (Christmas Day observed) - Closed » Tuesday 27th December (Boxing Day observed) - Closed

For Adults...

» Saturday 31st December (New Year’s Eve) - 9am-1pm

Please call Dr Francisco Martinez on (345) 939-9539

» Monday 2nd January (New Year’s Day observed) - Closed

If you have an emergency during these hours, proceed straight to Geroge Town Hospital or dial 911.

During these times, if you have any urgent concerns or queries, you can get in touch with us on our out of hours telephone numbers:

Apart from these dates, Integra Healthcare will be open as usual Monday to Friday 8am-5pm and Saturday 9am-1pm.

Changes to Out-of-Hours Paediatric Cover and Telephone We have recently made some changes to our out of hour cover for paediatrics and our out-of-hours paediatric telephone number.

READ MORE

Integra Healthcare | www.integra.ky

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H E A LT H A L E R T S

Chief Medical Officer says ‘No Cause For Concern’ over imported Dengue Case In a statement made last month, the Public Health Department, Customs and Border Control (CBC) and the Mosquito Research and Control Unit (MRCU) confirmed that there was a case of Dengue Fever reported in Cayman Brac. Chief Medical Officer, Dr Nick Gent explained that they will continue to track the situation and any developments and will keep the public informed. However, at this time, he stated there is: “no cause for concern”.

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Flu Now Rampant in the US After what declared itself as a very robust start to flu season in the United States and elsewhere across the globe, the influenza virus is now taking the US by storm, with cases doubling approximately weekly. The CDC now identifies 16 states or major urban areas as having the highest possible level, termed “very high”, for outpatient respiratory illness attendances. Over a third of these states have direct flights to Cayman.

READ MORE

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H E A LT H A L E R T S

Covid-19 Updates Covid-19 infection remains a real and omnipresent concern. It is vital that we continue to take it seriously and act responsibly to ensure our own health protection. We’re all bored of it but that doesn’t make it go away.

As if to reinforce this, the United States has just recommenced issuing free Lateral Flow Tests out of concern over rising cases and the impact this has on health systems over the busy winter period. An added concern is that of multiple co-infections, the potential for Covid, Flu and RSV, adding to illness severity. The UK update, released by the Office of National Statistics on 16th December, also points to rapidly increasing cases and hospitalisations.

We strongly advocate vaccination boosting, alongside sensible self-protective behavioural measures. This is especially

Integra Healthcare | www.integra.ky

important over the holiday period, when you may be travelling, visiting elderly relatives etc. In the Cayman Islands, we now have access to the Moderna Bivalent Vaccine and this provides better protection against more recent variants of the virus. You can see the latest schedule and download the consent forms to speed up your visit using our link.

If in any doubt, you can always check your antibody levels and predicted degree of protection, which can be advisable anyway to ensure the vaccine has worked for you.

Latest Public Health Vaccination Schedule: https://www.hsa.ky/public-health/ coronavirus

Attomarker Covid-19 Antibody Immunity Testing from Integra:

https://www.integra.ky/covid-19-antibodyimmunity-test 7

F A M I LY M E D I C I N E

Chronic Diseases & The Importance of Early Detection Chronic diseases are defined by the CDC “as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both”. Chronic diseases consist of: cancer, diabetes, stroke and hypertension to name but a few.

This article explains what chronic diseases are, the most prominent one in the Cayman Islands and the importance of early detection of these illnesses.

READ MORE

Know Your Screenings There are several common screenings individuals should have. It is important that you go for these screenings as early as possible (i.e. when you reach the recommended age to have these tests done) as physicians use these screenings to look for anything abnormal and if something arises, it can be detected early and effectively managed. This guide offers information on some of the most common screenings, how they work and the recommended age to receive them.

READ MORE

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Top Tips to Stay Safe and Healthy this Christmas » Get your flu vaccination - free from Public Health » Frequently wash/sanitise your hands » Avoid touching your face » Cold fronts are coming soon! With the weather becoming cooler, try ventilating your home or car by opening the windows, which helps prevent virus particles from becoming too concentrated in your house or car. » If spending Christmas with more vulnerable individuals, take a rapid test, just to be safe » If travelling, be cautious leading up to and during travelling and consider wearing a face covering

Integra Healthcare | www.integra.ky

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A D U LT A N D PA E D I AT R I C D E R M AT O L O G Y & D E R M AT O S U R G E R Y

Skin Cancer in the Cayman Islands Skin cancer is more common than all other cancers combined, and, collectively, their incidence is rising faster than that of any other cancer. In a climate like Cayman, it is even more of a concern. This article breaks down what skin cancer is, the main types and how skin cancer screenings work here at Integra.

READ MORE

Recognising Skin Conditions on Different Skin Tones With many skin conditions, the impacts to the individual can vary greatly depending on their skin tone. Representing skin diseases on various skin tones, especially in a country as diverse as the Cayman Islands is vital to ensure that every person receives the appropriate and relevant care.

The article aims to explore the most common skin conditions and to then break down the most common skin tones for dark skin. Links to the AAD are provided which offer imagery these conditions on darker skin tones to showcase how certain conditions can appear differently.

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At Integra, we have two highly experienced adult and paediatric dermatologists. In particular our specialist dermatologist Dr Alison Duncan has a considerable amount of experience with skin issues related to darker skin pigments. It is evident that the frequency of certain dermatological conditions can truly depend on an individual’s skin tone. Therefore, if something does not feel right, we encourage you to get in touch.

READ MORE

Dealing with Eczema in Changing Weather There are five factors to consider when dealing with eczema in the changing weather according to the National Eczema Association. This includes: temperature, humidity, moisturizers, clothing and infection. In this article we break down these five factors along with a recap of the top tips from National Eczema Association and our team here at Integra.

READ MORE

Integra Healthcare | www.integra.ky

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O B S T E T R I C S , G Y N A E C O L O G Y, F E R T I L I T Y & M E N O PA U S E

Polycystic Ovary Syndrome (PCOS) - The Signs and Symptoms What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome (or PCOS) is a commonly diagnosed condition that causes a hormone imbalance of the reproductive hormones in women. Essentially, the ovaries of people with PCOS produce higher levels of testosterone compared to those without PCOS. Many women suffer the effects of PCOS without knowing it, and so in this article we break down PCOS along with the signs and symptoms to look out for. If you believe you may have PCOS, please get in touch and book an appointment with one of our physicians.

READ MORE

Recognising Menopause Symptoms We’re delighted with the upturn in talk in the last month about menopause and breaking the stigma of discussing the topic.

Many ladies unnecessarily suffer in silence despite there being many options. Therefore, we wanted to share an article by Dr Lisa Joels, one of our Consultant Obstetrician & Gynaecologists and a specialist in menopause. Let’s recognise it and join the efforts to destigmatize it and more openly discuss.

READ MORE

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Navigating a High-risk Pregnancy at Integra What is classified as a high-risk pregnancy?

A ‘high-risk’ pregnancy is simply a pregnancy with a greater probability of complications for the mother or the baby. Dr Madhavi Manoharan, one of our Consultant Obstetricians & Gynaecologist, and our resident accredited Maternal Fetal Medicine specialist, discusses advice, along with guidance on our high-risk obstetric services here at Integra.

READ MORE

Integra Healthcare | www.integra.ky

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PA E D I AT R I C S , N E W B O R N A N D N E O N ATA L C A R E

Choosing Your Paediatrician Parental Rights Our Paediatrician & Neonatologist, Dr Sara Watkin has offered some guidance regarding choosing a paediatrician in Cayman.

Choosing a paediatrician in Cayman is much like choosing a family doctor in that you would generally want to maintain that relationship throughout your child’s childhood. It’s obviously not a decision taken lightly and many parents find it one of the more stressful ones they make. Therefore, we hope this small guide will take some of the stress out of the decision and provide some useful considerations.

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Increased Strep A Infections In Children: What You Need to Know Recent articles from The Times and the BBC revealed that several families in the UK have already tragically suffered loss of their children with the death toll for Strep A reportedly rising to seven since September 2022.

In this article, we explain the main symptoms children with Strep A have experienced.

We understand this can be scary news to you as parents, especially those travelling to

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the UK for the holidays. We are committed to providing quality care and are committed to helping you and your children. Our paediatric team is one of the largest on island and with highly experienced and respected doctors. We’re here for you.

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Why is My Child Sick All The Time?

Why is my child sick all the time? To a certain extent, this is a normal part of childhood. A ‘healthy’ child will have 8 to 10 infections per year. When you consider that many of these will last for 7-10 days or so, it can easily feel like they are always ill. Hard as it is as a parent to see your child feeling unwell, it is a necessary process for them to go through to strengthen their immune system.

Children across the world have had periods of social isolation during lockdown measures and many parents appreciated

Integra Healthcare | www.integra.ky

the ‘illness-free’ periods that were seen as a result. However, children were not exposed to the common illnesses that they should have met. Consequently, their immune systems are less strong.

Now that the world is trying to live with Covid and carry on, children are back at school and childcare settings and are encountering the usual childhood illnesses but with no immune memory.

READ MORE

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Fever Advice

Fever Advice Sheet Fever is a normal response of the body when fighting an infection. All children will experience fever during childhood at some point, especially in pre-school years. Our Specialist Neonatologist and Paediatrician, Siobhan Jaques has created a fever advice sheet for you which offers information and advice on what to do when your child has a fever.

Fever is a body temperature over 38oC or 100.4oF Fever is a normal response of the body when fighting an infection. All children will experience fever during childhood at some point, especially in pre school years.

Please use our traffic light system below to guide your response...

Urgent

Danreview ger needed Signifsyour child has fever and:

• Is Mottled or pale, not respond ing normally • Is Blue around the lips or tongue • Is less than 3months old (unless has had immunisations in last 48h) • Has a rash that does not go away when pressed • Is too breathless to talk or feed • Has not peed in the last 12h • Has a fit (convulsion) or violent shaking • Is crying inconsolably

Please arrange review within • • • • •

You can manage your child’s

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• • • •

24h if your child:

Is between 3 and 6 months old with a fever over 39oC or 102.2oF. Has had a fever for more than 48h and is not getting better Has had a fever for more than 5 days in a row Is drinking and peeing less than usual Is getting worse or you are worried

fever at home if they are:

Eating and drinking ok Peeing as normal Behaving normally when the temperature settles with medicat ion There are no features from the red or orange lights.

Integra Healthcare Ltd The Grand Pavilion Commer cial

Centre, Hibiscus Way, 802 West

www.integra.ky | team@in tegra.ky | +1 (345) 745 7450

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Bay Road

Fever with spots or rashes that do not fade under pressure is a

MEDICAL EMERGENCY

Did You Know?

The most reliable way to measure your child’s temperature is using a digital thermometer in the armpit or under the tongue. Try to avoid using forehead thermometers as these are less reliable.

Facts about Fever Can be caused by bacteria or viruses (most childhood infections are viral and therefore do not need antibiotic s).

Treat fever with medicine if it is making your child feel unwell- you can use paracetamol (also known as tylenlol/calpol/acetoaminop hen) or ibuprofen (also known as nurofen/a dvil).

It is safe to give both types of medicine together, but we recomme nd giving one, allowing an hour or so to have an effect and then giving the other one if needed.

Always read the directions.

Make sure your child is drinking or feeding, little and often to stay hydrated.

A low temperature can also be concerning- especially under 6 months. If your baby has a temperature of less than 36.0oC (96.8oF) then they need an urgent review.

Booking Appointments Appointment Availability: If you cannot see an Integra appointment slot available, please call us on (345) 745 7450 within office hours, and we will do our best within our capacity.

Sick Children Specifically: Please call us on (345) 745 7450 within office hours or on the Paediatric Outof-Hours Service (345) 326 4370 (Note: Calls only, Out-of-Hours Only) as we carry specific sick child capacity to help ensure your child can be seen when necessary.

BOOK APPOINTMENT

Integra Healthcare | www.integra.ky

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F E AT U R E D P H Y S I C I A N

Our Featured Physician for the month of December is:

Madhavi Manoharan

Consultant Obstetrician & Gynaecologist Specialist in Maternal Fetal Medicine

Dr Madhavi Manoharan is one of our two Consultant Obstetricians & Gynaecologists at Integra Healthcare. She has over two decades of experience in obstetrics and gynaecology, including a decade of tertiary experience.

Brief overview of her key specialties: » Obstetrics and High-Risk Obstetrics » Fetal Medicine » General Gynaecology » Gynaecology Surgery

VISIT PROFILE

» Colposcopy & Ultrasound Read more on Dr Manoharan’s key specialties...

Testimonial from patient: “...Without hesitation, I booked an appointment and was seen by Dr. Madhavi.

On my initial visit, she was incredibly thorough and detailed and I felt so confident with her. She talked me through everything in a way that I could understand and even wrote things down which made it easier for me in case I wanted to look back on, and had any further questions for her. Dr. Madhavi is the perfect combination of warm and professional.”

Read more reviews for Integra...

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EXPLAINERS

Insurance: What Happens After You Leave?

Over the coming months, we will attempt to demystify the seemingly opaque world of health insurance. We wish to start with

helping you understand what happens after leave clinic following a visit or procedure.

FIND OUT MORE

Many individuals have raised concern about Cayman First insurance, following news articles and social media comments. We also get calls asking if people will have to pay everything up-front, which they are being asked to do in certain practices.

The problems experienced by Cayman First relate to the implementation of new computer systems and provider portal, all designed to enhance the service they offer.

Integra Healthcare | www.integra.ky

Integra has a strong relationship with and complete confidence in Cayman First and we continue to manage individuals with this insurance in the normal manner. If you have friends and family having the full care bill charged on check out elsewhere, we can assure you that this is not happening at Integra!

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Contact Us Call us at: (345) 745-7450 Mon-Fri: 8am-5pm, Sat: 9am-1pm CLICK TO CALL US

Our physical address is:

The Grand Pavilion Commercial Centre, 802 West Bay Road We are conveniently located just across the road from Beach Suites (now Palm Heights & Tillies), slightly further up West Bay Road from what was Deckers Bar & Restaurant, in the South Entrance of Grand Pavilion, which can be accessed from the Grand Pavilion main entrance, then turning right and heading round to the South side.

M O R E I N F O R M AT I O N

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Staff Directory Directory Staff

Doctors Francisco Martinez

December 2022

Nurses & HCAs Dee Ryan

Medical Director & Family Medicine Physician francisco.martinez@integra.ky

Jaja Osuyos

Rebecca Deasey

Allie Campbell (Midwife)

Family Medicine Physician rebecca.deasey@integra.ky

Sara Watkin

Paediatrician & Neonatologist sara.watkin@integra.ky

Sarah Newton

Paediatrician & Newborn sarah.newton@integra.ky

Jasmina Marinova

Laura Petch Sarah Hoskin Patrick Ramirez Layla Aitkin Launa Cohen Latysha Powell (HCA) Tishanna Gauntlett (HCA) Ashley Swaby (HCA)

Paediatrician & Neonatologist jasmina.marinova@integra.ky

Siobhan Jaques

Reception & Billing

Paediatrician & Neonatologist siobhan.jaques@integra.ky

Vivian Zavala (Lead)

Lisa Joels

Sophia Wilks

Obstetrician, Gynaecologist & Fertility Specialist lisa.joels@integra.ky

Madhavi Manoharan

Obstetrician, Gynaecologist & Maternal Fetal Medicine madhavi.manoharan@integra.ky

Paola Canales Daisha Coleman Fernanda Moreda Claudia Moreda Jeimy Solomon

Alison Duncan

Dermatologist alison.duncan@integra.ky

Davide Altamura

Dermatologist & Dermatosurgeon davide.altamura@integra.ky

Nadine Yammine

Ear Nose & Throat Surgeon & Laryngologist nadine.yammine@integra.ky

Integra Healthcare Ltd

TheHealthcare Grand Pavilion Commercial Centre, Hibiscus Way, 802 West Bay Road Integra | www.integra.ky

Other Matthew Pellow Operations Lead

Andrew Vincent

Marketing, PR & Business Development Lead To email any of the above, use firstname@integra.ky (firstname as listed above)

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There’s an App for That Did you know that all patients who are part of Integra Healthcare Ltd can also have access to us and their records through an App that connects to their patient portal.

The App really adds to convenience, allowing you to organise and communicate directly from your phone, rather than just the web. You can: » Make appointments » See your appointment schedule » Message staff, including medical staff » Note and update health vitals » See your medications » Request medication refills » Upload documents » Complete forms & consents » See your billing information

How do I get the App? It is available on both the Apple App Store and Google Play and you need to search for Charm mPHR Note: You must have signed up for the Portal to have the App. If you need help with this, either ask when you next pop in or contact vivian@integra.ky to register for Portal access.

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