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Maria Parham Healthbeat A publication of Maria Parham Medical Center and The Daily Dispatch

April 20, 2011

Develop a diabetes plan with help from MPMC

During the CAP accreditation process, inspectors examined the laboratory’s records and quality control procedures for the preceding two years, in addition to other aspects of the lab.

Diabetes has reached epidemic levels in North Carolina. One in five North Carolinians has diabetes or is at high risk of developing it. More than 6,000 adults in North Carolina have diagnosed diabetes and another 228,000 adults have diabetes, but don’t know that they do. Diabetes is the seventh leading cause of death in North Carolina. The majority of those deaths are caused by the long-term complications of diabetes, which include heart disease, stroke and kidney disease. The good news is that many of these complications can be prevented by

managing blood glucose levels. Diabetes has no cure, but it is manageable with information and guidance from trained educators working along with your physician. It is possible to live a long and healthy life with diabetes and MPMC can help you learn how to do that through the outpatient diabetes program at the medical center. There are three major types of diabetes: Type 1 diabetes, Type 2 diabetes, and gestational diabetes. Pre-diabetes, formerly known as impaired glucose tolerance, is a state prior to Type 2 Please see DIABETES, page 7

Medical Diagnostic Laboratory receives national accreditation Maria Parham Medical Center’s Medical Diagnostic Laboratory has been awarded accreditation by the Accreditation Committee of the College of American Pathologists (CAP), based on the results of a recent on-site inspection. The laboratory’s director, Dr. Dianne B. Dookhan, was advised of the national recognition and congratulated for the excellence of the services being provided. The lab is one of more than 7,000 CAPaccredited laboratories worldwide. The CAP Laboratory Accreditation Program, begun in the early 1960s, is recognized by the federal government as

being equal to or more stringent than the government’s own inspection program. During the CAP accreditation process, inspectors examine the laboratory’s records and quality control procedures for the preceding two years. CAP inspectors also examine laboratory staff qualifications, as well as the lab’s equipment, facilities, safety program and record, in addition to the overall management of the laboratory. This stringent inspection program is designed to specifically ensure the highest standard of care for all laboratory patients.

Diabetes has no cure, but it is manageable with information and guidance from trained educators working along with your physician.





Be sure to give anti-depression medicines time to work In today’s lifestyle where we expect instant results and immediate gratification, we all have to take a step back and realize that our bodies are not computers and they do not respond at Internet speed. Human genetics and physiology just do not change that fast. We need to keep this in mind when taking certain medicines. We should expect prompt responses when taking medicines for pain, but when it comes to depression, for example, we must have realistic expectations. Depression is a typical illness that takes time to respond to medicines. There are several reasons for this. One is that it takes time for a steady level of the medicine to develop. Longer-acting medicines may take a week or more to get to a steady level. And since it is wise to start low and gradually build up, each time you increase your dose it takes a week to get to the new steady level. In addition to that, it can take weeks for the changes to occur in the levels of

neurotransmitters in the brain. Neurotransmitters are the chemicals that make the brain run. A deficiency or an imbalance can take time to return to normal. In some illnesses, the body needs time to “reset the thermostat.” These medicines need to be at a therapeutic level for 4-6 weeks before a decision can be made about whether they are effective or not. Making frequent changes and dabbling with all the different antidepressants available is doomed to failure, and failure makes the depression seem even more hopeless. Give your medicines time to work, whether they are for depression, high blood pressure, or some other illness. If you have any questions about your medication, talk to your pharmacist or your physician. For a listing of physicians in the area, go to the Maria Parham Medical Center website at or call the hospital’s marketing department at (252) 436-1800.

Exercising to lose weight takes time All photos and stories provided by Maria Parham Medical Center’s Marketing & Community Relations Department.

Losing weight and staying at an ideal weight is a lifelong battle for most of us. Everyone wants to lose weight, and everyone thinks that exercise is a quick, though not easy, way to do it. Actually exercise is a relatively slow way to lose weight. There are 3500 calories in each pound of fat, and this is more than

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The Daily Dispatch

Wednesday, April 20, 2011


Recognizing the signs of a warning stroke Before a person suffers a stroke, he frequently has some warning signs. If these signs and symptoms are heeded, a stroke can be averted and years of good health added to a person’s life. With a warning (or transient) stroke, the circulation to an area of the brain is temporarily decreased or obstructed. This results in weakness, numbness and difficulty with speech. These transient strokes completely resolve within 24 hours and a person feels fine again. If a person takes preventive measures at this time, he is likely to prevent a

Use the FAST test for recognizing and responding to stroke symptoms. If a person takes preventive measures at the time symptoms are observed, it’s likely to prevent a much more serious stroke, adding years of good health to a person’s life.

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much more serious stroke. Common causes of transient strokes are small clots that travel from the arteries of the neck to plug the arteries of the brain, a drop in blood pressure from dehydration or shock, or temporary clotting off of a small artery in the brain. If a person has a transient stroke, the cause can be discovered by undergoing an exam, lab tests, doppler studies of the arteries of the neck, a CT scan, and even evaluation of the heart to make sure small clots are not caused by an irregular heartbeat.

Stroke-like symptoms can also be caused by tumors, migraines, seizures, hypoglycemia or aneurisms, all of which deserve attention. Treatment is fairly effective and may be as simple as taking one aspirin a day. This cuts the chances of stroke by up to 50 percent. If the aspirin alone is ineffective, stronger blood thinners can be used, but they also increase the chance of more severe bleeding problems. Surgery on obstructed arteries in the neck and treatment of medical problems such as an irregular heart beat may also be necessary.



The Daily Dispatch

Diet can be a major factor in controlling symptoms of PMS Premenstrual syndrome, or PMS, begins seven to 10 days before a women’s period and ends a couple days after her period begins. It has a wide variety of symptoms, which include headaches, dizziness, palpitations, abdominal distention, cramps, swelling and arthritis-like symptoms. The cause of PMS is not known, but suggested causes are high levels of prostaglandins or prolactin (both hormones), excessive caffeine, or a lack of vitamin B6 or magnesium. What can you do about it? Dietary changes often help. First, stop using caffeine. This means no coffee, tea, caffeine-contain-

ing soft drinks or chocolate. If you must cheat, you may have a little chocolate and decaffeinated coffee. You should limit salt, which is high in most packaged and canned foods and in restaurant food. A mild diuretic may help to decrease the salt and fluid retention. Nutritious meals and a couple of high protein snacks, such as unsalted peanuts or yogurt, are advisable. Birth control pills alleviate symptoms for many women. They are an excellent choice when birth control is also needed. Progesterone (a female hormone) can help limit weight gain and other symptoms. If birth control pills are not

effective, the newer antidepressants are often very helpful. They may be effective even if taken just during the week or two of symptoms each month, although it is usually best to take them daily for the first few months. Aspirin, ibuprofen, and other pain pills are helpful in relieving the headaches, cramping and arthritis-like symptoms. Always discuss treatment options with your doctor. For a list of doctors who can help you live a healthier life, check out Maria Parham Medical Center’s website, www.mariaparham. com, or call (252) 436-1800 to request information.

Wednesday, April 20, 2011

Puncture wounds to the feet need immediate medical attention Stepping on nails often seems like a minor injury, but it is still more dangerous than many people think. It can cause tetanus, but more commonly, it causes serious infections in the feet. The infections are usually caused by debris that is left in the puncture wound. Frequently this is part of the rubber from the shoe, or stocking material, both of which are loaded with harmful bacteria. Retained material is also very common when slivers, toothpicks or needles are stepped on in a carpet or rug. These objects should be removed as soon as possible to decrease the chance of infection. The wound should be cleaned by removing a wedge of the thick callous from around the puncture to allow drainage. Then the doctor will explore the puncture, remov-

ing any material left in the foot. Early on, damage to the bones, cartilage or joints can be hard to detect, but if the wound is over the joints at the ball of the foot, the wound needs to be watched closely. Infections in a joint or cartilage can require several weeks of intravenous antibiotics. Certain medical conditions will also make a foot wound a serious problem. Diabetics commonly have trouble with their feet, including loss of sensation, which allows puncture wounds to become severe before they realize it. Poor circulation, cortisone use, and other medical conditions can make the infection spread more quickly. Even punctures that look very mild on the surface can damage and infect bones, joints and tendon sheaths. See a doctor promptly for any puncture wound.

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The Daily Dispatch


Wednesday, April 20, 2011


Protect your skin from damaging rays of the sun Now that we are getting into spring and summer and the days are long and warm, we all start to think about doing a little sunbathing or tanning on the lawn or by the lake. It sounds enticing, but the skin is not ready for so much sun exposure. It is the ultraviolet spectrum of sunlight that causes sunburns and contributes to skin damage. If these rays are not kept out by sunscreens or one’s natural tan, the elastic fibers of the skin are damaged and a person develops wrinkled and sagging skin. This damage accumulates over the years of carefree sun exposure. Besides damaging the elastic fibers, sunlight also causes skin cancers. These also occur in proportion to how much sunlight you get over

the years and your skin type. Severe burns directly increase the chance of developing a melanoma, the most dangerous form of skin cancer. You can protect your skin from these effects by using a sunscreen with a sun protective factor (SPF) rated from 15 to 60, with the higher numbers being more protective. Many dermatologists recommend the higher doses routinely since all lose their protective values as they wear off. It is good to choose one which stays on even if you swim. Clothing does not give complete protection. If you can hold the fabric up to the sun and see light through it, it is giving you an SPF rating of

Sand and water reflect the ultraviolet rays, so being on the beach or lake can increase your exposure.

about 5-8. Sand and water reflect the ultraviolet rays, so being on the beach or lake can increase your exposure. In fact, this reflection from the water or sand will reach you even when you sit in the shade. So remember to always use sunscreens. Maria Parham Medical Center and the American Cancer Society have established a You can protect your skin by using a sunscreen with a sun protective factor (SPF) Cancer Resource rated from 15 to 60, with the higher numbers being more protective. Center located in the basement of the Brodie-Waddill Wing of the hospital. The center has cancer-related educational materials, information on programs and Internet access, and is open to the public.


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The Daily Dispatch


Wednesday, April 20, 2011

Up to 20 percent of adult men have chronic bronchitis Chronic bronchitis is diagnosed when a person has a bronchial infection and increased lung secretions for three months out of a year for two or more years. Even using these strict criteria for the diagnosis, there are still many people with chronic bronchitis. Up to 20 percent of adult men have this lung problem and it is usually due to damage from cigarette smoking and air pollution. Chronic bronchitis can also be caused by infections, genetic factors and occupational exposure to fumes and particulate matter. Most people are not disabled by it since the lungs have a considerable reserve. Lung function must be nearly cut in half before a person has shortness of breath with normal activities. When lung function drops below a third of normal, a person will be short of breath at rest. If a person waits until he develops symptoms, he has allowed a great deal of lung damage to occur.

There are a number of things to do when a person has chronic bronchitis. The most important treatment is to stop smoking and limit exposure to any pollution or chemicals that may be making it worse. A person should also get a flu shot each year and a pneumonia shot every six to eight years. Regular exercise is useful, and any bacterial infections should be treated early with antibiotics. Finally, asthma medicines can help open the airways and decrease the amount of bronchial secretions. If you have frequent or prolonged bouts of lung problems, you should see your doctor for an exam and have lab tests, a chest x-ray, and lung function tests performed, which can measure exactly how well your lungs are working. For a list of physicians in the area who can help you live a healthier life, check out Maria Parham Medical Center’s website,, or call (252) 4361800 to request information.

If you have frequent or prolonged bouts of lung problems, you should see your doctor for an exam and have lab tests, a chest x-ray, and lung function tests performed.

The Daily Dispatch


Wednesday, April 20, 2011


Fiber is important to many aspects of overall good health Many doctors recommend high fiber diets, even for people who do not need it for sluggish bowels. A great deal of evidence shows that there are benefits for anyone who increases the amount of fiber in his diet. The foremost reason to eat more fiber is that it appears to cut the chance of getting cancer of the colon by up to 40-50 percent. Doctors are not sure why it protects against cancer, but fiber tends to form bulkier stools which may dilute any cancer-provoking chemicals in the colon, and it decreases the time that the material is contained in the colon because stools are passed more regularly. Since fiber forms a larger and

softer stool, it results in less pressure on the wall of the gut. This helps prevent diverticulosis, or outpouchings of the wall of the colon, which can become infected and cause abscesses. Fiber appears to lower the cholesterol. This is probably because it absorbs bile compounds in the gut. Fiber also slows the rate that the stomach empties and gives a more steady release of food for absorption. This is very helpful in regulating diabetes where sudden changes in blood sugar are troublesome. How much fiber should you eat? Current studies recommend an ounce of fiber a day — about twice as much as the average American


diabetes. The diabetes program at the medical offers instruction on all types of diabetes. Type 1 diabetes, or juvenile onset diabetes, occurs when no insulin is made in the body. People with Type 1 diabetes must have insulin delivered by injection to survive. Type 2 diabetes, or adult onset diabetes, accounts for about 90-95 percent

Properly monitoring blood sugar levels is key to managing all types of diabetes.

diet. It is believed to be better to get it through normal foods, such as vegetables and fruits, rather than by prescription preparations. Foods high in fiber are bran and other cereals, fruits such as apples, pears, raisins, and berries, and vegetables such as peas, corn, and potatoes. Baked beans and whole wheat spaghetti are also good sources. These provide soluble fiber which is believed to be better than insoluble fiber. Foods high in fiber are bran and other cereals, fruits such as apples, pears, raisins, and berries, and vegetables such as peas, corn, and potatoes.

of all diagnosed diabetes cases. Type 2 diabetes is a result of insulin resistance, than later lack of insulin production, as the disease progresses. Gestational diabetes is a form of glucose intolerance diagnosed early in pregnancy. This type of diabetes requires treatment to maximize maternal blood glucose and to lessen the complications to the infant. Pre-diabetes is the state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis. Without intervention, pre-diabetes can become Type 2 diabetes in 10 years or less. The outpatient diabetes education program at Maria Parham Medical Center is fully accredited by the American Diabetes Association. The program averages 10 hours in length and includes both individual and group instruction. The first visit is an individual visit with a dietitian who will develop an individualized meal plan. There are two four-hour group classes. The first class covers topics such as medications, monitoring, exercise, high/low blood sugar, sick days’ care, complications of diabetes, and behavior change/problem solving. The second class reviews nutrition basics and food selection.

The goal of the program is to provide participants with the information needed to prevent the complications of diabetes by managing blood glucose levels. Individuals with diabetes are encouraged to contact the medical center so the staff can

work with them to manage their blood sugar level. This information was provided by Cynthia Britton, RN, BSAS, Med, CDE and Ann Margaret Kane Ferguson, MPA, RD, LDN.

Nutritional foods high in fiber are key to controlling blood sugar levels.





With arrival of tick season, know the best way to remove them Now that the ticks are out again, it is time to review the best ways to remove them. There are many methods, none of which is successful every time. The best way to remove a tick is to take hold of it as close to the skin as possible and pull slowly and steadily. Most ticks will dislodge without any problems and without leaving any mouth parts in the skin. Wood ticks, or dog ticks, will usually come out whole, but the tiny deer ticks are very likely to break and leave the head or mouth parts stuck in the skin. These mouth parts must then be cut out of the skin. Deer ticks are distinguished by their small size and redder color than wood ticks. They usually do not lie flat on the skin when they bite — their bodies point out from the skin. There are many other methods of trying to get a tick to loosen his bite, such as covering it with gasoline, vasoline, ether, fingernail polish or other hydrocarbons. These are not particularly effective, but if you do

try any of these methods, be sure to give it several minutes to work before pulling on the tick. Burning the tick with a hot match will not usually make it let go and may cause the tick to inject more saliva into the skin, which can potentially transmit many different infections. The best treatment, of course, is to stop the ticks before they attach. This is done by wearing long-sleeved shirts and long pants in the tall grass and brush and by checking yourself after being outdoors. The pants legs can be tucked inside socks to keep the ticks from getting to the skin. Tick repellents containing DEET and permethrin can also be very useful in decreasing the chance ticks will climb on for a meal.

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Non-smokers suffer from other people’s smoke We know how harmful it is to smoke. But there is a growing amount of evidence that nonsmokers also suffer from other people’s smoke. In fact, experts estimate that about 50,000 people die each year from illnesses caused by second-hand smoke. These experts state that many people die from lung cancer and other cancers, but the majority die from heart disease. The same chemicals that contribute to heart disease in smokers are inhaled by non-smokers. Obviously, lung problems such as asthma and emphysema are also made worse by second-hand smoke.

The same chemicals that contribute to heart disease in smokers are inhaled by non-smokers.

Children suffer from secondhand smoke in other ways — the most common being infections. Children in homes where there is a smoker suffer many more infections of the ears, lungs and sinuses than children in nonsmoking households. This is especially true if it’s the mother or primary care giver who smokes. The children also have more trouble with wheezing and coughing. Smoke can even stunt the growth of a child’s lungs, affecting his full potential for participating in sports and vigorous activities. Here are two specific reasons why second-hand smoke is so bad. First, the smoke which comes off the burning end of a cigarette has a higher

concentration of the chemicals which cause cancers and heart disease than the smoke inhaled through the cigarette. Second, this smoke is composed of very small particles which are able to penetrate deeper into the lungs and thus take longer to clear out of the lungs. The annoyance caused by second-hand smoke is only one of the reasons why you should avoid it. The best reason is that it’s good for your own health. For more information about second-hand smoke, go to the American Lung Association’s website – — and type in “second hand smoke.”


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The Daily Dispatch


Swollen knee joints are sign of infection and inflammation

When a knee joint swells up, it means something is not right in the joint. The swelling can come on suddenly from a new injury, such as in sports or falls, or slowly from arthritic changes. Whatever the cause, it should be taken care of promptly to help protect the joint. Swelling in the knee can cause considerable damage to the cartilage of the joint. The enzymes from pus cells can eat away at the cartilage. If there is an infection in the joint, it is very important to treat it early and aspirate the pus to prevent cartilage damage and chronic arthritis. Joint infections are a true emergency. And even red blood cells from bleeding in the joint will cause unwanted inflammation. If the swelling is due to illnesses such as rheumatoid arthritis or lupus, it should be treated aggressively to protect the joint and surrounding tissue. Blood tests and exams can be used to monitor the control of these diseases.

Injuries are one of the most common causes of joint swelling. If swelling comes on quickly after an injury, it is often due to bleeding into the joint from a torn ligament or even a fracture. On the other hand, if it is a cartilage that tears, there is minimal bleeding and the swelling is likely to develop slowly over a few days. When an injury is the cause of the swelling, an exam, x-rays and possibly arthroscopy are needed to be sure of which ligaments or cartilages are involved. Some injuries will need to be repaired if a person plans to stay in sports. Loose pieces of cartilage in the joint should be removed to prevent trouble with the knee locking and giving out, and also to prevent arthritic changes from developing in the rest of the joint. For a list of physicians in the area who can help you if you have swollen knees, check out Maria Parham Medical Center’s website, or call (252) 436-1800 to request information.

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Wednesday, April 20, 2011

Concussion may bring long-term problems After an accident, an individual may ask, “Was there a concussion?” A concussion is when there is a sudden change in brain function due to trauma. Usually the doctor asks, “Were you knocked out?” If so, there has been a concussion. Sometimes it is not that clear whether or not there has been a concussion. The change in brain function does not need to be a complete loss of consciousness. A concussion has occurred if there has been a disturbance of vision (such as double vision), loss of balance, or similar symptoms related to impaired brain function. With a concussion, there normally has been no structural damage to the brain, such as bleeding. Nevertheless, there may be long-term problems related to the injury, such as chronic headaches or dizziness because there is certainly microscopic damage.

In checking for a concussion, the doctor or coach asks questions to check one’s orientation (i.e., “What day is it?”, “Where are you?”) and memory (“What did you eat for breakfast?”). There is a temporary loss of memory which lasts for minutes in mild concussions and for over a day in more severe concussions. In the hospital, the doctor will check for any abnormalities in sensation, muscle strength, balance and coordination. If a person has severe or repeated concussions, he may develop a post-concussion syndrome consisting of headaches, dizziness, irritability and fatigue. This may last for several months or longer. There is also the risk of serious harm from concussions if there are two or more concussions within a one to two month period, especially in children.

The Daily Dispatch


Wednesday, April 20, 2011


Gastrointestinal bleeds need immediate medical attention Bleeding from the gut is a frightening experience — and it can be very dangerous. The bleeding can be severe enough to cause a person to become light-headed or pass out. A person can lose several units of blood before the bleeding becomes apparent. Bleeding from the gastrointestinal, or GI, tract can have several different causes. The best known is bleeding ulcers. These occur when an ulcer erodes into a blood vessel in the wall of the stomach or duodenum. Bleeding is often brisk and may need surgery. Fortunately, today’s ulcer medicines have decreased the incidence of this illness significantly. Other bleeding from high in the GI tract can be from stomach cancers or dilated veins in the esophagus. Most other GI bleeds originate in the colon, either from cancers or blood vessels entering diverticula. There can also be abnormal clusters of blood vessels in the bowel wall which bleed. When the bleeding comes from the colon, it will be bright red, while blood from an ulcer in the stomach will be dark or black due to the action of the acid in the stomach.


is good, of course, but the number on the scale is what a person looks at. The good news is that the increased muscle mass burns more calories, even at rest. Even if it is a slow process, exercise is still the key to any

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Premier Women’s Health Professionals, PA Bleeding from the gastrointestinal, or GI, tract can have several different causes Any bleeding from the GI tract, whether it’s passing blood in the stool or vomiting blood, needs immediate medical care. Your doctor will need to check your blood count, pulse and blood pressure. Intravenous fluids are used to support the blood

pressure until the problem has been corrected. Blood transfusions can be used if necessary. The definitive test is usually a procedure to look into the bowel with a scope to make an exact diagnosis and then treat accordingly.

weight loss program. Eating habits usually improve right along with increased fitness. One of the most beneficial results is that a person tends to cut out snacks and other “empty” calories that would otherwise be eaten. An ounce of potato chips is the equivalent of walking almost two miles or biking five miles. Exercise also promotes a healthier life style. A person may take the stairs rather

than the elevator, or walk or bike to the post office rather than take the car. Over time, these small improvements in a person’s physical activity, as well as his eating habits, can make a big difference in weight and health. Life style changes are the most effective way to control weight, and regular exercise is the foundation for many of the necessary changes.

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Healthbeat - Maria Parham Medical Center - April 20, 2011