* Your baby is younger than age 3 months and has a rectal temperature of 100.4 degrees or higher
* Your baby is between ages 3 months and 6 months and gets a temperature of 101 degrees or higher, even if the child  doesn’t seem sick
* Your child is age 6 months or older and gets a temperature of 103 degrees or higher, even if the youngster appears to feel OK
* Your child has a seizure
* Your child has an earache or sore throat in addition to a fever

Acetaminophen, such as Tylenol, or ibuprofen, such as Advil or Motrin, help reduce fevers.   Do not give ibuprofen to children younger than age 6 months, though.   And ask your doctor before giving any medicine to children younger than age 3 months.   Do not give a child aspirin unless your doctor advises it.   Aspirin has been linked to Reye’s syndrome, a rare but potentially fatal disease.

These other strategies can also make your little patient more comfortable:

*Sponge your child with lukewarm water to reduce fever, but do not use rubbing alcohol or cold water for baths. Cold baths can cause shivering, which raises body temperature.
* Keep your child’s room cool.
* Dress your child in light clothing.
* Encourage your child to take in extra fluids by drinking water and eating popsicles, gelatin and soup.

It’s important to realize that fever is the body’s response to fighting off an infection.

One of the biggest worries parents have about high fevers is the risk for brain damage.   Knowing the facts may help you breathe a little easier.   It turns out that fevers do not usually cause brain damage unless they are higher than 107.6 degrees, according to the National Institutes of Health.

(from BCBS Newsletter- Feb 2010 )

Fruits are nutrient powerhouses and important for your body. For a 2,000 calorie diet, eating 2 cups every day is recommended. Try these out-of-the-ordinary fruits if you are looking for a little variety.

* Tomatillos are small, round, green or yellow fruits wrapped in a light-brown husk. They contain vitamin C. Like their cousin the tomato, tomatillos can be used in salads, salsas or sauces. Just remove the husk, wash and slice.
* Asian pears are round, yellow, fiber-rich fruits that are crisp and juicy like apples. Their flavor is slightly sweet and tart. They are ripe straight from the store. You can eat them as is or add them to slaws and sandwiches.
* Cherimoyas are green fruits that resemble pinecones and are loaded with vitamin C. They have a pulp that tastes like a combination of pineapple, papaya and mango. To eat, cut one in half, remove the seeds and scoop out the inside with a spoon.

Patient Center Medical Home is a concept that started in the 1960’s as a model for primary care practices.  It was originally intended for patients with chronic health conditions, especially diabetes.  In the past 4-5 years, the concept has been adopted and expanded by the professional societies for pediatrics, family practice and general internal  medicines.

The PCMH is an approach that provides comprehensive care for patients through their primary care physician.  The PCP coordinates the patient’s health status, manages chronic conditions such as diabetes and asthma, tracks all medications, can provide expanded office hours, and generally supervises the patients medical care.  One of the goals of the PCMH is to keep patients healthy and reduce the risk of complications through proactive and preventative health care management.   Another goal of PCMH is to provide cost-effective health care.     It is believed that if every American used a primary care physician as their usual source of care, health care cost would decline by an estimated $67 billion per year nationwide.

In the PCMH model,  patients with chronic conditions who are not seen on regularly can be contacted on a scheduled basis to schedule their appointments.  Providers utilize electronic prescribing and have better communication with specialty offices that their patients see.   Part of the model also includes a patient-provider agreement in which the physician works with the patient to establish the  patient’s own goal for improving his or hers health by helping the patient set self-management goals.

By no means does PCMH apply to only those patients with chronic conditions.  By patients taking a more proactive  role in their health and healthcare decisions, the patient feels that they have a health care working for them.

We at Troy Family Practice, PLLC are pleased that we were designated a PCMH office in June and feel that many of the goals set forth by  PCMH are what our providers approach to patient care and that of the staff  have been for the past 8 years.   It is truely a team approach which our  patietns will benefit from.

Preheat broiler.  heat oil in a large nonstick skillet over medium-high heat.  Add bell pepper; stir-fry 1 minute.  Add mushrooms, zucchini and garlic; stir-fry 4 minutes or until vegetables are crisp-tender.  Stir in black pepper; remove from heat.

To separate pitas into 2 rounds, use a small knife to cut around edges of the pita.  Place pita rounds on a baking sheet and broil 4-5 inches from the heat source for 1 minute or until lightly toasted.  Remove from broiler.  Turn pitas over; top with pizza sauce, vegetables and cheese.  Return to the broiler; broil 3 minutes or until cheese is melted.  Top each round with basil.

Makes 4 servings 

Dietary exchange: 1 fat, 1 starch, 2 vegetables

Calories 175, total fat 5g,  saturated fat 2g, protein 9g, carbs 25g, cholesterol 9mg, dietary fiber 5g, sodium 381mg.

So what’s your best course of action? Protect yourself from seasonal flu by getting a regular vaccination as soon as it’s available, says Dr. Beth P. Bell, associate director for epidemiology science at the National Center for Immunization and Respiratory Diseases. Also check with your doctor to see if a swine flu vaccine is available and if you’re amont those recommended to get one. Seasonal influenza alone causes widespread illness and, on average, 36,000 deaths a year. For the most current information about H1N1 and seasonal flu, check out pandemicflu.gov and cdc.gov/flu.

To prevent spreading any type of flu:

• Cover your mouth when you cough or sneeze
• Wash your hands frequently with soap and water
• Avoid touching your eyes, nose or mouth whenever possible
• Stay home of you child or you are sick to avoid spreading it to others

- Doug Donaldson Better Homes and Gardens, September 2009

Researchers found that each factor creates independent risk for the disease. This means that making small changes in even two or three areas can significantly help prevent diabetes. Of course, focusing on a healthy lifestyle that includes all five habits is even better. Follow these proven steps:

1. Eat healthier. Study participants who had a lower risk for diabetes followed these dietary habits:

• Eat more dietary fiber. Fiber is found in fruits, vegetables, whole grains, beans and peas. Aim for 20 to 35 grams of fiber each day.
• Add polyunsaturated fat to your diet. Polyunsaturated fat - one of the “good fats” - can be found in canola and soybean oil, walnuts, flaxseed and fish like salmon or trout.
• Cut out trans fat. Trans fat is found in many processed foods, such as prepackaged crackers, cookies and pies.
• Eat low-glycemic carbohydrate foods. These raise blood glucose less than other sources of carbohydrates. Examples include whole wheat bread, barley, kidney beans, lentils and most fruit.

2. Get active. The study found that regular exercise greatly reduced the risk for diabetes. But you don’t have to run a marathon to reap the results. Engage in moderate activities, such as gardening or taking a 30-minute walk, on most days of the week.

3. Drink in moderation. Researchers found that those who drank in moderation actually had a lower risk for diabetes than those who didn’t drink at all. But beware, as overindulging erased the benefits. If you drink, stick to one drink a day.

4. If you smoke, take steps to quit. The health benefits are substantial. Research shows that besides helping you prevent diabetes, quitting smoking can add years to your life - even at an older age.

5. Watch your weight. It can be challenging to drop extra pounds, but reaching a healthy weight can substantially reduce your risk for diabetes. Study participants with the lowest risk for diabetes maintained a waist circumference of 34.6 inches or less for women and 36.2 inches or less for men. Or they had a body mass index of less than 25. According to government guidelines, a BMI between 18.5 and 24.9 is considered normal weight.

• Researchers studied more than 13,000 people nationwide for an average of nine years. During that time, those with the lowest vitamin D levels were 25 percent more likely to die than the people with the highest levels.
• About 3,000 adults were followed for an average of eight years. The lower their vitamin D levels, the more likely they were to die of cardiovascular disease or any other cause during that time.

Sun is the main source of vitamin D

The lowest levels in these studies were below the recommended intake. However, experts estimate that about 40 percent of men and half of women in the U.S. are getting lower-than-optimal amounts. Although experts are still exploring its role in prolonging life, vitamin D is important to include in your diet for its other proven effects. It helps the body absorb calcium, which keeps bones strong and prevents osteoporosis.
The skin produces vitamin D when exposed to sunlight. Most people are able to meet their needs this way. The general rule is that 10 to 15 minutes of sunlight two to three times a week is sufficient. But some people may need more help meeting their vitamin D amounts, including:

• From November through February, people living in locations as far north as Boston or farther north.
• Obese people. Fat traps the nutrient, keeping it out of the bloodstream.
• Those with darker skin. They have more of the pigment melanin, which reduces skin’s vitamin D-producing abilities.
• Older adults. The body’s ability to make and use vitamin D declines with age.

You can get more “D” in your diet

Doctors recommend that adults consume 200 international units of vitamin D daily until age 50, 400 IUs daily until age 70 and 600 IUs daily after age 70. The following foods are good sources:

• Fish such as salmon, mackerel, tuna and sardines (200 to 360 IUs per 3.5 ounces)
• Fortified cereal, juice or milk (40 to 100 IUs per serving; check the nutrition label for serving size)
• Eggs, including yolks (20 IUs per egg)

If you’re concerned about your levels, talk with your doctor to find out if supplements are an option for you.

In a large glass or other nonreactive bowl, mix together all ingredients, except shrimp, until well combined.  Add shrimp, coat well and refrigerate for several hours.  Thread shrimp on skewers so they don’t touch.  Place on grill.  Cook two to three minutes until shrimp are curled.  Turn shrimp to the other side.  Dont over cook.

Serves 4

Each serving contains about 180 calories, 4 grams fat, 258 miligrams cholesterol, 551 miligrams sodium and 1.5 grams carbohydrates.

Place chickpeas, cucumber, tomatoes, cheese, onion, olive oil, vinegar and pepper in a medium bowl.  Mix until coated.

Makes 4 servings

This is a great side salad!  Or, eat a double portion for a vegetarian lunch, using the chickpeas as your main source of protein.

• Nutritional information per serving:  Calories 150, Fat 6grams, Saturated fat 1 1/2 grams, Protein 5 1/2 grams, Carbs 20 grams, Fiber 4 grams, Sodium 110 milligrams, Cholesterol 4 1/2 milligrams

• 8 red bell peppers
• 5 black peppercorns
• 3 thyme sprigs
• 1 bay leaf
• 2 tablespoons olive oil
• 2 cups diced onion
• 1 tablespoon fresh garlic, minced
• 4 cups chicken broth
• 3 tablespoons white wine vinegar
• ¼ teaspoon hot pepper sauce (Tabasco)
• ½ teaspoon salt
• ¼ teaspoon fresh ground black pepper
• 2 tablespoon chopped fresh chives

Directions:

1. Preheat broiler
2. Cut peppers in half lengthwise; discards seeds and membranes. Place skin side up on a foil lined baking sheet;flatten with hand. Broil on high for 15 minutes or until blackened. Place in a zip lock bag, seal. Let stand for 15 minutes. Peel and chop.
3. Place peppercorns, thyme and bay leaf on a double layer of cheesecloth, gather edges together and tie securely.
4. Heat oil in a Dutch oven over medium high heat. Add onion and garlic, cook 15 minutes or until onion is lightly browned, stirring occasionally. Add peppers, cheesecloth bag, broth, vinegar and hot pepper sauce to pan. Increase heat to medium-high, and bring to a boil. Cover, reduce heat, and simmer 20 minutes. Remove and discard cheesecloth bag: stir in salt and black pepper.
5. Place ½ of pepper mixture in a blender. Remove center piece of blender lid (to allow steam to escape); secure blender lid on blender. Place a clean towel over opening in blender lid (to prevent splatters). Blend until smooth. Pour pureed mixture in to a large bowel; repeat process with remaining soup. Return to Dutch oven and heat thoroughly.

To serve, sprinkle with chives.

Makes 6 servings.