Pisgah Family Health News

July 2015

Office News

Bug Bites of Summer

Asheville Events

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Office News

Welcome Anna Goswick

Pisgah Family Health will welcome Anna Goswick to our practice during the months of August and September. Anna is a 3rd year medical student at UNC Chapel Hill, completing her Family Medicine clerkship. She will be training with Dr. Curran for 6 weeks.

DEA Controlled Drugs

The DEA (Drug Enforcement Agency) defines how medications are regulated in the USA. Drugs which are "scheduled" or restricted include narcotic pain killers, benzodiazepine anxiety drugs, and stimulant drugs for treatment of ADD. To comply with regulations set out by the DEA, we have instituted the following rules for DEA controlled drugs.

All patients using these medications will be asked to sign a "DEA Controlled Medication Contract". This contract defines restrictions that a patient must follow, and how these prescriptions will be written. Violation of this contract will result in termination of these prescriptions.

All patients using these medications will be asked to submit a urine drug screen. This will test for abuse of recreational drugs as well as prescription drugs.

These prescriptions must be printed on copy-proof paper and hand signed by the prescriber. These prescriptions will be limited to 30 days of medication, with no refills.

DOT Physicals

Do you have a Commercial Drivers' License? The DOT now requires special training for all medical providers who perform CDL examinations. Dr. Curran and Melissa Martinez have both completed this training process and been certified for CDL physicals.

If you are due to renew your CDL license, please call us to make an appointment. Be sure to get your DOT papers, and complete your portion prior to the visit. If you wear glasses or contacts to drive, be sure to bring them for your visit.

Mammograms

Pisgah Family Health now offers digital mammograms on site. Our mobile mammography unit will be available one Tuesday each month, to perform screening mammograms. For women who have had their mammograms elsewhere in the past, we have the ability to retrieve and compare your old films.

Mammograms are the best way to detect breast cancer early, when it can treated with greatest success. Women over age 40 should have a screening mammogram every other year, and women over 50 should have a mammogram annually. Women with a family history of breast cancer may require earlier or more frequent mammograms.

Ultrasounds

Pisgah Family Health now offers ultrasounds on site. Ruth, our certified ultrasonographer, will be here on Tuesday afternoons for routine tests, and is available for urgent tests as well.

Ultrasound is very safe and painless, and does not involve radiation. Ultrasounds are often used to evaluate vascular structures such as the aorta, carotid arteries, and leg veins. Ultrasound is also the best way to visualize solid organs such as the liver, gallbladder, and kidneys. We do not offer obstetric ultrasounds.

Cardio-Pulmonary Stress Testing

Do you have hypertension, high cholesterol, or other cardiac risks? Are you a smoker over age 50? Do you have chest pain or shortness of breath with exertion? If so, you may benefit from a Cardio-Pulmonary Stress Test.

This stress test is perfomed in our office, by having a patient ride a stationary bicycle for about 10 minutes. By measuring an EKG during exercise, we can identify coronoary disease that could lead to a heart attack. This test also measures pulmonary function, and can detect emphysema and chronic lung disease.

Office Reminders

Thank you for referring your family and friends to Pisgah Family Health. We are always eager for new business.

Please bring your insurance card to every visit, and present it when you check in. This ensures we have the most current insurance information for you.

Please notify our office if you have a new mailing address or phone number.

Bring your medication bottles to each visit. This will help us provide you the most accurate care.

Please call 24 hours in advance if you are unable to keep your scheduled appointment. We reserve the right to dismiss patients who repeatedly miss appointments.

Office Hours

Our office hours are now 8:30-5pm Monday through Thursday, and 8:30 to 12 on Friday. Our answering service can be reached after hours at 251-4873. When the office is closed, emergency care is available at the Urgent Care Centers and Mission Hospital ER.

On nights and weekends, Dr. Curran shares call with five other physicians. These doctors are all Board Certified in Family Medicine. We do not handle prescription refills after hours.

  • Pisgah Family Health will be closed Friday, August 21st for a staff outing to celebrate the 11th anniversary of the practice
  • Pisgah Family Health will be closed Monday, September 7th in observance of Labor Day

Medical News - Bug Bites of Summer

Mosquito-Borne Illnesses

mosquito!

Viral diseases transmitted by mosquitoes and other arthropods are called arboviruses. In North Carolina, the three most common arboviruses that cause human illness are Eastern Equine Encephalitis (EEE), La Crosse encephalitis (LAC) and West Nile virus (WNV).

In general, most cases of arboviral illness show no or mild symptoms, but severe cases can occur. Illness usually begins with the sudden onset of headache, high fever, chills and vomiting. The illness may become more serious and involve disorientation, seizures or coma, significant brain damage or death. There is no specific cure for arboviral illnesses; therapy is limited to treating the symptoms of the disease.

In North Carolina, the viruses that cause illness occur naturally in wild animals, such as birds or small mammals. They are spread from animal to animal by mosquito bites. If mosquito populations grow very large, there is an increased risk of an infected mosquito biting a person or domestic animal, like a horse. Arboviral diseases are seen most often during the late summer or early fall, but they can occur whenever mosquitoes are active.

In North Carolina, human arbovirus cases that cause severe neurological illness are reported to the state and to the Centers for Disease Control and Prevention (CDC).

La Crosse Encephalitis

La Crosse encephalitis is the most frequently reported arboviral illness in the state. LAC appears to be maintained in small mammals such as squirrels and is transmitted by mosquito species that breed in tree-holes or small containers that hold water. Most cases have occurred in the mountain counties of Buncombe, Transylvania and Henderson, primarily in children under the age of 14. During 2012, 26 cases of LAC occurred in 10 counties. From 2003 to 2012, 187 cases of LAC occurred, distributed among 27 counties.

West Nile Virus

West Nile virus was first found in the U.S. in 1999 and has spread across the country. Carried by birds, the disease is spread when a mosquito bites an infected bird and then bites a person or an animal such as a horse. Most cases have been reported from the piedmont counties, although WNV can occur anywhere in the state. WNV cases are seen most frequently in people over 40 years old (75 percent of cases from 2003 to 2012). Seven cases of WNV were reported from seven counties in 2012. From 2003 to 2012, 43 cases were reported from 26 counties.

Eastern Equine Encephalitis

Eastern Equine Encephalitis is also a bird disease and is associated with mosquitoes that live in freshwater swamps and bite birds. EEE is most likely to occur in coastal or eastern piedmont areas late in the summer or early fall. In North Carolina, cases are most severe in children and in people over the age of 50. During 2012, the state reported two cases from two counties. From 2003 to 2012, six cases were reported from five counties.

Chikungunya Virus

Chikungunya Virus was previously only found in foreign countries. Since late 2013 and 2014, a total of 484 Chikungunya virus disease cases have been reported in the USA. Almost all of these cases occurred in travelers returning from affected areas in the Caribbean or South America. Four locally-transmitted cases have been reported from Florida.

Most people infected with chikungunya virus will develop some symptoms. Symptoms usually begin 3–7 days after being bitten by an infected mosquito. The most common symptoms are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. Chikungunya disease does not often result in death, but the symptoms can be severe and disabling. Most patients feel better within a week. In some people, the joint pain may persist for months.

Foreign Mosquitoes

Dengue fever, malaria and yellow fever are mosquito-borne illnesses not usually seen in North Carolina. Although, they are not transmitted by mosquitoes in this state, North Carolinians may contract one of these diseases if they travel to certain countries or regions where these diseases are found, such as the tropics or sub-Saharan Africa.

Disease Prevention

The best way to avoid becoming ill from a mosquito-borne virus is to prevent mosquito bites. When outdoors, wear long-sleeved shirts and long pants, if possible. Use repellents according to label directions. Reduce mosquito breeding areas around your home by emptying, recycling or throwing away items around your home that hold water, especially old tires. Make sure rain gutters are clean and in good repair. Empty and refill bird baths and pet bowls every three to four days. Make sure that outdoor faucets are not leaking, and fill in potholes and other areas that may hold water.

For general information on arboviruses – including EEE, WNV and LAC – and a factsheet on repellents, see the N.C. DHHS Communicable Disease website at http://epi.ncpublichealth.info/cd/diseases/arbo.html. For more detailed information, including diagnosis and treatment, see the CDC’s web site at www.cdc.gov/ncidod/dvbid/arbor.

Tick-Borne Diseases

ticks

In the United States, some ticks carry pathogens that can cause human disease. These tick species vary by region, and so these illnesses also occur regionally.

Anaplasmosis is transmitted to humans by tick bites primarily from the blacklegged tick (Ixodes scapularis) in the northeastern and upper midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.

Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of babesiosis in the U.S. are caused by Babesia microti. Babesia microti is transmitted by the blacklegged tick (Ixodes scapularis) and is found primarily in the northeast and upper midwest.

Borrelia miyamotoi infection has recently been described as a cause of illness in the U.S. It is transmitted by the blacklegged tick (Ixodes scapularis) and has a range similar to that of Lyme disease.

Colorado tick fever is caused by a virus transmitted by the Rocky Mountain wood tick (Dermacentor andersoni). It occurs in the the Rocky Mountain states at elevations of 4,000 to 10,500 feet.

Ehrlichiosis is transmitted to humans by the lone star tick (Ambylomma americanum), found primarily in the southcentral and eastern U.S.

Heartland virus infection has been identified in eight patients in Missouri and Tennessee as of March 2014. Studies suggest that Lone Star ticks may transmit the virus. It is unknown if the virus may be found in other areas of the U.S.

Lyme disease is transmitted by the blacklegged tick (Ixodes scapularis) in the northeastern U.S. and upper midwestern U.S. and the western blacklegged tick (Ixodes pacificus) along the Pacific coast.

Powassan disease is transmitted by the blacklegged tick (Ixodes scapularis) and the groundhog tick (Ixodes cookei). Cases have been reported primarily from northeastern states and the Great Lakes region.

Rickettsia parkeri rickettsiosis is transmitted to humans by the Gulf Coast tick (Amblyomma maculatum).

Rocky Mountain spotted fever (RMSF) is transmitted by the American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and the brown dog tick (Rhipicephalus sangunineus) in the U.S.

STARI (Southern tick-associated rash illness) is transmitted via bites from the lone star tick (Ambylomma americanum), found in the southeastern and eastern U.S.

Tickborne relapsing fever (TBRF) is transmitted to humans through the bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes.

Tularemia is transmitted to humans by the dog tick (Dermacentor variabilis), the wood tick (Dermacentor andersoni), and the lone star tick (Amblyomma americanum). Tularemia occurs throughout the U.S.

364D rickettsiosis (Rickettsia phillipi, proposed) is transmitted to humans by the Pacific Coast tick (Dermacentor occidentalis ticks). This is a new disease that has been found in California.

Symptoms of Tickborne Illness

Many tickborne diseases can have similar signs and symptoms. If you have been bitten by a tick and develop the symptoms below, see your doctor immediately.

The most common symptoms of tick-related illnesses are:

  • Fever/chills: With all tickborne diseases, patients can experience fever at varying degrees and time of onset.
  • Aches and pains: Tickborne disease symptoms include headache, fatigue, and muscle aches. With Lyme disease you may also experience joint pain. The severity and time of onset of these symptoms can depend on the disease and the patient's personal tolerance level.
  • Rash: Lyme disease, southern tick-associated rash illness (STARI), Rocky Mountain spotted fever (RMSF), ehrlichiosis, and tularemia can result in distinctive rashes:
    • In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite. It may be warm, but is not usually painful. Some patients develop additional EM lesions in other areas of the body several days later.
    • The rash of STARI is nearly identical to that of Lyme disease, with a red, expanding "bulls eye" lesion that develops around the site of a lone star tick bite. Unlike Lyme disease, STARI has not been linked to any arthritic or neurologic symptoms.
    • The rash seen with Rocky Mountain spotted fever (RMSF) varies greatly from person to person in appearance, location, and time of onset. About 10% of people with RMSF never develop a rash. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles. The red to purple, spotted (petechial) rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60% of patients with the infection.
    • In the most common form of tularemia, a skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
    • In about 30% of patients (and up to 60% of children), ehrlichiosis can cause a rash. The appearance of the rash ranges from macular to maculopapular to petechial, and may appear after the onset of fever.

Tickborne diseases can result in mild symptoms treatable at home, or can result in severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decreases the risk of serious complications. So see your doctor immediately if you have been bitten by a tick and experience any of the symptoms described here

Avoid Direct Contact with Ticks

Be extra vigilant to avoid ticks in warmer months (April-September) when ticks are most active. Avoid wooded and bushy areas with high grass and leaf litter. Walk in the center of trails. Wear clothing that covers your skin, especially long socks and pants.

Repel Ticks with DEET or Permethrin

Use repellents that contain 20 to 30% DEET (N, N-diethyl-m-toluamide) on exposed skin and clothing for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth. Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer. Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.External Web Site Icon

Find and Remove Ticks from Your Body

Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you. Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair. Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks. (Some research suggests that shorter drying times may also be effective, particularly if the clothing is not wet.)

Source: http://www.cdc.gov/ticks/avoid/on_people.html

Flea Bites

Flea

Flea bites are very common, and are usually no more serious than a persistent itchy bump. Fleas live on almost all mammals, feeding on their skin. Our pets often bring fleas inside, resulting in itchy bites on cats, dogs, and humans. Flea bites can occur anywhere on the body, but often are clustered on the exposed skin of the arms and legs.

Plague

Plague is a rare disease that affects humans and other mammals. It is caused by the bacterium, Yersinia pestis, which is carried by rats. Humans usually get plague after being bitten by a rodent flea or by handling an animal infected with plague. Plague is infamous for killing millions of people in Europe during the Middle Ages. Today, antibiotics are effective in treating plague. Without prompt treatment, the disease can cause serious illness or death. Presently, human plague infections occur in the western United States, but significantly more cases occur in parts of Africa and Asia.

Diagnosis

Plague is a plausible diagnosis for people who are sick and live in, or have recently traveled to, the western United States or any other plague-endemic area. The most common sign of bubonic plague is the rapid development of a swollen and painful lymph gland called a bubo. A known flea bite or the presence of a bubo may help a doctor to consider plague as a cause of the illness.

In many cases, particularly in septicemic and pneumonic plague, there are no obvious signs that indicate plague. Diagnosis is made by taking samples from the patient, especially blood or part of a swollen lymph gland, and submitting them for laboratory testing. Once plague has been identified as a possible cause of the illness, appropriate treatment should begin immediately.

Treatment

Plague is a very serious illness, but is treatable with commonly available antibiotics. The earlier a patient seeks medical care and receives treatment that is appropriate for plague, the better their chances are of a full recovery.

People in close contact with very sick pneumonic plague patients may be evaluated and possibly placed under observation. Preventive antibiotic therapy may also be given, depending on the type and timing of personal contact.

If you live or have recently traveled to the western U.S. or any other plague endemic area and have symptoms suggestive of plague, seek health care immediately

Source: http://www.cdc.gov/plague/

Free Music In Asheville

Concert Banner

Downtown After 5

The Asheville Downtown Association produces this free music series on the third Friday of each summer month. Located on Lexington Avenue, Downtown Asheville, this event includes beer and food vendors, and a big party vibe. Learn more at www.ashevilledowntown.org/downtownafter5. Read about the artists here.

Dates include:

  • Friday, July 17
  • Friday, August 21
  • Friday, September 18

Concerts on the Quad

These free concerts will be held on Monday evenings on from 7 to 8:30 p.m. on the UNC Asheville Quad. Attendees are invited to bring chairs, blankets and picnics to enjoy along with the music. Dogs and alcohol are not allowed. Learn more at https://news.unca.edu/articles/concerts-quad-return-unc-asheville-summer-2015.

Dates include:

  • Monday, June 22 (Ulali - Native American, folk, and blues)
  • Monday, June 29 (The Malpass Brothers - Country)
  • Monday, July 6 (StephaniesId - noir pop)
  • Monday, July 13 (Chatham County Line - bluegrass)

Shindig on the Green

Shindig on the Green , now in its 49th year, showcases the Southern Appalachians' best traditional mountain musicians and dancers. Bound by the tradition of "Along About Sundown" these gatherings call to mind the era when local folks of all ages gathered at the end of the day on front porches with fiddles, banjos and guitars in hand and dancing feet at the ready. Come celebrate the treasured cultural heritage of Western North Carolina throughout the summer at these events organized by Asheville's Folk Heritage Committee.

Held outdoors at Pack Square Park in the heart of downtown Asheville, Shindig on the Green is FREE and was voted the #1 Local Outdoor Concert in the Mountain Xpress "Best of WNC" survey for four years. Bring your instruments, your lawn chair or blanket, family and friends and join the fun for these eight summer Saturdays. Learn more at www.folkheritage.org/shindigonthegreen.htm.

Dates include:

  • Saturday, June 27
  • Saturday, July 11
  • Saturday, July 18
  • Saturday, July 25
  • Saturday, August 15
  • Saturday, August 22
  • Saturday, September 5

River Music

RiverLink's RiverMusic - five Friday nights of free live concerts by the French Broad River in the River Arts District of Asheville - will return for a fourth year in 2015. Once again, RiverLink huddled with Heira Productions to assemble a top-notch mix of quality national acts and local favorites at the RiverLink Sculpture and Performance Plaza in the River Arts District

Gates open at 5. The music starts at 5:30, with a second band at 6:45 and the headliner at 8:15. Learn more at riverlink.org/experience/rivermusic/.

Dates include:

  • Friday, July 10
  • Friday, September 11
  • Friday, October 9

Live after Five at the Biltmore Estate

With your Biltmore Estate pass, you can enjoy free music at Antler Hill Village every Friday and Saturday night. Passholders can bring friends to Antler Hill Village for free after 5:00 p.m. The whole family can relax and enjoy summer evenings on the Village Green as you watch the sunset over the Blue Ridge Mountains. There will be live music, wine and beer for sale, and fun for the kids throughout the village.

For a romantic evening meal, enjoy a farm-to-table dinner at the Bistro, or Cedric's Tavern (indoors or patio). Chef-inspired cookout favorites are available from the new grill station next to Cedric's Tavern. Seasonal salads and sandwiches are also offered at The Creamery.

Please note, no outside food and beverage is permitted in the village area, and no outside alcohol is permitted on Biltmore grounds. Learn more at http://www.biltmore.com/events/live-after-five.

Dates include Friday and Saturday Evenings, May 22 through October 31, 2015.

Concerts in the Park

What could be better than spending a beautiful Saturday summer evening enjoying delicious food, outdoor patios, shopping and blockbuster movies at Biltmore Park Town Square? Add free music to the equation and you have the perfect Saturday night!

Each concert will begin at 7 pm, giving you two hours of live music and dancing for the whole family. Definitely bring the kids! Concerts will take place in the green space near Hickory Tavern and Brixx Pizza.

Concerts in the Park 2015 Schedule:

  • Saturday, May 30 - PoshHammer
  • Saturday, June 27 - Mac Arnold and Plate Full O'Blues
  • Saturday, July 25 - Kat Williams
  • Saturday, August 29 - Blue Dragons
  • Saturday, September 26 - Tuxedo Junction

About our Newsletter

Dr. Curran and the staff at Pisgah Family Health are proud to publish the Pisgah Family Health News to our patients.  Our goal is to provide regularly updated information about the office and current medical topics.  We plan to publish a new issue each quarter with breaking news.  The newsletters will also be archived on our website, www.PisgahFamilyHealth.com/

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