Circulation Exercises to Keep you Warm

Exercises to keep you warm through the winter.

Winter is in full swing in The Ozarks! These frigid temperatures may cause significant circulation issues for many individuals. As we age, our body systems have to work increasingly hard to supply our body with all the nutrients and oxygen that it requires to perform the vital functions that we all need.

“Impaired circulation may cause significant issues with elderly individuals when you combine poor circulation with things like heart disease, diabetes or a lack of exercise. With the use of the above exercises you can help give your body the boost it needs to make it through this winter season.”

  • Dr. Brittany Wright, Physical Therapy

Here are three simple circulation exercises that have been shown to increase blood supply to assist with improved day-to-day health.

#1 – Supine Ankle Pumps – Begin lying on your back with your legs straight. Slowly pump your ankles by bending and straightening them. Try to keep the rest your legs relaxed while you move your ankles.

Supine Ankle Pump

# 2 – Supine Quad Set – Begin lying on your back with one knee bent and your other leg straight with your knee resting on a towel roll. Gently squeeze your thigh muscles, pushing the back of your knee down into the towel. Make sure to keep your back flat against the floor during the exercise.

Quad Set

#3 – Supine Glute Set – “Penny Pinchers” – Begin lying on your back with your hands resting comfortably. Tighten your buttock muscles, then release and repeat. Make sure not to arch your low back during the exercise or hold your breath as you tighten your muscles.

Glute Set

The above exercises have been recommended by the OCH physical therapy department as an easy and convenient way for adults to help pump blood through their body. This is not medical advice.



OCH Community Health Worker Shares Some Love with the Community

VenrunYou don’t have to work in direct patient care to impact patients’ lives in a big way. Ciara Day’s job is testament to that. While a medical degree helps doctors attend to medical conditions, Ciara works to mend the heart. Her entire job is based on the OCH mission of offering assistance in an atmosphere of compassion, respect and dignity. The stories that make up her every day speak to the passion OCH employees have for its patients.

As a Community Health Worker in OCH’s Integrated Care department, Ciara works to empower patients and give them the tools to improve their lives. “Everyone is different,” Ciara says. She says patients need help that is not just limited to healthcare visits with providers: sometimes patients need a ride to the appointment, a shower to clean off the fleas so the patient can address real problems with providers, or basic needs like nutritious food, or a safe place to call home. “It’s my job to check in and make sure those voices are heard.”

When considering healthcare, the Integrated Care department works as a team to look at overall well-being, not just an exchange of symptoms and healthcare solutions. “Everything is a lesson,” Ciara explains. It could mean providing patients with lessons on meal prepping for a chronic illness and what your refrigerator should look like. “You have to meet them where they are. If a patient doesn’t have access to food stamps or their Medicaid gets shut off, we connect them to resources that can help them get access to those things and show them how to work what they have.” Sometimes this means working with patients for a long time, and that’s okay. Changes do not happen overnight and Ciara is dedicated to working long term to better patient lives.

“I’m not afraid to call a patient up and be like, ‘Your provider is worried about you and part of the process for following up is a home visit. When are you available?’” And that’s just what she does. Understanding where a patient is now helps her figure out what the next steps are.

I’ve been doing this in the community for nearly a decade. I was initially hired to help the highest utilizers of the ER. But those aren’t the people screaming for help. It’s the silent ones who need it the most.

Within the first two weeks of joining OCH, Ciara started compiling a pantry for patients. Her office has boxes filled with supplies and walls covered in clean clothes, hygiene products, towels, and now, diapers. “I’m so excited! We just got a partnership approved with the Diaper Bank and now we can get diapers and wipes whenever we need them. We haven’t even started getting food in yet.” Ciara and others in the Integrated Care department do whatever it takes to share a little love.

It’s all a learning process, for Integrated Care and the patient. It is a process of bettering lives and strengthening communities. Community events like HOPE Connection and Everyone Counts in Springfield are integral to the mission. “Getting that access is huge. It’s invaluable to provide access to healthcare and information about how to get signed up for the programs people need.”

Sometimes that learning process takes a long time, like in the case of Allison*. Allison started going to a provider at OCH for over a decade. A  few years ago, she incurred a major life event and a variety of severe health issues that left her on disability and Medicaid, unable to care for herself. The medication she was taking was not working which resulted in chronic pain and a distrust of the medical system. When she moved in with friends, she had a limited food supply and limited quality of life. Ciara worked with her to get her food and looked at housing options. Every trip to the grocery store or produce distribution center was a lesson. “Again, you work with what they have. You shop within their budget. You show them nutritious options they can afford.”

After working with multiple agencies and with the help of Ciara, Allison found an apartment. Ciara helped her move out of her friend’s house and into her first “home” in four years. She showed Allison how to cook the food she has. “Sometimes you just need to let them know what they can do. Boil a potato and don’t add too much butter or cream and you have mashed potatoes.” Teaching patients to have the confidence to take care of themselves is one of Ciara’s favorite parts of her job. “[Allison] called me earlier this week saying she worked for hours cooking onions and potatoes and she was running around her apartment like a crazy person with joy.” It’s always a learning process. One day you boil potatoes; the next, you fry them up with some onions. During the interview, Kristen, the Integrated Care manager ran in the room exclaiming, “I found Allison a couch!” It’s the little successes that show the Integrated Care department and Ciara’s dedication to the patients.

Ciara summed it up perfectly when talking about her own children. “I have three rules. One is care about others. Hold the door open for everyone, not just girls. Always be a degree better of yourself than where you are now.” Always treat others the way you want to be treated. You have to share the love.

Qualifications for the Integrated Care program simply include being a patient at Ozarks Community Hospital. To be eligible for the Primary Care Health Home program, the patient must be a current patient, have Medicaid as a primary or secondary insurance and have one (or more) chronic condition(s). If you or someone you know is an OCH patient and in need of assistance, contact Integrated Care. For more information about the Community Health Worker position, email Ciara Day at

*Patient names and health information have been changed to protect patient confidentiality.

Trick or Treat, Safe and Neat



Halloween brings a holiday filled with candy, costumes and chaos. It can also bring a variety of safety hazards for the unprepared. Before embarking on your evening of adventure, review these safety tips from OCH pediatrician Christopher Spinelli, DO, FAAP. With a little preparation, you can guarantee your family’s favorite spooky holiday goes off without a hitch:

With Halloween coming up, it’s important to remember a few safety tips for your children when trick-or-treating or consuming their treasure chest of candy post-trip:

1. Costume Fit & Safety: When choosing a costume, make sure the costume fits your child well enough so he or she can see out of any masks. It is also important to make sure the costume is short enough to prevent tripping and to double check that the item is non-flammable.  Please make sure that there is some sort of reflective or other visible device so your child can be seen by cars at nighttime.

2. Parental Supervision: Always have an adult with your child. As an added bonus, it is good to have some sort of communication device such as a cell phone or walkie-talkie so you can get help if needed.

3. Watch out for Allergies : If your child does have food allergies, inspect the candy prior to consumption in order to avoid any adverse reactions.  If your child has anaphylaxis to certain foods such as peanuts, it may be wise to carry an EpiPen with you during trick-or-treating.  If any candy packages are already opened,  discard prior to consumption.

4. Hidden Choking Hazards: Avoid hard candies, suckers, or other choking hazards for smaller children.  Remember, not all candy is created equal from a dental standpoint!  Gummies and caramel can stick between the teeth and cause increased risk for cavities.  Receiving and distributing packages of pretzels (or other less sugary items) is also better for teeth.

5. Overconsumption of Candy: Consuming too much candy can cause a stomach-ache.  Parents may consider regulating how much candy children to consume or freeze the rest for later use. Families may also donate to local groups which can distribute the candy to less fortunate children.  

The Halloween Industry Association does have some additional safety tips listed online, to view click the following link:

From all of us at Ozarks Community Hospital, we hope you have a safe and happy Halloween!

This post was originally published on October 9, 2012; but as Dr. Spinelli offered such useful tips, we wanted to re-share as a reminder this year for all trick-or-treaters! 

Christopher Spinelli DO, FAAP, is a pediatrician at the OCH Northside Clinic in Springfield, MO. Dr. Spinelli is  a Major in the United States Air Force Reserve. After completing an undergraduate degree from Truman State University, Dr. Spinelli graduated from Kirksville College of Osteopathic Medicine and completed his Pediatric residency at Keesler Medical Center in Biloxi, MS.

Autism FAQ’s

In honor of World Autism Day on April 2nd, speech language pathologist Shannon Locke of the Ozarks Area Autism Clinic (OAAC) answers FAQ’s about autism spectrum disorders. Find out notable symptoms, who it affects and resources to help.

1. What is an Autism Spectrum Disorder (ASDs)?

ASDs are lifelong, behaviorally defined developmental disabilities in which an individual demonstrates disturbances in each of three areas:

  • Communication
  • Social interaction
  • Repetitive or restrictive and unusual behaviors

ASDs are a part of the broader category of Pervasive Developmental Disorders (PDD) which includes Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Symptoms of ASD vary greatly between individuals, but all will demonstrate varying degrees of disturbance within each of the three areas, that cannot be explained by other differential diagnoses. 

2. Who is at risk?

According to the National Institute of Health, the true incidence of Autism Spectrum Disorders is likely to be within the range of 30-60 cases per 10000.  ASDs occur in males significantly more often than in females; however, ethnicity does not appear to play a significant factor. 

This is an increase from early projections which is largely a consequence of improved ascertainment and a considerable broadening of the diagnostic concept. However, a true risk assessment is yet to be identified, although environmental risk factor cannot be ruled out and there have been preliminary studies indicating some familial tendencies. Empirical data do not support hypotheses of causation from dietary sources; however, good diet remains proven as a contributing factor to overall good health for all individuals. 

3. What are the signs?  

As suggested above all individuals with Autism Spectrum Disorders present differently, but below are a few common signs:

  • Underlying resistance/difficulty with social communication (like using common gestures and engaging in back-and-forth interaction with others, for example, Patti-cake games)
  • Difficulty greeting others independently or initiating interaction
  • Lack of eye contact to engage others or get attention purely for the purpose of “showing” something
  • Resistance to change or adherence to specific routines with no functional purpose

Here are a few examples of what it could look like if your child is demonstrating disturbances in social interaction and communication:

  • If your child doesn’t show you things or give you things to get you to play with him/her
  • If your child always prefers to “play” alone and will even outwardly resist your presence in his/her activities
  • If your child doesn’t seem able to say “hi” or “bye” to others with words or by waving without you constantly prompting him/her
  • If your child pulls you by the hand or arm to get things, but never looks at you to get your attention in the process
  • If your child has certain routines or ‘scripts’ that he/she will repeat over and over again even when the routine doesn’t seem to be appropriate to what’s going on, like imitating a line from a children’s program repeatedly throughout the day or insisting on toys being arranged in a certain way to avoid tantrums

As always, if you have any medical concerns for your child speak with your child’s pediatrician openly about your concerns and don’t be afraid to ask questions. Your pediatrician or nurse practitioner is your first stop resource for support, diagnosis referrals, and intervention services for your child.  

4. Where can I get help?

Start with your child’s health care provider, discuss your concerns and ask questions. You child’s doctor can make referrals as needed for medical diagnosis and intervention. Other resources include:

  • The Ozarks Area Autism Clinic (OAAC) is housed in the OCH Christian County Clinic located in Nixa, MO. It is the only multi-disciplinary autism diagnostic clinic of its kind for children from 18months to 6years of age in Southwest Missouri.  In addition, the OCH Christian County Clinic Pediatric Therapy Department provides individual pediatric therapy treatment services for children of all ages, including Speech and Language, Occupational, and Physical Therapies.   
  • In addition, the Missouri Department of Elementary and Secondary Education (MO DESE) Special Education offers educational support for children from birth though age 21 as they are deemed eligible through your local school district special services and Missouri Early Intervention First Steps programming.  
  • Finally, the Missouri State Department of Mental Health, Division of Developmental Disabilities offers support, case management, and referral services for children with diagnosed disabilities locally through the Springfield Regional Office; as well as facilitate connection with TouchPoint Autism Services , which provides supports for children in Southwest Missouri with ASDs.

Contact for support through these agencies can help families navigate the multitude of information floating in cyberspace about Autism Spectrum Disorders, point families in the right direction for hands-on help, and assist in finding everyday solutions and needed services for children in Missouri.

Blog report compiled by Shannon Locke, M.S.-CCC/SLP, Director of Pediatric Therapy Services and co-creator of the Ozarks Area Autism Clinic at OCH.  Shannon has been treating ASDs for over 20 years in educational, vocational, recreational, and medical settings.  She received her Master of Science degree from Missouri State University in 1998 and Certificate of Clinical Competence and licensure, Speech and Language Pathologist in 1999 through the State of Missouri Department of Professional Registration.  Shannon has previously been certified as an In-district Autism Consultant through Greene County Special Education Cooperative and received the ACE Award from American Speech Language and Hearing Association for exceptional participation in Continuing Education. When Shannon is not working in the Nixa OCH Clinic, she enjoys time with her husband, Scott and 10 year-old daughter, Katie and their rescue pets, two dogs and one cat, as well as spending time exploring the great outdoors hiking, kayaking, biking, and sky-diving. 

Beating the Cold and Flu Season

Odds are, there will be a few or more days this winter season that you are coughing up stuff similar to that Gak stuff from the 90’s, sneezing your way through several boxes of Kleenex or unconscious thanks to a double shot of NyQuil. It’s basically inevitable. It will happen. But if you follow the helpful tips courtesy of the Christian County Health Department below, you might stand a fighting chance at limiting the amount of cash spent at Walgreens this winter. 

  • Eat a balanced diet. Don’t concentrate on any one certain food. Rather eat the foods that supply your body with good nutrients on a daily basis.
  • Get regular exercise. Throwing some lbs. up and down or pounding pavement (or a treadmill) helps to improve the immune system, but try not to take it too far which could temporarily suppress your immune system.
  • Get adequate sleep and drink plenty of fluids.
  • Do not touch your nose, eyes or mouth with your hands. Just keep your hands below the neck.
  • Cover your nose and mouth when you cough or sneeze and throw away the tissue. No handkerchiefs. They went out of style in the Reagan administration for one thing, and they also become a cesspool of germs.
  • Get a flu shot if you haven’t already.
  • This one is pretty obvious but wash the hands. Also become a frequent user of one of several of the 261 Purell hand sanitizer dispensers installed around the hospital.

10 Things You Didn’t Know About Nuclear Medicine

In honor of National Nuclear Medicine Week (October 2-8), we’ve put together a list of facts you may not know about the study of Nuclear Medicine. But before we begin, here’s a little refresher about the topic: nuclear medicine is a branch of medicine that uses radioactive substances to image your body. In other words, it provides doctors another way to look inside your body in a non-invasive manner to search for tumors, aneurysms, inadequate blood flow, blood cell disorders, and more. Here are a few additional interesting points you may not know about nuclear medicine.

  1. An estimated 16 million nuclear medicine imaging and therapeutic procedures are performed each year in the United States. Of these, 40 – 50% are cardiac exams and 35 – 40% are cancer related.
  2. Nuclear medicine has been around for at least 58 years.
  3. There are nearly 100 different nuclear medicine imaging procedures available today.
  4. Unlike other tests, procedures, etc., nuclear medicine provides information about the function of virtually every major organ system within the body.
  5. Nuclear medicine procedures are among the safest diagnostic imaging tests available.
  6. The amount of radiation in a nuclear medicine procedure is comparable to that received during diagnostic x-ray.
  7. Children commonly undergo nuclear medicine procedures to evaluate bone pain, injuries, or kidney and bladder function.
  8. Nuclear medicine procedures are painless and do not require anesthesia.
  9. Common nuclear medicine applications include diagnosis and treatment of hyperthyroidism (Graves’ disease), cardiac stress tests to analyze heart function, bone scans for orthopedic injuries, lung scans for blood clots, and liver and gallbladder procedures to diagnose abnormal function or blockages.
  10. There are approximately 4,000 board certified nuclear medicine physicians and 15,700 certified nuclear medicine technologists worldwide.

Ozarks Community Hospital has an extensive list of Radiology and Nuclear Medicine services available in Springfield, Mo. For more information about the tests and services offered, visit or call (417) 837-4000.

Top 10 Childhood Rashes – Part 2

In Part Two of the childhood rashes blog post series OCH pediatric nurse practitioner, Sandy Hinds shares the second set of common rashes among children. See below for a quick guide to identifying each of them and learn the causes, symptoms, and treatment options available.


Eczema is characterized by a red, extremely itchy rash. It often starts on the cheeks at 2-6 months of age, and is most common on the creases of elbows, wrists, and knees or occasionally the neck, ankles and feet.

  • Cause: Eczema is an inherited type of sensitive skin.  A personal or family history of asthma or hay fever, makes it more likely that your child has eczema.  Flare ups occur when there is contact with an irritating substances. Certain foods can cause eczema to flare up including cow’s milk, eggs, peanut butter. This itchy flare up could develop 2 hours after eating. 
  • Expected Course: This can be a chronic condition, and will usually not go away before adolescence. 
  • Treatment: Steroid creams is the main treatment for itchy eczema. When the rash quiets down, use it at least once daily for an additional 2 weeks. 
  • Bathing and Hydrating: Hydration of the skin followed by lubricating cream is the main way to prevent flare-ups.  Your child should have one bath each day for 10 minutes.  Water soaked skin is less itchy. Eczema is very sensitive to soaps.  Some lubricating creams are Keri, Lubriderm, Nivea and Nutraderm.  Avoid applying any ointments, petroleum jelly, or vegetable shortening because they can block the sweat glands, increase itching and worsen the rash (especially in warm weather).  
  • Prevention: Wool fibers and clothes made of scratchy, rough materials make eczema worse.  Cotton clothes should be worn as much as possible.  Avoid triggers that cause eczema to flare up such as excessive heat, sweating, excessive cold, dry air (use a humidifier) chlorine, harsh chemicals, and saps.  Never us a bubble bath.  Keep your child off the grass. Try to avoid the foods such as cow’s milk, eggs, peanut butter, wheat, and fish during the first year of life.  

HIVES  (Urticaria)

Hives are a very itchy rash, raised pink spots with pale centers (looks like mosquito bites.) Size can rage of ½ inch to several inches across, shapes variable, and rapid repeated changes of location, size and shape. 

  • Cause: Hives are usually an allergic reaction to a food, drug, viral infections, insect bit, or a host of other substances. Often, the cause is NOT found. Localized hives are usually due to skin contact with plants, pollen, food or pet saliva. Hives are NOT contagious.
  • Expected Course: 10% (or more) of children get hives for 3-4 days and then it disappears. Swelling can be common around the eyes, lips, and genitals. Some may develop as big hives (called popular urticaria) at the sites of old and new bits that can last for months. 
  • Treatment: Antihistamine medicine. This medicine will not cure the hives, but I will reduce their number and relieve itching.  Benadryl is one of the most commonly used drugs for hives, with the main side effect being drowsiness.  Please check the dosage according to your child’s weight. Cool baths are helpful to relive the itching.  Avoid triggers that might cause the hives. Call your pediatrician if your child is having trouble breathing, swallowing or acting sick. Also, if the rash does not go away after 1 week, or 24 hours of antihistamines are not effective.   


Scabies are little bugs (mites) that burrow under the skin and cause severe itching and little red bumps. They are so small that they can only be seen with a microscope.  Usually more than one person in a family has them. 

  • Care: Creams are usually prescribed by your physician.  Pregnant women need special medicines for scabies and need to see their physician.
  • Expected Course: The itching and rash may last for 2-3 weeks after successful treatment with the medication. Cool baths without the use of soap, followed by 1% hydrocortisone cream, which you can buy without a prescription.
  • Contagiousness: Children can return to school after one treatment with the scabies medicine, otherwise scabies is HIGHLY contagious.  The symptoms take 30 days after exposure. Machine wash all your child’s sheets, pillowcases, underwear, pajamas, and recently worn clothing.  Blankets can be put away for 3 days.  Scabies cannot live outside the human body for more than 3 days.

IMPETIGO (Infected sores)

Impetigo, or infected sores, are sores within less than 1 inch in diameter; and begin as small red bumps that rapidly change to cloudy blisters, then pimples, and finally sores. They can be covered by soft, yellow-brown scabs that can contain pus.  Impetigo often spreads from scratching and picking at the initial sore. 

  • Cause: Superficial infection of the skin, caused by Streptococcus or Staphylococcus bacteria.  It is more common in the summer when the skin is often broken by cuts, scrapes, and insect bites.  When caused by the strep infection of the nose, the impetigo usually first appears near the nose or mouth. 
  • Expected Course: With proper treatment, the skin will be completely healed in 1 week.  Scars are unusual unless your child repeatedly picks her sores. 
  • Treatment: After the crust has been removed, antibiotic ointment should be applied to the surface three times a day prescribed by your physician. 
  • Prevention: Discourage your child from touching or picking at the sores.  Keep your child’s fingernails cut short, clean and wash their hands with one of the antibacterial soaps.
  • Contagiousness: Impetigo is quite contagious.  Do not share your child’s towel or washcloth.  Keep your child out of school until she has taken oral antibiotics for 24 hours.  For mild impetigo treated with an antibiotic ointment, the child can continue to attend day care or school if the sore is covered with a Band-aid. 


Pityriasis alba is characterized by multiple oval, scaly, flat hypo-pigmented patches on the face, extensor surface of arms, and upper trunk.  Multiple patches may be seen. Pityriasis alba occurs predominantly between the ages of 3-16 years, and up to 40% of all children may be affected.  The lesions do not itch, and medical help is sought because of the child’s appearance.  It can be distressing in dark-skinned children.

  • Expected Course: It is a chronic dermatitis and may be recurrent over several years.  It can be diagnosed as atopic dermatitis. 
  • Cause: The cause of the hypo-pigmentation is not known, but is likely related to inflammatory mediators that inhibit melanocyte function.
  • Treatment:  There is no satisfactory treatment for pityriasis alba.  Bland lubricants and topical gluco-corticorsteroids have some influence on the disorder.

All pictures courtesy of Instructions for Pediatric Patients, second edition, W.B. Saunders Company, 1999

Sandra Hinds, CPNP-PC works at the OCH Christian County Clinic located in Nixa, Mo. She received her education from the University Missouri-Columbia, the University of Missouri-Kansas City School of Nursing and the Vickie Millazzo Institute. Sandra is currently a member of the following professional organizations: National Association of Pediatric Nurse Associates and Practitioners, American Academy of Nurse Practitioners, Kansas City Nurse Practitioner Networking Association. To contact Sandra, call OCH Christian County Clinic at (417) 725-8250.