Top 10 Childhood Rashes – Part 1

Not all childhood rashes are created equal. Some are more contagious, others are life threatening. And, (of course) all are unpleasant! OCH pediatric nurse practitioner, Sandy Hinds shares the top 10 common rashes among children and offers a quick guide to identifying each of them. Learn the causes, symptoms, and treatment options available (Part 1). Take note, moms and family members, and stay tuned for the second set of common rashes to be posted next week. 

HAND, FOOT & MOUTH DISEASE

Hand-foot-and-mouth disease is always caused by a Coxsackie A-16 virus. It has no relationship to hoof and mouth disease of cattle. Symptoms include the following: small ulcers in the mouth and a mildly painful mouth, small water blisters or red spots located on the palms and soles and on the webs between the fingers and toes, five or fewer blister per limb and sometimes on the buttocks. Low-grade fever between 100 and 102. It mainly occurs in children 6 months to 4 years of age.

Image of Hand, Foot & Mouth

  • Expected Course: Fever and discomfort are usually gone by 3-4 days. Mouth ulcers resolve in 7 days, with the rash lasting 7-10 days. Only complication is dehydration from refusing fluids.
  • Home Care: Antacid solution: use for pain relief. Children under 4 yo. ½ tsp. antacid solution in the front of their mouth 4 times a day after meals. Children over 4 yo. 1 tsp. antacid solution after meals.
  • Diet: Soft diet for a few days and encourage plenty of liquids. Cold drinks, popsicles, sherbert. Avoid citrus, salty or spicy foods or ones that need much chewing.
  • Fever: monitor fever and administer fever reducer as needed.
  • Contagiousness: Quite contagious and usually some of your kids playmates will develop it at the same time. Incubation period is 3-6 days. Because the condition is harmless, these children do not need to be isolated. They can return to daycare when the fever is normal. Most children are contagious 2 days before to 2 days after the rash, but avoidance of other children is unnecessary.

POISON IVY

Poison Ivy causes redness and blisters, eruption on exposed body surfaces. It is shaped like streaks or patches, very itchy, onset 1-2 days from being in a forest or field.

 

Image of poison Ivy

 

  • Cause: poison, ivy, sumac can cause the same type of rash. More than 50% of people are sensitive to the oil of these plants. The course usually lasts 2 weeks. Treatment reduces the symptoms, but doesn’t cure the disease. Prevention is the best approach.
  • Prevention: Learn to recognize these plants. Avoid all plants with three large shiny, green leaves. If exposed wash clothing and areas of skin with soap for 5 minutes, because after 1 hour it is of little value in preventing absorption of the oil.
  • Contagiousness: The fluid from the sores is not contagious, however, anything that has poison ivy oil or sap on it is contagious for about 1 week. This includes the shoes, or clothing worn as well as any pets that may have it in their fur. The rash begins 1-2 days after exposure.
  • Home Treatment: Cool soaks, Benadryl (weight appropriate dosage).

RINGWORM

Ringworm is a ring-shaped pink patch, scaly, raised border, increases in size, clearing of center, mildly itchy. It is caused by a fungus infection of the skin, often transferred from puppies or kittens who have it.

Image of ringworm.

  • Contagiousness: it is mildly contagious. It requires direct skin-to-skin contact. It is only transmitted animal to human, not human to human. After 48 hours of treatment it is not contagious at all. Animals must be treated by their veterinarian.
  • Home Care: antifungal cream, Tinactin, Lotrimin cream applied twice daily to the rash.

FIFTH DISEASE (ERYTHEMA INFECTIOSUM) 

This rash is characterized by bright red or rosy rash on both cheeks for 1-3 days ( slapped cheek appearance) , followed by a pink “ lacelike” or “netlike” rash on extremities. Lacy rash mainly on thighs and upper arms, comes and goes several times over 1-3 weeks. No fever or low grade fever – less than 101F ( 38.4). Fifth disease was so named because it was the fifth pink-red infectious rash to be described by physicians. The other four are: 1. Scarlet fever 2. Measles 3. Rubella 4. Roseola. Fifth disease is caused by the human parvovirus B19.

Image of fifth disease.

  • Expected Course: The lacelike rash may come and go for 5 weeks, esp. after warm baths, exercise, and sun exposure. No treatment is necessary. The rash is harmless and causes no symptoms that need treatment.
  • Contagiousness: Over 50% of exposed children will come down with the rash in 10-14 days. The disease is mainly contagious during the week before the rash begins. Therefore, exposed children should try to avoid pregnant women, but that can be difficult. Once the child has ‘slapped cheeks’ or the lacy rash, he is no longer considered contagious and does not need to stay home from school. If a pregnant woman is exposed to a child with fifth disease, she should see her obstetrician. The doctor will obtain and antibody test to see if the mother already had the disease and is therefore protected.

ROSEOLA

Children ages 6 months to 3 years, presence of a fine pink rash, mainly on the trunk. High fever during the preceding 2-4 days that cleared within 24 hours before the rash appeared. Child only mildly ill during the time with fever, child acting fine now. Roseola is caused by the human herpesvirus-6. The rash lasts 1-2 days followed by complete recovery. Some children have 3 days of fever without a rash. No particular treatment in necessary. Roseola is contagious until the rash is gone. Other children of this age who have been with your child may come down with roseola in about 12 days. Call if the rash last more than 3 days, fever longer than 4 days or the spots become purple or blood-colored.

Image of roseola. 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.

Coping with Fall Allergies

Just when your nose finally adjusted to the sights and smells of summer, fall allergy season hits full force. Sure, the crisp autumn evenings offer a welcome relief from the summer heat; but for those suffering from allergies, fall is one of the worst times to be outside. Ozarks Community Hospital of Gravette nurse practitioner Anita Marie Kane shares a few tips on how to keep the sniffles, itching and irritation at bay.

Sneezing, itchy eyes, runny nose, throat drainage…yes it is that time of year again! We are blessed to live in a region with beautiful foliage and dramatic seasonal changes. However, one of the drawbacks to this seasonal beauty is an abundance of budding, blooming, seeding, and blowing allergens.

The CDC reports over 17.6 million people were diagnosed with “hay fever” in the last year. According to Dr. Moses of Family Practice Notebook, hay fever affects 35 million people yearly, with 3 million missed work days.

What can you do to avoid those missed days? Talk to your provider about your options. Generally, try to avoid allergens you react to, use an air purifier in the home if indicated, avoid tobacco smoke, and use a mask if needed when mowing or working in dust-filled areas. Medications may offer some relief also. These include antihistamines (such as Allegra, Benadryl, Claritin and Zyrtec), intranasal corticosteroids (such as Flonase and Nasonex) and saline nasal spray. Other options in severe cases may include systemic steroids or even allergy testing with hyposensitization.

Just remember, the season will change (and there will be new allergens!). Stay healthy, drink plenty of water, exercise regularly and get adequate rest, a healthy you is your best defense.

Anita Marie Kane, APN is a long time resident of Gravette, AR, who started out as a nurse’s aide at the Gravette hospital shortly after moving to town. She obtained her MSN as a Family Nurse Practitioner from Pittsburg State University in Kansas. Kane specializes in Family Practice and Urgent Care.

Pesky Mosquitoes can be Deadly

Warm weather signals the prospect of bare feet, outside barbeques and (unfortunately) insects. These tiny annoyances are more than just pests capable of ruining your outdoor picnic; they can be deadly. This past week mosquitoes with West Nile Virus were reported just a few hours away in St. Louis. Here’s what you need to know to keep your family protected from the deadly mosquito disease (courtesy of the Center for Disease Control):

  1. Use an effective insect repellant. Repellents are an important tool to assist people in protecting themselves from mosquito-borne diseases. Click here to find out the CDC’s recommendations for skin and clothing repellant).
  2. Fix the screens on your doors and windows. When dealing with West Nile virus, prevention is your best bet. Ensuring your screens are free of holes and tears will not only reduce mosquitoes, but other insects that might creep into your home. You can also stay indoors during dawn, dusk and early evening with are peak mosquito biting times.
  3. Empty any containers holding water around the yard. These items might include (empty flower pots, pet food dishes,  bird baths, swimming pool covers, buckets, barrels, and cans, discarded tires, trash cans, etc). In this way, you reduce the number of places mosquitoes can lay their eggs and breed.
  4. Watch for updates from your local health departments. Click here for updates from the Missouri Department of Health and Senior Services.

Symptoms of West Nile virus include: headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Serious illness can occur in people of any age, however people over age 50 and some immunocompromised persons (for example, transplant patients) are at the highest risk for getting severely ill when infected with WNV. NOTE: Most people (about 4 out of 5) who are infected with West Nile virus will not develop any type of illness (an asymptomatic infection). If you suspect you may have West Nile virus, please visit your nearest emergency room.

Protecting your family is easy! With the help of these simple tips from the CDC, Ozarks residents can enjoy a safe and pest free summer.

Deadly Desk Job: Health Risks You & Your Co-workers Should Know About

Working behind a desk offers a fairly low risk job (unless you are a bit clumsy, and in that case everything is risky), but there are a few “under the radar” risks that pose a threat to your long-term health. If gone unchecked, your everyday desk-job habits have the potential to affect long-term eye, back, wrist and overall body health. OCH/Advantage physical therapist, Jennifer Witt offers a few tips to keep you at your peak while on the job and behind your desk.  

  •  Watch that monitor. Try to keep it at a distance of 24-inches (or arms length away) to reduce eye strain. Also, make sure your monitor is at eye level. If it isn’t, stick a ream of paper underneath to boost it to the proper height.
  •  It’s all in the wrists. Keep your keyboard at the edge of your desk to avoid hurting your wrists. Excessive pressure over an extended period of time may lead to carpal tunnel syndrome. If you find your wrists resting on your desk, ask your manager for a gel pad to set them on.
  • Catch the mouse. Don’t let your computer mouse drift far away. Reduce your arm strain by keeping it within easy reach. The same goes for any frequently used item: the closer the better. Smaller movements mean less strain on your arms. 

 

  • Keep it at 90 degrees. Employees who sit with their hips, knees and ankles in a 90 degree angle have better posture and less back pain. For all you math nerds out there: slouching is not “acute.”  
  • You’ve got to move it. If you work at an office, chances are the only time you move is when the clock strikes noon. Try to break yourself away from your diligent work habits and move around at least once an hour. After all, what are water coolers for?
  • Don’t be macho. Save the heavy packages for the heavy lifters. If something looks too big to handle, call for assistance. It’s not worth the strain. If a box or package is manageable, try breaking it up: using your back and legs for support to lift the box to a chair. Then, lift the box to the table.
  • Sorry Elle Woods, no “bend and snap.” If you happen to drop something on the floor, kick back your leg in ‘golfer stance’ to maintain the “S” shape in your back. This will help prevent pulling something, or future back pain.

Jennifer works at OCH/Advantage Therapy in Springfield, Missouri and at OCH Christian County Clinic in Nixa. She received both her Bachelor of Science in Psychology and Doctorate in Physical Therapy from Missouri State University. She has experience in inpatient, outpatient, home health and pediatric  settings. Her primary interest in physical therapy is pediatrics, specifically the 0-3 age group covering a variety of diagnoses. To contact Jennifer, call OCH/Advantage Therapy at (417) 777-4749. For more information about OCH/Advantage Therapy visit www.advantagetherapyonline.com

After the Disaster: How Tornado Victims Cope with Tragedy

As the death toll grows, OCH providers and staff continue to mourn the loss and tragedy that took place less than a week ago in Joplin, Missouri. We are deeply moved by the recent tragedy and remain committed to helping the people of Joplin recover throughout the next weeks, months and years.

Below, OCH psychologist, Dr. William Myers reacts to the recent tornado in Joplin and offers insight into thoughts emotions and behaviors of the current residents. Most importantly, however, Dr. Myers provides suggestions for helping victims heal.

One of the most touching moments of television coverage of the devastating tornado hitting Joplin occurred 10 minutes after the storm cut its deadly path through the city. Veteran Weather Channel Reporter Mike Bettes and his crew set up across the street from the demolished St. John’s Hospital. The camera started to roll as Mike began to describe the horrific scenes in the background of destroyed homes, people wandering around in shock looking for loved ones, and what was a modern hospital minutes before – left in shambles by an F-5 tornado – one of the most powerful forces nature can produce. As the camera panned the scene, Mike stated: “It’s everything, it’s just completely demolished . . . All I can say is that it looks very reminiscent of what we saw last month in . . .” And then there was a period of silence. Mike was so emotional he couldn’t speak. Eventually, after taking a few deep breaths and choking back tears, Mike said: “It’s tough . . . No question about that.” Watching this I couldn’t help but feel compassion and admiration for this man who so honestly expressed the emotions that thousands would experience in the minutes, hours, and days to come.

What emotions do individuals experience from living through such a horrible, terrifying, and devastating experience? Survivors of events of this nature commonly experience a broad array of emotions including disbelief, anger, helplessness, despair and anxiety. For a period of time, many will feel intense fear whenever a thunderstorm looms on the horizon. Other individuals may experience a sense of emotional numbing, or diminished emotional responsiveness to events going on around them. Individuals may also feel a sense of detachment from the environment itself, as the world they have always known is dramatically changed, and familiar landmarks or well-known places no longer exist. Difficulty sleeping, increased irritability, poor concentration and exaggerated startle responses are all hallmarks of living through such a catastrophic event.

It is important to note, the emotions described above are normal reactions to living through a very abnormal situation. For most people, these uncomfortable emotions will dissipate over the weeks to come. During the period following a severe emotional trauma good self-care is one of the most important factors in emotional recovery. Assisting individuals in getting adequate amounts of rest, good nutrition and the provision of resources for basic physical and medical needs are among the most important components facilitating emotional recovery. It is also helpful to positively orient people to progress being made in the disaster recovery process and regaining those factors returning as much normality to life as possible. Perhaps the most essential part of the initial recovery process is reuniting individuals with family members and significant others in a supportive environment, where the process of beginning to share difficult experiences can begin.

When should an individual seek the services of a mental health provider in regard to the painful emotional consequences of such an event? Although there is no clear cut answer to this question, a good rule of thumb is whenever negative emotions cause impairment in an individual’s ability to function – characterized by difficulty interacting with family members, friends, or fulfilling personal responsibilities such as work, or caring for others.

Dr. William Myers specializes in Psychology at Ozarks Community Hospital. He received his training from the Forest Institute of Professional Psychology and is currently a member of the following groups: American Psychologist Association, National Register of Health Service Providers in Psychology, Division 22 of the American Psychologist Association, Division 40 of the American Psychologist Association, National Academy of Neuropsychology, Springfield Neuroscience Society. To contact Dr. Myers’ office, call (417) 875-4682.

OCH is forming volunteer groups to provide disaster relief after the first responders and those on site now have been exhausted.   OCH plans to schedule several trips to support the community in the coming weeks and months. Visit www.OCHonline.com for more information.

Celebrate National Women’s Health Week

There are many of reasons females should feel empowered, and today is no exception. Monday, May 9, marks the start of a National Women’s Health Week, a weeklong national observance empowering women to make their health a top priority.

The theme, “It’s Your Time!” encourages women to take steps to improve their physical and mental health and lower their risks of certain diseases. Women can live longer healthier lives through disease prevention, early detection, and lifestyle modifications.

Medicare is now helping to pay for more preventive services and screenings. Some of these include:

  • Bone Mass Measurements
  • Cancer Screenings
    • Breast (Mammogram and Clinical Breast Exam)
    • Cervical and Vaginal (Pap Test and Pelvic Exam)
    • Colorectal
  • Cardiovascular Disease Screenings
  • Diabetes Screening
  • HIV Screening
  • Immunizations
    • Hepatitis B
    • Influenza
    • Pneumococcal
  •  Tobacco Use Cessation Counseling
  • Yearly Wellness Exam (New for 2011)

Note:  While coverage by Medicare is subject to certain eligibility criteria, many preventive services and screenings can now be received with no out-of-pocket costs to the beneficiary.

For more information, contact Beverly Gann, WHNP at Ozarks Community Hospital via phone (417) 837-4079 OR visit National Women’s Health Week or click here:  National Women’s Checkup Day.

Diagnosing your Sleep Disorder

If you’re finding it hard to stay awake at work, it may be because you’ve been up watching the latest March Madness stats on ESPN. Or, it might be something worse. Unless you’re an avid basketball fan, your droopy eyes and excessive yawns (along with snoring, morning headaches, dry mouth, restless leg movement and a list of other symptoms) could be the cause of a sleep disorder. Rachel Kepford, RPSGT for OCH’s Sleep Lab, elaborates on the process for evaluating your symptoms and the types of tests taken to determine your sleep health.

If a patients’ complaints include such things as excessive daytime sleepiness, lack of energy, persistent snoring, morning headaches, morning dry mouth, restless leg movements in sleep, witnessed apnea, weight gain (especially on the upper body), etc., your primary care provider may begin to suspect a sleep disorder.  Or the provider may take note of a patient’s intractable high blood pressure (despite treatment with medication), a past stroke or heart attack, or a history of diabetes.  A combination of these varied symptoms may alert the provider to investigate further, and thus the provider may refer the patient to a Sleep Specialist.  The Sleep Specialist will then meet with the patient to conduct a more in-depth and sleep-specific consultation, to determine if a sleep study is warranted.   

Sleep study patient room at Ozarks Community Hospital.

Here at the Ozarks Community Hospital Sleep Lab, we perform a variety of sleep studies that may either be performed during the night or during the day, depending on the patient’s sleep schedule.  These include:

  • Diagnostic Polysomnogram (Dx PSG)

A Diagnostic Polysomnogram is the test to initially determine if a patient has a sleep disorder such as obstructive sleep apnea. 

  • Titration Polysomnogram with CPAP (Continuous Positive Airway Pressure)

If the patient already has a diagnosis of obstructive sleep apnea, the doctor will likely order a Titration Polysomnogram with Positive Airway Pressure (PAP) treatment (below). 

  • Titration with Bi-level (PAP treatment with alternating pressure levels)

PAP treatment involves wearing a small lightweight mask that delivers air pressure to keep your airway open during sleep.  The type of PAP treatment and the level of pressure used during the test will depend on the observed physiological data that is recorded, and also both the physical and subjective response of the patient to treatment. 

  • Bi-level with Auto Servo-Ventilation

This test is used for more complex cases of apnea.

  • Multiple Sleep Latency Test (MSLT)

An MSLT is used to empirically assess the level of the patient’s daytime sleepiness. 

  • Maintenance of Wakefulness Test (MWT).

An MWT is used to empirically assess a patient’s ability to stay awake.  This test is commonly ordered on behalf of the patient’s employer, especially in the trucking industry, for people who operate heavy machinery such as forklifts or bulldozers, and for pilots. 

Patient undergoing a sleep study test.

For each of these tests, multiple small electrodes are attached to the patient’s skin surface with a conductive paste.  No needles are used, no blood is drawn, the patient is not exposed to any radiation, and the test is painless.  The Sleep Lab at OCH has four comfortable bedrooms which resemble hotel rooms.  Each room is private, with an attached bathroom, and each room has cable tv and a fan.  We try to make you as comfortable as possible, while still preserving the integrity of the test.

Rachel is a Registered Polysomnographic Technologist (RPSGT) for Ozarks Community Hospital’s Sleep Lab. For more information about this post or OCH Sleep Lab services, please visit http://ochonline.com/patients-and-visitors/services/sleep-laboratory/ or call 417-875-4640 to schedule an appointment.