HealthCh@t with Dr. Phifer

HEALTH QUESTION:

Why are kids so prone to ear infections? I can’t remember the last time I had one, but I’ve lost count of how many times my toddler did in the last year.

DR. PHIFER’S ANSWER:

Ear-related issues and complaints, especially in children, are one of the most common conditions seen by primary care physicians and urgent care facilities. There are two main types of ear infections:

Otitis Media: An inner ear infection behind the eardrum. This could be caused by bacteria, which may need an oral antibiotic to clear, or it could be caused by a virus, which requires observation.

Otitis Externa (“Swimmer’s Ear”): A bacterial ear infection on the outside of the eardrum that usually requires antibiotic drops to clear.

Children are more prone to ear infections, especially Otitis Media, because they have a different type of ear anatomy than adults.

EAR INFECTION SYMPTOMS MAY INCLUDE:

  • Abrupt onset of pain in one ear (sometimes both ears)
  • Feeling of fullness in the ear
  • Drainage from the ear
  • Fever
  • Increased fussiness

The Eustachian tube (the tube in red, pictured above) allows fluid to drain from the inner ear to the nose/mouth cavity. When this tube gets plugged up, you feel a sense of fullness in your ears and sometimes pain. In younger children, this tube is shorter and more horizontal and can get “clogged” more easily when your child is fighting a viral illness. When the Eustachian tube is not flowing, fluid builds up in the inner ear and this fluid can become infected with bacteria, causing an ear infection (Otitis Media).

This can occur in adults as well, but it’s less common. Because their Eustachian tubes are more vertical, plugged tubes will resolve more easily on their own.

If you think you or your child has an ear infection, it’s worth a consultation with 98point6. Our doctors can assess the signs and symptoms (see above), answer questions and potentially rule out an ear infection. However, if we think it’s in your best interest, you may still be referred to have the ears looked at in-person, where the doctor can look at the eardrum (this is the only way to definitively diagnose Otitis Media). Additionally, some parents are purchasing a tool online called a digital otoscope that can be used to assist in virtual care visits. By connecting the otoscope to a computer or smartphone, parents/guardians can look into the ear and send physicians images so they can diagnose (and rule out!) ear infections all from the comfort of home.

Post-Lockdown Summer:
How to Get Out and Stay Safe

As states reopen and restrictions continue to lift, there is still so much uncertainty around COVID-19. One thing we do know for sure: everyone has grown tired of staying home—and this season normally filled with family reunions, vacations and road trips is going to be different. Here, we take a closer look at the facts so you can make the most informed choices about socializing, travel and more.

The Rules Still Apply

We’re excited to reconnect with the world and each other, but COVID-19 hasn’t gone anywhere. That means applying the same general principles to plans for summer activities. These include:

Distance is safer than close

Maintain a distance of 6 feet from individuals outside your household.

Open is safer than closed

Outdoor areas reduce the risk of spread compared to enclosed spaces.

Masks help everyone

You can spread COVID-19 even if you don’t feel sick. Masks reduce the risk of infecting others.

Hygiene helps

Stay vigilant about hand washing, and stay home when you feel sick.

Understand Risk is Key

The first step before venturing out or mingling with others is acknowledging your personal, family and workplace risks. While it’s unfair, higher risks around these categories means treading extra carefully—and maybe saying “no” more than “yes” to summer travels and activities—to protect yourself and others.

Personal risk

Being over age 65 or having underlying conditions like diabetes or asthma that put you at a higher risk for COVID-19-related complications.

Family risk

Same high-risk health factors, but pertaining to those close to you, perhaps in your household. For example, if your child has a heart condition or you care for a parent over age 65.

Workplace risk

Your risk of occupational exposure to COVID-19, determined by factors such as on-the-job contact (healthcare worker) with those infected or strong interaction with the general public (teacher, retail salesperson).

Putting Advice into Action

So how do you make the most of your summer safely and responsibly? We’ve put together some helpful thought-starters for activities you may be considering.

Gathering with Guests

Questions to ask

Are any guests high-risk?
What has their exposure been in the past 14 days?

Safety Tips

Keep the guest list small, and think of each household as a “quarantine unit.” So, for example, invite a family of 5 vs. 5 individuals from separate homes.
Keep the party outdoors; arrange chairs 6 feet apart
Make it BYO food and drink; use disposable dishes and cutlery
Create a clear path to the bathroom inside; have cleaning supplies handy, encourage everyone to wipe high-touch surfaces and be vigilant about hand hygiene

Day Outings

Questions to ask

Are there any specific COVID-19-related policies or regulations I should know about the beach/pool/park/etc. before I go?
What are the peak times in terms of crowding; how can I avoid this?

Safety Tips

Aim for a location closer to home so you can avoid public restrooms and locker rooms.
Time is a key part of the exposure equation; shorter outings (1–2 hours) are preferable to an entire day spent in a public location.
Be cautious about physical distancing; if you start to feel crowded, move.
BYO food and gear vs. relying on concession stands or rentals.

Vacation

Questions to ask

What is the status of the outbreak in the geographic area you are considering, and what are the related rules and regulations?
What are your getaway expectations (i.e., change of scenery vs. high-activity); if the latter, how will you make it safe and manageable?

Safety Tips

Keep it (fairly) close to home and drive a car if possible (avoid planes, trains, rideshares).
Choose a rental property, campground or RV versus staying at a hotel
Do your own careful inspection and cleaning of surfaces upon arrival.
If traveling with friends or family, make a pact to limit exposure for 14 days prior and stay home if feeling the slightest bit unwell.

Depression: What to Know and When to Act

Mental health was already an increasing issue prior to the COVID-19 pandemic, when concerns about contracting the virus have been compounded by lockdown, physical distancing, the economic downturn and resulting job loss. A recent poll showed that nearly half of adults in the United States reported a negative health impact due to anxiety and stress related to coronavirus.

Almost everyone is affected mentally and emotionally by the events taking place in the world right now. But if those feelings become more and more overwhelming, interfering with daily activities or leading to additional symptoms like fatigue or loss of appetite, you might want to consider the possibility of depression. And now more than ever, the stigma, shame and reluctance to talk about this struggle with family, friends…even your physician…should be put aside once and for all. Now is the time to get support for yourself and support one another.

“Depression can feel isolating,” says Dr. Phifer, “but you are not alone. Statistically speaking, it’s estimated that up to 8% of Americans suffer from it. And there are so many resources and treatments that can help.”

Not sure where—or with whom—to start? “First and foremost, it’s important to connect with a physician,” says Dr. Phifer. Not only can many medical conditions, including thyroid disease and vitamin deficiencies, mimic depression, certain chronic health problems can be a trigger or risk factor for developing depression, as can be seen with stroke, heart disease and chronic pain. Even other behavioral health issues can look like major depression including bipolar disorder and autism spectrum.”

If you suspect you or someone in your household may be dealing with depression, know what to look for and what resources are available. The information below can help put you on the right track.

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RISK FACTORS INCLUDE:

  • Being female (Women statistically have higher rates of depression, though men have higher rates of suicide)
  • Family history of depression or suicide
  • LGBTQ-identified
  • Social isolation
  • Substance use
  • Career or academic difficulties
  • Loss of a loved one
  • Chronic illness
  • Traumatic life experiences or events

SYMPTOMS MAY INCLUDE:

  • Sleep changes (insomnia or sleeping too much)
  • Difficulty concentrating
  • Weight changes
  • Irritability
  • Sadness
  • Feelings of worthlessness
  • Loss of interest in things that used to be enjoyable
  • Suicidal thoughts

NATIONAL SUICIDE PREVENTION LINE 1-800-273-TALK (1-800-273-8255)

Family Planning Spotlight

“Because my medical specialty is reproductive health, Spring always reminds me to have a ‘birds and bees’-style discussion with patients at risk for undesired pregnancy,” says Dr. Phifer. If you or someone in your household is curious about the options available, this infographic offers a breakdown, plus some common misconceptions it’s time to debunk for good.

Contraception Options:

(RANKED FROM MOST EFFECTIVE TO LEAST)

  • Tubal ligation or vasectomy (permanent)
  • IUDs and implants
  • The pill/patch/ring
  • Condoms
  • Withdrawal
  • Spermicides
  • Period tracking

The pill is the most common method used by women in the U.S., according to the National Survey for Family Growth (data 2011–2015).

“Not only are these all extremely common conditions in primary care, they are all easily addressed in a virtual visit.”

Urinary Tract Infections (UTI)

As you can see in our Cheat Sheet, left untreated, UTIs can cause kidney infections and other problems with the urinary tract, so it’s always a good idea to connect with a physician sooner rather than later.

Upper Respiratory Infections (URI)

It’s tempting to seek a prescription for antibiotics, especially if that’s how you’ve addressed the condition in the past. However, most URIs are self-limited and last about 1.5 weeks. Start a visit—we’ll help you manage your symptoms and discuss whether antibiotics are the best course of action.

Low back pain

Low back pain is typically caused by muscle strain. Most patients I see in the virtual clinic are simply seeking relief and reassurance. We can assess if what you’re experiencing is serious and requires in-person care. If not, we can offer guidance on over-the-counter pain management.

Cold sores

Getting a prescription at the first signs of a cold sore will help it go away faster. Because 98point6 is available on-demand via text-based messaging, you can get that prescription while you’re in a meeting, out running errands or cooking dinner.

Headaches

Pain in the head can be scary; of course patients come to us looking for peace of mind as well as treatment of symptoms. We’re able to help assess if what you’re feeling is a typical headache vs. a migraine vs. a sinus headache, and whether you should follow up with in-person care or a specialist. If you’re a migraine sufferer, we can also assist with medication management and refills.

Rashes

The option of being able to send a photo makes rashes an ideal thing to manage via virtual care. We can recognize and diagnose, and offer many over-the-counter and prescription treatments. And it’s just as easy to follow up if the condition isn’t improving!

Acne

This is another condition that can often be so easily managed without having to schedule an in-person doctor visit. Whether treatment is needed for your teenager or yourself, we can work with you to find the best solution, even if it takes some time to find the best option.

Other Q&A Topics

The scoop on supplements

Q: It seems like half the people I work with are on some kind of trendy diet or another. Some involve taking lots of supplements with meals, others revolve around costly powders and shakes. What should I be on the lookout for in terms of safety?

Find out more

Headache red flags

Q: Having a headache can put a stop to my day. At what point should I be concerned that there is a larger underlying issue?

Find out more

First steps to health change

>Q: I’ve resolved to live healthier in 2020 but I have a long way to go and don’t know where to start. What are the most important first steps? How do I set myself up for success in a way that fits my lifestyle and job?

Find out more

Something health-related keeping you up at night?

Whether your child has a fever or you’re worried about that dizziness you’ve been feeling, 98point6 is available 24/7 to you and your eligible family members ages 1 and older. With access to on-demand primary care via a mobile app, care is always at your fingertips.

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