Caring for Families of the CSRA Since 1993

This Newsletter Brought to You by the Physicians and Staff of the Center for Primary Care

Immunizations Important for Children

Immunizations Important for Children Trypanophobia is the fear of getting a shot. Many children dread a visit to the doctor because they worry about getting a shot, but some injections, such as immunizations, are an important part of keeping healthy, especially for children and young adults. Most immunizations are given during the first six years of life, and some are followed up with booster shots to maintain resistance to disease later in life. Immunizations, also known as vaccinations, are administered to prevent an individual from getting sick with a certain disease. A trace or a weakened or dead version of the disease organism, such as a virus, is injected into the body.

The bodys immune system reacts to this intruder and makes antibodies to defend against it. These antibodies stay in the body so that even when an individual is exposed to an active form of the disease, the immune system can fight it off. The bodys rapid response means that individuals who have received the immunization are less likely to become sick. Immunizations are effective 85% to 99% of the time and are considered the best protection from disease.

The diseases against which the routine childhood immunizations offer protection include Measles, Mumps, and Rubella (MMR), Diphtheria, Tetanus, and Pertussis (DTaP), Polio, Haemophilus Influenzae Type b (Hib), Varicella (chickenpox), pneumococcal disease, and Hepatitis B. The vaccine for Hepatitis A, not mandatory, is rarely given and only then in high-risk populations. Annual flu shots, however, are strongly recommended for almost everyone.

There are many misconceptions about immunizations. One such belief is that they can cause infection instead of helping to protect against it. The most common side effect, however, is swelling at the site of the injection. Vaccines containing live viruses, such as MMR are Varicella, are not given to people whom they are likely to harm, such as pregnant women and patients with weakened immune systems. Overall, the risk of contracting a disease from its corresponding immunization is extremely small. Although immunizations are most often associated with protecting against childhood diseases, the need for this sort of preventative medicine does not stop at adulthood. For more information about recommended immunizations, consult your family physician or visit the Centers for Disease Control and Prevention website: www.cdc.gov/nip/.

Source: Facts and Myths About Immunizations, (online) The Nemours Foundations Center for Childrens Health Media; Immunizations, WebMD Health; CDC National Immunization Program (online).

Physician Profile: S. Lynn Mishra, M.D., of CPC-North Augusta

When you first meet Seema Lynn Mishra, she will tell you her life is not the least bit interesting. After only a few minutes with her, however, you will realize her claim is anything but true. Seemas vibrant personality and upbeat perspective on lifes parade of events will both put you at ease and keep you entertained.

 The story of her adventures along the road to North Augusta begins in her parents native land, New Delhi, India, where Seema was born. When she only two years old, she and her father, an engineer, and her mother, a pediatrician, relocated to Pennsylvania, a world away in both distance and culture. For nearly seven years, young Seema had no idea what her mother did every day at work. At the time, I thought women were nurses and men were doctors, Seema admits. When she finally found out her mother was a physician, she was pleasantly surprised and realized for the first time that she would also like a career in medicine.

 Taking advantage of her mothers connections at the local hospital, Seemas first job as a teenager was washing dishes. She laughingly admits to having broken four trays of glasses her first day but remembers it fondly for the experiences and friendships she developed there.

With her goal of attending medical school as a driving force, she graduated a year early from high school and migrated South to attend the University of South Carolina in Columbia. Continuing on the educational fast track, she graduated in three years with a major in biology, spending her scarce free time as a top salesperson at the local Express, holding office at the Honors College, and dancing in the USC production of Cabaret. Despite Seemas enduring desire to attend medical school, her father was very much against it. He wanted me to do anything but medicine, she recalls. He thought it was difficult; trying to manage a family and be a physician while finding enough time to give to both was near impossible. Instead, he strongly advocated her going into law, and even sent her applications for the LSAT, the law school entrance exam, in the hopes she would become a lawyer instead. Despite his disapproval, Seema applied to medical school at age 19, and was soon accepted at USC. Her first two years of medical school fell well short of her expectations. They were misery, Seema recounts. It was just obscure facts that had nothing to do with actual people. Disheartened by her initial experience, she took a year off and taught anatomy and physiology for the nursing program at a nearby college. Finally, Seema decided to give medical school another try, and was pleased to find the second half of her medical education profoundly different. The last two years were phenomenal for me, she recounts. Her clinical experiences during these years made her return worthwhile and rekindled her love for medicine.

 Dr. Mishra spent her residency at Flower Hospital, a small community health center in Ohio. It was absolutely an incredible experience. If something happened in surgery, you handled it. If something happened in cardiology, you handled it. You were it! This intensive, hands-on experience gave her the opportunity to further develop her skills caring for patients. In terms of preparing her for whatever challenges lay ahead, she states, it was unbeatable.

Soon, a job offer came from a rural health center in Wilson, North Carolina. Intrigued by the prospect of living in the South again, Seema moved to Wilson with her three young children, twins Noah and Alex and daughter Natalie. After two years of treating patients for everything from the flu to life-threatening farming accidents, she decided to open her own practice to see how she would do working independently, where she would have more control over how she practiced. I believe I took better care of my patients [while in private practice], she explains. I saw fewer people and made house calls, which really made a difference. When the challenges of balancing private practice and single parenthood began to take its toll, Dr. Mishra decided to move one last time. It was her father, now working at Savannah River Site, who mentioned the opportunity available at the Center for Primary Care. After receiving a warm response from the physicians and staff, Dr. Mishra knew CPC was the right place for her. I met 11 out of 13 doctors, which really impressed me, she recalls. It made me feel as though all the physicians really cared about who was going to be there. Having her parents and extended family nearby was another plus for returning to South Carolina. My sons know that being near grandma and grandpa means food, and that is always a good thing, she jokes. Seema and her family now make their home in North Augusta.

As a family physician, Dr. Mishra focuses on patient well-being. She advocates to her patients that they can improve how they feel on a daily basis reducing exhaustion and headaches, for example by taking greater personal responsibility for proper diet, exercise, and stress management. If you can feel good on a day-to-day basis, you can learn how to handle those bad days as well. Almost everyone can live a healthy and happy life. When she isnt hard at work, Dr. Mishra enjoys attending live theater and art shows and also doing crafts. Her No. 1 priority, however, is and always has been spending time with her children. She truly is a Renaissance woman, armed with the knowledge and compassion only experience can provide. She brings yet another dimension to the Center for Primary Care, contributing not only to CPCs diversity but also to its energy and personality.

Here is a simple test to see how well you take care of your skin: compare the top of your hands with the skin on the underside of your arm. If you are like many people, the skin on your hands will look thinner and mottled, appearing older than the skin on your arm. This difference is due to sun exposure. Even if youve managed to avoid serious sunburns and blistering, a lifetime of basking in the sun eventually takes its toll.

Almost everyone knows the sun can damage skin, but few people understand how and why it happens.

Test your knowledge of sun exposure by reviewing the following questions and answers:

Q: Why is the sun so bad for my skin? A: Ultraviolet radiation from the sun can cause changes in the skin and body. UV rays come in three forms: UV-A, UV-B, and UV-C. UV-A rays are capable of penetrating deeply into the skin, damaging tissue and leading to premature aging. UV-B rays are stronger than UV-A and affect the outer layers of the skin. These rays, which increase in intensity during the summer months, are believed to cause sunburn and skin cancer. UV-C rays, the strongest and most hazardous type of ultraviolet radiation, are blocked by the ozone layer and thus never reach the earths surface. Tanning beds, which emit the same UV rays as the sun to produce a tan, are just as dangerous as direct sunlight and cause the same skin damage.

Q: What exactly does long-term sun exposure do to my skin? A: After many years of unprotected sun exposure, the structure of the skins elastic fibers, called collagen, may be affected. Damage to collagen results in the formation of fine lines and wrinkles, known as elastosis. Changes in skin coloring may appear in the form of freckles, localized discolorations called mottled pigmentation, and sallow skin tone. The skin can also adopt a thickened texture, giving it a leathery, aged look. A patch of scaly skin that is pink, yellow, or brown in color is another indicator of sun damage. Known as an actinic keratosis, this lesion is precancerous, meaning it may lead to skin cancer. Ultraviolet radiation from the sun is the No. 1 cause of skin cancer today. The three main types of skin cancer are squamous cell carcinoma, basal cell carcinoma, and melanoma. Carcinomas make up the majority of all skin cancers and are considered less dangerous than melanomas. Melanomas are capable of spreading to other parts of the body and can lead to death if left untreated.

Q: What can I do about that damage now? A: You cannot reverse existing damage, but you can learn to recognize and regularly check yourself for signs of skin cancer. A common indicator of skin cancer is a change in the appearance of a new or existing mole. Become familiar with the pattern of moles and marks on your body, so you can tell if something has changed. Perform a complete check monthly, using a full-length and hand mirror. Carefully examine all parts of your body, even those not usually exposed to the sun. Be sure to examine the back of your neck, scalp, and shoulders. Carcinomas often appear as a pale, waxy nodule, a red, scaly patch, or a sore that does not heal. Melanomas begin as small, mole-like blemishes. The ABCD rule can help you remember the warning signs of skin cancer: Asymmetry Half of the mole does not match the other half. Border The edges are irregular or blurred instead of smooth. Color The coloring is patchy and variable from one area to another. Diameter The area covered by the mole is greater than 6 millimeters (the size of a pencil eraser) or is growing. If you discover a mole or mark with one or all of these characteristics, visit your family doctor to have it examined.

Q: How can I avoid future sun damage? A: The three most important things you can do are to use a sunscreen with a high-SPF (sun protection factor), wear protective clothing, and avoid midday sun exposure. See the Spring 2004 issue of From Our Family To Yours to learn more about protecting yourself and your family this summer. Source: Detecting Skin Cancer, (online) American Cancer Society; Skin Cancer and Sun

CPC Says: And, Hey, Were in North Augusta, Too!

The Center for Primary Care and Doctors Hospital Rehab Health & Imaging Center celebrated the official opening of the North Augusta Health Center, 105 Hugh Street, with a ribbon cutting and open house on June 3, 2004. The event marked the official opening of the center, which was developed by CPC and is the home of its fourth family practice office in the CSRA. S. Lynn Mishra, M.D., who has been with CPC-North Augusta since January, will be joined by Robert A. Suykerbuyk, M.D., in September. The most prominent architectural feature of the 12,000- square-foot North Augusta Health Center is the clock tower, which can be seen from all sides of the building. The idea for the tower was inspired by Dr. Paul Fischers mother, Dolle. She said we should think about having a clock tower in our next office, Dr. Fischer said. North Augusta seemed like a perfect location for it because it would be seen by lots of people going to work and coming home. Like a good son, Dr. Fischer did what he was told, and the clock and tower were incorporated into the building design. The clock tower, featuring a backlit clock five feet in diameter, is dedicated to his parents, Elmer and Dolle Fischer.

CPC-North Augusta Welcomes Dr. Robert A. Suykerbuyk

The Center for Primary Care-North Augusta is proud to announce the addition of Robert A. Suykerbuyk, M.D., to its physician staff beginning in September. He will be the 15th physician on the CPC medical staff.

Dr. Suykerbuyk received his bachelors degree from Ferris State University in Michigan and his medical degree from Michigan State University College of Human Medicine. He completed his residency at the Department of Family Practice at Eisenhower Army Medical Center, Fort Gordon, in 2000. After serving as a staff physician in Taszar, Hungary, Dr. Suykerbuyk returned to Georgia in 2001 and has taught and practiced at both Fort Gordon and the Medical College of Georgia.

In North Augusta I will be able to develop long-term relationships with my patients and their families while still having access to nearby state-of-the-art diagnostic and inpatient services at local hospitals when needed, Dr. Suykerbuyk says. He is particularly interested in chronic medical conditions, such as diabetes and hypertension.

Dr. Suykerbuyk and his wife Danielle enjoy traveling and gourmet cooking. They look forward to settling down in North Augusta and taking advantage of South Carolinas beautiful hiking trails. To schedule an appointment with Dr. Suykerbuyk, call the office at (803) 279-6800.