From Our Family to Yours

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

Spring Yields to Dangers of Summer Heat

Summer forecast: hot and humid
These are ideal conditions for heat-related illnesses

It seems that springtime in the deep South scarcely makes an appearance before retreating to make way for the long, hot summer with its oppressive temperatures and stifling humidity. If youve lived in this part of the country for a while, you probably accept this unfortunate circumstance as the price we pay for the moderate weather we enjoy the rest of the year. You may have even acclimated somewhat to our sizzling summers, but dont take them too lightly. Its important to remember that no one is immune to the dangers of extreme heat.

Hot weather can be responsible for a variety of medical problems. Most of these problems result from working or exercising in hot weather without drinking enough fluids. Liquids help keep the body cool and maintain adequate blood pressure. When the body is low on fluids, its internal temperature rises, causing problems such as heat cramps, heat or sun exhaustion, and the most serious heat or sun stroke.

Depending on the degree of illness, heat-related symptoms can include dizziness, disorientation or fainting, headache, profuse sweating, weak pulse, fatigue, nausea, rash, and skin that is cool and clammy to the touch. These symptoms warn of the possibility of heat stroke, a life-threatening medical emergency. Learning how to recognize the progression of heat-related illnesses and how to respond appropriately may help prevent a potentially serious or fatal outcome.

Heat cramps are typically the first sign of

heat-related illness. These muscle pains and spasms, which usually begin in the arms, legs and abdomen, occur when sweating causes a drop in the bodys electrolytes (e.g., calcium, sodium, and potassium), which the body needs to function properly. A person experiencing heat cramps should rest in a cool place, with a breeze and mist of water, if possible; and drink electrolyte beverages, such as commercially available sports drinks. Cramping muscles should be massaged.

Heat exhaustion, the next in the progression of heat-related illnesses, is a medical emergency that occurs when the body attempts to increase its cooling efficiency. Characterized by profuse sweating and pallor, heat exhaustion usually happens to people exposed to temperature conditions they are not accustomed to. As with heat cramps, a victim of heat exhaustion should be moved to a cool, shady area; cold compresses should be applied to the head, neck, armpits, and groin; feet should be elevated and fluid intake increased. Given in small quantities, sports drinks are a good choice. Fluids containing alcohol or caffeine should be avoided, as these substances can interfere with the bodys ability to control its temperature.

Heat stroke, the worst heat-related injury, occurs when the brain can no longer regulate body temperature. It is characterized by extremely high temperature (up to 106o F); hot, red, dry skin with little or no perspiration; rapid pulse and respiration; confusion, headache, and possible loss of consciousness. The extreme internal temperatures that accompany heat stroke can result in dangerously low blood pressure, brain damage, and even death. This life-threatening condition requires emergency medical treatment to cool the body as quickly as possible.

Effective ways to cool body temperature rapidly include immersion in cool water; wrapping the victim in cool, wet sheets; and applying cold compresses. If the victim starts shivering, the cooling process should be slowed, and the internal temperature should not be allowed to drop below 100o F to avoid risk of hypothermia. The victim should not be given any medication to lower fever as it is ineffective and potentially harmful, should not be rubbed with alcohol, and should not be given anything by mouth even fluids until his condition is stabilized.

Although anyone can suffer from heat-related illness, some people are more susceptible than others. These include very young children, the elderly, and obese individuals. Alcoholism and chronic illnesses, such as heart or respiratory disease, are additional risk factors. Use of certain medications, such as diuretics and antihistamines, for example, and substances such as alcohol and cocaine can also increase the likelihood of heat-related illness. People who live alone, especially those who are unable to relocate to a cooler environment when needed, are also at higher risk.

As with most illnesses, prevention when possible is always preferable to treatment. Here are some steps you can take to avoid heat-related illnesses this summer:

Drink plenty of non-alcoholic, caffeine-free beverages before and frequently during physical activity. Dont wait until you feel thirsty, as thirst is a poor indicator of dehydration.

Avoid physical activity and exposure to the sun during the hottest parts of the day (11 a.m. to 4 p.m.), and on days when the temperature and humidity are excessively high.

Wear a hat and loose, light-colored clothes, and keep the neck covered to keep your body cool.

Know the warning signs and stages of heat-related illness, and learn how to perform mouth-to-mouth resuscitation. In an emergency, you may someday save a life.

Source: Guidelines for prevention of heat-related illness and sun damage, CNB Online News Release, Communication New Brunswick, Fredericton, N.B., Canada, July 6, 2000; Heat Stroke, MediResource (website), Virtual Learning, 2000; Heat Stress (Sun Stress), Personal Safety, City of Phoenix, AZ (website), 1997; Heat First Aid/Heat Exhaustion, Kafkas Kool Tie (website).

CPC Physician Profile: Dr. Priya Deshpande of CPC Central

One of the first memories Priya Deshpande has of growing up in India is concern for her sick grandmother. Only a small child at the time, Priya recalls watching and listening intently when the doctor visited their home. She felt sad and frustrated that she could do nothing to help her only living grandparent, who was severely diabetic, wheelchair bound, and always quite ill.

Watching someone she loved so much suffer with a debilitating disease was perhaps the first seed of inspiration for Priyas career in medicine. I felt an inner need to help her and others like her, she explains. My parents have said many times that from a very early age, all I talked about was becoming a doctor. Never wavering from her goal, she remained in India, where she completed her formal education and embarked on her medical training.

Priya attended Catholic public school in the Bombay suburb where she and her family lived. Her school and community, like the rest of India, were characterized by a wide range of cultures and religions, such as Hinduism, Islam, Catholicism, and Buddhism. Diversity is something I became accustomed to growing up, she explains. India is a country made up of many states with different cultures, languages, foods, and religious beliefs. It is very complex. Even within Hinduism, the predominant religion in India, there are many sects that worship different deities.

In spite of the problems inherent in such a varied society, cultural diversity offers the advantage of a broader view of the world. Dr. Deshpande believes that growing up and working in India taught her to listen to and appreciate people with life experiences different than her own and to recognize the common threads shared by the worlds religions, cultures, and humanity itself. What I have learned is that basically people are the same everywhere, she says. Human nature crosses all barriers.

Another aspect of having grown up in India that Dr. Deshpande values is the medical education and residency training she received. She attended GS Medical College in Bombay, and after graduation, completed a residency training program in obstetrics and gynecology. The training I received there is quite dissimilar from medical education in the United States, she explains. Because there is no health insurance, there is much more emphasis on treatment based on clinical judgment rather than diagnostic testing. Physicians are trained to be very selective of diagnostic testing and use of the sophisticated equipment that is available.

The greatest benefit of her medical training in India was her profoundly demanding clinical experience. During her residency at King Edward Memorial Hospital, a very old British hospital affiliated with the medical college, it was not uncommon for her to deliver 35-40 babies a day. The intensity of this training period made the transition to private practice in America very easy. I believe the demands of my clinical experience in India have been a big advantage to me as a physician, she says.

While attending medical school, Priya met a fellow student, Sharad Ghamande, who would eventually become her husband. They married after their residency training in Bombay, about 6 months before moving to the United States in 1991. They chose to make America their home to broaden their personal and professional experience. We both enjoy travel and other cultures, she explains, and we were interested in how medicine is taught and practiced here. Another factor influencing their move was that Priyas older brother, Harsha, had relocated to the United States many years earlier. He is a media consultant in California, and while they do not see each other often, they keep close contact.

Priya and Sharad first settled in Massachusetts near Boston, where they spent a year taking board examinations required of foreign medical school graduates before entering an American residency program. When they successfully completed the series of exams, Dr. Deshpande began a family practice residency at the University of Massachusetts while her husband started an obstetrics and gynecology residency at Boston University.

While at UM, she had the privilege of serving as medical director of a Southeast Asian health project, an outreach program designed to familiarize immigrants with the American health care system. She found the experience rewarding not only because it allowed her to help people who needed her, but also because it gave her an opportunity to work with and learn about people of other Eastern cultures.

For her American medical training, Dr. Deshpande chose family medicine rather than obstetrics and gynecology because she it allowed her to treat a broader range of people while continuing to utilize her skills in ob/gyn. After completing the family practice residency program at UM, she served on the medical university faculty as an assistant professor, researcher and clinician for 2 years. In 1997, the couple moved to Buffalo, NY, where Dr. Deshpande had a private practice in family medicine and her husband, Dr. Ghamande completed a fellowship in gynecologic oncology. While in Buffalo, the couple became a family, welcoming into their lives a son named Salil, now 3 years old.

When her husband finished his training, they decided to move to the South, as it was similar in terms of weather to where they had grown up. Her husband accepted a position at the Medical College of Georgia. Because of her love of diversity, she specifically looked for a practice that was less rather than more homogenous and found just what she wanted in the Center for Primary Care. I wanted to be in a family practice group, and I liked the individuality I saw among the CPC physicians, she says. I liked their personalities, felt we had common goals, and found them to be a well-rounded group. Last fall, Dr. Deshpande became the fourth physician on staff at CPC Central.

Since settling in Augusta, Dr. Deshpande and her husband have spent much of their time becoming acquainted with the community and building their medical practices, but whenever possible, they travel and explore our own areas diversity. We both love traveling, she says, naming Europe, India, the Caribbean and other areas of the United States as favorite destinations, and we relish all types of food, especially Thai , Indonesian and Ethiopian cuisine. At home, Dr. Deshpande likes to cook and enjoys decorating their home with items they have acquired during their travels. I like surrounding myself with things with meaning and memories, she says. Interior design is an outlet for her creative side and a personal interest she would like to develop in the future.

Professionally, Dr. Deshpande wants to continue with her earliest goals of being a help to the people she cares for. I want to make people feel better and to guide them through the process of dealing with complicated health problems, she says. I want to be someone they can talk to about their health or anything else.

In pursuing this goal, Dr. Deshpande consciously strives to keep a healthy perspective on lifes events. I try to stay focused on the big picture both at work and in my family life, she explains. It is easy to get caught up in little problems and the constant demands in life, but I try to step back and ask myself, Whats more important here? This philosophy allows her to focus on the important aspects of her work, her personal life, and her purpose in the world, and as a CPC physician, to bring both a balanced perspective and another interesting dimension to the Center for Primary Care.

Cause is Key to Treating Gastroesophageal Reflux Disease (GERD)

If you suffer from heartburn or acid indigestion, its important to find out why so you can begin a treatment plan that will alleviate this unpleasant digestive disorder.

One of the common causes of heartburn is gastroesophageal reflux disease (GERD), a digestive disorder that affects the muscle that controls the opening between the base of the esophagus and the stomach. Known as the lower esophageal sphincter (LES), this muscle is designed to contract to keep the contents of the stomach from flowing back into the esophagus, a process known as reflux. When the LES becomes weak or inappropriately relaxed, food and acidic stomach juices can flow back into the esophagus, irritating its lining and causing the burning chest pain and bitter taste associated with heartburn.

GERD has many contributing factors. One is thought to be the presence of a hiatal hernia. This condition occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, which can result in the retention of acid and other stomach contents above this opening. Other factors that can contribute to GERD include eating foods that are fatty or otherwise irritating to the esophagus and stomach; some physical conditions, such as pregnancy and obesity; and lifestyle choices, such as smoking and drinking alcohol.

Once the LES muscle has been weakened by any of these choices or circumstances, certain foods, such as pepper, citrus fruits and beverages, and tomato-based products, can further aggravate the condition because of their irritating properties.

If you have developed symptoms of GERD, there are some simple changes you can make in addition to avoiding irritating foods. One such change is to either elevate the head of your bed about 6 inches or sleep on a wedge-shaped cushion that raises your head slightly. This approach uses gravity to keep stomach contents from flowing back into the esophagus at night. Antacids are another approach to lessening heartburn. They can neutralize acid, relieving symptoms temporarily. Antacids with a foaming agent provide even more relief for some people. This type of medication, however, is not a long-term solution because it can cause diarrhea, interfere with the bodys metabolism of calcium, and result in a buildup of magnesium in the body. Generally, it is best not to take antacids longer than 3 weeks without consulting a physician.

Chronic reflux can be treated with medications known as H2 blockers (e.g., cimetidine, famotidine, nizatidine, and ranitidine) or a proton pump inhibitor (e.g., Prilosec or Prevacid) to reduce the production of stomach acid. Another approach is the use of motility drugs (i.e., bethanechol and metoclopramide) that act on the upper esophageal muscles.

If GERD becomes chronically severe and is not alleviated by the first-line treatments, a more thorough diagnostic evaluation may be necessary. Diagnostic tests for GERD include an upper gastrointestinal series, which can rule out other possible causes, such as peptic ulcer; endoscopy, which allows the examiner to actually view the esophagus through a tiny video camera attached to the end of a scope and to take a small tissue sample (biopsy), if needed; the Bernstein test, which can confirm that the heartburn is a result of acid in the esophagus; esophageal manometric studies, which can identify low pressure in the LES or muscle contraction abnormalities; and a pH test, which measures acid levels. Surgery for GERD (fundoplication) can be performed to increase pressure in the lower esophagus, but it is rarely needed and should be performed only if all other therapeutic options have been explored.

Untreated long-term GERD can have serious complications, such as bleeding ulcers in the esophagus; chronic scarring, which can narrow the esophageal passage; and Barretts esophagus, which is severe damage to the esophageal lining that may be a precusor to esophageal cancer.

If you are experiencing early symptoms of GERD, you may be able to avoid the latter complications of this disorder by seeking medical advice from your family physician and by making the following lifestyle changes:

Discontinue eating fried and fatty foods, peppermint, chocolate, alcohol, coffee, and highly acidic foods, such as citrus fruits and beverages and tomatoes.

Lose weight if obese, and stop smoking.

Raise the head of the bed by at least 6 inches or sleep on a wedged pillow.

Keep the upper body upright for a few hours after meals

Use antacids sparingly and on a short-term basis to reduce stomach acidity.

Source: Gastroesophageal Reflux Disease (Hiatal Hernia and Heartburn), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Public Health Service, NIH Publication No. 94- page posted 1998, updated 2000).

The Center for Primary Care offices are staffed by 13 board-certified family physicians who provide care at three convenient locations:

CPC South

2011 Windsor Spring Rd., Augusta, GA 30906

(706) 798-1700

Tracy Barefield, MD

Riaz Rassekh, MD

Edwin Scott, MD

Keith Harden, MD

CPC Central

3614-D J. Dewey Gray Cir.

Augusta, GA 30909

(706) 868-7380

Denise Kennedy, MD

Phillip Kennedy, MD

Jay Tomeo, MD

Priya Deshpande, MD

CPC Evans

363 N. Belair Rd.

Evans, GA 30809

(706) 650-7563

Robert Clark, DO

Paul Fischer, MD

James Mobley, MD

Rebecca Talley, MD

Richard Livingston, MD

From Our Family to Yours is published by the

Center for Primary Care

Denise S. Kennedy, MD Editor

Melody H. Collins Associate Editor