Josyann Abisaab

Lyme disease is an infection which is often misunderstood by parents and misidentified by the health community.  One of the reasons for the confusion is that Lyme disease manifests in many different ways in the body.  Another reason is that it varies so widely from state to state.

The most classic symptom of Lyme disease, and the one that most doctors like Dr. Josyann Abisaab, will ask you about is a rash.  The circular rash occurs at the site of the tick bite approximately 7-14 days after the initial bite. The rash actually resembles a bulls-eye.  Other symptoms are commonly flu-like symptoms including fever, muscle aches, chills, headache, fatigue and joint pains.

Unfortunately, when Lyme disease goes untreated, it can cause many problems including continued fever and fatigue, swollen glands, pink eye, aseptic meningitis, Bell’s palsy, arthritis and concentration problems.

If you live in an area where Lyme disease is more common, like in the Northeastern area of the United States, and you are exhibiting these types of symptoms, you should seek attention from a medical professional.

One of the main reasons that children end up in the E.R. is because of falls. The more precautions you take in the home, the less likely it will be that you’ll experience a dangerous fall. For very small children, this means never leaving a child unattended on the bed, sofa or changing table.

Advice on Small Children & Falls with Josyann Abisaab

Once your child is between 6 and 12 months old, make sure that all furniture is away from windows so that they can’t climb up on the furniture and fall out of the window. Put window guardrails on all second-story windows and above. Obviously, one of the most tragic things that emergency room doctors like Josyann Abisaab see is children who have fallen from windows in the home. Make sure to put safety gates at the top and bottom of each staircase.

Older Children & Falls Advice with Josyann Abisaab

Finally, for slightly older children, make sure to keep the stairways clear so that no one trips over toys, clothing and other items. Also place rubber pads under any loose rugs so that they don’t slide across the floor and cause accidents.

Children’s Health Care: Is it an Emergency?

Certainly, there are times when a child gets hurt badly enough that you know they need to go to the emergency rooms. There are other situations, however, that aren’t as clear cut.  During these times, you have five main options.

You can handle the problem at home.  Minor illnesses and cuts, some rashes, minor coughs, colds, bruises and the like can all be handed with over the counter treatments and love.  If you aren’t sure what your child needs, you can always call your primary care physician.  The doctor or nurse can help you to figure out what steps need to be taken.

You can always visit an urgent care center if you have a non-emergency at night or on the weekends.  You can usually have X-rays taken, have stitches done, and have care for minor injuries that require medical attention but that aren’t life threatening.

The last two actions are more extreme and they include visiting the ER where emergency room physicians like Josyann Abisaab will care for you, or calling 911.  Many serious conditions require a visit to the emergency room including head trauma, dehydration, meningitis, breathing issues and more.  Sometimes, you may feel that you need the help immediately and that you’ll need the help on the way to the hospital. In this situation, it’s best to call 911 and to get the care that you need immediately.

Chest Pains: A Leading Cause of Er Visits

According to AHRQ News and Numbers which is based on data in Emergency Department Visits for Adults in Community Hospitals from Selected States, 2005, chest pains are one of the leading reason that people visit the emergency room.  Chest pains that did not appear to be a heart attack upon examination accounted for 1.6 million visits in 23 states in 2005.

The top four reasons to visit the emergency room, as reported by this study were: sprains and strains (2.4 million visits), bruises and superficial injuries (2 million), abdominal pain (1.7 million), and then chest pains at 1.6 million.  In less than 5% of the cases, the patient was actually admitted to the hospital.

Five additional conditions that were seen a great deal by the emergency room were: back problems (1.4 million), leg and arm open wounds (1.3 million), headaches (1.2 million), nose and throat infections (1.1 million), and skin infections/urinary tract infections (1 million).

In an interesting study in 2008, Dr. Manya Newton, an emergency room physician at the University of Michigan, and others, authored a paper explaining some of the reasons that emergency rooms are so overcrowded.  While many of us make the assumption that the uninsured are coming to the emergency room too frequently for non-essential visits, they found this to be a myth.  They found that, while 17% of the people in American were uninsured at the time, they only accounted for 10-15% of the visits to the ER.

One factor that they did find to explain the overcrowding is that the population at large is getting older and sicker.  More people are legitimately coming to the ER for real emergencies.  In addition, with fewer primary care doctors available, it’s harder to get an appointment.  If you call your doctor’s office and are put off, you might consider going to the ER instead.

These are a few of the interesting findings that these emergency room doctors reported.

When someone has been in the emergency room for care, they often don’t bother to follow through afterwards.  They might be happy to be feeling better the next day, or they are exhausted from their ordeal and don’t have the energy to follow through.  The follow through, however, is as important as is the emergency room care itself.  What does this mean?

Usually, when you are discharged from the emergency room you’ll be given follow-up instructions from the doctor.  You’ll often receive a written summary of how you should continue your care, when you should visit your primary care physician, what you should do if symptoms return, and more.  Before you leave the emergency room, make sure that you understand all instructions that the doctors and nurses give to you.  Don’t leave feeling that you still have questions that haven’t been answered!

Then, make sure to follow through.  Go and see your primary care physician the next day to give them the paperwork from the emergency room and to have them follow your care.  Get your prescriptions filled and take the medicine that the emergency room has recommended.  Pay attention for recurring symptoms, and more.  Just because you’ve left the emergency room, and the emergency doctor’s care, doesn’t mean that you shouldn’t continue to be careful about your treatment and your follow-up care at home.

Dr. Josyann Abisaab is an Assistant Attending Physician at New York Presbyterian Hospital in New York City. In addition, she is an Assistant Professor of Clinical Medicine in the Department of Internal Medicine at Weill Cornell Medical College in New York City.  She has held both of these positions since 1992.

Educated at the American University of Beirut in Lebanon where she received a Bachelor’s of Science Degree, Dr. Abisaab went on to complete her medical degree at the University of Rochester School of Medicine.  Her numerous academic honors included receiving the Janet H. Glasgow Memorial Achievement Citation and being part of the Alpha Omega Alpha Honor Society.

She is board certified by the American Board of Internal Medicine, the American Board of Emergency Medicine and by the State of New York. She is affiliated with the American College of Emergency Physicians (ACEP), the American Medical Association (AMA), and the American Board of Emergency Medicine (ABEM).

Dr. Abisaab, along with N. Nevadunsky and N. Flomenbaum, published an article which appeared in the November, 2004 issue of the Annals of Emergency Medicine: “Emergency department presentation of bilateral carotid artery dissections in a postpartum patient”.