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Josyann Abisaab: Arthritis, Joint Pain and Winter

Josyann Abisaab: Arthritis, Joint Pain and Winter

Winter weather can affect each person differently. For those of us with either lupus or rheumatoid arthritis, the cold weather which winter brings can be a real challenge.

Many people suffering from arthritis feel especially stiff upon waking in the morning. It can be difficult to get going with your day when it takes longer to loosen your joints and alleviate the aches and pains these illnesses cause.

Although there is very little scientific evidence that cold weather directly causes arthritis or alters its course, there is no doubt that the cold makes arthritis feel worse.

When air pressure drops, as it does on cold winter days, this can affect the balloon like tissue surrounding the joints. Lower air pressure means the balloon can expand a little, which places additional pressure on already sensitive joints. People can actually feel the pressure around them changing in their joints. This is the reason many people say they can predict coming bad weather in their joints.

One doctor from the National Institutes of Health suggests:

“Do what you can to keep warm. Bundle up from head to toe in several layers, preheat the car before getting into it and make sure your home or apartment is kept warm.”

Additional suggestions are: Sleep under an electric blanket, warm clothing in the dryer before dressing and drink warm or hot drinks, such as coffee, tea or hot chocolate.

It can also be helpful to keep the joints moving. Before going out in the cold, warm up your joints, and a regular, yearlong exercise program can also be extremely helpful to relieve the extra joint pain of winter.

Dr. Josyann Abisaab is an emergency room physician at the Presbyterian Hospital of New York, wishing you a warm, pain free winter.

Three Emergency Medicine Locations of New York-Presbyterian Hospital

Three Emergency Medicine Locations of New York-Presbyterian Hospital

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

New York-Presbyterian Hospital offers New Yorkers and others from nearby locations cutting edge emergency medical care at no less than three locations: Weill Cornell at 525 East 68th Street; Columbia Hospital at 622 West 168th Street; and at the Allen Hospital at 5141 Broadway at 220th Street.

New York-Presbyterian Hospital prides itself on its goal to provide the highest quality care possible, using the most modern and cutting edge techniques and equipment available, to all New Yorkers no matter their background. The emergency medical facility also offers quaternary referral centers for those arriving at the emergency room with complicated medical or surgical issues from all over the globe.

Josyann Abisaab, MD, is an emergency room physician at New York-Presbyterian, as well as an Assistant Professor of Clinical Medicine at the Weill Cornell Medical College. In her capacity as a physician working in the front lines of emergency care, Dr. Josyann Abisaab is able to bring back to the classroom the lessons of the emergency room. This is just one part of the uniqueness and strength that makes New York-Presbyterian Emergency Medicine strategically positioned, in both the academic and clinical realms, to advance successfully into the future of state-of-the art emergency care.

Josyann Abisaab: Avoid Heat Stroke This Summer

Josyann Abisaab: Avoid Heat Stroke This Summer

With the advent of summer the possibility of suffering from heat stroke increases. Over exertion in hot, humid weather when not staying properly hydrated can lead to heat stroke, which is a medical emergency.

Heat stroke is a kind of hyperthermia, when the body temperature becomes elevated. This happens when the body is not able to regulate its temperature properly, either because the cooling mechanism of evaporation of sweat is hampered, due to extreme heat and humidity causing the body temperature to rise dangerously, sometimes to as much as 106 degrees Fahrenheit.

Another contributing factor to heat stroke is dehydration, so it is important to drink plenty of fluids, especially water, when exercising or otherwise exerting yourself outside on hot, humid days.

Some signs and symptoms of heat stroke are:

• Nausea
• Vomiting
• Fatigue
• Dizziness
• Weakness
• Headache
• Muscle Cramps

Sometimes individuals can get heat stroke without warning and without showing signs in advance.

Other things to look for in someone who you suspect may have heat stroke:

• high body temperature
• the absence of sweating, with hot red or flushed dry skin
• rapid pulse
• difficulty breathing
• strange behavior
• hallucinations
• confusion
• agitation
• disorientation
• seizure
• coma

Heatstroke is a true medical emergency, and should be dealt with immediately. If you suspect someone is suffering from heatstroke do the following:

• Take steps to cool the victim: Take him into the shade, take off clothing, place cool or lukewarm water on the skin, you can use a garden hose to gently spray the victim, fan the sufferer to encourage evaporation, and place ice into the armpits and on the groin.
• Encourage the intake of cool liquids such as water or other drinks which do not contain caffeine or alcohol.
• Observe body temperature and continue the cooling steps until the temperature drops down to 101 or 102 Fahrenheit. (38.3 – 38.8 Celsius)
• Call 911 as soon as the heat stroke is detected. If they will be delayed they can help you with instructions for how to help the victim further.

Emergency room doctors such as Josyann Abisaab, MD see many victims of heat stroke all summer long. Keep cool, drink a lot, and you will hopefully be able to avoid such an emergency.

Josyann Abisaab Urges Urgent Care When Appropriate

Josyann Abisaab Urges Urgent Care When Appropriate

Sometimes it can be a difficult decision whether or not to visit the emergency room. No matter what you do end up deciding, remember that it is always a good idea to get your primary care doctor involved, the sooner the better. When your primary care doctor is kept informed he will be your guide and help direct you to the care of a specialist as well as insuring that your own personal history is considered before treatment is given. Your primary care physician will also help you decide whether a trip to the ER is needed, or to an urgent care center, or if it is something that can wait until a regular appointment can be made.

Here are some guidelines to help decide what to do in different cases requiring a decision about the next step in treatment.

In the case of a child who is injured over the weekend who was already brought to the emergency room for treatment:

•    Contact your child’s pediatrician and tell him/her what the ER doctors said over the weekend. If your pediatrician agrees with the assessment, then have him make an appointment for you to see the specialist that the ER doctor recommended. It is very common to need a referral to see a specialist.

•    Make the appointment yourself if your pediatrician can’t get an appointment for you  soon enough. Call the specialist and tell him “My doctor (give his name) said that we need an appointment with you as soon possible.”

If you feel that you need a diagnosis of an illness or other similar situation urgently then it is best to proceed as follows:

•    Ask your doctor if he agrees with the urgency of the matter. If you don’t have a primary care physician, you can call a nurse’s hot-line. This is a good way to find out just how urgent it is. Just as you should not stay home if you have bronchitis, you should also not wait for hours at the emergency room for just a cold.

•    Before you leave for the ER, call a local urgent care center and find out how long the wait there is. Consider going to the urgent care center instead of the emergency room if the line there is not long. If it turns out the situation is a minor one, then you’ve saved yourself a trip to the ER, and if it is truly dire, then the urgent care referral will get you into to see an ER doctor sooner.

Josyann Abisaab is an emergency room doctor practicing medicine in New York City’s Presbyterian  Hospital.

Study Shows Prescription Drugs Caused 700,000 ER Visits

Study Shows Prescription Drugs Caused 700,000 ER Visits

According to a new study which was published last February in the American Journal of Emergency Medicine, it is estimated that about 700,000 Americans visited emergency rooms due to poisoning related to the wrongful taking of prescription drugs in 2007. The estimated cost for this misuse of drugs was given as close to $1.4 billion, about 41% of which was paid for by either Medicare or Medicaid.

Aim of Study to Fight Drug Abuse

The study was produced out of Nationwide Children’s Hospital, at their Center for Injury Research and Policy in Columbus, Ohio, and was done as part of their efforts to more accurately quantify the problem of and focus in on trends that could help professionals to fight drug abuse in our society.

The director of the Center of Injury Research and Policy, Dr. Gary Smith, admitted being surprised by the size of the problem.

Rural Areas Hit Hardest

The study showed a large difference between urban and rural areas for overdoses among adults taking pain medications and psychotropic drugs. The most common age group for overdosing was the 35 to 54 range, with 3 times the number in  rural areas.

Smith said that he could not explain why there was such a wide difference between urban and rural settings. It has been known, however, that at least in Ohio, “pill mills,” places where doctors prescribe large quantities of painkillers, have been of great concern in rural areas.

Josyann Abisaab:Keep Meds Away From Children
Josyann Abisaab:Keep Meds Away From Children

Children Also Victims

Among children, those five years old or younger had the largest number of accidental poisonings. In most of those cases it was found that children were playing with medicine which was prescribed for older relatives, or else taking too much of something that was meant for them or other children.

It was noted that syrups are especially problematic as far as children’s poisonings is concerned. Dr. Leslie Mihalov, the chief of emergency medicine at Children’s Hospital said that syrups which contain acetaminophen taste good to children, and they can easily drink down an entire bottle if no one is properly supervising them.

An easy way to prevent much of the inadvertent poisoning of children is to be vigilant in making sure that children do not have access to any medicines. As Dr. Mihalov said, prescription drugs should be kept out of reach and out of sight of children.

“I think the biggest problem is, elderly people or people who don’t have children in their home get those caps that are easier to open,” she said.

The problem is that children can often find medicines in Grandma’s purse, or they might fall out of Uncle’s pocket, to be swallowed by a child who does not know these things can be quite harmful.

The National Drug Abuse Warning Network believes that emergency visits due to prescription-drug abuse grew by twice from 2004 until 2008, from half a million visits to one million in 2008.

Dr. Josyann Abisaab is an emergency room physician practicing at New York’s Columbia-Presbyterian Hospital.

Safety Issues Over Spring Break: Dr. Josyann Abisaab

Safety Issues Over Spring Break: Dr. Josyann Abisaab

With Spring Break quickly approaching, it’s important to think about safety considerations for the family. The many ERs throughout the country, where doctors like Dr. Josyann Abisaab work, see frequent avoidable injuries and accidents at this time of year.

If you’re heading to the beach, make sure that all babies under six months of age are kept out of the direct sunlight. If the sun can’t be avoided completely, it is acceptable to apply a small amount of sunscreen to the baby. Whenever possible, dress babies in light weight clothing that covers their arms and legs and give them brimmed hats for protection.

Josyann Abisaab: Avoid Wasting Time and Money- Go to the Doctor, Not the ER

Josyann Abisaab: Avoid Wasting Time and Money- Go to the Doctor, Not the ER

Josyann Abisaab
Emergency Room

Research has shown that more than half of all emergency room visits in the US are for non-emergencies. The trend to use the emergency room as if it were a doctor’s office is wasteful in several ways. First of all, it wastes money. The cost of seeing a doctor in the emergency room can be three times more than seeing a doctor in his office. Time is also wasted while the person who is ill waits his turn to be seen by a physician. Contrary to what many people seem to believe, patients are not seen on a ‘first come, first served’ basis. Not even close. An emergency room is designed to see the most critical patients first, and everyone that comes through the doors of the emergency room goes through ‘triage’, French for sorting. The less urgent the case, the longer patient will wait. According to statistics the average wait in an emergency room is about 2 hours.

Emergency room physicians like Josyann Abisaab urge people to only come to the emergency room if a real emergency arises which requires urgent care. Otherwise schedule an appointment with a primary care physician who will be glad to see you at a scheduled time and for a reasonable price.

Asthma in Children:Josyann Abisaab

Asthma in Children:Josyann Abisaab

Often children with asthma sometimes find themselves in the emergency room where an emergency room doctor, such as Dr. Josyann Abisaab will treat them for the difficult breathing asthma sufferers experience.

Although the underlying cause of asthma is unknown it often runs in families. What happens is that certain substances which the person with asthma is sensitive to, such as dust, smoke, or animal fur irritate the lining of the bronchial tubes causing the production of phlegm, which blocks the air passageway. The increased level of mucus (phlegm) makes breathing difficult, causing the main symptom of asthma.

View this video to learn a bit about how asthma is often treated and which inhaler is right for children.

Treating Croup in the Emergency Room:Dr. Josyann Abisaab

Treating Croup in the Emergency Room:Dr. Josyann Abisaab

Dr. Josyann Abisaab
Baby with Croup Coughing

Many parents of young children have had to deal with the illness known as croup at some time. Also known as laryngotracheobronchitis, croup is a respiratory illness which is often caused by a viral infection in the upper airway. The infection causes swelling inside the throat causing an impediment to normal breathing. The interference to the child’s breathing is what causes the barking cough and hoarseness. Symptoms can be mild, moderate or severe, and often send parents to the emergency room with their sick child. In the emergency room the doctor will first rule out other more serious causes of the symptoms, such as epiglottitis or some foreign object blocking the airway, and then treat if necessary. Treatment usually involves one dose of oral steroids and sometimes epinephrine in more severe incidents. Rarely is hospitalization needed.

Croup is a relatively common illness which affects about 15% of all children between 6 months old and 5-6 years old at some time, but it is extremely rare in teens and adults.

As an emergency room physician, Dr. Josyann Abisaab treats children with croup when they arrive in the emergency room seeking care for their distressing and sometimes frightening illness.

Emergency Rooms are For Emergencies: Dr.Josyann Abisaab

Emergency Rooms are For Emergencies: Dr.Josyann Abisaab

Statistics show that most people that come to the emergency room are not in need of emergency care. Here are some things that  you need to know so that you do not become part of this statistic.

•    First of all, use good judgment. Become knowledgeable about the signs of serious illnesses which need immediate attention such as heart attacks and strokes, and trust your instincts.

•    Call your family doctor and describe to him/her your symptoms. If your doctor feels it’s warranted, then he/she will recommend a trip to the emergency room. If the problem is not urgent enough for a trip to the emergency room, but nevertheless urgent, your doctor will make room in his schedule to see you. Also, a good primary care physician should ideally be available 24/7 or else he/she takes turns covering after-hours on-call responsibilities with other doctors. In other words there are alternatives to getting off-hour or last-minute care instead of going  to the emergency room.

•    Keep a booklet in your home which is easily accessible which describes the types of symptoms which need emergency room treatment.

Dr. Josyann Abisaab is an emergency room physician practicing in New York City at New York Presbyterian Hospital.

Josyann Abisaab: Diagnosing Strep Throat

Josyann Abisaab: Diagnosing Strep Throat

Its winter, a time of year when people are more susceptible to illness, and do seem to get sick more frequently. One of the more common illnesses which is seen by doctors, usually during  regular office hours, but sometimes by emergency room doctors like Josyann Abisaab, is strep throat.

Strep throat is generally not an emergency and almost never requires a visit to the emergency room, but the development of a sudden and severe sore throat, especially in a young child, might drive a frantic parent to the emergency room anyway.

In most cases, even without treatment, strep throat will resolve on its own and go away within a few days. However, one of the dangers from step throat, aside from the pain, fever and lost time from work or school, is if it goes undiagnosed and/or untreated with antibiotics. Without antibiotics the infection can spread to other parts of the body, including the sinuses or the middle ear.

There is also a possibility that when the body’s immune system responds to the untreated strep it will attack healthy tissue which can cause rheumatic fever and some other illnesses. It has been shown that antibiotics given even nine days after the start of the infection will prevent rheumatic fever from developing.

When is High Blood Pressure an Emergency?

When is High Blood Pressure an Emergency?

There is no exact number which determines that someone with high blood pressure should go to the emergency room or dial 911. However, if there are other symptoms accompanying the high blood pressure reading, including severe headache with no known cause, back-pain, severe chest pain or impaired or blurry vision, or any other type of symptom connected to brain function, it is probably a good idea to go the emergency room or call 911.

Normal blood pressure readings are around 120/80. If you experience blood pressure where the systolic (first) number is at or above 180, or the diastolic (second) number is above 110, you should probably have it checked by a physician. If your instincts have a bad feeling about it, or its accompanied by any other symptoms, it is probably a good idea to go to the emergency room where a qualified emergency room doctor like Josyann Abisaab can check you and make a proper diagnosis.

ER Doctors Train RAF Medics

ER Doctors Train RAF Medics

Emergency room doctors, like Josyann Abisaab, MD, deal with an extraordinary range of medical issues on a regular basis. This makes them uniquely qualified to train army medics, who can be the difference between life and death for soldiers on the field, but who may not have the experience necessary to treat the issues with which they are confronted on the battlefield.

To that end, the British Royal Air Force has started its Trauma Inoculation Programme (TIP), in which RAF medics carry out a two-week placement at a hospital, receiving the ER training they need to be able to treat troops on the front lines. The results have been so successful that that the RAF hopes to put all of its trainee medics through similar training.

ER Blood Tests: Dr. Josyann Abisaab

ER Blood Tests: Dr. Josyann Abisaab

An informed ER patient is one who has a basic understanding of the workings of the emergency room, and so can better appreciate the complex and wide range of medical care that is provided. ER physicians, like Dr. Josyann Abisaab, explain that a visit to the ER frequently involves one or more blood tests, which helps the ER team to accurately diagnose the source of the patient’s symptoms.

When a blood test is performed, the patient’s blood is placed into different colored tubes, each with a specific additive that relates to the test in question. A CBC (complete blood count) test uses a purple-top tube. The CBC measures the numbers of each of the three types of bloods cells: red blood cells, white blood cells, and platelets, in order to help diagnose specific illnesses and health conditions. A serum (the liquid/non-cellular part of the blood) test uses a tube with a red top, while a blue-top tube is used to test blood clotting.

When to Visit the ER

When to Visit the ER

People often make the mistake of going to the ER when their condition is not an emergency. Not only is this a waste of time and money, it also causes stress and unnecessary disorder in the emergency room. Doctors such as Dr. Josyann Abisaab recommend that you think objectively about the condition you encounter, before making that decision. Here is a general list of symptoms which may need to be dealt with in an ER:

  • Loss of consciousness
  • Poisoning
  • Signs of a stroke such as numbness or sudden weakness in one side of the body such as in the face, an arm or a leg; sudden loss of vision, especially in one eye; loss of speech, trouble talking or understanding; sudden memory loss; unexplained dizziness or sudden falls
  • Serious traumatic injury (to the head, for example)
  • Instant, severe, inexplicable pain
  • Bleeding which does not cease after ten minutes of direct pressure
  • Signs of a heart attack such as a feeling of pressure, squeezing, fullness or tightness in the chest for over two minutes; burning or aching under the breast bone; chest pain accompanied by lightheadedness
  • Sudden severe/ persistent vomiting