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.

Josyann Abisaab: Arthritis, Joint Pain and Winter is a post from: Josyann Abisaab

There are three ways to receive a flu shot which are delivered via  needle, usually in the arm: the normal shot which is approved for all people older than 6 months; a high-dose vaccine which is approved for those over 65 years old; and an intradermal shot for those between 18 and 64 years old.

Also available for use in healthy people ages 2 to 49 who are not pregnant is the nasal-spray flu vaccine. This is made with live, but weakened flu viruses, as opposed to the ‘shot’ which uses killed viruses. The nasal spray is also called LAIV, which stands for “Live Attenuated Influenza Vaccine.”

The best time to get vaccinated is as soon as the vaccine comes available. It takes about two weeks after administration of the shot to develop immunity to the flu, so the sooner the vaccine is given, the sooner people are protected. However, just because it may be late in the season is not a reason to refrain from getting the flu shot. The CDC recommends getting vaccinated from October all the way to May, reasoning that different viruses circulate in different places at different times, and it is always wise to get protection.

Josyann Abisaab, MD wishes all a healthy flu season this winter.

Josyann Abisaab: Flu Season Means Flu Shots is a post from: Josyann Abisaab

When the flu strikes there is no question that you should be examined by a health care professional, but the question is how urgent is it that you are checked immediately, or can you wait to make a short-notice appointment with your doctor?

The determination of whether or not to go to the emergency room should be based on how ill you are. Also, if there are other chronic conditions present as well. For instance, if someone with diabetes, asthma, COPD or congestive heart failure develops flu symptoms, he/she should be seen within one day by their regular doctor. If a short-notice appointment cannot be made, then a trip to the emergency room is in order.

Pregnant women should also take the flu seriously, more so than non-pregnant women. Other generally healthy people, including children are usually better off staying home, even if they are not eating during their illness. As long as the patient is holding down liquids, there is no immediate health threat if a person, including a child, does not eat for a week, or even two.

The following symptoms may indicate that the patient may need antiviral drugs like Tamiflu, or even the need for hospitalization:

•    Fever of 102 degrees or higher
•    Serious fatigue
•    Stubborn cough with either yellow or green phlegm
•    Difficulty breathing, shortness of breath
•    Confusion
•    Feeling light-headed or thirsty from dehydration which can be caused by vomiting and/or diarrhea.

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.

Josyann Abisaab: Flu Season is Back-To the ER or Not, That is the Question is a post from: Josyann Abisaab

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.

Three Emergency Medicine Locations of New York-Presbyterian Hospital is a post from: Josyann Abisaab

As Michelle Dressman, a pediatric ER nurse at Johns Hopkins Hospital in Baltimore, Maryland explains, patients get evaluated upon arrival. The length of time that you have to wait will depend on your symptoms and history, not whether or not you arrived with blinking lights.

If you do decide that you need an ambulance, make sure to find out which hospital they plan to take you to. Some hospitals may be better suited to help with you with the specific type of issues that you have. A major medical center, for instance, may be more suited for your needs than is a community hospital. This is particularly true if you have neuromuscular disease or other tricky issues.

Ambulances: Do They Get You Treated Faster in the ER? is a post from: Josyann Abisaab

If there is a high heat or humidity warning in your area, children should only participate in intense physical activities for 15 minutes or less. Before they participate in prolonged physical activities, children need to be well-hydrated.

During the first hour of exercise, children should then be given plenty of water to drink and they should continue drinking either water or a sports drink every 20 minutes for as long as they are exercising.

During strenuous activities in the heat, children should have on light-colored and lightweight clothing and should only be wearing one layer.

If children start to feel lightheaded, too hot, or fatigued, they should get to a cooler, shaded environment and should drink plenty of water or carbohydrate-electrolyte beverages.

These tips will help to reduce the number of visits to the E.R. where physicians like Josyann Abisaab treat heat-induced sicknesses each summer.

Exercise Safety Tips in the Heat: Dr. Josyann Abisaab is a post from: Josyann Abisaab

There is virtually no end to accidents that may occur during the summer months, with children enjoying swimming, boating, outdoor playing and sun exposure. Accidents can be avoided, however, and it’s important for parents to know these safety tips.

Emergency room doctors like Josyann Abisaab see boating accidents each summer that could easily be avoided with the proper care. Children should always wear life jackets when they are in a boat, or when they are going to be near bodies of water.

The life jacket needs to actually be the right size for the child. The jacket should fit tightly and it should be worn exactly as instructed with all of the straps belted.

Adults who are taking a boat ride with a child should also wear life jackets. This is both to protect them in the water, and to set a good example for the children on board. Blow-up water toys like air mattresses, wings and toys should never be used as life jackets or as personal flotation devices.

Keeping these boating tips in mind will help to keep everyone safe and secure while enjoying the warm, summer months and the water activities that abound.

Boating Safety Tips with Josyann Abisaab is a post from: Josyann Abisaab

Until recently most PAs worked in family practice medicine. However, between 1996 and 2008 the percentage of PAs working in this area decreased substantially from almost 40% to only 26%. The decrease is attributed to the move of PAs from family practice to emergency room practice as their presence in the emergency room became more accepted while patient use of emergency rooms went up during the same period by 32%.

Patients should always be aware who is treating them, and whatever diagnosis that is made should be verified with a staff physician.

Josyann Abisaab, MD is an emergency room physician practicing in the Columbia Presbyterian Medical Center in New York City.

Physician’s Assistants Help Cut Costs in the Emergency Room is a post from: Josyann Abisaab

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: Avoid Heat Stroke This Summer is a post from: Josyann Abisaab

Symptoms of a Heart Attack

Sometimes it’s necessary, and sometimes it’s not, but it is certainly true that almost all of us have been to the emergency at one time or another. Maybe it was a broken leg, or the fear of one. Perhaps it was a poisoning or a burn. Whatever it was, we are certainly glad for the existence and accessibility of the ER, and we all want them to run as efficiently as possible.

Unfortunately many times people just don’t know the difference between a good reason to go to the ER, and a “not such a good reason” to go. The more people can tell the difference, the better the emergency rooms can service their patients.

Here are the five most common reasons people go the ER, whether they are good reasons or not.

1.    Stomach pain, cramps, and spasms- Severe stomach pain can be frightening. It is no wonder that this is the most common reason for visits to the ER. Stomach pain can also pose a more serious danger than simple food poisoning, so this is a reasonable reason to visit the ER.

2.    Chest pain and related symptoms- Since chest pains can mean the possibility of having a heart attack most people rush to the ER if they have this symptom.

3.    Fevers are the third most common reason for trips to the ER, but on the first day of a fever this is almost always not necessary. There are many reasons for people to exhibit a fever, from too much stress or even bad weather. However fever can be a sign of danger if it is already the third day of a fever which has not returned to normal, or if the fever is very high.

4.    Cough-There are many reasons a person can develop a cough, but almost always the cough is harmless, meaning that it does not present a threat to life in and of itself. Although coughs should definitely be checked by a doctor, especially persistent coughs; there is almost never a reason to go to the ER to do this. Just make an appointment with your doctor. An exception is if the cough is combined with blood or other symptoms. Then off to the ER with you.

5.    Headache- Head pain can be quite severe, and if it is people will go to the ER to get quick relief. But if your headache is not a recurrent symptom, it is most likely just a plain headache. Another thing to note; doctors can not treat a headache fast. If the only symptom is the headache, the doctor will want to run some tests to determine what is wrong.

Dr. Josyann Abisaab is an emergency room physician at the New York Presbyterian Hospital.

Josyann Abisaab: The Most Common Reasons for Going to the ER is a post from: Josyann Abisaab