News From Grace Cottage

What to Expect When Your Doctor Refers You to a Warfarin Clinic

| Graceful Health

By John Kim, PharmD
as originally appeared in the Brattleboro Reformer’s Graceful Health series, July 29, 2016

If you or a family member has been recently diagnosed with irregular heartbeat (atrial fibrillation) or a blood clot, your doctor may prescribe a medication called warfarin and refer you to a warfarin clinic.

What is warfarin, you might ask? It is a medication classified as an oral anticoagulant (often called a blood thinner) used to treat and prevent blood clots.

This is serious business. The U.S. Centers for Disease Control (CDC) estimate that one or two people per thousand have blood clots, most often caused by injury, surgery, or heart disease. Atrial fibrillation increases the risk of clots because blood tends to thicken when the heart does not pump in the proper rhythm, thus encouraging clots to form. Many people die every year when a clot breaks loose, travels through the circulatory system, and lodges in the brain or the lungs.

So how does a warfarin clinic help people survive? Read on, to find out!

Warfarin, also known by brand names such as Coumadin or Jantoven, is a medication that works by counteracting vitamin K in the body. Vitamin K is responsible for producing clotting factors, which play an important role in healing cuts and wounds. If you are diagnosed with an active blood clot, or have an increased risk of blood clots, warfarin therapy can help you. By reducing the production of clotting factors, warfarin creates an environment for your body to dissolve current blood clots more easily and to decrease the chances of new clots from forming.

With warfarin therapy, it is very important to make sure there is enough drug in the body to effectively treat and prevent blood clots, while at the same time, making sure drug levels do not drop too low or get too high. Too low, and the medicine is ineffective; too high, and the patient has an increased risk of uncontrolled bleeding. Monitoring the level is the job of a warfarin clinic.

So how does a warfarin clinic monitor this medication? Well, that is done by the INR test.

The International Normalized Ratio, or INR test, is a way to measure how quickly your blood clots. Depending on the clinic and what is available at the facility, it can be done with a blood draw in a lab, or as a finger prick test. Grace Cottage has a lab, so the blood draw method is used. The results of the INR test allow the warfarin clinic staff to determine if your warfarin dose needs any adjustment.

At this point, you might be wondering how often you need the INR test. In the beginning, you will need to get tested more frequently, from every few days to every week or two. This is because the warfarin clinic staff needs time to get to know how you are responding to the medication. Once your INR results stabilize, the testing will likely stretch out to monthly or so, at an interval of time that your warfarin clinic recommends.

When it comes to warfarin therapy, it is important to understand that each individual responds to the medication differently. This means that each warfarin patient most likely is on a different dose. It is the job of the warfarin clinic to help you find a dose that works best for you.

As a warfarin patient, it is also important for you to follow your clinic’s instructions carefully. It may be helpful to have a pill organizer and a pill cutter ready to use after you speak to your clinic about your INR results.

Remember the statement that warfarin counteracts vitamin K? Well, vitamin K is found in many of the foods we eat. A general rule to know is that dark green leafy vegetables, such as spinach and kale, tend to contain higher amounts of vitamin K. However, it is a common misconception to think that warfarin patients need to avoid high vitamin K foods. When it comes to your diet, warfarin clinics preach CONSISTENCY! In practice, it is much easier to control your warfarin doses than your diet.

Along with your diet, it is important to keep in mind the other prescription medications, over-the-counter medications, herbal supplements, and even dietary supplements that you take. If there are any changes to these, or if you plan to try a new product, you need to let your warfarin clinic know. This way, the warfarin clinic staff can search for any potential interactions that may affect your warfarin therapy.

Generally, warfarin is well-tolerated, but just like any other medication, it does have side effects. The main side effect to look out for is increased bruising or bleeding. If you notice any unusual signs of bruising or bleeding, it is important to notify your warfarin clinic and doctor. It may be due to a high INR that would require a dosage adjustment.

Regular INR tests and communication with your warfarin clinic can help you manage warfarin therapy safely. As a pharmacist, I take great pride and pleasure in my warfarin clinic work. Our small size at Grace Cottage allows us to provide individualized attention to each patient and promotes a strong collaboration between patient and healthcare provider, leading to the best possible outcomes. I am happy to provide more information if anyone has further questions.

John Kim, PharmD, joined the Grace Cottage staff in January 2014. He earned his PharmD degree from the Massachusetts College of Pharmacy and Health Sciences in Boston.


Behavioral Health Specialist Now Full-Time at Grace Cottage

| Featured, News
Caroline Chase

Behavioral Health Specialist Caroline Chase is now working full-time at Grace Cottage Family Health in Townshend, VT, thanks to a grant from the Fannie Holt Ames & Edna Louise Holt Fund.

Chase joined the Grace Cottage staff in October, 2015. A member of the Grace Cottage Community Health Team (CHT), her short-term counseling services are offered to the community free of charge, as are those of the other CHT members, which include two RN Care Coordinators, two Health Coaches, and a Diabetes Educator.

Chase holds a Bachelor’s of Science from Mills College and a Master’s of Science in counseling psychology from Dominican University. She is a licensed Mental Health Counselor. A practicing psychotherapist for the past 34 years, she works with adults, children, couples, and families.

Originally, the CHT’s services were funded through a program established by the Vermont Department of Health, and that funding still supports the CHT in part. A recent grant from the Holt Fund has allowed Grace Cottage to expand those services.

The Fanny Holt Ames & Edna Louise Holt Fund makes grants to not-for-profit organizations that provide health and medical services to individuals living in and around Grafton, VT, where the Holt sisters were long-time residents. They were both long-time advocates of Grace Cottage.

The Grace Cottage CHT works with individuals to assess their health situations, develop plans, and establish attainable goals. This service is especially helpful for managing a chronic condition. A referral from a medical provider is not necessary. Any resident of Southern Vermont can contact the CHT directly for an appointment. No insurance is needed, and there are no co-pays or deductibles.

For more information about the Grace Cottage CHT, visit or call 802-365-3715.

Plants to Avoid This Summer

| Graceful Health

Danny headshot smallBy Danny Ballentine, Grace Cottage Emergency Department Physician Assistant
as originally appeared in the Brattleboro Reformer’s Graceful Health series, July 15, 2016

If you grew up in this country, you’ve probably somewhat familiar with our three most common poisonous plants: poison ivy, poison oak, and poison sumac. We don’t have to worry about poison oak in the Northeast, as it generally grows only in the Southeast and along the West Coast. But poison sumac and poison ivy are both native here, so they are definitely plants to look for and to avoid.
It’s good to be reminded of what these plants look like, but keep in mind that there are variations depending on where the plant grows. Eastern poison ivy typically has three shiny green (or red in the fall) leaves on one small stem. Poison sumac is a shrub with multiple leaves on each stem. The Centers for Disease Control and Prevention (CDC) website has photos that can help you learn to identify these plants.
Remember that it doesn’t take much exposure to develop a rash. If you brush against the leaves and bruise them, they will exude a noxious oil, and just a tiny bit of this oil can cause a rash. With “an amount that is less than one grain of table salt, 80 to 90 percent of adults will develop a rash,” according to the CDC.
You can be exposed to the oil by touching the plant itself or by touching tools, clothing, or even animals that have the oil on them. And, very important, you can be exposed by burning these plants. Inhaling plants particles in smoke can cause a very severe allergic reaction or even deadly breathing problems. Don’t forget: you may be careful to avoid the smoke, but it can also harm a neighbor who isn’t aware.
Another poisonous plant that is a common nuisance for us is the wild parsnip, sometimes called poison parsnip. These plants grow along roadsides and in other unmaintained locations. The flower is very pretty, looking similar to Queen Anne’s Lace, only yellow. Do not be fooled – this is not a good choice for a wildflower bouquet. The sap from this plant, when it interacts with sunlight, can cause a rash that is similar to second-degree burns. If you need to clear brush or mow where this plant is growing, be sure to wear clothing that fully covers your arms and legs, and wash that clothing as soon as you are finished. If you are using a string mower, be sure to wear eye protection.
It’s a good idea to learn about all of the plants growing in your yard. Of course, many of us like to go hiking or do other outdoor activities elsewhere, but knowing the plants closest to where we live is a good start. You can take photos and compare them to photos in a plant identification book, or you can take them to a garden center for help.
Sometimes the whole plant is poisonous, and sometimes just a part of it. For example, eating the leaves of the rhubarb plant can be deadly. A substance present in the leaves can cause burning in the throat, breathing difficulties, and even kidney failure, depending on how much is eaten. On the other hand, eating the stalks of this plant is perfectly safe, as anyone fond of rhubarb pie already knows.
You can find a good list of the most common poisonous plants in the Northeast by going to the State University of New York Upstate Medical University’s website, and typing “poisonous plants” into the search field. This list is especially useful because it tells which part of the plant is poisonous.
Any of us who are parents know all too well that children love to explore the world by putting things into their mouths. Foraging is a wonderful skill to have but it is important to teach your children to avoid all berries, nuts, mushrooms, flowers, and other plant parts, whether they are growing outdoors or in a pot in the house, unless you have positively identified the plant and know it’s safe.
If you or a companion is accidentally exposed to a poisonous plant, it is important to immediately wash the skin, clothing, and any tools exposed with soap and water. If you are exposed to poisonous smoke, get to fresh air immediately and seek medical help. For ingestion of a poisonous plant, get all pieces out of the mouth as soon as possible and seek medical attention right away, either at a hospital emergency room, or by calling the Poison Hotline, 1-800-222-1222. Do not induce vomiting unless told to do so, but it’s okay to take a few sips of water or milk.
Danny Ballentine works in the Grace Cottage Hospital Emergency Department. He earned his B.S. in Wellness and Alternative Medicine from Johnson State College and his Master of Physician Assistant Studies from Franklin Pierce College. He joined Grace Cottage in 2012.

Living Alone Support Group

| News
Living Alone

Grace Cottage is hosting a Living Alone Support Group, meeting the third Wednesday of every month. Support group meetings will include an informal group discussion on the challenges of living alone. Topics may include cooking and shopping for one, finding people to help with chores around the house or yard, how to meet others with similar interests, and other topics of interest to the group. Whether you have been living alone for years, or are new to living alone, this group welcomes you and your input.

The group meets from 10:15 a.m. to 11:15 a.m. at the Grace Cottage Wellness Center, 133 Grafton Rd. (Route 35), Townshend, VT. The facilitator is Alicia Moyer, the Support and Services at Home (SASH) local coordinator. There is no charge to attend. Call 802-365-3753 to sign up.

July 20: Lyme Disease Prevention Event

| News
Be Tick Smart

Come to the Grace Cottage Community Wellness Center in Townshend, VT, on Wednesday, July 20, to learn more about preventing Lyme disease and anaplasmosis.

Disease-carrying ticks are tiny but mighty when it comes to wreaking havoc with one’s health. During this presentation Megan Lynde, Public Health Nurse with the VT Department of Health, will share important information about the cause and symptoms of Lyme disease and anaplasmosis and provide guidance on ways to protect against ticks and prevent infection.

This program is offered free of charge. It will be held from 5:30 – 6:30 the Grace Cottage Community Wellness Center (Heins Building), located at 133 Grafton Rd., Townshend. No pre-registration is needed to attend.

The Right Formula for Colon Health

| Graceful Health
William Monahan

William Monahan 300pBy Bill Monahan, Grace Cottage Community Health Team RN Outreach Coordinator

as originally appeared in the Brattleboro Reformer’s Graceful Health series, July 1, 2016

When applied properly, any well-proven equation produces good results. The formula for avoiding colon cancer is relatively easy: Colon Health = Preparation + Screening + Prevention.

Colorectal cancer, often referred to as colon cancer, is the third leading cancer killer among men and women in the United States. Colorectal cancer is largely preventable with regular screenings and curable with early detection.

With screenings being the common denominator, you would think that all Baby Boomers would flock to a primary care provider or a gastroenterologist to complete this step, as a rite of passage for a healthy, mature lifestyle. Colon and rectal cancer screening should be a priority for all of us over fifty years of age, and for younger folks with a family history of colon cancer.

Colorectal cancer screening can be accomplished by several different tests, each requiring varying amounts of preparation. Colonoscopies require by far the greatest preparation, and so some patients prefer to start with an easier test. There are several options.

One well-proven, reliable, and fairly easy colorectal cancer screening test that can be performed as a precursor to colonoscopy is the fecal occult (hidden) blood test (FOBT), which tests for blood in the stool, an indicator of problems in the large intestine. The test can be performed at home and requires little preparation beyond a few diet and medication restrictions. The FOBT has been credited with a 30% reduction in colon cancer deaths.

There are two other tests that can be done at home. One of these, the fecal immunochemical test (FIT), has been proven to be more accurate with less false positives than the FOBT. The third home test, the Stool DNA test, is a relatively new, FDA-approved test that looks for cancerous cells and blood in the stool. This particular test has some limitations and is used in the “average” screening patient, someone with no known risk factors.

Any of these three home tests would be ordered by your primary care provider, and test results should lead to a discussion about further testing, which could include a full colonoscopy. None of these tests requires much advance preparation.

The “preparation” component of the equation moves our discussion to other tests that require more extensive preparation than the home tests.

One exam that has a long history in colorectal cancer detection is the Flexible Sigmoidoscopy. An expansive 20-year study published in 2012 has shown that this test can reduce colorectal cancer deaths by to 26%. Sigmoidoscopy may be performed in the doctor’s office, or provided by a gastroenterologist, a doctor who specializes in in the structure, functions, disorders, and diseases of the digestive organs.

Sigmoidoscopy takes about 15 minutes, sometimes more, and sedation is not generally required. Preparation for this test is similar to that for a colonoscopy. The test involves examination of the lower two feet of the colon with a lighted flexible scope by which the doctor can directly visualize the lining of the rectum and the colon. The equipment can take tissue samples for biopsy and can remove polys.

Removing polyps is the “prevention” part of the equation. The two most common types of polyps found in the colon and rectum include hyperplastic/inflammatory polyps and adenomatous polyps (adenomas). Inflammatory polyps do sometimes transform into cancer. Undetected adenomas often transform into colon cancer and are considered precancerous. Early detection is the key to curing colorectal cancers.

While the preceding tests are useful in certain cases, colonoscopy is still the gold standard in colorectal cancer screening because the gastroenterologist can see not just the final two feet, but the entire length of the colon. The instrument used can also remove and biopsy any suspicious areas. The commitment, of course, is the 24-hour preparation and the sedation required during the exam, but these are well worth it for the peace of mind this test provides.

If you are over fifty or have a family history of colon cancer, be on the lookout for some prodding from your primary care provider in the form of a letter or a call. The missing element of the metaphorical colon health equation as it is stated above, of course, is you.

Bill Monahan is one of Grace Cottage’s Community Health Team RN Outreach Coordinators. Bill received his AA in Liberal Studies from Berkshire Community College, his AS in Nursing from Greenfield Community College, and his BA in Health Advocacy from UMass Amherst.

Happy Father’s (Health) Day

| News

William Monahan 300pBy Bill Monahan, Grace Cottage Community Health Team RN Outreach Coordinator
as originally appeared in the Brattleboro Reformer’s Graceful Health series, June 17, 2016

The author Ken Nerburn once said, “It is much easier to become a father than to be one.” Beyond the obvious humor, there is a health-related idea here. Being a father and a member of modern society presents some great challenges.

Often, the odds are working against us, particularly in men’s health. Research has shown that men die an average of five years earlier than women; men’s life expectancy is an average of 76 years. The leading cause of death in both men and women is heart disease; more than half of all cardiac-related deaths are men.

The goal of our primary care providers today is to get us all to our best optimal health and to keep us there. Increasingly, they use a team approach by adding educational and coaching services. Their game plan is to encourage better heart and general health by decreasing the risk factors.

We are up against a formidable “risk-factors team.” Players on the risk-factors team are all working hard to beat good fathers out of a healthy lifestyle. They have a deep bench, including lifestyle choices that lead to medical conditions. Right at the top of the order are smoking, inactivity, poor diet, and excessive alcohol use, all of which can lead to being overweight or obese, to diabetes, and to the buzzer-beater, erectile dysfunction (ED).

Heart disease is a leading player for the risk-factors team. It is the number one killer of men. When it comes to good cardiac health, controlling high blood pressure is key. One in every three adult Americans, approximately 65 million, have a diagnosis of high blood pressure (hypertension). Over half of all Americans age 60 and older have hypertension, and over a lifetime, the risk of diagnosis is 90%.

Blood pressure often begins to rise in men starting at age 45, although it can start in younger men. African-Americans tend to develop it at younger ages and to have more severe hypertension. Obesity in a younger population can contribute to the diagnosis.

Hypertension is especially dangerous because it is often “silent.” One in three people with hypertension don’t know it. A person can have high blood pressure for years without knowing it, and this is when it has its most devastating effects.

Blood is under pressure in our arteries and circulatory systems, similar to water in a garden hose or water pipes in our homes. When blood pressure increases to a point greater than the circulatory system’s capacity, a variety of problems can arise. Bulges in the arteries called aneurysms can form. Hypertension can lead to an enlarged heart, weakening its pumping efficiency. Many other body systems can also be affected, including kidneys and eyes, which contain very small arteries that may be damaged due to increased pressure over time.

High cholesterol is another major player on the risk-factors team. It can have a “hat-trick” effect. First, it causes plaque to form on the artery walls and thus puts men at a higher risk of heart attacks when one or more arteries in the heart become blocked. Second, it causes peripheral artery disease (poor circulation), limiting blood flow to the main arteries in the legs. And third, it can cause a stroke, which may have devastating, long-lasting or permanent effects on all aspects of neurological functioning.

Studies show that men tend to avoid seeking health care for urologic issues, including benign prostatic hyperplasia (enlarged prostate gland due to a benign overgrowth of prostatic tissue). This is a major cause of urinary frequency, especially during sleep, and in more severe cases can lead to urinary retention, where an individual is unable to urinate at all and requires a trip to the Emergency Department.

Prostate cancer is the most common non-skin cancer in the United States, affecting one in seven men. Prostate cancer screening is suggested starting at age 50, younger if there is a family history. A simple blood test can help track this condition.

Yes, the risk factors are formidable, but there are many things we can do to strengthen our team’s defense against the risk factors. First and foremost, it’s important to develop a great offence: knowledge! In order to compete, we need to improve our health literacy.

The individual is at the center of his own care and needs to know as much as he can to help obtain optimal health outcomes. Simply put, we have to understand what we are being taught about our health at many levels or we will not be able to put into practice the tools to maintain or improve our lifestyle.

As men and fathers, we can make changes to improve our well-being. Some training tips, small ones at first, not too time-consuming, can have great overall benefits.

First, seek out a Primary Care Provider and visit regularly, every six months to a year. Start no later than age 50, younger if medical conditions apply. Next, take your medications as prescribed. These simple practices have huge benefits.

Walking, moving, any healthy exercise, and deep breathing will help reduce stress.  If you don’t want to rush into big changes in your diet, just read the labels on processed food packages. Look at grams of sugar, mg. of salt, and processed carbohydrates. That should scare you enough to make some helpful changes.

Taking the time to understand the best strategies and to plan and implement small goals can make winning at optimal heath an adventure, not a game of risk.

Bill Monahan is one of Grace Cottage’s Community Health Team RN Outreach Coordinators. Bill received his AA in Liberal Studies from Berkshire Community College, his AS in Nursing from Greenfield Community College, and his BA in Health Advocacy from UMass Amherst.

7th Annual Tee It Up For Health Golf Tournament: A Great Success

| News

Thanks to very generous sponsors, golfers, and volunteers, Grace Cottage Hospital’s seventh annual Tee It Up for Health raised over $32,000, after expenses, for Grace Cottage’s Patient Care Fund.

Thirty-three teams participated in the tournament, held on Saturday, June 11th at The Hermitage Club at Haystack Mountain. The winning team was Coop Bills, LindaJane Parson, Scott Cleary, and John Streeter. Second place team was Ward Dannemiller, Eileen Ranslow, Elizabeth Walker, and Scott Wilson. The third place team was Tony Tribuno, Marty Roth, Chad Bullock, and Jack Powers.

Event sponsors were The Richards Group and The Hermitage Club at Haystack Mountain and Elizabeth Walker. The Gold Sponsor was Brattleboro Subaru. Silver Sponsors were: Andy & Linda Barber, Brattleboro Memorial Hospital, Brunelle & Son, Cerner Corporation, Lawrence & Lober Electric Services, and People’s United Bank. Hole sponsors were: Baker Newman Noyes, Dead River Company, Durand Motors, Five Maples, G. S. Precision, G.S. Precision Coatings, Homestead Landscaping, Howard Printing, Irving Fuel, Lavallee Brensinger, Northeast Delta Dental, Primmer Piper Eggleston & Cramer, River Valley Credit Union, Southern Vermont Podiatry, West River Family Dental, the Windham Foundation, and WW Building Supply.  Bronze Sponsors were: Advance Notice Advertising, BlueCross BlueShield VT, Lawton Floor Design, and Leader Beverage. The Hole-in-One Sponsors were Brattleboro Subaru (nobody won the 2016 Subaru Crosstrek) and The Hermitage Club at Haystack Mountain. 50 organizations and individuals were generous Flag Sponsors of the event. Brown Computer Solutions of Brattleboro donated an Ipod Touch for the putting contest; Barb Oles and Tracy Sloan tied in the putting contest and Sloan won the putt-off.

Special thanks to volunteer organizers Elizabeth Walker, Eileen Ranslow, and Betsy Miller, and to The Hermitage Club’s golf pro, Drew Anderson, and his staff.

Bone Density Testing: Not Just for Women

| Graceful Health, News
Angie Clark

Angie Clark headshot 180By Angie Clark, Grace Cottage Hospital Director of Diagnostic Imaging
as originally appeared in the Brattleboro Reformer’s Graceful Health series, June 3, 2016

The latest news to come out regarding osteoporosis is that testing for men tends to fall through the cracks.

While women’s bone health is often followed closely by their primary care and ob-gyn providers, men aren’t as likely to get regular check-ups or to be referred for bone density testing when it is needed.

On May 12, researcher Dr. Mary Ruppe, a Houston Methodist Hospital endocrinologist, announced this finding and remarked that, “Women have a screening safety net. Between their primary care physician and ob-gyn, women will begin bone density screenings at the appropriate age. Men are less likely to have routine primary care checkups and don’t receive preventative care similar to what is provided for women.”

Statistics do show that women are more susceptible to osteoporosis, a condition that makes bones brittle and thus prone to breakage. But men are not immune to the disease. The May 12 press release cited a study that found an estimated 1.5 million American men older than 65 have osteoporosis, and another 3.5 million men are at risk.

The best way to determine whether you are at risk for osteoporosis it to have a bone mineral density (BMD) test, which measures the amount of calcium and other minerals that are present in a section of bone. It does this by taking a picture of the bone that shows how dense it is. The more density, the stronger the bone. If the test determines that density is low, the condition can be treated, but it all starts with the test.

Most often, a scan is performed on the lower spine and one hip. On rare occasions, the whole body is scanned. The test generally lasts about 20 minutes. The patient lies on a padded platform and the scanner’s metal arm passes over him or her, casting a thin ray of low-dose radiation over the bone being tested. The patient is fully clothed in either street clothes or a hospital gown and does not feel any effect from the test.

Osteoporosis risk increases with age. Our bodies are constantly breaking down old bones and replacing bone mass throughout our lives. For most people, the rate of build-up exceeds break-down until approximately age 30-35. Until that point, the body is making new bone faster than it is breaking down old bone, so bone mass increases. As we age, the rate of replacement slows down, while the rate of break-down increases. The higher one’s peak bone mass in youth, the more bone the body has to sustain it through old age.

A combination of strength training and weight-bearing exercises can help to mitigate the decline, as can getting enough calcium and Vitamin D. Calcium in one of the principle components of bone, and Vitamin D help us to absorb calcium. Low-fat dairy products, dark green leafy vegetables, canned sardines with bones, canned salmon, and soy products are also good, natural sources of calcium.

The National Osteoporosis Foundation recommends a bone density test for all women over age 65, and for any woman who has broken a bone after age 50. Women who are post-menopausal in their 40s may need the test sooner even if they haven’t had a bone fracture.

The American College of Physicians recommends that, by the age of 50, men should be screened yearly for risk factors associated with osteoporosis, and the National Osteoporosis Foundation recommends that all men begin routine bone density screenings by the age of 70.

The biggest risk factor for osteoporosis among men is a family history of the condition. Other risk factors that could increase a man’s chances of developing acute bone loss include prescription steroid use, gastrointestinal disease, use of prostate cancer drugs, and overuse of alcohol. Patients with thyroid conditions, those who have had a transplant, who smoke, or who are especially tall or thin should also discuss the need for this test with their medical providers.

According to Dr. Ruppe, “Each year, approximately 80,000 men will suffer a hip fracture, and studies have shown they have a higher mortality rate after a hip fracture than women of the same age.” Such data underscores the importance of routine osteoporosis screening for men as well as for women.
Grace Cottage accepts bone density test orders from all providers. The Grace Cottage Diagnostic Imaging Department is open Monday through Friday, 7 a.m. to 6:30 p.m. For more information, call 802-365-3639.

Angie Clark joined the Grace Cottage staff as Director of Diagnostic Imaging in 2011. She holds a Bachelor of Science degree in Business from Granite State College and an Associates of Radiologic Science from the NH Technical Institute. She also serves as the hospital’s Director of Clinical Informatics, overseeing training and data collection for Grace Cottage’s Electronic Medical Records system.

Be Prepared for Anaphylaxis

| Graceful Health
Natalie Harding

Natalie headshot200By Natalie Harding, Grace Cottage Hospital PA-C
as originally appeared in the Brattleboro Reformer’s Graceful Health series, May 20, 2016

Summertime in Vermont. It’s a great time of year for getting together outdoors with family and friends, fixing up the house, catching up on yard work.

Unfortunately, it’s also a great time of year for bugs that bite and sting, and they love to join the picnic.

Recently, there has been much attention given to the dangers of mosquito and tick bites, and that’s important because diseases from these insects are becoming more common – think Lyme disease, and the occurrence of Zika virus when travelling to certain parts of the world.

But let’s focus on stinging insects, particularly bees, hornets, and wasps.

While it’s true that the great majority of people do not have any lasting or severe reaction to insect stings, for some people, it can be a deadly situation, perhaps worsening over time.

Most people experience a sharp and burning pain at the site of the sting, with redness and swelling around the sting, which can be alarming and quite painful. This will usually go away after a few hours. Some people get a larger local reaction, with redness that spreads out from the sting site and lasts for several days. Cold compresses, pain relievers, and antihistamines can help with these symptoms. These reactions are not necessarily signs of sting allergy.

Children are more likely to have a larger local reaction to a sting than adults. Men are more likely than women to become allergic to stings. Beekeepers and people who are stung numerous times, or receive multiple stings in a short time, are more likely to develop a sensitivity and possible allergy. This could include housepainters, carpenters, or gardeners as well.

If your reaction gets worse every time you are stung or bitten, it is probably wise to speak to a medical provider about prevention and treatment, because occasionally, it is possible for someone to have a mild reaction to an insect sting one time, and when stung later, to have what is called an anaphylactic reaction.

The symptoms of anaphylaxis can vary, but generally a person will develop hives; severe itching; tingling in the mouth; swelling of the tongue, lips, or any part of the body away from the sting site; and/or difficulty breathing. Some may vomit, have belly cramps, or feel dizzy. When these symptoms occur, there is no time to wait. A person with an anaphylactic reaction can go into shock. This can be fatal.

Do you know what to do if you are with someone who goes into anaphylactic shock after being stung by a bee? Those with known anaphylactic triggers should plan how to avoid these dangers and should carry an epinephrine injector or two (often called an EpiPen®) with them at all times. Hopefully they can administer it to themselves. What if they cannot? Do you know how to help?

In a pinch, when there is no other alternative, an antihistamine like Benadryl® may buy you a little time, but truly it is no substitute for epinephrine, which must be administered as soon as possible during an anaphylactic reaction. A person who is having a hard time breathing will not likely be able to take Benadryl® by mouth, so do not rely on this option as a back-up plan. If available, use the injector.

Epinephrine injectors are designed to be easy to use. These simple directions are provided by EpiPen® (their website includes a how-to video): Flip open the cap and remove the injector from the tube. Hold the injector around the middle with the orange end down (remember the phrase, “blue to the sky, orange to the thigh”).

Being careful to keep the orange part away from your fingers (that’s where the needle is), remove the blue cap. Then smack the orange part of the injector against the upper thigh, hold it there for ten seconds, then remove it. The needle is strong enough to go through clothing, including heavy clothes like jeans.

After you remove the needle, rub the spot for 10-15 seconds, and immediately call 911 or head straight to the emergency room. This is important because sometimes the symptoms come back. Epinephrine injectors often come in a two-pack, and a second dose can be administered 10-15 minutes after the first.

If you have been prescribed an EpiPen®, be sure your prescription is not out of date. The pharmacy can tell you about proper storage of the injector pack.

There are some contraindications for those who have cardiac issues and a few other illnesses, but if someone has an EpiPen®, you should not hesitate to use it. An epinephrine injector should NOT be used in response to normal, non-allergic bee sting reactions, so it’s important to know the difference.

All of us can be good citizens by increasing our awareness about anaphylaxis and by thinking about how we could help in case of an emergency. You can find good information on the American Academy of Allergy, Asthma, and Immunology’s website,, or the Cleveland Clinic’s website,

Natalie Harding is a Physician’s Assistant practicing at Grace Cottage Family Health in Townshend, VT. Natalie earned her Master of Physician Assistant Studies from Franklin Pierce College in New Hampshire. She worked in Greenfield, MA, before joining Grace Cottage Hospital in 2014.