What should I keep in my first aid kit?

How many times have you been skipping through the park, stubbed your toe and wished you had a first aid kit? Been home, sliced your finger on a knife but had no bandaids? You aren’t alone. There are so many options for what you may want to have on hand in a first aid kit. Let’s review which supplies are good to have and what to think about when getting your kit ready.

First, keep in mind that a first aid kit for home and light travel should have basic items, but if you are headed out camping or on an adventure where there is no access to healthcare or emergency care, you may want to be sure you do some research and have more options available. 

What should a basic first aid kit contain?

A first aid kit should be well marked and in a known location. Keep one in the car that you can grab and throw into a backpack or stroller for when you are on an excursion. You can purchase a pre-packaged kit and add to it as needed. You can find some kits come with all you may need and more!

The American Red Cross suggests this list for a family of 4:

  • 2 absorbent compress dressings (5 x 9 inches) 
  • 25 adhesive bandages (assorted sizes)
  • 1 adhesive cloth tape (10 yards x 1 inch) 
  • 5 antibiotic ointment packets (approximately 1 gram) 
  • 5 antiseptic wipe packets
  • 2 packets of aspirin (81 mg each) 
  • 1 emergency blanket
  • 1 breathing barrier (with one-way valve)
  • 1 instant cold compress
  • 2 pair of non-latex gloves (size: large)
  • 2 hydrocortisone ointment packets (approximately 1 gram each) 
  • 1 3 in. gauze roll (roller) bandage
  • 1 roller bandage (4 inches wide) 
  • 5 3 in. x 3 in. sterile gauze pads
  • 5 sterile gauze pads (4 x 4 inches) 
  • Oral thermometer (non-mercury/non-glass)
  • 2 triangular bandages
  • Tweezers
  • Emergency First Aid guide

What’s in a first aid kit?

This list seems long, but each item has a purpose. You want to have something to stop minor bleeding and cover up a cut or laceration. Check your kit to be sure it includes a few gauze bandages, bandaids in a few shapes and sizes and some paper tape to wrap up cuts and scrapes as needed. A longer roll of gauze can come in handy with a larger bleed or to cover a large scrape. 

The next thing you want to think about is having some ointments and creams for the more common issues you may face. Having some single use packs or small tubes of over-the-counter items such as burn ointment (for minor burns), triple antibiotic ointment (for cuts and scrapes), hydrocortisone (for itchy bug bites or rashes) and some alcohol or antiseptic wipes to clean dirty hands before touching your “patient”. A pair of gloves will protect you as well and are important to have in your kit.

Other items to keep handy in your first aid kit

You can also consider some additional tools to help you along if you get stuck in a bind: 

  • A small pair of tweezers can help remove a splinter, bug stinger or tick
  • A small pair of medical scissors can help you cut clothing or tape as needed
  • An instant cold pack can soothe a minor injury or help cool down a person who may be experiencing a heat related illness
  • A nice emergency blanket can warm up a cold or ill patient until help arrives
  • An emergency CPR one-way valve mask in case you need to administer CPR. This provides a barrier for your mouth and the victim during rescue breaths (although with new CPR compression only guidelines, it is less likely that you would need to give rescue breaths).

Medications to consider having on hand

Other items that you could consider having in your kit are over-the-counter Motrin, Tylenol and Benadryl. They sell these in small packages so that you can keep a few tablets on hand, or a few chewables for the kiddos. You never know when you will have a throbbing headache and need Tylenol for the pain, or twist an ankle and could use some Motrin to help decrease inflammation. These are both great to keep handy at home too for that unexpected fever or ache you might experience. 

Benadryl is also good to keep handy. It works quickly to help with a nasty, itchy rash or bite, or an unexpected case of seasonal allergies. Other meds you may want to keep handy include Tums and Pepto for when the occasional heartburn hits!

If you have a person with severe allergies in the home and have been prescribed an EpiPen, keeping your EpiPen handy is a very important part of any excursion and should always be with you or your first aid kit. Make sure to keep this in a bag or purse that doesn’t sit in a hot car, and that comes with you wherever you go. Seconds count when it comes to administering an EpiPen when someone is having an anaphylactic reaction. You should have one in the home that is accessible and in a known location for those who may need to administer it. Using a brightly colored label helps make the EpiPen easier to find. 

Remember to restock your kit after every use and make sure to check your items for expiration dates. Ask a nurse first if you are unsure about your minor injury, but don’t hesitate to call for help if it’s more serious.    


The opinions expressed in Nurse-1-1 Health Center Blogs are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Back to school options in 2020

We normally would be looking for the best sale on new backpacks and getting school clothing ready for the fall semester. But here we are waiting for information on what is going to happen next… Will there be school in classrooms? Will it be online? A mix of both? Will I be the teacher? Will the kids get on the bus? 

We all know that things have been changing by the minute, and we never know what the next announcement will be. National, state and local officials don’t agree and neither do parents and neighbors. COVID has taken the country by storm. How will we get through another school year? What will our year look like?

We just don’t know. Nobody has the answers we need. I for sure don’t. But as a mom of three,  I cycle through how September will look for us, on a daily basis. In my mind, scenarios change by the hours. It’s going to be hard. It’s going to be new and unexpected. Here are the options that most of us face in just a few short weeks: full day in-classroom learning, hybrid learning, full remote learning, homeschooling, microschooling, among others. What are these different types of learning options?

Full day in-classroom learning

Full day in-school learning means your school will allow all students and teachers to enter back into the classroom for a full day of school. Entering school will involve new rules like handwashing and face masks to decrease spread of COVID-19. Some schools will follow the CDC recommendation of social distancing 6 ft apart and some will follow the American Academy of Pediatrics recommendation of 3-6 ft apart. Learning will be all in the classroom but may look different than a usual year. Many schools will keep the class in the same room for the entire day, including lunch and specials such as gym and art. Some will have classes outside. Teachers and students will likely be wearing masks and there may be clear barriers set up around the class. Gone are the days of rug time and group desks. Desks will be facing forward in most classrooms with different setups from what we are used to seeing in the classroom. 

Hybrid learning

Some schools will offer a hybrid learning option. What this will mean is that children will be able to go to school some days and do at-home remote learning on other days. Splitting them up allows for more room to social distance with conservative spacing at 6 ft apart. It also separates the school into separate cohorts to prevent an outbreak from affecting the entire larger group. For many schools, this looks like an every other week in-school option, ½ days in school option, or some variation. This will differ by school. The remainder of the days can be a combination of independent online learning, flexibility of schedules, live classroom instruction video, and one-on-one calls. Some areas may be able to test innovations at home that non-traditional approaches to education can provide, such as theme- and project-based assignments, interdisciplinary units that tap into students’ interests, mastery-based grading, and solving real-world problems. The hybrid learning  option decreases the amount of kids in a school and classroom at one time and allows for a safer school day, knowing there are less children in the space. 

Full remote learning

Many towns are offering full remote learning as well. Parents need to keep in mind that in many towns, this will not be the same experience they had during the emergency shutdown. School systems have learned a lot from that experience and are adapting and creating remote learning plans. States are choosing remote learning platforms that allow for deeper instruction and learning experience. Gone are the days of simply jumping on a zoom call. 

Full remote learning is an option many school systems are offering students, families, and staff who are immunocompromised and students who feel they can thrive in the remote learning environment and prefer a non-traditional school experience. Full remote learning will offer flexible schedules for families who need to make adjustments based on their schedules. 

Students in the full remote learning options will have a curriculum that will align with their peers in the in-classroom and hybrid options. Day-to-day teaching will look different, and students will be provided with a rigorous learning experience that takes into account the social nature of how kids learn. Fully remote learning should also take into account the unique challenges and opportunities of effective online instruction and learning. A proper online learning program will need to prioritize the creation of strong relationships between teachers and students, and between students. 

Classes such as music or band, that cannot happen in-classroom during the pandemic, can proceed online if towns take action to deliver cleaned instruments to students’ homes. At home, wind instruments can be played without face masks, and other instruments can be handled without other restrictions that are preventing many in-classroom options from having music class all together.  


Homeschooling is led by the parent independently or through a private homeschool program. This option requires unenrolling your student from public school and either enrolling into a private homeschool program or submitting your own plan for homeschooling. Homeschooling allows parents to have some control over their child’s day and curriculum. For some families, this mimics a traditional school day with a classroom-like schedule and for others a more child-led, flexible learning environment. These children can integrate back into public schools at any time, or can homeschool until college. Homeschooling allows for flexibility and provides options for students and families who wish to lead learning in their home. There are many homeschooling resources available for this fast growing option that is legal in all 50 states.

Microschooling or pod-based schooling

Parents who are not ready to send their kids into a school building with many unknowns are getting creative. A new homegrown option for those who can’t rely on the ever-changing and unpredictable school environment have come up with their own plan: micro schooling or pandemic pods. For some who have the resources, this means hiring a retired or unemployed teacher to teach a small group of children. For others, it means parents will take shifts or have a rotating schedule where they support  the remote learning plan. This small group develops with many factors in mind and makes their own rules. Is this a low-risk family? Are they the same age and grade? Do they get along? Do they live close by? How will we discipline and keep these kids focused? For some, the thought of sharing the responsibility is very attractive and for many with limited resources, an alternative option is essential. 

Options for learning

We don’t have all the answers, and going back to school (or anywhere for that matter during the pandemic) is not 100% safe. Wearing masks and distancing yourself helps in preventing the spread of COVID-19.  Many parents and teachers worry that not all students will be able to follow these directions properly.  Unfortunately with COVID-19, it only takes one person to spread their germs and one misstep to catch them. 

We know that not all families have the same options and opportunities for learning. Education disparities already exist, and this gap will only widen with COVID-19. Race, economic status, geographic location and now disruptions in school are all major contributors to disparities in health and also in education.

As the back-to-school plans evolve, we realize that there are limited resources and plans for those without the economic resources or time, who are uncomfortable with in-classroom options to rely on. Many are feeling frustrated and uncertain. One resource is the Families First Coronavirus Response. For some who qualify, this may provide an option for a paid leave to some parents who wish to participate in fully remote learning.

Do what is best for you, your family, and your community

No matter what you decide to do, be kind to your neighbors and friends. Fighting about these back-to-school options will not get us an answer on how to solve this pandemic. Remember, it’s ok to have different opinions. It’s natural to think our way is the best way. It’s fine to discuss, but it’s not ok to tell anyone they are wrong, or that they are making a bad choice. This is a crisis. We are anxious. We are uncertain. What we do know is that each of us is making decisions for our families, communities, teachers, and school staff. We are doing the best we can. Given the options you may be given, you are doing what you think is best. Pat yourself on the back, and press on. You are an awesome parent!

The opinions expressed in Nurse-1-1 Health Center Blogs are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Beat the heat: avoid heat stroke and heat-related illnesses

Summer is in full effect and getting outside for some sun feels oh so good. Summertime is full of fun, but let’s make it safe! Besides lathering up for sun protection and wearing a helmet when riding bikes, we want to make sure you know about heat-related illnesses, too. 

Heat exhaustion and heat stroke occur when the body can’t keep itself cool. More than 600 people in the United States are killed by extreme heat every year, according to the CDC. The good news is that heat-related deaths and illnesses are very preventable. Read on for everything you need to know about heat stroke and heat exhaustion.

How much heat is too much? What exactly is heat exhaustion?

Feeling tired after a day at the beach is a common feeling, but an important one to pay attention to. The CDC defines heat exhaustion as a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. Heat exhaustion happens quicker and more commonly to the elderly, children four years old and younger, people with high blood pressure, and anyone working or exercising in a hot environment. 

Signs of heat exhaustion to look out for are:

  • Heavy sweating
  • Paleness
  • Muscle cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting

Heat illnesses occur when the body can’t cool itself off. Typically, when it is hot out, the body will sweat to cool down. However, cooling off can be especially difficult for the body when it is hot and humid. When the humidity is high, it makes it hard for the sweat to evaporate and cool off the skin quickly. Your body continues to sweat and lose water, but it isn’t actually able to reduce its temperature.

How can I prevent heat exhaustion and heat stroke?

The first steps to cool the body during heat exhaustion are hydrating the body and keeping cool. You may notice a fast heart rate and/or fast breathing. With any signs of heat exhaustion, you should immediately:

  • Drink cool, nonalcoholic beverages
  • Rest
  • Take a cool shower, bath, or sponge bath
  • Seek an air-conditioned environment
  • Wear lightweight clothing

It may seem obvious, but it’s worth highlighting: keeping cool and hydrated are KEY to preventing heat-related illnesses. If you can access an air conditioned area, or a shady cool spot on a hot day, make sure to take breaks and do so. 

Make a plan before heading outside

  1. Schedule breaks inside an air conditioned home, or a public location such as a library or community center throughout the day
  2. The cool ocean water, sprinkler and shower are great options to quickly reduce body temps
  3. Prepare cooling towels or ice packs covered with a damp towel for instant relief
  4. Using a fan can help cool the body, but be careful on hot days, as 90 degree heat is still dangerous, even with a fan on. It’s important to drop the temperature of the body, which a fan won’t do in extreme temperatures. Try your best to find some AC on those days!
  5. Bring fluids in a cooler with you (or at least keep them in the shade!) and make sure to drink plenty of fluids on hot days, especially when you are sweating a lot. Drinking water before heading out helps, too!
  6. If you are sweating in the heat, it’s also important to replace the salt, sugar and minerals you’re losing in order to and keep a nice balance of electrolytes in your body. A sports drink such as Gatorade or Vitamin Water can help achieve this. For organic options, check out NOOMA Organic Electrolyte Sports Drink or Roar Organic. FYI, we don’t get any payment for promoting these brands; we just love sharing options. (Of course, be sure to talk with your doctor about drinking sports drinks or excessive amounts of water if you have any medical conditions such as diabetes, high blood pressure, or are on any special diet or fluid restrictions, as these conditions can require a delicate balance of salts and minerals in your body.)
  7. Keeping hydrated is harder when drinking sugary drinks, caffeine and alcohol, so consider limiting these types of drinks on especially hot and humid days

If you notice that your symptoms last longer than one hour, you are vomiting, symptoms are worsening, or don’t improve, seek medical attention right away. Don’t hesitate to chat with a nurse first if you are concerned about your symptoms. Our experts are here to help! Heat exhaustion can progress to heat stroke, which can be life threatening, so don’t hesitate to seek medical attention.

Heat stroke is a medical emergency

Heat stroke is the most serious heat-related illness and is considered a medical emergency. Heat stroke occurs when the body becomes unable to control its temperature: your temperature rises rapidly, your sweating mechanism fails, and your body is unable to cool down. In the case of heat stroke, your body temperature may rise to 106°F or higher within 10 to 15 minutes. The body just can’t cool down. Heat stroke can cause death or permanent disability if emergency treatment is not provided. Call 911 right away if you are worried you have heat stroke.

Signs of heat stroke include:

  • An extremely high body temperature (above 103°F, different than temp from fever)
  • Red, hot, and dry skin (no sweating)
  • Rapid, strong pulse
  • Throbbing headache
  • Dizziness
  • Nausea
  • Confusion
  • Unconsciousness (passing out)

Heat stroke is an emergency. Call 911 right away for medical assistance if you suspect heat stroke. While you wait for help, the CDC recommends these steps to cool the victim 

  • Get the victim to a shady area
  • Cool the victim rapidly, using whatever methods you can. For example, immerse them in a tub of cool water, place them in a cool shower, spray them with cool water from a garden hose, sponge them with cool water, or if the humidity is low, wrap them in a cool, wet sheet and fan them vigorously.
  • Monitor body temperature and continue cooling efforts until the body temperature drops to 101-102°F
  • If emergency medical personnel are delayed, call the hospital emergency room for further instructions
  • Do not give the victim anything to drink 

Stay safe in the sun!

Make a plan for the day and set timers for taking breaks from the sun, rehydrating and putting on sunscreen. It’s easy to forget (or put off) these things but easier with a reminder in place. Many of us love the hot weather, but your body will need to be able to cool off especially in extreme or prolonged heat. Never leave a child or elderly person in a hot car and don’t forget to check on your neighbors when the weather is very hot. And remember, Nurse-1-1 is always here to help. Chat with us about your symptoms, and tag us in your summer fun in the sun! We love to know what our friends are up to!

Kim Liner, PNP

Nurse-1-1 Chief Nurse Practitioner

The opinions expressed in Nurse-1-1 Health Center Blogs are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Bike safety and signs of head injury

The nice weather is here and we are all trying to get outside. Bike riding is a common activity for all ages. You should never ride a bike without a helmet. People of all ages should be wearing helmets and we should protect ourselves as best we can. It is important to review bike safety recommendations and rules of the road before hitting the pavement.

When you ride a bike, it is often at a high speed or on the road near fast moving cars. Simply going down a small hill may seem like no big deal until you hit a rock and are catapulted over your bike handlebars head first into the concrete. Even a slow moving car can cause major damage to a bike and send you flying. Most bicycle accidents occur between a motor vehicle and a bike. The vehicle will always be ok—according to a NYC study, 100% of car operators are just fine. Your head will take the impact and a helmet can take on some of this impact before it gets to your skull, which can help diminish the injury to your brain, head and neck.

An article by US News reports that only 1 in 10 children and teens who suffered head and neck injuries from cycling crashes said they wore a helmet, and only 1 in 5 for adults. Head injuries increase with the good weather as people are out and about in the summer. One third of non-fatal bike injuries are to the head, and brain injuries account for 80,000 emergency room visits annually, according to the National Safety Council.

What’s in a bike helmet?

First off, make sure you are always wearing a helmet when you ride a bike. More than half of bikers in fatal accidents in a 2016 study were reported not wearing helmets. The helmet can’t help if you aren’t wearing one! Wearing a helmet properly is just as important. A good fit will help to protect your brain so lets be sure your helmet fits!  

  1. Make sure that you have a helmet appropriate for your head size. Not all companies are the same, so measure your head and make sure to read the size requirements. You also want to try on the helmet for a comfortable fit. Most are adjustable to provide a nice snug fit.  
  2. Check to be sure that the helmet sits low on your forehead. You can check by measuring about 2 finger widths above your eyebrows.
  3. Adjust the side straps to form a “V” shape that sits below and just forward of the ears. Lock the straps in place in this position.
  4. Adjust the chin buckle so that it is under your chin.
  5. Buckle the chin strap and be sure that there is not more than 2 fingers of space between your chin and the buckle.
  6. Finally, check the helmet! It shouldn’t rock or slide around. If it does, go back and readjust!

How to avoid a bike crash

Avoiding crashes in general is the goal here but we know that is not always possible. There are, however, some steps you can take to help avoid a crash. Both common falls and more serious crashes with motor vehicles can cause damage to your body, brain injuries, or death. The National Highway, Traffic and Safety Association (NHTSA) reports that regardless of the season, bicyclist deaths occurred most often between 6 p.m. and 9 p.m and are 8 times more likely in men than women. So men, take note of these bike safety tips! They recommend the following steps to prepare yourself for a safer ride:

  • Ride a bike that fits you—if it’s too big, it’s harder to control the bike.
  • Ride a bike that works—it really doesn’t matter how well you ride if the brakes don’t work.
  • Wear equipment to protect you and make you more visible to others, like a bike helmet, bright clothing (during the day), reflective gear, and a white front light and red rear light and reflectors on your bike (at night, or when visibility is poor).
  • Ride one per seat, with both hands on the handlebars, unless signaling a turn.
  • Carry all items in a backpack or strapped to the back of the bike.
  • Tuck and tie your shoe laces and pant legs so they don’t get caught in your bike chain.
  • Plan your route—if riding like a vehicle on the road, choose routes with less traffic and slower speeds. Your safest route may be away from traffic altogether, in a bike lane or on a bike path.

 Be alert and follow the rules of the road:

  • Ride with the flow, in the same direction as traffic.
  • Obey street signs, signals, and road markings, just like a car.
  • Assume the other person doesn’t see you; look ahead for hazards or situations to avoid that may cause you to fall, like toys, pebbles, potholes, grates, train tracks.
  • No texting, listening to music or using anything that distracts you by taking your eyes and ears or your mind off the road and traffic.

What happens if I crash?

A bike crash can be non-serious and you might end up with just a few scrapes or bumps. Unfortunately, this isn’t always the case. In 2015 in the United States, the CDC reports over 1,000 bicyclists died and there were almost 467,000 bicycle-related injuries. 

If you have a more serious crash, collide with a car, hit your head, or have an injury, it is important to get checked out. Always call 911 for a serious crash. If you hit your head in your crash but it seems like you are ok, it is important to know that you could have a brain injury or concussion and may need to be seen.

Signs of a serious head injury

The first concussion symptoms we often see are headache, fatigue, irritability, memory loss and confusion. Some people will feel dizzy, dazed or overly emotional. They can experience headaches, vomiting, nausea or blurred vision. Go directly to the ER if you had a bad collision or fall, or if you are vomiting, have worsened headaches, pass out, or have a seizure. According to the CDC, you should call 911 or go to the Emergency Room with any of the following dangerous signs and symptoms of a concussion:

  • One pupil larger than the other
  • Drowsiness or inability to wake up
  • A headache that gets worse and does not go away
  • Slurred speech, weakness, numbness, or decreased coordination
  • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching)
  • Unusual behavior, increased confusion, restlessness, or agitation
  • Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously

Wear a helmet and be safe

According to a self-reported consumer survey in the Journal of Safety Research, “Despite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.” Wear that helmet and set a good example for your family and friends. A helmet can’t help if it’s not on your head! Young children look up to adults and often will model your behaviors. If they see you wearing a helmet on every bike ride, they are more likely to do the same.

If you have had a mild injury and aren’t quite sure if you should be seen, don’t hesitate to reach out to us. We hope to help make summer extra safe, so be sure to read up on our water and sun safety recommendations, too!

The opinions expressed in Nurse-1-1 Health Center Blog are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Water safety and drowning prevention

Summertime fun is here! Everyone is outside playing and hanging out and ready for a refreshing dip in the pool, pond, or ocean. Let’s make sure everyone is prepared for how to be safe in the water. Let’s talk about water safety, drowning, and non-fatal drowning (or as some used to call it, “dry drowning”). Water safety is important for adults and teens as well as little children. Reviewing water safety education is important for a safe summer for all.

The National Safety Council reports that drownings are the second most common cause of preventable deaths in children under 15 years of age, and the most common in children 2 and under. Drownings can happen quickly. Here are some water safety and drowning prevention tips.

Learning to swim should be a priority for every family

Teach your family how to swim and how to exit the pool safely with age appropriate swim lessons. Teaching basic skills such as rolling to your back, floating, and identifying exits from a pool can be the difference between life and death. Even little toddlers should know how to exit a pool. Teach them to swing a leg over the side to help them get out. This is important in case they ever fall in unnoticed. It can make a difference.

Don’t go for a dip alone unless you know how to swim. Many people will go into the ocean or jump off of the diving board into a deep pool but have no idea how to swim to the edge. If you can’t swim or aren’t a strong swimmer, don’t swim in water over your head and always wear a US Coast Guard certified life vest.

Swim where there is a lifeguard present. A lifeguard isn’t a babysitter, so don’t take your eyes off your child or use the lifeguard as a safety net if you can’t actually swim. If you are swimming alone, don’t! Even if you are a strong swimmer, please make sure to take a buddy. Keep an eye on each other. Swimming can be a very enjoyable form of fun and exercise, but it is important to do it safely.

Pay attention when children are nearby or in the water

Pay close attention to the swimmer that you are watching. Checking a text message or turning your back for just a moment can turn a fun day into a tragic one. Keep your eyes on the water and be sure that you never leave the water area for any reason without taking your gang with you. 

Teach children to ask before going into the water so that a responsible adult is always aware when they want to swim. Also, never ask another child to watch your kiddos in the pool! Be sure there is an adult present at all times. A responsible adult should be within arms length of any child under five years old at all times.

Boating, currents, and open water safety

Open water safety is very important for all ages, as well. Always wear a life vest while doing any kind of boating, kayaking or water activity. A life vest can save you if you were to ever slip, hit your head, and fall into the water. Be sure to avoid alcohol and drugs when driving any type of boat.  

Do remember that oceans and lakes can have dangerous currents. Pay attention to how deep the water is where you are swimming, where the shore is, and where lifeguard stations are located. If you get stuck in a current, the best way to get out is to swim with the current and aim towards the shore while yelling and/or waving for help.  

In oceans, ponds and shallow pools, always jump in feet first as there is a risk of spinal cord injury (breaking your neck or back) if diving into water. If you can’t see the bottom clearly, it is hard to know if there is a rock or sandbar there. Sand can shift and a deep section on one jump may be shallow on your next jump, as the tides can change things quickly. Many accidents happen when people dive off boats and into an unknown sandbar or rock. Hitting your head can knock you unconscious, causing you to be unable to swim and leading to drowning. The impact can also cause a severe neck injury, resulting in a broken neck that can cause paralysis of some or all of your body, and in some cases, the inability to breathe.

Make a plan for who is watching the kids

Never assume that someone else is watching your child in the water. Just because your partner or friend is with you doesn’t mean they are watching your child. Make a clear plan on who is watching the child at any given moment. Some people call this person the “water watcher.” Print a water watcher card and pass it every 15 minutes if there are lots of children swimming. This designates the responsible watcher. Oftentimes when there are lots of adults around, that is when bad things happen. Everyone assumes that someone else is watching the kids. People get distracted. Be extra sure to keep your kiddos safe by putting life jackets on them especially at a gathering, and be sure to plan who is in charge of watching the kids.  

If you have a pool or hot tub, make sure there is a barrier or fence to keep the kids out. Most drownings in children under four years old occur in home swimming pools, according to healthy children.org. Keeping the pool secure and locked up when there is no adult around is so important. Pool covers should be tight so that no child can squeeze through the edge, and strong enough to hold a child that could run out onto the cover. Ladders should stay locked and inaccessible to children when there is no supervision. Water safety takes a village. Make a plan with your family, neighbors and friends. 

Know what to do in an emergency

If a child goes missing, check the water FIRST. Seconds count in a drowning, so be sure they are not in the water! If you have a pool, take a CPR course so that you can start CPR right away if needed. Keep a cell phone near the water so that you can call 911 in an emergency. 

Don’t hesitate to call 911 and have a child evaluated if they have been found underwater, hit their head in the water, are choking on water, have turned blue or appear in any distress. If you suspect that someone hit their head but they are still able to breathe, try to keep their head and neck still while you wait for the ambulance to arrive. 

What is dry drowning or non-fatal drowning?

There are two types of drowning: fatal and non-fatal drowning. Fatal drownings result in the person dying from lack of oxygen while underwater. Non-fatal drownings occur when the child has an incident where they are submerged or immersed but are rescued. Even children that have had a non-fatal drowning episode are at risk. This used to be more commonly called “dry drowning”. 

Symptoms of drowning most commonly appear immediately, but infrequently can develop subtly between 4 and 6 hours after the incident. Symptoms can range from persistent to worsening cough, tachypnea (fast heartbeat), vomiting, and mental status changes (acting differently or off). If, after a brief immersion event, children are persistently symptomatic or the parent is worried, they should be taken to the nearest emergency department for assessment. They should receive a complete examination and have their oxygen saturation checked. If symptoms go away completely, oxygenation is normal, and the child is doing well 6 to 8 hours after the incident, they can be safely discharged home with adequate follow-up care.

Symptoms to look out for when swimming that could indicate a near drowning event are: turning blue, trouble breathing or speaking, coughing, choking, pain in the chest and/or sleepiness after the event. If you notice your child struggling to breathe, their ribs popping out with breathing, color changes, they seem limp (like a wet noodle), or seem to be out of it, don’t wait, call 911 or have them checked out right away.

The CDC reports that ten people die from unintentional drowning every day. Be prepared. Know where the lifeguard is and don’t hesitate to call for help. Seconds count. If your child has been underwater for a prolonged period of time or if you are worried that someone may be drowning or appears to be missing, call 911 right away.

Enjoying summer should be safe and fun. You can always check in and chat with our nurses about your summer concerns or check out our blog on common summer issues like tick bites and sun safety to name a few.

The opinions expressed in Nurse-1-1 Health Center Blog are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Summertime and sun safety

It’s summertime and the sun is blazing.  Let’s talk about how to protect your skin from the summer sun.  According to the American Academy of Dermatology, 1 in 5 adults in the US will develop skin cancer, making it the most common type of cancer. They state that “Even one blistering sunburn during childhood or adolescence can nearly double a person’s chance of developing melanoma.”  The importance of sun safety is critical and should be considered from an early age and continue through adulthood.  There are a number of ways you can keep safe and still enjoy the sun. 

How can I limit sun exposure?

Blocking the sun prevents exposure to harmful UV rays.  Make sure you have a thoughtful plan for prolonged sun exposure.  Limiting time in the sun is the best way to avoid harmful rays.  The sun is strongest during the hours of 10am and 4pm. During these hours, limit direct sunlight exposure by seeking shade. Remember, you can get a sunburn and expose yourself to harmful rays even on a cloudy day.  Keep that in mind as you head out!

There are a number of tools we recommend to help you block the sun:

    1. Broad brimmed hats: There are really nice hats that use UV blocking material for both children and adults that will protect not only the sensitive top of your head and ears, but also your eyes, face and shoulders.  Look for a nice wide hat for optimal coverage.  
    2. Sun shirts:  Protective clothing is another great way to block UV rays.  There are lots of nice options available for babies, children and both men and women.  Long sleeved sun shirts provide nice coverage to the high sun areas on your shoulders, back and arms and allow you to feel cool and comfortable in the summer heat.  They dry quickly and make summer sun fun, easy and breezy!  Regular clothing provides some coverage, but you can get sun damage through your regular clothes, which is more likely with prolonged sun exposure. 
    3. Umbrellas and pop-up tents:  These come with UV protection, as well.  They can be found at your local grocery store as well as most sports stores and baby gear shops.  They help adults and kiddos catch some shade at the beach or an outdoor event where they may otherwise be stuck under the blazing sun.  These tents and umbrellas can adjust with the sun as it moves across the sky and provide continued protection while you are outside and unable to find natural shade.  Stroller shades can be adjusted to keep those babes out of direct sun, too!
    4. Sunglasses:  Don’t forget those eyes!  Wearing sunglasses provides protection to not only your eyelids, but your eyeballs, too. Protect those corneas, lenses and other sensitive parts.  Using sunglasses with both UVA and UVB protection is key not only to skin, but eyes too.

Sunscreen usage for babies, children, and adults

Sunscreen use is a common concern for children and babies.  When can you use sunscreen on your baby? There are so many options!  Parents of winter and spring babies are ready to roll outside when summer hits and oftentimes are unsure about slathering sunscreen all over that sensitive baby skin. 

According to American Academy of Pediatrics (AAP), if you can avoid using sunscreen until your baby is 6 months of age, this is ideal.  It is best to use sun shirts, wide brimmed hats and be sure to keep your baby out of direct sunlight, especially under 6 months of age.  If you absolutely cannot, it is advised to use sunscreen sparingly on the face and exposed skin until they are over 6 months old when it is considered safe to use sunscreen.  The best choice for babies and all children in general is to keep them in a shaded area and avoid harsh sun exposure. 

Once your child is moving and grooving, it is going to be a challenge to keep them safe from the sun’s rays.  They are wiggly and picky, and usually slimy sunscreen isn’t on their agenda.  The best option for applying sunscreen is at home, before you head out into the sun.  Sunscreen works best if applied 30 min before sun exposure.  This also eliminates trying to slather lotion on a sandy or already wet child who wants to run and play!

AAP recommends looking for the words “broad-spectrum” on the sunscreen label in order to have protection against both ultraviolet B (UVB) and ultraviolet A (UVA) rays.  Using a zinc based cream on the face, ears, nose, cheeks and shoulders can provide extra protection for high sun-exposed areas.  We will talk more about these different types of sunscreens, as they can be confusing!

The best, most consistent coverage will come from a water-resistant sunscreen.  Regardless of which type you use, be sure to reapply at least every two hours, or after swimming, sweating or towel drying. No sunscreen is waterproof, and will need to be reapplied often, based on your activities and sun exposure.  

For adults, choosing a daily moisturizer with SPF is a nice easy way to get some coverage on your face, ears and neck regularly.  You can then add additional sunscreen and protection with prolonged sun exposure.  

What kind of sunscreen should I buy?

The most important thing to remember is to sunscreen yourself and your child.  A common question is which sunscreen has the least amount of chemicals or works the best.  The FDA has proposed that sunscreen becomes more regulated so that consumers are ensured that they are both safe and effective.  It is important to read the ingredients and see what works best for you.  There are two basic types of sunscreen based on ingredients and how they protect the skin: chemical sunscreen and physical sunscreen.  

  1. Chemical sunscreen absorbs the sun’s rays and may contain one or more of many possible active ingredients, including oxybenzone, octinoxate, octisalate, octocrylene, homosalate and avobenzone.  This type is usually easier to rub in and doesn’t leave a thick film but can be more irritating.  
  2. Physical sunscreen acts by deflecting or blocking the sun’s rays, and includes active ingredients titanium dioxide and/or zinc oxide. This type of sunscreen is usually best for those with sensitive skin, but doesn’t rub in well.  It commonly leaves a white film, but you can find more clear options these days, as it has become a more popular product.

There are ongoing studies to determine if the chemicals in sunscreen are harmful.  What we do know is that some studies have shown these chemicals get into the bloodstream because they are absorbed into the skin.  More studies need to be done to determine how safe it is to have detectable levels of these chemicals in your body. 

Some of the more common chemicals in question are currently being studied.  In 2019, the FDA concluded that the risks of using aminobenzoic acid, or PABA, and trolamine salicylate outweigh their benefits, and it proposed classifying them as unsafe.  What we do know is that two ingredients, zinc oxide and titanium dioxide, are recognized by the FDA as safe and effective.

How do I find the right sunscreen for my family?

There are many options for sunscreen choices and there are lots of opinions on which ones are best.  The best is to be sure to use a sunscreen that is at least 15+ SPF (30+ is best) and keep in consideration that your child may have sensitive skin so it may take a few tries to find the right sun care regimen for you.  The AAP recommends about 1 oz of sunscreen per application per child, which can add up quickly. 

Once you find a sunscreen you love, make sure you have some with you whenever you leave the house as you may need to slather up on the go.  Keep in mind that leaving sunscreen in a hot car can decrease its effectiveness, so try and keep it in a travel bag that comes inside with you and isn’t left out in the sun all day.  

If you are looking for some sunscreen options that work well and have low amounts of chemicals, you can check out EWG (Environmental Working Group), who reports on different products with reviews, so you can make the best choice for you and your family.  

The Nurse-1-1 team has a few family favorites that we are happy to share (with no affiliation!)  Since we know that zinc oxide and titanium dioxide are reported as safe, we have stuck to these options:

  • Nurse Kim has found Think Baby products work really well for the kiddos.  They are also rated as one of the cleanest products by EWG.  We especially love the face stick for easy application to those sensitive areas of the face, hair part, ears and chest. 
  • Badger products are a close second for Nurse Kim’s fam. Their product is a little thicker but works just as great and is just as clean. Sunbum is a newer find and we’ve found the face stick to work great! 
  • Nurse-1-1 CEO Mike Sheeley’s family loves Blue Lizard sensitive SPF 30+ for the kiddos and Vanicream for Mom, both rated highly on the EWG rating for clean products.
  • The Nurse-1-1 Dads prefer spray sunscreen with no brand preference.  We have to agree with the Dads that something is better than nothing. The most important thing is to avoid a sunburn!
  • Dr. Igor loves to supplement his sunscreen use with a Sundaily skincare gummy, which is thought to decrease sun damage with plant-based antioxidants.
  • Marketing Director Bailey sticks to the clean products at BeautyCounter and loves their Countersun Mineral Sunscreen Lotion SPF 30 (they also have daily moisturizer and mist versions available).

We would love to hear which sunscreens you love!  Drop us a comment on our Instagram. 

Sunburns and skin damage – when should I get checked out?

It is important to try and avoid getting a sunburn in general.  Even a mild burn is an indicator that you have sun damage.  The more often you burn, the greater the risk for skin cancer.  All skin types and colors are at risk for skin cancer with prolonged sun exposure and sun damage. Skin damage can occur over time to everyone, even without a sunburn so it is very important to keep sun safety on our minds all year round.  

Any blistering rash or burn should be checked out, especially if it covers more than 20% of your body.  If you aren’t sure, call your primary care provider.  Also, if you have a sunburn along with a fever, chills, severe pain, extreme thirst, dry mouth, dizziness, decreased urination, or fatigue, you should be seen right away. Heat stroke and heat exhaustion are preventable heat-related illnesses. They can occur quickly in the heat even without a sunburn. Learn more about avoiding heat exhaustion and heat stroke. Remember, you can always ask a nurse first if you are unsure!

Skin cancer warning signs include changes in size, shape or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal.  If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, it is important that you make an appointment with a board-certified dermatologist.  If you are unsure, we are here to help determine what your next steps should be.

The opinions expressed in Nurse-1-1 Health Center Blogs are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Understanding racial health disparities in America

Nurse-1-1 was founded to increase access to affordable and compassionate healthcare for everyone. Significant racial health disparities exist in our country, particularly for the Black population, and our goal is to decrease these disparities by providing a digital connection to a trusted nurse, whenever, wherever, and for whoever you are. This problem is big and complicated, as exemplified by the fact that Black Americans’ “mortality rates are about 20% higher than those of Whites, resulting in a 4-year lower life expectancy”. Nurse-1-1 hopes to be a part of the solution addressing this public health crisis.

Healthcare innovation often focuses on the well resourced patient rather than the marginalized one. We want Nurse-1-1 to be different. In order to reach underserved patients, we made the decision to provide our digital triage platform for free to Federally Qualified Healthcare Centers. We also help hundreds of uninsured patients a month, keeping many out of the ER and an associated $2,000 bill. We know it will take a village to bridge the enormous gaps in health outcomes that exist across our country, but we all have to start somewhere. It is important to acknowledge there are gaps in healthcare based on race and ethnicity, socioeconomic status, geographic location, disability, and sexual orientation. These gaps aren’t an easy fix and will require change in the way we care for others, not only in healthcare but in all aspects of life.

Here we are in 2020 and we are still fighting for equal treatment and opportunities for all. Nutritious food for all. Clean water for all. Jobs for all. These disparities have been made even clearer as COVID-19 has changed how we approach and access healthcare. We know that a person’s health isn’t just measured by disease—there are many factors to health, such as access to:

  • High-quality education
  • Nutritious food
  • Decent and safe housing
  • Affordable, reliable public transportation
  • Culturally sensitive health care providers
  • Health insurance
  • Clean water and non-polluted air

Disease may be visible and immediate while these other factors have a slower, longer-term impact on a person’s health. But that doesn’t mean they aren’t just as important to a person’s wellbeing. For example, families living in food deserts may be forced to eat more processed, unhealthy foods, leading to higher rates of diabetes, high blood pressure, and heart disease. 

The trickle down effect on health starts with a secure, well-paying job

The COVID-19 shutdown took on an entirely different meaning for those who lost their job and couldn’t provide food for their family. Rates of COVID-19 infections are higher in poorer communities, mimicking healthcare trends generally seen in patients living in poverty. Crowded living spaces due to inadequate affordable housing, inability to afford and access healthy food, and subpar access to healthcare are just a few factors that stem from not having a consistent, well-paying job. These factors increase the risk of contracting an infectious disease such as coronavirus and then exacerbate the associated mortality rates when you avoid healthcare given the associated out-of-pocket costs. 

Chronic conditions more commonly associated with poverty – diabetes, obesity, and heart disease – also are a setup for increased chances of dying from COVID-19. To put it simply, living in poverty worsens your health for many reasons, especially during this pandemic. 

According to the CDC, nearly 25% of employed Hispanic and Black workers are employed in service industry jobs compared to 16% of non-Hispanic Whites. As the pandemic began, this employment sector took the biggest hit, leaving many people of color unemployed at higher rates than their White counterparts. Even pre-COVID, unemployment rates for these segments of the population were not equal. According to the US Joint Economic Committee, historically, the unemployment rate for Black Americans has been approximately twice the rate for White Americans. In 2020, pre-COVID, this continues to be the case: 6.0% for Black workers and only 3.1% for White workers. The trickle down effect on health starts with a secure job. 

It is also quite easy to fall into poverty once unemployed if you lack financial reserves or family members who have the ability to support you. In Boston, for example, the median net worth of non-immigrant African Americans is $8, while it’s $247,500 for Whites. Unfortunately, this enormous disparity did not happen by accident, and instead stems from systemic racial injustices causing immeasurable consequences to the Black community. Whether it be atrocities such as the massacre of Black Wall Street or keeping minority populations from purchasing real estate in desirable areas through redlining, systemic racism has continually prevented wealth accumulation for Black communities

You can’t have good health without proper housing, access to food and health insurance, and a good, stable job.

You can’t talk about health without talking about race

We know that a person’s race contributes significantly to their health. According to US News and World Report, Black Americans are sicker and die younger than their White American counterparts, even when education and income factors are controlled for. This also extends to Black children, who have a 500 percent higher death rate from asthma compared to White children. 

The Journal of Perinatal Education reports that Black women are 2-6 times more likely to die from complications of pregnancy than White women, depending on where they live. Expressed differently, Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan. Read that twice. 

These poor health findings are not just simply explained by genetics or poverty. We are seeing that persistent discrimination and racism directly impact these disturbing statistics.

COVID-19 exacerbates health disparities for Black communities

According to a recently published article titled COVID-19 and African Americans, Black populations in major metropolitan areas are seeing disproportionately higher rates of COVID-19 cases and deaths. This includes cities like Chicago and states such as Louisiana, Michigan, and New York. They also report that the COVID-19 infection rate in predominantly Black counties in the US is more than 3-fold higher than that in predominantly White counties, and the death rate 6-fold higher. These figures should be terrifying, but may not be that surprising given what we have reviewed thus far. COVID-19 has highlighted the longstanding divide in health between White and non-White Americans. The ability to telecommute and social distance from clean and affordable housing is a privilege that fewer people of color have, thereby resulting in higher infection rates among a community already plagued with higher chronic health conditions.

How racism worsens health outcomes directly

Poor health outcomes in the Black community are shocking. There is no easy way to fix this, especially since the cumulative effect of many years of unjust treatment based on skin color is one of the main contributors to poor health. New research is showing that common, repeated exposure to stress in the form of racism and discrimination causes increased health problems in the Black community. The American Journal of Men’s Health reports the main psychosocial stressors linked to poor health outcomes for Black men include: (a) negative, narrow stereotypes of Black males; (b) interpersonal and structural discrimination; (c) disproportionate poverty, unemployment, and underemployment; (d) residential segregation in investment-poor, underserved, and decaying neighborhoods; (e) inadequate health care; (f) negative interactions with the criminal justice system; and (g) barriers to fulfilling valued masculine roles. Stress in the body can be measured by certain hormones, specifically cortisol levels and patterns. In this same report, it was shown that Black men have cortisol trends that are correlated with poor physical and mental health outcomes as well as an increase in mortality rates as compared to the cortisol levels in those of White men. The American Psychological Association reports that Black adults are more likely to have feelings of sadness, hopelessness and worthlessness than are White adults. Somehow, Black women have increased rates of mortality during childbirth even when health, income and education levels are controlled for. Years of systemic discrimination, everyday racism, and microaggressions continue to increase stress in the Black community, thereby leading to poorer health outcomes.

Improving patient care for Black Americans

Lastly, when we are considering poorer health outcomes for Black Americans, we also have to consider implicit bias and outright racism in healthcare. We’ve seen it throughout history, and we certainly see it today with COVID-19.⁣ A 2012 report found the Black community receiving lower quality of care 43% of the time in measures ranging from quality of annual exams to life threatening treatments for disease. In this particular study, all participants, White and Black, were of the same socioeconomic status with equivalent insurance. Color of skin was the main contributing reason for poor care, and it is thought that racial bias among providers was the contributing factor. 

New statistics coming out during the pandemic show one is less likely to get tested for COVID-19 if they are Black. Check the news and you will see numerous stories of Black men and women dying from COVID-19 without receiving the necessary support or treatment, possibly due to implicit bias

Instead of 2020 being labeled as the year that COVID-19 shut us down, let’s try and make 2020 the year of change, the year that racial bias and injustice ends and health improves for all Americans, regardless of race and ethnicity, socioeconomic status, geographic location, disability, and/or sexual orientation.

The opinions expressed in Nurse-1-1 Health Center Blog are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Anxiety During COVID-19

Article Disclaimer 

This article is aimed at giving you and your family some helpful tidbits on how to stay mentally and physically fit during this pandemic. This is just helpful information. This is not medical advice. If your stress, anxiety, or mental health is concerning you, or becoming difficult to live with, please speak with a licensed medical professional.

Anxiety During COVID-19

The word “anxiety” has a whole new meaning in 2020. COVID-19 has changed how we think, act, and feel.  We need to learn how to live in this new world and accept our new normal.  But, let’s be honest, we don’t have answers yet and nobody really knows what next week will bring. COVID-19, or coronavirus, has really thrown us for a loop.  We are now worried that one breath or cough in the wrong direction can land our parents, family, friends, patients, or loved ones in the hospital.  Transitioning back to our old ways is uncharted waters with new normals and new fears. We just have to do our best with what we know. Remember, you aren’t alone.

How can I decrease COVID-19 (and COVID stress) in my home?

When you feel out of control about something, one of the best ways to cope is to figure out what can be done, and understand what you can’t control.  In this case, with the COVID-19 pandemic, there may be many unknowns, but there are also many knowns.

According to the CDC, COVID-19 is primarily spread from person to person, through a few ways:

  1. You can become infected by coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. 
  2. You can become infected from respiratory droplets when an infected person coughs, sneezes, or talks near you. 
  3. You may also be able to get it by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes.

Remember, the virus may spread by people who do not even know they have COVID-19 (i.e. they have no symptoms). 

So the good news: we know how to best prevent getting the virus. We can control our behavior in our own home and when we are out in public by following some basic rules of thumb.  We can ease our worried minds by continuing to follow social distancing, staying away from others when possible, wearing masks in public places, washing our hands frequently, and avoiding touching our faces. These are some of the best ways to decrease the spread of this virus. 

Worrying about the symptoms of COVID-19

Patients with COVID-19 can exhibit many different symptoms, often  not consistent or specific, which can make this seem even more stressful.  Symptoms vary and can include cough, runny nose, chest pain, shortness of breath, vomiting, chills and aches. Sometimes, people with the virus show no symptoms at all. Often times, people convince themselves that they have any of these symptoms. Add in the new symptoms children are experiencing, such as fevers, rashes, diarrhea and more, and you could self-diagnose anyone in your house with COVID-19.  

This is going to be hard.  We will worry.  The news is full of new symptoms to watch out for and fear levels are high.  Worrying is inevitable but the important part is that you are able to take care of yourself and family. If you feel you’re unable to do that, let’s go over what you should do.

What kind of stress are you having?

Ask yourself or a loved one if they feel you are able to carry on with your daily activities.  If you are finding your stress is preventing you from getting work done, caring for yourself or loved ones, or keeping you from completing your usual tasks and routines, then please don’t delay care.  It is important to talk to a trained professional such as your primary care provider, a therapist or licensed mental health provider so that you can stay healthy.  It’s possible that you need some regular therapy sessions or medication to help you get through these times.  It’s ok!  If you are feeling this way, contact your healthcare provider now.

According to the WHO, one in four people in the world will be affected by mental or neurological disorders at some point in their lives.  The American Psychological Association found in a poll from 2004 (well before COVID and increase in telemedicine) that 48 percent of those polled reported a visit to a mental health professional by someone in their household during the year.  Now with mental health providers doing telehealth visits and people with all time high stress levels, this number is likely to be much higher.  Video visits are much more accessible and you can access this care quickly from the comforts of home.  We can help you find a telehealth visit now.

What can you change?

If you feel like you are doing ok, just more overwhelmed here and there throughout your day, you may be able to eliminate some stressors by limiting your triggers.  For example, if 5pm usually brings a mix of stress—scary news on the TV, kids getting hangry, increase in the phone ringing—consider eliminating what you can control such as turning off the TV and maybe, just maybe, silencing your phone.  

Think about what helps and what doesn’t and try and put some protective measures in place to cushion the stressors from directly reaching you.  Be in charge of some of what stresses you out.  We all know you can’t manage every stressor, but we can limit some of them.  

A little bit of self care goes a long way

We recommend setting aside some time for yourself each day. Here are a few ideas to get you started:

  1. Journal or doodle to relieve stress.
  2. Try a free online yoga class, or go for a brisk walk to clear your head.
  3. Try meditation.  Think happy thoughts.  
  4. Take a cold shower. Cold water can release endorphins!
  5. Send kind handwritten notes or texts.  
  6. Donate to a charity.  
  7. Color some inspirational sidewalk chalk messages. 
  8. Offer to pick up an elderly neighbor’s groceries.  
  9. Schedule some time to connect with a friend if you’re feeling lonely.
  10. Go outside and clip a few flowers from your yard or some wildflowers from the edge of the road.

Do what makes you feel good. Small amounts of self care will go a long way!  

Take care of your medical needs

Don’t put off your regular visits to take care of any chronic illnesses or new symptoms.  We don’t want to see otherwise preventable and treatable issues causing long-term health effects for those that are too afraid to seek care. Call your provider and start with a telehealth visit when possible.   

Stress can make things worse

Keep in mind that stress can make your symptoms, aches and pains, and health issues seem worse.  It can make you tired, wear you out and shorten your ability to cope.  Chat with Nurse-1-1 if you are having symptoms you want to discuss, and we can help you find a mental health professional if you are worried your stress is interfering with everyday life.  Sometimes, all it takes to relieve stress is chatting with someone who is compassionate, knowledgeable about your concerns, and can help point you in the right direction when you need additional care.  Our nurses are all of the above!  

Remember, if you or a loved one has thoughts of self-harm, please call the suicide prevention hotline at 1-800-273-8255, or seek emergency care by calling 911. Mental health is a serious topic, so please take the necessary precautions to keep you and your loved ones safe. 

Kim Liner, PNP

Nurse-1-1 Chief NP

The opinions expressed in Nurse-1-1 Health Center Blog are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

Snoring and sleep apnea: what you need to know

How often have you been startled awake at night by your partner snoring away? Have you ever shook your partner, gave them a little kick to stop the snoring or a nudge to see if they were still breathing? If this is you, your partner may have sleep apnea.  

What exactly is sleep apnea?

First off, sleep apnea is a medical condition that needs attention. It is a sleep disorder that causes you to temporarily have periods of involuntary breath holding, and is characterized by loud snoring and episodes of observed pauses in breathing. Now, not everyone who snores has sleep apnea, so don’t panic. Sleep apnea is, however, the cause of serious sleep disruptions and can lead to other health problems. According to sleephealth.org, one in five adults suffers from sleep apnea in the US. Sleep apnea not only causes daytime fatigue and mood swings, but can also lead to more serious issues such as heart disease, diabetes, stroke and cognitive disorders. 

Types of sleep apnea

There are a few types of sleep apnea. Obstructive Sleep Apnea and Central Sleep Apnea are the most common types. Remember, sleep apnea isn’t just snoring. We can help you to determine if you need to be checked out.

Obstructive Sleep Apnea occurs when the muscles in the back of your mouth relax while you are asleep and block your airway. When this happens, your body automatically wakes you up and signals your body to take a big breath, often resulting in a gasp for air. This can occur over and over throughout the night (from a few times to hundreds of times!!) but most people don’t realize it’s actually happening.

Central Sleep Apnea is less common and occurs when your body forgets to signal you to breathe while you sleep. You awaken as you catch your breath.

Both of these types of sleep apnea cause sleep disruption and prevent you from falling into a restful phase of sleep. Your provider can rule out more serious causes and help determine which type you may have.  

What are the symptoms of sleep apnea?

The most common symptoms of sleep apnea are snoring, waking at night, gasping for air, and apnic episodes (periodic stopped breathing). People with sleep apnea often wake up tired, with headaches, poor concentration, daytime fatigue, poor memory and dry mouth. If your partner is noticing that you are gasping for air at night and/or snoring loudly, you should get checked out for sleep apnea.  If you are waking up at night to the jabs of your partner, ask them, am I snoring loudly? Does it seem like I am not breathing normally?  If the answer is yes, it may be worth getting a sleep evaluation.

How do I know if I need treatment?

If you are experiencing symptoms of sleep apnea, it is important to get evaluated. Your provider will determine if there are other causes for your symptoms and order a sleep study if appropriate. Sleep study?? Sounds awful! Don’t fret! 

Sleep studies can now often be done from the comfort of your home (we know that people don’t sleep well in labs!) According to National Heart, Blood and Lung Institute, testing can:

  • Detect apnea events (when your breathing stops or slows during sleep–think breath holding)
  • Detect low or high levels of activity in the muscles that control breathing
  • Monitor blood oxygen levels during sleep
  • Monitor brain and heart activity during sleep

Once you have this data, you will know how severe your sleep apnea is and what treatment you may need.

Is there a treatment for sleep apnea?

The answer to this question is yes! There is treatment and hope that everyone will sleep soundly in their rooms with a little help! The most common treatment for sleep apnea is a Continuous Positive Airway Pressure (CPAP) machine. This machine does exactly what the name says: it gives continuous air pressure to keep your airway open while you sleep. Your provider will determine what pressure you need based on your testing results. They can also help tailor the air flow to allow for the most natural sleep possible while preventing you from having episodes of apnea. 

There are different mask types that administer the flow of air and in most cases, the mask can be worn over just the nose or both the nose and mouth based on your preference for comfort. The goal is that the patient uses the CPAP machine nightly by making it as comfortable as possible while providing the appropriate amount of air flow to best treat your sleep apnea. The machine has become more discrete over the years, making it a very user friendly option. Your provider will recommend settings for your machine based on your specific needs and you should not adjust your recommended settings without medical guidance.

Can I fix my sleep apnea without a machine?

In some cases, a healthy lifestyle can improve symptoms. Things like diet, exercise and weight loss can improve symptoms, especially in obese patients. Stopping smoking and eliminating alcohol before bedtime can also help decrease symptoms. People can decrease risks for many chronic illnesses like sleep apnea by adopting a healthy lifestyle in general.  

Some more invasive options for treatment include surgery, mouth pieces, and in very rare cases when nothing else works and there is risk to the patient, permanent devices in the body.

Can untreated sleep apnea really cause me to have other health problems?

Yes. Untreated sleep apnea can lead to other chronic health conditions. It is important that you take care of your sleep so that you can decrease this risk. Treating sleep apnea is similar to seeking care for any other medical condition, so don’t hesitate. Correcting sleep apnea can improve mood and concentration, reduce blood sugar levels, and decrease risk for stroke and heart attacks, according to John Hopkins Medicine. Treating this medical condition is important to achieve optimal health. Poor sleep, fatigue, and prolonged breath holding results in low oxygen, and can strain other parts of the body such as the heart and lungs. It is important to include sleep health in your plan for a healthy lifestyle. 

Harvard Medical School reports “The sleep disorder is found in 47% to 83% of people with cardiovascular disease, 35% of people with high blood pressure, and 12% to 53% of people with heart failure, atrial fibrillation (a heart rhythm abnormality), and stroke. Researchers estimate that untreated sleep apnea may raise the risk of dying from heart disease by up to five times.” These serious health issues can be decreased with sleep improvements and treatment of sleep apnea.  

Talk to a healthcare provider about your concerns about sleep apnea

Talk to a nurse first or contact your primary care provider if you have one. Snoring, waking at night and poor sleep will not only cause health issues, but also make you moody and tired. If you think that you should get checked, you probably should! Your partner, your pillow and loved ones will thank you!

Kim Liner, PNP

Nurse-1-1 Chief NP

The opinions expressed in Nurse-1-1 Health Center Blog are solely opinions of the writer. Other than information received directly by you from your personal provider, the health center blog should not be considered medical advice. Read more.

The science behind coronavirus testing

Coronavirus testing– the science

Ever been tested for the flu? If you have, you may have noticed there are two different types of tests: the quick one that comes back with an answer within minutes, and the longer one that takes 45-60 minutes. These same techniques are used for coronavirus testing, with PCR testing being the long one, and antigen testing the quick one. Then there’s antibody testing, which is used to help determine if a person has previously been infected, and in certain cases, can identify patients with current infection (see details below). 

In this article, we’re going to break down the science behind how each of these tests work—for somebody with a non-medical background, of course. Want the high-level overview on these three tests, their reliability, and how to access them? Check out our post on “Coronavirus testing: what you need to know”. If you’re looking for a more in-depth explanation, however, keep reading below.

PCR or Diagnostic testing

The PCR test takes a sample of mucus from your nose or mouth and then puts the sample through what’s called a “polymerase chain reaction” (PCR). This is a laboratory process that helps identify if any of the virus’ genetic material (think DNA) is present in the mucus. This process takes a bit longer than the antigen test (the “rapid flu” or “rapid strep” test of coronavirus) because it requires a lab technician to literally run the sample through the PCR process. In order for the test to be positive, the virus must have enough time to multiply and actually get into the mucus in your nose and throat. Said another way, the test may be negative for the first few days after you are infected. 

Antigen testing

Antigen tests identify the presence of certain proteins from the virus in upper respiratory secretions from your nose or mouth (e.g. saliva, mucus, and of course, “boogers”). It uses the same technique as the rapid strep test, which you may have previously done for yourself or your children. 

Unlike the rapid strep test, which has been around for awhile and is relatively accurate, the coronavirus antigen test is fairly new (the Food and Drug Administration only approved the first test of its kind in early May of this year) and the jury is still out on how accurate it will be. For example, the rapid flu test, which also uses this type of lab technology, isn’t as accurate as the rapid strep test. In summary, we still need to learn more about the effectiveness of this type of coronavirus testing before we can truly rely on it. 

Antibody testing

Finally, we get to antibody testing, the one that seems to be always in the news. But what is it exactly and can we trust it? Antibody testing has been around for a long time, so this method of testing is well known and tried and true. Unlike PCR and antigen testing, which looks for evidence of the virus, antibody testing is completely different and measures specific parts of your immune system. Unfortunately, this type of testing is only done with a blood specimen (ouch). 

See, whenever you get infected with a virus, your immune system says to itself, “how can I kill this virus now? How can I ensure that I’m ready to prevent it from coming back in the future?” To answer these questions, your immune system starts creating what’s called “antibodies”. 

The really cool thing is that (through a pretty complicated process that isn’t worth explaining here) your immune system makes a few different types of antibodies: an antibody for actively fighting off the infection (let’s call that Antibody A), and an antibody for after you fought off the infection to help prevent future infections (let’s call that Antibody B). Why is that cool? Well, because it makes it easy to test both types of antibodies and come up with one of the following conclusions:

  1. You have never been infected with coronavirus (you don’t have either type of antibody against coronavirus, neither A nor B)
  2. You currently have coronavirus (you only have Antibody A but not Antibody B)
  3. You had coronavirus in the past, but not now (you only have Antibody B, as Antibody A slowly went away as the infection passed)

With all that said, it is a bit unclear how effective antibody testing for coronavirus actually is at the moment. We simply don’t know if this virus will act like other viruses when it comes to the way antibody testing is looked at (as above). Early reports show that it takes several days to weeks for your body to produce the initial antibodies to coronavirus (the Antibody A type ones that come when you are actively fighting the infection). One study showed it took 12 days from the first sign of symptoms. This means antibody testing may not be great at telling us if someone has an active coronavirus infection. 

But isn’t antibody testing great at telling us if someone has had COVID-19 before and is now immune to it (i.e. they have the Antibody B type)? Well, honestly, the jury is still out on this question too. Yes, antibody testing should be pretty reliable at telling us that someone has had the infection before, but, unfortunately, there isn’t enough evidence yet to prove that having had the infection before actually protects you from future infections by a similar, yet different form of COVID-19. 

This can be complicated to think about, especially if you are worried about being sick, so feel free to leave the thinking to us! Chat with a nurse if you are unclear about what to do next. We can help! 

– Igor Shumskiy, MD