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Patients can now chat with a nurse for free to receive live, personalized healthcare guidance

Nurse-1-1 and Zocdoc have come together to help patients gain peace of mind while reducing the strain on the healthcare system during a critical time

In light of the recent spread of the novel coronavirus (COVID-19), the team at Nurse-1-1 is leveraging its existing on-demand nurse chat platform to provide every person in the United States with immediate access to a trusted nurse, regardless of their insurance status or ability to pay. This tool will allow all patients to contact a nurse digitally, remotely, and faster than trying to reach their existing provider, ultimately reducing the increasing burden on our healthcare system during this time of uncertainty.

As part of this nationwide effort, Nurse-1-1 is enabling chats – free through Zocdoc’s platform – with its network of over 750 experienced nurses, nurse practitioners, and physician assistants to support patients’ questions related to COVID-19 in addition to any other medical questions or concerns they may have. Chats are live, instant, and text and photo-based. To access the free chats, patients in the U.S. can visit and click “Chat now” to ask their personal, health-related questions. From there, they’ll get real-time support from a network of highly experienced licensed nurses, nurse practitioners, and physician assistants for free. 

“At a time when the healthcare system is increasingly strained and public health efforts are focused on mitigating community spread, we feel it is our responsibility to quickly introduce new ways to help patients digitally access care,” said Oliver Kharraz, M.D., Zocdoc founder and CEO. “By teaming up with Nurse-1-1 and their experienced network, we can help patients instantly get free guidance on their health-related questions and concerns when they need support most.”

“Nurse-1-1 is a new way of delivering personalized, secure and immediate healthcare information and guidance to worried patients,” said Michael Sheeley, co-founder and CEO of Nurse-1-1. “We are proud to partner with Zocdoc to provide free chats through their platform with our network of over 750 nurses during a time when patients and families are struggling for answers.”

In line with Nurse-1-1’s mission to provide accessible and compassionate healthcare for all, this free offering aims to help patients quickly feel more informed and assured when it comes to their healthcare concerns – regardless of whether they’re at-risk, the ‘worried well’, or in good health. It also helps reduce unnecessary visits and call volumes to healthcare providers by giving people with non-urgent cases a faster, easier way to get healthcare information and guidance remotely.

Launched from Harvard University’s Innovation Lab, Nurse-1-1 is the digital doorway to healthcare for the billions of worried patients searching for information about their health concerns every day. Its proprietary smart-routing technology connects anybody with a licensed nurse within seconds. Outside of this partnership with Zocdoc, chats are either free or cost $12.50, depending on whether the patient’s provider, insurance plan, digital health service, or any local clinic is partnered with Nurse-1-1. If those aren’t available, patients can pay $12.50 (which is less than most consultation copays) to chat with an independent nurse. Nurse chats will not result in a prescription, diagnosis, or be a replacement for visiting a provider. However, they will provide helpful guidance and follow up instructions. 

Nurse-1-1 partners with providers, health plans, and digital health services to guide patients on how best to navigate the healthcare system at a fraction of the cost of traditional nurse call centers. To learn more about how you can partner with Nurse-1-1 to provide free nurse chats to your patients or members, click here.

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About Nurse-1-1

Nurse-1-1 is an on-demand nurse chat that allows anybody to chat securely and immediately with a nurse 24/7 for healthcare information and guidance. Our mission is to provide accessible and compassionate healthcare to the billions of worried patients searching for information about their health concerns every day. With a network of over 750 highly experienced nurses, nurse practitioners, and physician assistants, we reach patients through personalized, live, text and photo-based nurse chats, providing trusted health information so they can make better decisions about where they should turn to for care. Visit for more information.

About Zocdoc

Zocdoc is the tech company at the beginning of a better healthcare experience. Each month, millions of patients use or our iOS and Android apps to find in-network neighborhood doctors, instantly book appointments online, see what other real patients have to say, get reminders for upcoming appointments and preventive checkups, fill out their paperwork online, and more. With a mission to give power to the patient, Zocdoc’s online marketplace delivers the accessible and simple experience patients expect and deserve.

Redness around the eyes

Ever wake up with redness around your eyes? Do you have a rash around your eyes? Eyelid swelling or drainage? 

Redness on the skin around the eyes can be from a multitude of things. Don’t panic. Here is what you need to know.

What causes eye redness?

First, get up, wash your face and assess the situation. Did you cry all night about your spilled milk? If the answer is yes, then the redness is likely from all of your crying. Grab a bag of peas and ice those eyeballs. 

Do you notice redness under your eyes? Dark circles? Are you super tired? Dark circles under your eyes can be from lack of sleep or rubbing your eyes from being tired. Rest those eyes and try some cool cucumbers to soothe those tired eyes!

When should I worry about redness around my eyes?

Redness around your eyes that seems more like a circle of redness can be a big deal. (Unless you dressed as a clown yesterday or your kid drew on his face with a marker, then disregard). Redness of the skin can be caused by infection. Cellulitis is an infection of the skin tissue. Periorbital cellulitis is an infection that occurs around the eye, in the tissue in the eyelids and below the eye. Usually with cellulitis, the skin feels warm (or even hot!), it can be puffy and you can experience fever and pain. You will need to be seen right away for this. Cellulitis may be accompanied by swelling of the eye or eye drainage. If you are experiencing pain with just moving the eyeball, then you need to be evaluated ASAP! Send us a photo and we can help you with your symptoms.

Redness around the eye from an eczema rash 

A rash around the eye can also be a cause of redness. Common rashes can be caused by eczema, which is dry, scaly skin that can occur on sensitive skin around the eye. Eczema can be caused by inflammation that usually occurs when something is irritating the skin (rubbing your eyes or an irritating substance or allergy). The skin around the eyes is delicate and more sensitive than other areas of the body and can become red or irritated quickly. 

Skin irritation around the eyes is common in babies and kids who rub their eyes when they are tired. I’m sure tired parents rub their eyes too, but likely not enough to cause a rash! Dry scaly skin around the eyes from eczema is usually easy to remedy. First, try not to rub and itch the eyes. You can also try applying a thin layer of Aquaphor to your itchy dry patches. Try not to glob it on too thick or you will get ointment in your eyes. A thin layer goes a long way. Following our eczema guidelines will help too, especially avoiding products that contain fragrance. 

Eye redness from an infection

Redness around the eye that is accompanied by goopy eyes can be due to germs in the eye. If you are noticing yellow goop, or your eyes are sticking together and you feel like they are about to be swollen shut (ew gross), this could be conjunctivitis. 

Now, conjunctivitis can be caused by a virus or bacteria. If it’s a virus, it will typically move from one eye to the next over about a day and then start to clear up. Usually, it’s bright red and runny. It clears as quickly as it starts. Normally if you wait 24 hours you can save yourself a visit to the office. 

If you find that you have nice pink eyes 👁, your eyelids are swollen, you have yellow drainage from one or both eyes 👀 and it lasts more than 24 hours with no end in sight, this is probably bacterial conjunctivitis and you will need antibiotic drops or ointment. Some people call this “pink eye.” 

Pink eye is easily treated with a prescription. Call for an appointment and get your infection taken care of if you think you could have bacterial conjunctivitis. This is the type of illness that can easily be treated over a video visit with a provider. If you have access to an affordable telemedicine service through your insurance or primary care provider, definitely consider it. If you have pain with these symptoms you should be seen right away as eye pain is not typical with straightforward bacterial conjunctivitis. 

Eye redness from an allergy

You can also get redness around the eye, symptoms of eye discharge and sticking together just like an infection, but instead it could be caused by an allergy. Seasonal allergies can often cause red, itchy eyes. We also call this conjunctivitis (just like the paragraph above), but this time it’s “allergic conjunctivitis”. It is caused by airborne allergens (usually the invisible kind) contacting the eyeball and causing your eyeballs to react. Allergic conjunctivitis usually consists of redness in both eyes, watery discharge, and itching (lots of itching!). Itchiness usually means it’s an allergy problem and not an infection. 

Start by avoiding rubbing the eyes, washing your eyes out with clean lukewarm water, using cool compresses, and trying artificial tears (aka visine). Try to avoid whatever you think you might be allergic to. If that doesn’t help, oftentimes trying some over the counter antihistamine remedies such as diphenhydramine (benadryl) or loratadine can help if you have allergy symptoms beyond just the eyes. You can also find over the counter antihistamine eye drops, specifically for itchy eyes, such as ketotifen. Remember to check with your doctor and pharmacist to ensure safety for any long term use! 

Eye redness prevention

Eye redness can be serious so any time you have redness accompanied by pain, fever or warmth, or it seems like you have a circle of redness, it’s important to get checked right away!

One of the biggest ways to keep your eyes healthy and germ-free is by good hand washing! 🖐🏻 Good hand washing is a great way to prevent the spread of germs. It can keep you from getting eye infections as well as introducing other germs into your body that can give you cold symptoms or the flu. Ask a nurse first, if you have concerns or want us to take a look!

Kim Liner, PNP

Nurse-1-1 Chief NP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to prevent concussions in kids?  What should parents know about screen time for toddlers? What’s the best way to approach shingles prevention in the elderly? Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Prepping the general population for COVID-19

How should I prep for the great Coronavirus of 2020, aka COVID-19?

So unless you live in complete seclusion, you are aware of the current fears and realities surrounding Coronavirus that are currently happening across the globe. A simple Sunday Funday trip to Costco this weekend proved to me that people are not following the CDC guidelines. Some people are panicking. We witnessed people in masks pushing and shoving each other to check out and a line that was snaking around the entire store. I mean who goes to Costco on a Sunday anyways?? First mistake made.

So I wanted to think about this virus and how the general population, including my own family, should prepare. Here is what we have done to get ready and what I think that you should do too.

Check your soap supply, and wash those hands!

First is the “soap check”. Make sure that you have soap next to all of your sinks—this will encourage handwashing. Seems like a no brainer, right? Just a simple task to help you feel ready. 

Next, remind your family that simply wetting their hands with a splash of water after using the bathroom or sneezing and coughing into their hands is not going to do much of anything. Handwashing success is based on the amount of time that you wash, the friction that you use and the surface of your hands that you actually wash. 

Here are the 5 steps the CDC recommends every time you wash your hands:

  1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Make sure you get the backs of your hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.

Now that you have handwashing checked off your list, let’s move onto the next.

Update your health care to the extent possible

Make sure that you are up to date on your health care. What exactly does this mean? Well for starters, have you had your annual flu shot? Have you had your physical visit this year? How about those daily medications? Do you have refills left? 

Right now, influenza is getting forgotten about. Influenza, or the flu, is still in season and deserves some continued attention. The flu is still hitting hard. If you really want to protect yourself and your family, get your flu shot. Wash your hands. Stay clear of sick people. And hey, wash those hands! 

Do you have asthma or a history of wheezing with illness? Now would be the time to make sure you have refills on your albuterol and flovent inhalers and make sure you are familiar with your asthma action plan. Call for refills of your asthma medications so that you have them on hand in case you do catch any sort of respiratory illness (flu anyone?). The last thing that you will want to be doing is going into a germy pharmacy or waiting for a call back from your primary care provider if you suddenly realize you need a new inhaler. Check how many puffs of albuterol are left. Don’t wait until 2am for your refill. Be prepared. 

This goes for anyone with any health conditions. Make sure that your health is tip top. Follow your plan that you were given for your health issue and make sure that you are up to date on medication refills, appointments and hey, while you’re at it, set up auto-delivery of your medications. This will make things easier for you as things get busier around here. 

If you’re already sick…

If you or a member of your household is sick, your best bets in order to prevent the spread of germs are to:

  1. Clean all surfaces, especially door knobs, light switches, and anything else you regularly touch
  2. Wash your hands. Seriously, you can’t wash your hands enough during this time.
  3. Sneeze into your arm or a tissue!
  4. Stay home! Don’t go out and spread germs to others when you are sick with any illness. 

What not to do 

It is not a good idea to scour the internet and pay hundreds of dollars for some strange masks resembling the n-95 mask from Amazon. You really only need a mask if you are a health care provider or if you have COVID-19 and are going out on the town (which you shouldn’t). If you have a respiratory illness and need to be seen in the office or ER, they will give you the appropriate mask. If you happen to catch Coronavirus, then worry about the mask if and when you need it. It will not do you any good now in terms of prevention as they need to be fitted properly and can’t be lifted up for every itch or to talk on your cell phone. The hospital will provide you with the appropriate gear if and when it is time. Masks right now should be saved for providers and personnel taking care of sick patients. Besides, how will you activate your facial recognition on your cell? Better get that passcode ready! 

Also, do NOT go running into the ER with the sniffles or for any old fever for that matter. The Emergency Room was named that way for a reason. It is for emergencies. If you or your loved one look like a wet noodle, won’t perk up, are not drinking at all, have had no urine in over 8 hours, have persistent or worsening pain, are very ill appearing or you are concerned and feel like you should be seen, then head to the ER. Just remember the ER is not a walk-in clinic. Call your primary care provider or pediatrician for your general sick care needs. 

Leverage telehealth tools

The CDC recommends “Leveraging existing telehealth tools to direct people to the right level of healthcare for their medical needs.” Hey, that’s US! Talk to a nurse first, and get the right care. We are also on standby if you can’t get in touch with your provider, or their wait times are too long. We are here to help! Chat with us so we can help you decide the best plan for you and your loved ones. 

The CDC is keeping close tabs on current illnesses and how to keep yourself and loved ones safe. We agree with the CDC and their personal health habit recommendations for your home and hope this gentle reminder will help you too. Keep calm and wash your hands…

Kim Liner, PNP

Nurse-1-1 Chief NP

Answering Your Patients’ COVID-19 Concerns

Here at Nurse-1-1, we recognize we are uniquely positioned to support the public health response to the COVID-19 outbreak. That’s because we’ve developed a HIPAA-compliant text and photo-based chat platform that meets patients where they are—online—and gives them the option to chat with a live, trusted nurse offering education and care navigation. In fact, if you’re a healthcare provider in the Massachusetts area, it’s likely we’ve already helped some of your patients, for free. During a time when patients and families are struggling for answers, let’s work together to ensure your patients are well educated and accessing care correctly.

Nurse-1-1 has already been helping our patients, for free? How’s that possible? 

Well, tens of thousands of patients find us when they search online for health information and see our content. Turns out that many patients who already have established PCPs are still using Nurse-1-1 to help with their health concerns. We know because they tell us! 

Wait, my patients call me first before going online!

How sure are you of that? These days, many offices and call centers are facing hours-long queues. As a nurse practitioner who does plenty of triage in an Urgent Care setting, I know this firsthand as I’ve had to call patients back 3, 4, even 5 hours after they called on a busy weekend during flu season. Do you really think patients are waiting hours without going online to educate themselves? Studies show 80-90% of patients use online health information to make their healthcare decisions. 

By the time you’ve called your patients back, they may have already sought care elsewhere such as a walk-in clinic, urgent care, or ER. Nurse-1-1 diverts patients away from fear-inducing websites and into a live chat with our 675 trained nurses, who then help guide them to the right care location.

Is your practice ready for what is coming with the COVID-19 outbreak? 

The CDC currently recommends that patients with low risk of being infected with COVID-19 that have symptoms or exposures should seek telephone health advice to determine if medical evaluation is needed. This likely means a large increase in patients contacting their providers for advice on whether evaluation is needed is coming. Are your triage systems ready? 

Because of the crisis and our company’s mission, we are now offering Nurse-1-1 for free to as many patients as possible during this time. We can’t help everyone, but we can do our part in the public health response. If you’d like to ensure your patients are able to use Nurse-1-1 for free during this period of uncertainty and confusion, contact us. A partnership with Nurse-1-1 can help your patients make proper healthcare decisions, avoid unnecessary visits to alternative sites of care, and educate them on appropriate preventative measures. 

Why trust Nurse-1-1 during this time?

We only staff experienced triage nurses and nurse practitioners ready to chat with your patients 24/7. We are also HIPAA-compliant and can share patient notes under a BAA. Our real strength? We meet patients where they are—online—and connect them within minutes to a trusted nurse. 

During this critical moment in history, more and more patients will be searching for information and answers to their health questions. Let’s work together to ensure your patients stay calm and feel cared for. Reach our below for more information.

Kim Liner, PNP

Nurse-1-1 Chief NP

Vomit Color– Green, Yellow, Brown, Black, Clear

So you are puking.  Ugh. I’m sorry to hear that.  Not to be a Debbie Downer but you might have the stomach bug.  Yuck.  Not all funky vomit colors are from the stomach bug though! 

Let’s talk about common vomit color concerns.  Disclaimer: do not read if you get queasy easily 🤣🤣🤣

Green/Yellow Vomit

Green vomit could be the green frosting your kiddo just ate way too much of… or could be something else if they didn’t just smash back three pieces of Green Monster themed cake.

Green vomit after having a few episodes of vomiting can be from bile in the stomach which is typically green/yellow in color.  Bile is made from the liver and stored in the gallbladder until it is used by the stomach to break down food. Green vomit or bile is usually seen when the stomach is empty, either because you have been vomiting all night, or you just woke up and have nothing to vomit, except the bile sitting in your belly waiting for breakfast.

People with morning sickness for example can wake up with an empty stomach and vomit bile.  Someone who vomited all night will also wake up with a similar empty stomach. Make sense?

If this green vomit lasts more than a few days, or is accompanied by severe pain, fever, weakness, constipation, or any other concerning symptoms, you should get checked out right away.  Chat with us about your green vomit.  We can help figure things out!

Brown Vomit

Brown vomit can be the cause of eating too many chocolate brownies… Or can be associated with more serious issues.  It is most commonly going to be because of brown food. Let’s talk about more serious issues in case you are having brown vomit.  

The first serious issue we worry about is whether this brown vomit is actually blood.  Old blood turns to a dark brown color and can sometimes look like dark coffee grounds. If you have brown vomit (and didn’t eat a ton of brownies),  especially if it looks like coffee grounds, then you should be concerned. Bleeding in the stomach can cause there to be blood that darkens up by the time it is puked out.  This can be a serious issue.  

If you have abdominal pain or a history of ulcers or acid reflux (AKA heartburn) then you should be checked out to be sure this brown vomit isn’t blood. Most offices can do a simple test that will tell you if there is blood in the vomit or if it’s just a brownie…(you can always bring in a sample for them to test if you are courageous). 

Now sit down for this one.  Ok, are you sitting? If there is severe constipation, and stool (poop anyone?) is backed up, you can vomit brown poop-smelling vomit.  Gross, right?? But think about it… What comes in, must come out! If the poop isn’t getting evacuated properly (through the normal exit), it can come back up.  If this is the case, you likely haven’t pooped in a while. If you have poop smelling vomit, bloating, and abdominal pain, then get yourself seen. You will likely need a cleanout for your constipation.

Get checked right away if you are experiencing these symptoms.  

Black Vomit or Coffee Ground Vomit

What if you are throwing up black? Very dark brown or black vomit can be old blood, again, especially if it appears to look like coffee grounds.  If you are unsure of the actual color, take a bit of vomit and smear it on a white paper towel. This should help you to see if it is really dark green, or truly black.  Maybe it’s just from all the kale and spinach you have been eating, or the black frosting you ate at the Halloween party yesterday.  

But if this appears red at all or truly black (and you didn’t eat black frosting or have been taking Pepto Bismol), you need to get checked out.  Old blood, likely from further down the digestive tract, can turn black over time. Get checked right away, especially if you have any pain or history of stomach or digestive issues.  Black vomit is not normal, unless of course, frosting.  

Clear Vomit

Do you have the stomach bug? Just chugged some water on an empty stomach?  It’s going to look like water. Vomiting clear liquid like this is a common result. Don’t panic. You will likely have green/yellow vomit soon, see above.  Clear vomit can be normal when you have an empty stomach and are vomiting.

If you hit your head and are suddenly vomiting clear fluid, or vomiting at all, get looked at.  This can be a sign of a serious issue. Another red flag is clear vomiting that persists and doesn’t seem to improve after 24 hours or when accompanied by inability to ingest food or liquids.

Pink or Red Vomit  

Bloody vomit deserves a check by a medical provider.  Unless of course you had a bloody nose or smashed your lip and swallowed some blood.  In that case, a small amount of blood is ok, as blood is pretty irritating to the stomach. Once you swallow it, it’s likely to come back up. Don’t get too worried if it happens once or twice but then stops when you’re no longer vomiting. Vomit that has a little blood once but then clears up right after usually isn’t an issue. 

It also isn’t abnormal to have a little tiny amount of blood in your vomit once it’s the 15th or 16th time you vomited from a stomach bug. With that constant retching, you can also get tiny tears in your esophagus that lead to a little bit of blood. As long as it goes away quickly (like only 1 or 2 episodes of vomit with a little blood), don’t panic. Check with us or your provider. 

If you notice large amounts of blood, like filling the toilet bowl, or coffee ground or dark red vomiting, then get checked right away.  Large amounts of bloody vomit can be a sign of a serious issue with your liver, a tear in your esophagus, or some other life threatening emergency. Large amounts of bloody vomit are never normal. Also, persistent bloody vomit is never normal either. Unless… you guessed it, frosting! Or red Kool-Aid. Or pepto-bismol. Or that red popsicle you were craving. 

Vomiting the Colors of the Rainbow

Don’t panic.  Don’t google. Talk to us about your vomit! We are here to help you.  Searching the web about vomit color can be scary without taking into consideration all of your current symptoms.  Ask a nurse first.  

Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to prevent concussions in kids?  What should parents know about screen time for toddlers? What’s the best way to approach shingles prevention in the elderly? Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Shingles prevention– What you need to know

Shingles is caused by a virus known as the varicella-zoster virus. It is the same virus that causes chickenpox. Once you get chickenpox, the varicella-zoster virus lays dormant in your body, aka takes a nap, until the virus reactivates or wakes up causing shingles. About 1 in 3 people in the US will develop shingles according to the CDC. Here is what you need to know about shingles prevention, symptoms, and other important aspects of this illness. 

What are the symptoms of shingles?

You will know when the virus wakes up! Shingles usually starts as a painful area on one side of the body that then develops into a strip of a blister-like, painful rash. The rash can be accompanied by fever, achiness, headache, fatigue and sensitivity to light. The blisters will break open and then crust over in around 7-10 days. Shingles can last 2-4 weeks. It can make you miserable and very uncomfortable. Not everyone will present with the same symptoms. Some people do not develop a rash, and some will get a rash over the face instead of the back or chest or arms/legs. 

Can I catch shingles from someone with shingles?

Ok, get ready for this super confusing statement. You may have to read this a few times:

You can only get shingles if you have had the chickenpox or chickenpox vaccine in the past. Once your body has had exposure to the virus that causes chickenpox in any way, the virus becomes dormant and sleeps in your body until it wakes up again as shingles.You can not catch shingles from someone with the shingles. Shingles only appears when it wakes up in your body, usually when you are older, run down or stressed. 

You CAN however get chickenpox from someone with shingles since it is the same virus, IF that is, you haven’t gotten chickenpox before or haven’t been vaccinated. Phew!


  • If you or your child HAVE NEVER HAD the chickenpox (or the vaccine), don’t hang with anyone who has shingles
  • If you or your child HAVE HAD the chickenpox (or the vaccine), you can hang with someone who has shingles— you won’t catch shingles or chickenpox! 

When I say “hang” I mean don’t get near the fluid blisters or touch them. The virus is spread by direct contact with blister fluid. It is important to keep the blisters covered especially if you are around babies who have not been vaccinated yet or adults who have never gotten the chickenpox vaccine or chickenpox. 

Shingles exposure

If you are around someone with shingles, they are most contagious when they have blisters. The virus is not contagious prior to blisters developing nor after the blisters crust over. Do not touch the blisters! I mean, who would do that? But babies or unsuspecting adults might get close enough to get exposed to the blisters and the shingles virus. If you have shingles, keep the blisters covered, avoid scratching the rash and wash your hands well and often. Avoid coming in contact with newborns, with pregnant people who have not had the chickenpox or the vaccine, and with immunocompromised people such as the elderly, people with HIV, those with cancer or with chronic illnesses, or people who take immunosuppressant medications or steroids. 

What happens if I get shingles?

Shingles is painful and you can be pretty miserable when you have it, but once it goes away you should be ok. It usually resolves within 2-4 weeks. Now, the virus is worse for adults over 60 years of age, and especially those with complicated health problems, those on certain medications, and those who are immunocompromised. 

One complication that is more common over the age of 60 years is post-herpetic neuralgia (PHN). This is when the pain from shingles lasts longer than the illness lasts. Once shingles clears, the pain should clear as well. If not, you may have PHN. It is best to follow up with your provider for any pain that persists after the blisters crust over, or pain that lasts more than 2 months.

Shingles prevention— Is there a shingles vaccine?

YES! There is now a shingles vaccine to help with shingles prevention. Zostavax and Shingrix are shingles vaccines recommended for all adults over 60 years of age. Getting the shingles vaccine is thought to provide protection for about 5 years. The vaccine reduces the risk for getting shingles by 50%, and post-herpetic neuraliga by 67%, according to the CDC. The shingles vaccine is recommended for anyone over the age of 60 years for shingles prevention, even if you don’t recall getting the chickenpox. 

Remember, you can’t get shingles if you haven’t gotten chickenpox (or the chickenpox vaccine) but almost everyone over the age of 40 years of age has gotten the chickenpox! Hello?! chickenpox parties anyone? You don’t hear about chickenpox much anymore, but those younger than 40 years of age likely got the chickenpox vaccine, and some of us, good old fashioned pox. No offense to those over 60, but it’s during those “older” years that you need extra protection.

Is there treatment for shingles?

There is no treatment to completely eradicate the virus, but there is medication called an antiviral medicine that can weaken it. Antiviral medications can reduce the symptoms that you experience and may shorten the duration of the illness. Using steroids along with antivirals can help with inflammation and pain. You will need to start these medications right away. Antiviral medications work best when started ASAP. Call your provider right away as soon as you think you may have shingles. Let us help you figure out if your symptoms could be shingles. 

Shingles can be painful and itchy. Using a bag of cold peas or a bag of ice can help relieve some of the pain and itching. But don’t feed the peas to unvaccinated baby Sue…make sure to toss them after! Also: 

  • A lukewarm oatmeal bath can provide some relief to the rash.
  • Some people suggest using calamine lotion for itching and the blistery rash.
  • Wearing socks over your hands may prevent you from scratching the blisters in your sleep. 

Rest, good nutrition and lots of fluids can also help you recover faster as your body fights the virus! Take care of yourself and your body. Don’t hesitate to chat with us if you have any questions!

Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like is there a Coronavirus vaccine?  What should parents know about screen time for toddlers? Do I have a cold sore or a canker, and is it contagiousWell we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Health System Call Centers: We Got Your Back

Nurse-1-1 proactively engages with a diverse population of patients with a variety of questions and concerns. Over the past few months, the number of patients coming to Nurse-1-1 has skyrocketed. 

One industry question we get a lot is about who these patients are. Are they uninsured? Do they come because they don’t have a primary care provider? Why would a patient use Nurse-1-1 when they can just call their provider? 

To answer this last question specifically, we added 2 simple questions that patients now answer before we connect them with a nurse: Do you have health insurance? And do you have a primary care provider? 

The results from over 400 patients this weekend: 

  • 73% of patients coming to Nurse-1-1 have insurance 
  • 63% of patients have a primary care provider 

So why would an insured patient with a primary care provider use Nurse-1-1? Well for one, they don’t want to play the callback game with their provider’s office. Oftentimes, the patient has already gone to the emergency room before getting a callback from whoever’s on call. Call volume is just too high this time of year, and call centers are overworked and struggle to keep up without the modernization of technologies required. In fact, we recently heard that a large health system had over 100 patients who needed to be called back at one point this weekend. Patients have no choice but to look elsewhere for help.

Seeing these results, we wanted to know more. So just last week, we launched a feature in the Boston area that further asked patients who have a primary care provider to let us know who they have and what health system they are a part of. 

Just over the weekend (Saturday & Sunday) in the Boston area alone we had:

  • 68 patients from Beth Israel Lahey Health
  • 47 patients from a well known Boston pediatric network 
  • 30 patients from Atrius Health 

These are some of the best institutions in the world and their patients are coming to Nurse-1-1 to answer their health questions. This makes our team very proud to be helping their call centers during this very busy season. Anytime we can help, we are here. 

Unfortunately, not all of these patients had a chat with a nurse. Until more providers and health plans offer Nurse-1-1 to their patients and members, a chat with a nurse costs $12.50. Although most telemedicine platforms cost $49 a session, when health systems or insurance plans partner with Nurse-1-1, Nurse-1-1 becomes free to patients and members. Patients and members can be routed directly to nurses who work for these health systems. The conversations can also be saved directly to the patient’s health record. 

We are just getting started here at Nurse-1-1. We are working closely with forward-thinking health systems and health insurance plans to engage more patients and members, providing them the help they need to make better healthcare decisions. Nationwide we are seeing similar patterns, as the map below shows a pin in each city or town where a patient has come to Nurse-1-1 in just the last few months. That’s a patient in all 50 states.  

Concussions in kids

Concussions in kids are a year round issue. We know that concussions in sports are all too common, especially among kids and teenagers. Whether it’s football, basketball, skiing, soccer, ice skating, hockey, random falls off the couch or car accidents, anyone can get a concussion at any time. Doing something where you might hit your head? WEAR A HELMET! Help to keep your brain safe. You need your brain for the rest of your life. Protect your child’s brain and your own brain. Get that helmet on!

What exactly is a concussion?

A concussion occurs when you bang your head so hard, that your brain sort of jiggles inside, and bangs against the opposite end of your skull that was bashed. The back and forth motion is no good. Jello jiggler anyone? This trauma causes your brain to release chemicals, and can damage cells in the brain. Oftentimes after a blow to the head, we don’t realize that there is an issue until days later when some symptoms may arise. It’s important to take any blow to the head seriously and watch for symptoms closely.

What are symptoms of concussion?

The first concussion symptoms we often see are headache, fatigue, irritability, memory loss and confusion. (A little worse than your typical teenager’s behavior?) 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 accident 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 & 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.

Dangerous Signs & Symptoms of a Concussion for Toddlers and Infants

  • Any of the signs and symptoms listed in the Danger Signs & Symptoms of a Concussion list (above)
  • Will not stop crying and cannot be consoled.
  • Will not nurse or eat”

What to do after a head injury– concussion treatment in kids

Do not let your child keep playing in that football game or take another run down the mountain! Any athlete who sustains a head injury should STOP play, take a break and be evaluated. Do not jump back in the game. This means YOU coach! Do not put your kiddo back in. Let his brain rest. Make sure she can go back in to play safely before giving the green light to return. These days, many athletic programs will do pre-concussion testing, so that if a concussion does happen an official test can be done to decide if it’s safe to go back in to play. 

It is important to be checked by a medical professional after a concussion. Your child’s doctor or nurse practitioner will provide you with recommendations to recovery and a Concussion Return to Play protocol.

Diagnosis of concussion in kids

Although post-injury testing and pre-concussion testing can be compared to help with diagnosis if a concussion is suspected, there is no actual definitive test to diagnose a concussion. Your kid’s concussion will not show up on a head CT. So if you go to the ER, they will only be doing imaging of your child’s head to rule out anything more serious, such as a fracture or brain bleed. This is why we need you to take care of that brain! If this seems like it is “just” a concussion, then imaging is likely unnecessary. Let your provider decide. You can always chat with us if you are unsure about what to do or are concerned about a concussion in your kids. 

Treatment of concussion in kids

There is no medication treatment for concussion. Instead, treatment focuses on supportive and preventative care. 

The CDC outlines 4 steps to recovery post-concussion. 

  1. REST: Resting your brain is the most important part of recovery. 

Take it easy for the first few days after injury to really let your brain heal. According to the CDC, these are the best ways to rest your body in the first fews days after injury. 

  • Early on, limit physical and thinking/remembering activities to avoid symptoms getting worse.
  • Avoid activities that put your child at risk for another injury to the head and brain.
  • Get a good night’s sleep and take naps during the day as needed.

Once you are feeling a little better, then you can add back some very light activity

  1. Light Activity: As your child starts to feel better, gradually return to regular (non-strenuous) activities.
  • Find relaxing activities at home. Avoid activities that put your child at risk for another injury to the head and brain.
  • Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated.
  • Get maximum nighttime sleep. (Avoid screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake up schedule.)
  • Reduce daytime naps or return to a regular daytime nap schedule (as appropriate for their age).
  1. Moderate Activity: When symptoms are mild and nearly gone, your child can return to most regular activities.
  • Help your child take breaks only if concussion symptoms worsen.
  • Return to a regular school schedule.
  1. Back to Regular Activity: Recovery from a concussion is when your child is able to do all of their regular activities without experiencing any symptoms

You may receive a Return to Play Protocol. There is a specific protocol for returning to play. You must REST your brain before going back to any physical activity and be able to be symptom free as you progress to full play. Your provider will outline this for you and give you strict guidelines for returning to play,

Baseline testing for athletes can help diagnose a future concussion in kids

Some medical offices can provide some baseline testing for kids at higher risk for concussion. Call your PCP or ask your sports coach if they have this available for your child. This testing allows the patient to get their brain function tested BEFORE a head injury occurs. This information, including memory, concentration and attention skills can be compared to brain function after an injury occurs. It can help determine if there was a concussion and how severe it is. This must be done by a medical professional who is trained in concussion management. They then can use this information to help guide return to play protocols and recovery needs for your child. 

Long term concerns following concussion

Some concussion symptoms can last weeks to months. It is important to keep your child’s brain rested and avoid any further brain injury. Repeated injury to the brain can cause worsened damage.Repeated concussions become harder and harder to recover from. Do your brain a favor and protect it! If you sustain a concussion, don’t bash your head against the wall again and surely don’t jump back into football practice again just yet! Let that brain REST and recover. 

Make sure to really question your child after ANY head injury. Don’t let them fool you into thinking they can jump back into the game. Make an effort to be sure they have no symptoms of concussion, and have them checked out after a head injury. I say this all the time, you need your brain forever! Take care of it! No sport or game is worth forever damage to your brain. When in doubt, pull them out. Missing a few games is worth it when it comes to your brain and health. 

– Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how should parents approach screen time for toddlers? Do I have a cold sore or a canker, and is it contagious?  How to take a temperature to see if my child has a fever? Do antibiotics work on viral and bacterial infections?  Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Screen time for toddlers and babies– how much is too much?

According to the National Institutes of Health (NIH), screen time usage in children increases from 53 minutes for babies at age 12 months to more than 150 minutes for toddlers at 3 years old. Screen time (TV, computer, smartphone, tablet, laptop, etc…) for toddlers and babies can be very confusing. Is it good? Bad? How much screen time is too much? 

Parents often feel guilty for letting their young children watch TV or play video games. For some parents, it is the only way for them to get a break during a long day of activity. But what parent doesn’t have a kid who becomes a zombie once they are in front of the TV too long, or one that becomes a complete maniac when they have to end their screen time? Is screen time for kids a good or bad thing? What is the correct thing to do when these kiddos ask for screen time? 

The answer isn’t simple. There are lots of actions patents can take to make screen time in babies, toddlers, and older kids a positive experience. It is important for parents to set screen time limits and create rules around screen time that best fit their family. 

In general, the less screen time the better! Children under 2 years of age really shouldn’t be having any screen time. Toddlers over the age of 2 should be limited to no more than 1 hour of screen time a day! 

Screen time guidelines and recommendations

Here are the American Academy of Pediatrics’ recommendations for screen time: 

  • “For children younger than 18 months, avoid use of screen media other than video-chatting. 
  • Parents of children 18 to 24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they’re seeing.
  • For children ages 2 to 5 years, limit screen use to 1 hour per day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children ages 6 and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health. 
  • Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
  • Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.”

One comment about the AAP’s screen time recommendations for babies and toddlers under 18 months. This age group needs stimulation from YOU, the parent. Not from a screen! It may seem like they are learning something, but turns out they really are not. They need to see your face, your facial expressions, and all the great, diverse words you are saying to really learn well.

Can screen time increase learning in babies and toddlers?

Some say that screen time, when done properly, can increase learning in children this age. In a world filled with screens, we would expect that screen time usage will increase for our children compared to years ago when technology wasn’t as advanced. Now, there are screens everywhere, and of course the kids want in on the fun too! Children will need to be able to use screens to function in today’s society. It is inevitable that they will be exposed to screens. The question is, how can we make screen time beneficial? 

Screen time in kids and toddlers, ages 2-5 years old

There is a place for screen time in kids who are 2-5 years of age. It is important to choose screen time wisely, and utilize their time online by picking educational programs. Toddlers can learn from online apps and educational shows. But it is important that the parent then introduce this information learned in the real world. The parent needs to connect what the child learns online with the real world. Otherwise the child doesn’t understand what they see, and screen time becomes just distraction time with no additional educational value. So after Johnny watches Elmo sing ABC’s… make sure to sing them together, and point out some real “A”pples! Connect with your toddler to be sure that they can see what they watched on the screen, in the real world. 

If screen time usage for your toddler must be lengthy, then it is important to utilize high quality content for the child. Shows like Mr. Rogers and Sesame Street are great choices to optimize screen time. Letting your child navigate YouTube or 10 shows of Caillou is probably not the best idea. Choose wisely. Not all ABC programs are good. Check out the programs you are letting your child watch. You may be surprised at what you see. Don’t let your child navigate YouTube or the app store! Guide their choices. Help make screen time for your kids high quality. 

Make screen time meaningful

The American Academy of Pediatrics has some great tips for screen time use. One favorite tip of ours is engagement with your child during screen time use. Use screen time as a chance to play a game, sing, dance or snuggle up and watch a show together. Get those dancing shoes ready. Bounce around the room with your child. BE there with your child. We get it, one (or two) episodes of Sesame Street isn’t horrible, but use some of the time your child is on a screen as time you can interact together. Your kiddos love you and want you to play with them. Join in the fun! Kids love to dance. And they love to dance even more with their parents! Ask your child questions about what they are seeing, hearing and feeling. These types of interactions will help make time with the screens more meaningful. “Cookie monster loves cookies, do you?” “Caillou is so whiny, isn’t he?”

That being said, according to The Journal of Pediatrics (the official publication of the American Academy of Pediatrics), responsive parent-child interactions are what makes children successful and able to complete tasks, have impulse control, regulate emotions, be creative and flexible. This is developed through unstructured social play, and not digital screen time. So it’s not the screen time that actually increases success, but the interactions they have with YOU, the parent! Make sure that your screen time doesn’t take the place of unstructured play time! Get outside, get on the floor, break out those blocks and have some fun!

When is screen time bad for toddlers?

The Journal of Pediatrics reports that overall, TV time has decreased in ages 2-5 yr olds, but is this because of the push to limit screen time? Or is it because those little buggers are taking over mom’s ipad and stealing dad’s cell phone to watch shows on YouTube? The answer seems obvious. The decrease of actual TV time has been replaced by portable screens. Screen time in general can vary, but a screen is a screen! 

Kids of all ages are impacted. What 8 year old isn’t asking for a phone? How many toddlers do you see at dinner with a tablet? In general, screen time is bad when it isn’t educational, exceeds pediatricians’ recommendations of daily usage, or replaces the opportunity for children to have healthy interactions with their parents. Moms and Dads, I urge you, make your children interact with you at dinner. Don’t bring the tablet. Make some parts of your life “screen free.” Interact with your child by looking at them and talking with them. Don’t let screens replace human interaction, sports, physical activity and the ability to communicate with others. 

Screen time in school aged children and teens

What about older kids? Screen time usage in older children and adolescents has risen, mostly because of the increase in cell phone usage. Once they have a cell phone, they have constant screens at their fingertips. Means of communication change and screen time becomes essential to communication. Make sure to teach your teen about the safety of the internet. Review their screen usage and set limits. Be sure that you teach your teen about respect, privacy and safety. Mental health illnesses are on the rise, partly due to social media use and cyberbullying. It is very important that you have a discussion and plan with your teen about social media usage given the significant risks associated with its use in this age group. 

Screens are here to stay. Make your child’s screen time usage meaningful, set limits, interact with your child during screen time and be sure to monitor what your child is looking at! Now, excuse me while I shut off Mickey Mouse!

– Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to choose a pediatricianDo I have a cold sore or a canker, and is it contagiousHow to take a temperature to see if my child has a fever? Do antibiotics work on viral and bacterial infectionsWell we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.

Fevers, and how to take a temperature

You have a fever, it’s OK!  Fever is one of those dreaded things that nobody wants. You feel cruddy when you have a fever, your kid is cranky, your body aches, and you want to curl up under a giant blanket, even if you are sweating. 🤒

Fever is your body’s way of telling you that you are fighting off an illness. Your immune system is eliciting a response from your body. The response is a fever. A fever is a good thing. Fever means your body is doing its job.

How do I know if I have a fever?

Temperatures over 100.4 degrees F are considered a true fever. 🤒 99 degrees is not a fever! If you have a temperature of 99 and you “run cold,” it’s still not a fever. But that also doesn’t mean you or your child aren’t gearing up to have one. Feeling chills, achy or warm to touch are all signs that fever is impending or that maybe your thermometer didn’t get an accurate reading.

Everyone will likely get a fever at some point in their life, some more than others. It’s ok! 

How to take a temperature

These are the main methods for checking your temperature:

  1. orally (by mouth) 🤒
  2. axillary (armpit) 💪🏼
  3. tympanic (ear) 👂🏻 
  4. Forehead 🤕
  5. rectal (butt) 🍑 

Temperature can vary depending on how you check it. In babies and some children, a rectal temperature can be a more accurate way to get a temp. 🤒

thermometer– how to take a temperatureTaking a temperature can be frustrating. You may have difficulty getting your toddler to sit still to check a temp. Your teen may have heated the thermometer on a lightbulb 💡 …There are frustrations with each type of thermometer on the market and with the various ways to take the temp. Don’t panic. 😳 As health care providers, we believe you when you tell us your child had a fever. It’s nice to know a general temp, like 103 vs 100, but the actual number isn’t as important as how long the person has been over 100.4, and what is happening along with the fever. 

Don’t go crazy buying the fanciest thermometers. The basic $4 thermometer is just as frustrating as the $99 one that also tells you your child’s heart rate and the time of their next poop. 

Getting a perfectly accurate temp is hard. Don’t add a degree. Don’t go crazy over taking temps. Just tell us how you got the temp. Let your provider figure out the rest. 😀

What is important to notice during fever

When you have a fever 🤒 we want to know what else is happening. What other symptoms are you or your child having. Does your child perk up when the fever decreases? Are they drinking? Getting up to play? Chat with us here at Nurse-1-1 and we can help you decide if you should get checked out!

Anyone with a fever who appears ill, isn’t able to drink, hasn’t peed for 6-8 hours, looks BAD 😵, or isn’t able to get up and about AT ALL needs to be seen by their doctor, an urgent care, or the ER.

If you or your child have NO symptoms other than fever 🤒 for more than 48-72 hours, then you should also be checked out

Most viruses will last about 7 days. Usually, a fever 🤒 with other symptoms that is caused by a virus will last only 4 days. ON the 4th day, the fever 🤒 should clear if this is JUST a virus. Your child’s symptoms may last a few days longer. If the fever lasts for 5 days, you should be seen to figure out why there are still ongoing fevers. Fevers lasting OVER 4 days often need to be worked up by a healthcare provider. 🏥

Remember fever means your body is doing its job. It’s easy to lose sight of this when you have a sick kiddo or you are feeling cruddy yourself! Drink lots of fluids, take a layer of clothes off, but keep cozy enough that you aren’t shivering, grab the TV remote and snuggle up on the couch 🛋 . Chat with us if you aren’t sure. Rest up and let that body work it’s magic and fight off those germy 🦠 bad guys! 

– Kim Liner, RN, MSN, CPNP

Nurse-1-1 Health Center is written by nurses in a straight to the point type of way to provide basic health information. We get a lot of people like you searching online for answers to health concerns or looking for a hotline to ask a nurse a few questions. Questions like how to choose a pediatrician? Do I have a cold sore or a canker, and is it contagiousDo antibiotics work on viral and bacterial infectionsHow to stop pertussis or whooping cough in babies. Well we can help. We put some info here for you to find while searching through all that other dry, scary medical information online. Stop that. Read our posts, or chat with us. This is not medical advice or a replacement for medical care, but see what we have to say with our free health information, and hopefully it will stop you from scaring yourself any more than you already have. We can help.