Preventive Visits (Physicals) and what it means for you!

The Good news about Preventive Visits/Physical/Well-Visits!

Have you heard the good news- “Preventive Visits” are 100% free to you! That sounds like great news doesn’t it?  It is, but it’s very important to know what “preventive” means so you can take full advantage of the opportunity.  The easiest way to determine what is a preventive visit (versus diagnostic) is to think of it as an information gathering visit to determine what your current state of health and well-being is and how it corresponds to other people of your age and gender. It’s best to do it when you are feeling well (thus the common moniker “well-visit”), you don’t have any current or new health concerns to discuss during the visit (thus no change in medication, no new prescriptions are given, no normal screening labs are ordered),  and /or no follow-up for a health issue discussed during the visit is scheduled.   For example, during your Physical/Preventive/Well-Visit, your doctor may notice that you are at risk for diabetes and have not been tested.  Your doctor then decides to test you. That screening/testing is part of your preventive visit.  However, if you are diabetic and you are at your Physical/Preventive/Well-visit and you are having complications due to your diabetes that are addressed by your doctor, that preventive/physical visit is now two visits: A physical/preventive visit and a diagnostic care visit where you will be responsible to pay a co-pay/co-insurance or deductible.   The same also applies if you are coming to your doctor and the doctor performs a routine screening related to the visit that may have been covered as preventive if you had come in for a preventive visit.  The screen is part of your diagnostic care and as such you will be responsible for the co-pay/co-insurance deductible for that visit.   So regular preventive care can help you stay well, catch problems early on, save you money and may be potentially life-saving.

So what can you expect during a Preventive/Physical/Well-Visit?

The rules for what is considered a preventive visit or part of a preventive visit and what isn’t are set by the Center for Medicare and Medicaid Services and your Health Insurance company.   As your health care provider, we are required to submit accurate health records indicating the exact reason for your visit and everything that was done and discussed during your visit. Each concern is grouped into a visit code and a diagnostic code.  That is how the different topics and health concerns addressed at your visit are organized into “preventive” versus “diagnostic” care.   Any attempt to not accurately account for everything puts you at risk and undermines our ethical obligations.  With that said, there isn’t a set rule as to how a Physical is conducted. Each doctor or practice will develop its own method of gathering necessary information (basically the purpose of a Physical) to see what is your current state of health and well-being.

Generally you can expect all, some or a variation of the following (courtesy of WebMD):

History: This is your chance to mention any complaints or concerns about your health. Your doctor will also likely quiz you about important behaviors, like smoking, excessive alcohol use, sexual health, diet, and exercise.  The doctor will also check on your vaccination status and update your personal and family medical history.

Vital Signs: These are some vital signs checked by your doctor:

·         Blood pressure: less than 120 over 80 is a normal blood pressure. Doctors define high blood pressure (hypertension) as 140 over 90 or higher.

·         Heart rate: Values between 60 and 100 are considered normal. Many healthy people have heart rates slower than 60, however.

·         Respiration rate: Around 16 is normal. Breathing more than 20 times per minute can suggest heart or lung problems.

·         Temperature: 98.6 degrees Fahrenheit is the average, but healthy people can have resting temperatures slightly higher or lower.

General Appearance: Your doctor gathers a large amount of information about you and your health just by watching and talking to you. How is your memory and mental quickness? Does your skin appear healthy? Can you easily stand and walk?

Heart Exam: Listening to your heart with a stethoscope, a doctor might detect an irregular heartbeat, a heart murmur, or other clues to heart disease.

Lung Exam: Using a stethoscope, a doctor listens for crackles, wheezes, or decreased breath sounds. These and other sounds are clues to the presence of heart or lung disease.

Head and Neck Exam: Opening up and saying "ah" shows off your throat and tonsils. The quality of your teeth and gums also provides information about your overall health. Ears, nose, sinuses, eyes, lymph nodes, thyroid, and carotid arteries are also examined.

Abdominal Exam: Your doctor can use a range of examination techniques including tapping your abdomen to detect liver size and presence of abdominal fluid, listening for bowel sounds with a stethoscope, and palpating for tenderness.

Neurological Exam: Nerves, muscle strength, reflexes, balance, and mental state are assessed.

Dermatological Exam: Skin and nail findings could indicate a dermatological problem or disease somewhere else in the body.

Extremities Exam: Your doctor will look for physical and sensory changes. Pulses can be checked in your arms and legs. Examining joints can assess for abnormalities.

Male Physical Exam

An annual physical exam for men might also include:

• Testicular exam: A doctor can check each testicle for lumps, tenderness, or changes in size. Most men with testicular cancer notice a growth before seeing a doctor.
•  Hernia exam: The famous "turn your head and cough" checks for a weakness in the abdominal wall between the intestines and scrotum.\
•  Penis exam: A doctor might notice evidence of sexually transmitted infections such as warts or ulcers on the penis.
•  Prostate exam: Inserting a finger in the rectum lets a doctor feel the prostate for its size and any suspicious areas.

Female Physical Exam

A woman's annual exam might include:

• Breast exam. Feeling for abnormal lumps may detect breast cancer or benign breast conditions. The doctor will also check the lymph nodes in the underarm area and look for visual abnormalities of the breasts.
• Pelvic exam: The pelvic exam allows examination of the vulva, vagina, and cervix. Routine checks for sexually transmitted infections are often done. A Pap test can screen for cervical cancer. 

Laboratory Tests

There are no standard laboratory tests during an annual physical. However, some doctors will order certain tests routinely:

• Complete blood count
• Chemistry panel
• Urinalysis (UA)

Unless symptoms already suggest a problem, these tests are unlikely to provide useful information.

A lipid panel (cholesterol test) is recommended every five years. Abnormal cholesterol levels increase the risk for heart attacksand strokes.

Physicals Should Emphasize Prevention

• At age 50, it's time to begin regular screening for colorectal cancer. People with immediate family members with colorectal cancer may need to be screened before age 50.
• For most women, age 40 marks the time to begin annual mammogram screening for breast cancer.
• Everyone should have their cholesterol (lipids) checked every five years after age 20, according to the American Heart Association.

When making an appointment for a preventive service, make sure you inform your physicians at the time you are making an appointment that it is for a covered preventive service.  Make the appointment when you truly are well so the visit can focus on verifying your health and helping you manage your good health.  Check with your insurance company which other services are considered “preventive” and thus have no co-pay/co-insurance or deductible.  For example, most insurance companies are now fully covering a variety of immunizations such as: Hepatitis A and B, Flu, Herpes Zoster, Pneumococcal and more.  All you have to do is come in specifically for and only for a covered vaccination and it’s totally free to you (your health insurance will be billed and your health insurance carrier will cover your co-pay, co-insurance and any deductible).  The best way for you to know which services your plan considers “preventive” and free to you is to call your insurance company and ask. Visit avecinia’s list of  health insurance companies it is contracted with to find your insurance company’s website/contact information.  Generally, the preventive services listed under the Affordable Care Act will be covered services.  Take advantage of this great opportunity to save money and save your life today!

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Dad, He-Man, Superman. Whatever you call him, he's special!

Father's day is June 19^th, celebrate your father's good health with him!

Men's health in their 20's, 30's, 40's, 50's and beyond!

Father's day is June 19^th! But fathers and other important men in our lives should be honored every day. A good way to honor them is to make sure they honor and value their health. The more they value their health, the more father's days we all get to celebrate. Unfortunately, many men don't value their health enough. According to the American Academy of Family Physicians, only 50% of men 45 years and younger had a physical exam in the past two years. Men are also 30% more likely than women to be hospitalized for preventable conditions such as diabetes. Here are some important men's health issues and reminders for each age group!

20-30's

The 20's and 30's are the best time for a man to develop the right habits, such as:

• Getting regular exercise (at least 30 minutes a day, 3-4 days a week);
  
• Eating well by learning portion control, how to read nutrition labels, and eating your veggies;
  
• Giving up bad habits or not even picking them up-smoking is the number 1 cause of preventable death (lung cancer) and alcohol induced accidents are the leading cause of death in young men (alcohol also lowers male hormones, killing your sex life!); and
  
• Saying "Hi" to your doctor! Get to know your doctor now so as you age your doctor can help you keep track of your health.
  

40's-50's

Most men reach their 40's having achieved their career goals, started young families and are looking forward to another 40- to 50 years of quality life. It's not too late to start good habits

• Definitely start with exercise. The American Academy of Family Physician's Men's Health study showed that nearly 40% of men between the age of 45 and 54 don't exercise at all. However, they do watch at least 20 hours of TV a week! You can still incorporate 30 minutes of physical activity 3 to 4 times a day and have 18 hours of TV left;
  
• Have you tried Salmon with Tomato and Dill rice? No? Maybe you've had an olive or two? If not, you're missing out on an easy way to incorporate a Mediterranean diet into your routine! Mediterranean diets are rich in whole grains, fruits, vegetables, fish and other lean protein which lower your risk of heart disease, diabetes, depression, Alzheimer's and even prostate cancer. And go ahead and drink that extra cup of coffee- studies show that men who drink 6-8 cups of coffee (caffeinated or decaf) a day are less likely to develop prostate cancer then men who don't drink any; and
  
• Now that you've become friend with your doctor, don't hold back. The more they know about you, the more they can help you age gracefully! A few important things to consider: Get a physical/preventive exam every 1-5 years; Learn about prostate cancer and ask your doctor if it's time to start getting regular exams; talk to your doctor about skin cancer. According to the Skin Cancer Foundation, skin cancer is the most common cancer among men over the age of 50! Make sure you wear a UVA/UVB broad spectrum sunscreen with at least SPF 15. Apply it 2-3 times day, especially when you're out on the golf course or are spending a day outside. Try Colorescience Protect Aftershave moisturizer with SPF 20 or Obagi's Award Winning NuDerm SPF50 sunscreen. Both are 33% off and available at avecinia wellness center during our Big June Sale!
  

60's and beyond!

65 is the new 50 and 85 is the new 65. If you've been living a healthy life since your 20's and 30's, this is certainly true. Even if you haven't, there's still hope for you. But you are going to have to work for it.

• Treating chronic disease conditions such as diabetes or hyperlipidemia (high cholesterol) is imperative;
  
• If you have Medicare, take advantage of several free, preventive services now offered. Start with your Medicare Annual Wellness Visit. This is a great opportunity for you to discuss your current health, your health concerns for the next 5 years and more;
  
• If you are retired, this is the perfect time to take up new hobbies. Staying physically and mentally active keeps your body and mind healthy and happy. A good exercise routine can help you double your hand grip strength in 3 months. Hand grip strength is a good indicator of long term survival; and
  
• Staying fit can also help you have an active sex life. 15-25% of men over 65 years of age experience erectile dysfunction (ED). ED can be caused by alcohol use, smoking, certain medications, anxiety, depression, obesity, diabetes and heart disease. It's also an early warning sign of atherosclerosis (hardening of the arteries).
  

With the proper attention to your health and well-being, you can live into your 100's and your loved ones can celebrate more fathers' days with you. Think of all the gifts you can get!

Happy Father's Day!



For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Top “Five” Fitness Tips For The Holiday’s!

Annie Malaythong- Health Coach Studio 108

Holiday season is here! With family gatherings and holiday parties filled with baked goods, foods and alcohol it’s hard to stay on track. Let’s face it; we all worry about putting on “winter weight.” But what exactly are we doing about it? It’s time to be realistic. It would be a shame for you not to enjoy your family and friends and all the goods. So, let’s set realistic health and fitness goals to keep you on track! Here’s to a healthy 2010 and to a better 2011!

1. Realistic Fitness Action Plan- Write out a “top 3” daily “Active To-Do” list to keep you feeling accomplished and productive with your fitness. Again, emphasize the “realistic.” If you currently are doing nothing for your fitness here’s an example:
1. Walk for 15 minutes today. (Anywhere)
2.  Stretch for 5 minutes.
3. Perform 3 different exercises that you are confident with.
2. Spice it up! Spicing up your workout can do wonders for your mind and body. Try doing something different. Studio 108 in Fresno offers unique classes such as Thai Budokon, Self-Defense Classes, Mind/Body/Stress-Free Yoga, or (30 minute) Express Cardio Intervals. If you’re not a group exercise person, try a personal trainer or a fitness specialist to mix it up. Mixing up your workouts and spicing it up will keep you motivated throughout the holidays and keep your body guessing. This will result in a longer fat burn
3. Easy on the Alcohol -Alcohol consumption packs on additional calories. Think of every 8oz alcoholic drink as roughly 30 minutes of additional cardio.
4. Understand your Calories IN vs. Calories OUT- Check out your BMR (Basal Metabolic Rate). The number of calories you’d burn if you stayed in bed all day. That number represents how many calories you need to consume just to maintain life without working out or being active. If your calorie intake is more than calories being burned, you are more than likely progressively gaining weight. Staying active is the key!
5. “Cheating” moderately- We all know sugar, sugar and sugar is the main ingredient for the holidays. If you can’t stay away or are tempted, try keeping your sugar intake to a minimum. A great trick is to fill up your sweets in the palm of your hand and limit choices to one “sweet palm” for the whole day. Example:

• “I have choices of apple pie, cookies, toffee, pumpkin pie, etc...”
• “I can only fit 2 pieces of toffee, and ½ of a pumpkin pie in the palm of my hand. I will limit my sweets to only these two options for the WHOLE day.
• “I will not attempt to stack, mash, crumble, combine or overflow my palm. For every additional serving of a “sweet palm” is another 1,000 calories which is roughly two hours of cardio for an average 150lb person. Or for every three “sweet palms” is one extra pound of pure body fat. “ * Eating balance meals focusing on macronutrients will avoid cravings and keep you feeling full longer.*

Moderation, balance and keeping active are key to a healthy you. Setting realistic goals, using some or all of the steps above, is a great way to start and stay on your fitness and well-being plan.  Share it with your family and friends so you don't have to do it alone!  Happy holidays and Happy New Year!

This blog was written by Annie Malaythong, Health Coach, Fitness Studio 108.  Annie is owns Fitness Studio 108 and was previously the Director of Fitness at Gold's Gym (Central Fresno).  Annie is a spokesperson and Nutrition Specialist for "Run For The Dream" Project Child Obesity Campaign, has been on KMPH 26 and KSEE 24 and can be seen beginning December 29th on MTV's "I Used To Be Fat".   avecinia wellness center works with Fitness Studio 108 to help our patients achieve their optimal well-being.  Our individual weight loss and management program incorporates fitness and nutrition provided by experts at Fitness Studio 108.  To learn more about avecinia wellness center and Fitness Studio 108's weight loss/management program, visit www.avecinia.com

avecinia wellness center is Fresno's premier integrative medical and wellness center. We combine primary care with health management, weight management, acupuncture, massage therapy and aesthetics to provide a holistic approach to your health and well-being.  We use a state of the art electronic health record program and patient portal (by athenahealth) to help deliver our unique services to our patients. Learn more by visiting our website at www.avecinia.com or "like" us at www.facebook.com/avecinia or follow us on twitter at www.twitter.com/avecinia4health

Healthy Holiday Eating Strategies

Thanksgiving, and thus, the holiday season is rapidly approaching! It’s an exciting time of family, friends, giving, and, oh yes, FOOD! Many start worrying about their weight and their waistlines, especially those who are working on lowering that number on the scale.

According to the National Institute of Health, the average weight gain during the holidays is only about 1 pound. That’s right, about 1. The problem is that most Americans don’t ever lose that pound of weight gain and it begins to add up over the years, increasing the risk for many chronic diseases.

Don’t panic. It’s important to recognize that you can enjoy holiday foods (it’s part of the fun!), but you want to stay balanced in the meantime. You don’t have to be afraid with a few strategies in mind:

1. Don’t attempt to diet and lose weight, instead try to maintain your weight. (This is a more realistic goal and will help you to feel successful through the holiday season) If you continue to lose weight, that’s great, and you can certainly continue to do so by maintaining healthy eating behaviors you’ve developed, but keep your expectations realistic.
2. Exercise to compensate for the extra calories you might be consuming, and to help relieve holiday stress. (This could be a walk with friends and family or outside playing with the kids)
3. Don’t skip meals, trying to “save up” for that big holiday meal. (This will contribute to ravenous hunger, causing you to overeat.)
4. Limit alcohol as much as possible. (A mixed drink can have as much as 500 calories per cup!) Calorie content of drinks:

• Beer: approx. 140 – 200 calories per 12 oz.
• 1.5 oz. shot of liquor: 115 – 200 calories
• 4 oz. wine: 60 – 160 calories
• 8 oz. margarita: approximately 400 calories
• 8 oz. egg nog: approximately 350 calories

5. Put your snacks & appetizers on a small plate instead of a large one and limit your trips to the buffet. Wait 20 minutes before getting another plate of food. (It takes 20 minutes for your brain to get the message that you are full.)
6. Take smaller bites and eat slowly. Try taking time to enjoy your food and the conversation with the people around you.
7. Substitute butter and margarine with plant sterol based products like Benecol and Take Control.
8. Try a healthy recipe for popular dishes such as Mashed Potatoes:

• 5 medium russet potatoes (medium white or red potatoes can also be used)
• 2 green onions, white and part of green, finely chopped
• 1/3 cup fat-free half and half (low-fat milk or whole milk can also be used)
• 1/4 cup fat-free or light sour cream
• 1 tablespoon butter (or no- or low-trans fat margarine or plant based sterol product)
• 1/2 teaspoon minced or crushed garlic (optional)
• Salt and pepper to taste

Preparation:

1. Pierce each potato several times with a fork and microwave the potatoes on HIGH until they are tender throughout (about 20 minutes depending on your microwave.) You can also bake or boil the potatoes until tender if you prefer. Let potatoes cool a few minutes.

2. Peel off skins (and discard) and add the potato flesh to a large mixing bowl along with the green onions, fat-free half and half, sour cream, butter or margarine, and garlic.

3. Beat on low speed until fairly smooth and blended. Add salt and pepper to taste.

Yield:

6 servings

Nutritional Information:

Per serving: 187 calories, 5 g protein, 37 g carbohydrate, 2 g fat (1.2 g saturated fat, 0.6 g monounsaturated fat, 0.1 g polyunsaturated fat), 6 mg cholesterol, 3.5 g fiber, 55 mg sodium (not including salt to taste).

9. Forget the “all-or-nothing” mindset. Instead, focus on “sometimes” and “for special occasions” to consume certain foods and beverages. Depriving yourself of special holiday foods isn’t a healthful eating strategy.
10. Remember that it is a holiDAY, not a holiWEEK! Make the special occasions special!

Have a Happy Thanksgiving!

This blog was written by Sunny Yingling, MS, RD.  Sunny is one of avecinia wellness center's trusted resources and we refer many of our patients needing diet and nutritional counseling to Sunny.  Sunny is a Professor of Nutrition at Clovis Community College and can regularly be seen on Central Valley Today on KSEE 24.  Sunny also works with our friends at Fitness Studio 108.  If you have any questions or would like to make an appointment with Sunny, you can email her at sunnymarie3@hotmail.com.

avecinia wellness center is Fresno's premier integrative medicine and wellness center and your partner in optimal well-being! We invite you to join us on facebook and follow us on twitter 

    

Massage Therapy

Massage therapy has a long history in cultures around the world.  In fact, references to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece (Hippocrates defined medicine as “the art of rubbing”), and Rome.

Massage became widely used in Europe during the Renaissance.  In the 1850s, two American physicians who had studied in Sweden introduced massage therapy in the United States, where it became popular and was promoted for a variety of health purposes.

Today people use many different types of massage therapy for a variety of health-related purposes. In the United States, massage therapy is often considered part of Complementary and Alternative Medicine (CAM), although it does have some conventional uses.

The term “massage therapy” encompasses many different techniques.  In general, therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body.  They most often use their hands and fingers, but may use their forearms, elbows or feet.

The Benefits Of Massage  

People use massage for a variety of health-related purposes, including to relieve pain, rehabilitate sports injuries, reduce stress, increase relaxation, address anxiety and depression, and aid general wellness.  Massage is useful for all of the conditions listed below and more:

• Alleviate low-back pain and improve range of motion;
• Ease medication dependence;
•  Enhance immunity by stimulating lymph flow—the body’s natural defense system;
• Exercise and stretch weak, tight, or atrophied muscles;
• Help athletes of any level prepare for, and recover from, strenuous workouts;
• Increase joint flexibility;
• Lessen depression and anxiety;
• Promote tissue regeneration, reducing scar tissue and stretch marks; 
• Pump oxygen and nutrients into tissues and vital organs, improving circulation;
• Reduce post surgery adhesions and swelling;
• Reduce spasms and cramping;
• Relax and soften injured, tired, and overused muscles;
• Release endorphins—amino acids that work as the body’s natural painkiller; and
• Relieve migraine pain.

 A Powerful Ally

Regardless of the adjectives we assign to it (rejuvenating, therapeutic) or the reasons we seek it out (stress relief, pain management), massage therapy can be a powerful ally in your healthcare regimen. Experts estimate that upwards of ninety percent of disease is stress related. And perhaps nothing ages us faster, internally and externally, than high stress. While eliminating anxiety and pressure altogether in this fast-paced world may be idealistic, massage can help manage stress. This translates into:

• Decreased anxiety;
•  Enhanced sleep quality;
• Greater energy;
• Improved concentration;
• Increased circulation; and 
• Reduced fatigue.

Furthermore, the emotional balance bodywork provides can often be just as vital and valuable as the more tangible physical benefits.

Consequently, the medical community is actively embracing bodywork, and massage is becoming an integral part of hospice care and neonatal intensive care units.

At avecinia wellness center, our approach to incorporating massage therapy into your health care and wellness is unique in Fresno.  Our highly trained therapists, Bethany Clague and Michael Greene work with our providers, Dr. Unaiza Hayat and Ali Kunkel, MPA, PA-C to coordinate care in instances where massage therapy is deemed useful. By incorporating massage therapy and coordinating care, you can be assured that you receive the best, specific care to match your needs. Make your appointment today to see either Beth or Mike. In September, a basic, 25 minute massage is only $30 (save $10).  

(Written by Michael Greene)

Back To School

As summer is coming to an end, many parents may dread what’s coming next: Back to School! More than wondering what back to school sale to go to first, most parents are concerned how to prepare their child emotionally and mentally for school and how stay healthy during the school year. By following the tips below, we hope to make back to school a happier, healthier transition for both parent and child!
Tips:

• Establish sleep and nutrition routines before school starts! Avoid difficult mornings the first week of school by setting bed and wake-up times a few weeks before school starts and gradually adjusting them to be earlier as the first day approaches. And make sure they start every day with a healthy breakfast such as whole grain, low-sugar cereals!

• Keep them going throughout the day with the right foods! Pack their lunch with colorful mix of fruits and vegetables. Apples, baby carrots, berries, grapes, pears are easy to pack and easy to eat and provide essential nutrients to keep them energized and ready to learn. Avoid sodas and sports drinks! One can of soda per day can add 30 pounds in a year.

• Help your kids know their school like the back of their hand! Visit the school in advance so children know where their classroom is. Give them a chance to meet their teacher, the school nurse, and other staff, if possible.

• Encourage communication! Encourage your child to talk to you about how they feel about going back to school. Practice listening to them (hint, pay attention to them when they speak the same way you would want someone to pay attention to you). When kids feel they are being heard, they are less likely to hide something from you, such as whether they are being bullied at school.

• Dealing with Bullies! Going back to school is never easy and having a bully to deal with can make it ten times worse! But you can help your child stand up to bullying by instilling them with confidence, help them make friends, encouraging them to communicate if they are being bullied and working with their teachers and school administrators to make the school a bully safe environment.

• A stitch in time saves nine! If your child has a chronic health condition requiring medication, such as asthma, diabetes, a food allergy, or any type of health care concern requiring special attention, contact the school nurse early to put a plan in place well in advance of the first day of school.

• August is National Vaccination Month! Immunizations, which are a very necessary part of the back-to-school routine, can be a little scary for kids, but you don't need to drag them kicking and screaming to the doctor's office. Ease kids' worries by talking with them about the health benefits of vaccines so they understand why the shots are important and are less anxious about getting them.
Here is a summary of vaccinations recommended by the CDC for school aged children: (www.cdc.gov/vaccines/events/niam/default.htm)

Children 4-6  (Click on the bold items to learn more about them)

• DTap (Diptheria, Tetanus, Pertussis)
• PPSV (Pneumococcal) - for pneumonia
• IPV (Inactivated Poliovirus)
• Influenza - for the flu
• MMR (Measles, Mumps, Rubella)
• Varicella for chickenpox
• Hepatitis A
• MCV (Meningococcal)

Children 7-18

• TdAP (for children 11-18) - for whooping cough
• HPV (for children 9-18) - HPV vaccine is also known as Gardasil
• MCV (Meningococcal) - for meningitis
• PPSV (Pneumococcal) - for pneumonia
• IPV (Inactivated Poliovirus)
• Influenza - for the flu
• MMR (Measles, Mumps, Rubella)
• Varicella - for chickenpox
• Hepatitis A
• Hepatitis B

Many of the vaccines listed above are available at avecinia wellness center. Call us at 559-450-7299 and speak with Jennie if you have any questions about immunization and vaccinations or would like to make an appointment.  As Fresno's premier integrated medical practice, we aim to provide our patients with total wellness.  If you have questions about stress management or how to help your kids cope with starting school, we are proud to refer our patients to Corinne Soares, LCSW.  You can learn more about Corinne on her blog here: http://therapistsdesk.blogspot.com/

We hope you and your family have a wonderful August and an exciting beginning to the new school year!

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