Chronic Kidney Disease

Approximately 30 million adults in the United States are living with chronic kidney disease (CKD).  This condition causes damages to kidneys and leads to a loss of function over time.  If your kidneys are unable to function properly, complications such as hypertension, nerve damage, weakened bones and anemia can develop. CKD also increases the risk of developing cardiovascular disease.

While high blood pressure can result from chronic kidney disease, it can also be the cause of it.  Other conditions and diseases that can cause CKD include diabetes, recurrent kidney infections, prolonged obstruction of the urinary tract and vesicoureteral reflux.

Anyone at any age can develop chronic kidney disease; however, some people are more at risk than others. You may have an increased risk for CKD if you:

  • Have a family history of kidney  failure
  • Have diabetes
  • Have hypertension
  • Are obese
  • Have cardiovascular disease
  • Are a smoker
  • Are of African American, Native American, Pacific Islander or Asian American descent
  • Are an older adult

Signs and symptoms of chronic kidney disease can vary by individual and may appear over time as the disease progresses. They can include:

  • Muscle cramps and twitches
  • Swelling of feet and ankles
  • Trouble concentrating
  • Fatigue
  • Frequent urination, especially at night
  • Itchy skin
  • Shortness of breath
  • Difficulty sleeping
  • High blood pressure
  • Vomiting

There are several things you can do to prevent CKD and keep your kidneys healthy.  Maintaining a healthy diet and cutting back on food rich in sugar and salt is beneficial for your kidneys, as well as monitoring cholesterol levels, keeping hydrated, quitting smoking and drinking in moderation.

If you are living with chronic kidney disease, it is strongly advised that you keep blood pressure and blood sugar levels under control, moderate protein consumption, reduce salt intake, avoid NSAIDs (nonsteroidal anti-inflammatory drugs) and get the flu shot each year.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Flushing Hospital’s Hernia Center Offers Expert Care to Those in Need

Flushing Hospital Medical Center now offers a comprehensive center to diagnose and treat a variety of forms of hernias.

A hernia occurs when an organ or fatty tissue pushes through a weak spot or an opening in the muscle or tissue that is supposed to hold it in place.  There are many different types of hernias, including inguinal, hiatal, umbilical, and incisional.

 

  • An inguinal hernia occurs when the intestines push through the lower abdominal wall, often in the inguinal canal located in the groin. . This is the most common type of hernia and it is more common in man than women.
  • A hiatal hernia develops when part of the stomach protrudes up through the diaphragm into the chest cavity. This type of hernia almost always results in gastroesophageal reflux. Hiatal hernias are most common in adults 50 years or older.
  • Umbilical hernias present in children and babies under six months old. They occur when the child’s intestines bulge through their abdominal wall, near the belly button.  An umbilical hernia is the only type that can go away on its own as the babies muscles get stronger.
  • An incisional hernia can take place after abdominal surgery. During this time, the tissues and muscles are typically weak and the intestines may push through an incision scar.

Hernias can develop quickly or slowly build over a long period of time. There are many factors that can contribute to the onset of a hernia. One of the most common reasons is straining a muscle while lifting heavy weight. Other factors include: being pregnant, being constipated, sudden weight gain, or persistent coughing or sneezing.

The most common symptom of a hernia is a bulge in the affected area. They are most identifiable through touch, especially when standing up, bending over, coughing, or crying (in babies). Other symptoms include pain in the affected area, weakness, or a burning sensation. Hiatal hernias will often result in acid reflux, chest pain, and possibly difficulty swallowing.

Your doctor can diagnose a hernia through a physical examination. Sometimes an x-ray or endoscopy is necessary. Treatment options for your hernia depend on the size and severity and can include lifestyle changes, medication or surgery.

Lifestyle changes can include altering your diet, exercising to increase muscle strength, avoiding lifting heavy objects and maintaining good posture.  Medications may be helpful in the treatment of a hiatal hernia. In most cases however, surgery may be required.

Hernia procedures can be done using open or laparoscopic techniques and Flushing Hospital’s new Hernia Center offers a wide variety of options for both methods. Our expert staff has a great deal of experience in this field with excellent outcomes. Many of the procedures can be performed with minimally invasive techniques, including the utilization of our da Vinci Robotic Surgery System.

For more information about Flushing Hospital’s Hernia Center, please call 718-670-3135.

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Benefits of Eating Dark Chocolate

Dark Chocolate has received a great deal of attention because it’s believed to help protect your cardiovascular system. The reason being is that the cocoa bean is rich in a class of plant nutrients called flavonoids.

Higher grades of dark chocolate are where you will find an abundance of flavonoids.

Some benefits to adding a moderate amount of dark chocolate to your diet are:

  • Nutrition – If the dark chocolate you are eating has a high cocoa content it will also have a sufficient amount of soluble fiber and will be rich with minerals.
  • Antioxidants – Dark chocolate is loaded with organic compounds that are biologically active and function as antioxidants, such as polyphenols, flavanols and catechins to name a few.
  • Blood Flow and Hypertension – The bioactive compounds in cocoa have been known to improve blood flow in the arteries and cause a small but significant decrease in blood pressure.
  • Heart Disease – Eating dark chocolate has shown to be beneficial in improving several important risk factors for heart disease, reducing insulin resistance, increase high density lipoprotein (HDL or “good” cholesterol) and decreasing low density lipoprotein (LDL or “bad” cholesterol). These reductions could show decrease in cardiovascular disease.

Be careful about the type of dark chocolate you choose: chewy caramel-marshmallow-nut-covered dark chocolate is by no means a heart-healthy food option. Watch out for those extra ingredients that can add lots of extra fat and calories.

There is currently no established serving size of dark chocolate to help you reap the cardiovascular benefits it may offer, and more research is needed in this area. So, for now, it is recommended that a moderate portion of chocolate (e.g., 1 ounce) a few times per week is sufficient while eating other flavonoid-rich foods (lettuce, almonds, strawberries, celery oranges, etc.).

Even though there is evidence that eating dark chocolate can provide health benefits, it doesn’t mean you should over indulge.  It is still loaded with calories and easy to overeat.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

How Can Wearing Gloves Get You Sick?

We wear gloves during this time of year to protect ourselves from the cold, wintery elements. These accessories are meant to serve as a layer of defense, but could they actually contribute to getting us sick during cold and flu season?

While outer garments like gloves serve a very important function in keeping us warm, they can also be the potential transmitter of harmful germs if they are not washed regularly. When you think about it, we use our gloves when we open doors, hold escalator rails, and ride the train, all of which are breeding grounds for viruses. After touching these things, we might use our glove covered hands to scratch our noses and cover our mouths. In a pinch, we might even use our gloves to wipe our nose when a tissue isn’t available.  These actions can take place every day for the duration of the winter, but ask yourself when was the last time you washed your gloves? The fact is gloves pick up everything bare hands do and very few people wash their gloves frequently enough.

It is estimated that certain viruses such as the flu can live on your gloves for two to three days, while stomach viruses, such as the rotavirus and norovirus can remain active for up to a month.

To avoid getting sick from your gloves, follow these simple tips:

  • Wash them at least once a week. Cotton products are easiest to clean by using a washing machine while wool products need to be hand washed. Leather gloves will require dry cleaning
  • Never use your mouth to pull off your gloves. The best way to remove your gloves is from back to front, similar to healthcare workers
  • If you are wearing your gloves in snowy or wet conditions, allow them to air dry rather than shoving them into your pockets or into the sleeve of your coat.
  • Avoid touching ATMs, elevator buttons, railings, or shopping carts with a gloved hand. It is much easier to sanitize your bare hand than it is to clean your gloves
  • Always wash your hands after removing your gloves to avoid contamination

Following these steps can reduce the chances of getting sick this winter.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Winter Weather Exercising Tips

Winter weather doesn’t mean the end of your outdoor exercise routine. If you plan to continue to run or bike after the mercury drops, consider following these tips so you can stay safe and warm while exercising in the cold.

Know the weather conditions before heading outdoors – In addition to the temperature, those heading outside to exercise need to understand how wind and precipitation can affect your health.  These factors, combined with the length of time spent outdoors need to be taken into consideration before beginning an outdoor exercise regime.

Know the signs of frostbite and hypothermia –Frostbite is most common on exposed skin, such as your cheeks, nose and ears. It can also occur on hands and feet. Early warning signs include numbness, loss of feeling or a stinging sensation.

Hypothermia is abnormally low body temperature. When exposed to cold temperatures, your body begins to lose heat faster than it can be produced. Hypothermia signs and symptoms include intense shivering, slurred speech, loss of coordination and fatigue.

Get out of the cold and seek emergency help right away if you experience symptoms of frostbite or hypothermia.

Dress in layers – Dressing too warmly is a big mistake when exercising in cold weather. Exercise generates a considerable amount of heat — enough to make you feel like it’s much warmer than it really is. The best option is to dress in layers that can be removed as soon as you start to sweat and then put layers back on as needed.

Protect your head, hands, feet and ears – When it’s cold, blood flow is concentrated in your body’s core, leaving your head, hands and feet vulnerable. Ways to protect these parts of your body include wearing a thin pair of glove liners under a pair of heavier gloves, purchasing exercise shoes one size larger to allow for thick thermal socks or an extra pair of regular socks. And don’t forget a hat to protect your head or headband to protect your ears.

Use proper safety gear – If it’s dark when you exercise outside, wear reflective clothing. If you ride a bike, both headlights and taillights are a good idea. Also choose footwear with enough traction to prevent falls, especially if it’s icy or snowy.

It’s as easy to get sunburned in winter as in summer — even more so if you’re exercising in the snow or at high altitudes. Wear a sunscreen and lip balm with sunscreen. Protect your eyes from snow and ice glare with dark glasses or goggles.

Drink plenty of fluids – Don’t forget about hydration, as it’s just as important during cold weather as it is in the heat. Drink water or sports drinks before, during and after your workout, even if you’re not really thirsty.

These tips can help you safely and enjoyably exercise in cold conditions. Closely monitor how your body feels during cold-weather exercise to help prevent injuries. While exercise is safe for almost everyone, even in cold weather, if you do have certain condition such as asthma or heart disease that could limit you ability, you should check with your doctor first.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

How Can You Save Someone From Choking? Learn How to Perform the Heimlich Maneuver

The holidays offer us with many opportunities to surround ourselves with friends and family.  While these gatherings with loved ones are meant to be happy times, there are opportunities for a tragedy to occur. Whether it is a loved one choking on food at a Christmas party or a young child having a small toy stuck in their throat, there is always the potential for a bad outcome. By learning how to administer the Heimlich maneuver, you can avoid a catastrophe by saving a choking victim.

Choking occurs when a foreign object gets lodged in the throat or windpipe, blocking the flow of air. In adults, a piece of food is often the culprit. Young children often swallow small objects. Because choking cuts off oxygen to the brain, give first aid as quickly as possible.

You can act fast if you know what signs to look for. The universal sign for choking is hands clutched to the throat. If the person doesn’t give the signal, look for these indications:

  • Inability to talk
  • Difficulty breathing or noisy breathing
  • Squeaky sounds when trying to breathe
  • Cough, which may either be weak or forceful
  • Skin, lips and nails turning blue or dusky
  • Skin that is flushed, then turns pale or bluish in color
  • Loss of consciousness

If the person is able to cough forcefully, the person should keep coughing. If the person is choking and can’t talk, cry or laugh forcefully, The American Heart Association advises administering the Heimlich maneuver immediately.

How to perform the Heimlich Maneuver on someone else:

  • Stand behind the person.Place one foot slightly in front of the other for balance. Wrap your arms around the waist. Tip the person forward slightly. If a child is choking, kneel down behind the child.
  • Make a fist with one hand.Position it slightly above the person’s navel.
  • Grasp the fist with the other hand.Press hard into the abdomen with a quick, upward thrust — as if trying to lift the person up.
  • Perform between six and 10 abdominal thrustsuntil the blockage is dislodged.

If you’re the only rescuer, continue to perform these measures before calling 911. If another person is available, have that person call for help while you perform first aid.

Measures to save a choking child differ from those administered on an adult. Follow these tips if the victim is under age 1:

  • Assume a seated position and hold the infant face down on your forearm, which is resting on your thigh. Support the infant’s head and neck with your hand, and place the head lower than the trunk.
  • Thump the infant gently but firmlyfive times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object. Keep your fingers pointed up to avoid hitting the infant in the back of the head.
  • Turn the infant face up on your forearm,resting on your thigh with the head lower than the trunk if the infant still isn’t breathing. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions. Press down about 1 1/2 inches, and let the chest rise again in between each compression.
  • Repeat the back blows and chest thrustsif breathing doesn’t resume. Call for emergency medical help.
  • Begin infant CPRif one of these techniques opens the airway but the infant doesn’t resume breathing.

If the child is older than age 1 and conscious, give abdominal thrusts only. Be careful not to use too much force to avoid damaging ribs or internal organs.

To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Hepatitis C

Hepatitis is a virus that causes an inflammation of the liver. The liver is an organ in the body that processes nutrients, filters the blood and fights infections. The most common forms of hepatitis are A, B, and C.

Hepatitis B and C are spread from person to person through contact with bodily fluids.  Hepatitis A can be transmitted by coming in contact with food or objects that are contaminated, and can also be spread from person to person. There are ways to reduce the rate of transmission for the virus; here a few:

  • Using sterile equipment for injections
  • Practicing safe sex
  • Encouraging people to receive appropriate vaccinations

Many people have the hepatitis virus and are unaware of it. It is possible to remain without symptoms for many years while the disease is slowly destroying the liver. When symptoms do occur, they include:

  • Fever
  • Nausea
  • Loss of appetite
  • Jaundice
  • Abdominal pain
  • Fatigue

Blood tests are available that can detect the virus at an early stage.  Early detection and treatment can lessen the effects of the virus. Medication exists that can cure hepatitis C and can control hepatitis B infections. When given properly, people are less likely to die from liver cancer and cirrhosis and also are less likely to transmit the disease to others. The hepatitis B vaccine is given in three doses over a 6 month period and it is recommended that the first dose is administered right after birth if possible.  Mild cases of Hepatitis typically do not require treatment and most people who are infected recover without developing permanent liver damage.  A vaccine is available for those who are at risk.

If you would like to schedule an appointment with a physician at Flushing Hospital, please call 718-670-5486.

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Flushing Hospital Pulmonologist, David Wisa Provides Information on COPD

Chronic Obstructive Pulmonary Disease (COPD) is a common lung disease that is prevalent in our community. COPD can also be described as chronic bronchitis or emphysema.

COPD may cause shortness of breath, coughing, sputum production and wheezing. These symptoms result from damage and narrowing of the airways. COPD may also put patients at risk for pneumonia which is an infection of the lung

According to Dr David M. Wisa, Associate Director of Pulmonary Medicine at Flushing Hospital, “The most common cause of COPD is damage to the lung from smoking cigarettes, although not all smokers develop COPD.  The use of indoor wood burning stoves may cause similar lung damage leading to COPD. People who are found to have COPD at a young age may warrant further evaluation for possible predisposing genetic conditions.”

COPD can be a serious disease and symptoms may worsen over time without proper evaluation and treatment. The most important treatment methods are ones that patients can do on their own. First, quitting smoking will help reduce symptoms and reduce further damage to the lung. Lung function in all patients decline due to normal aging, in smokers with COPD that decline is significantly accelerated.  Second, patients should receive their flu shot annually and the pneumonia vaccine at the proper time as recommended by their doctor.

Further therapies for COPD can be prescribed by your primary care doctor or a lung specialist called a Pulmonologist who can prescribe medications that can help reduce symptoms and improve lung function.  They may include a variety of inhalers that can be taken daily or when symptoms arise. There are also some oral medications that are indicated in specific situations. Other therapies include home oxygen, an exercise program called rehabilitation and rarely surgery.

If you are having symptoms consistent with COPD see your doctor. If you would like to schedule an appointment with Dr Wusa, or any the Pulmonologists at Flushing Hopsital, please call 718-670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Keeping Your Immune System Strong During Cold and Flu Season

Our immune system protects our bodies from illness and infection. While having a strong immune system is important all year long, there are times of the year that its effectiveness is tested more than other.

body defense

With cold a flu season upon us, Flushing Hospital wants to offer some day-to-day lifestyle tips to avoid weakening your immune system and keep you healthy.

STRESS
Prolonged periods of intense stress can affect the immune system. Stress causes the brain to boost the production of hormones that weaken the function of the infection-fighting T cells. If you are experiencing high levels of stress, try to adopt stress-relieving activities to boost your immune system.

POOR SLEEP
Poor sleep is strongly associated with a weak immune system as it reduces the number of killer cells needed to fight germs. Recent research has suggested that the amount of flu-fighting antibodies produced was cut in half in those who were sleep deprived.

ALCOHOL
Excessive intake of alcohol may reduce the immune system’s response to invading pathogens because alcohol contains ingredients that impair lung functionality, making us more prone to viral or bacterial infections.

POOR DIET
Excessive consumption of refined sugars and highly processed food containing pesticides, chemical additives and preservatives can weaken the immune system. In addition, obesity can lead to a weakened immune system as it affects the ability of white blood cells to multiply, produce antibodies and prevent inflammation.

By adopting some healthy lifestyle practices and avoiding certain others, we can give our bodies the best chance of staving of illness this cold and flu season.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Great American Smokeout

On November 16, 2017, the Flushing Hospital Medical Center’s Smoking Cessation Team joined with the American Cancer Society and participated in The Great American Smokeout. The Smoking Cessation Team hosted an informational table in the hospital’s lobby.

The Great American Smokeout is designed for you to have a chance for you to make a plan to quit smoking.  Did you know that by quitting for even one day, you will be taking an important step toward a healthier life and can reduce your risk of getting Cancer? Well, you can!

Tobacco is the single greatest cause of multiple diseases and premature deaths in the USA today.  It kills more Americans each year than alcohol, crack, heroin, homicide, suicide, car accidents, fire and AIDS combined. There are an estimated 480,000 deaths in the United States annually that are due to tobacco use. It is the only legal consumer product that is lethal when used exactly as recommended by the manufacturer.

Smoking cigarettes affects many aspects of health. Tobacco smoke contains about 7000 chemicals, including low concentrations of such strong poisons as ammonia, cyanide, arsenic and formaldehyde.  It also contains 69 carcinogens – substances that are known to cause cancers in humans. Direct association has been established between smoking and cancers of the lung, mouth, nose, throat, larynx, esophagus, colon and rectum, stomach, pancreas, cervix, bladder, kidney and blood.
In the United States, Illnesses caused by smoking cost more than 300 billion dollars per year in direct medical care and lost productivity. Smokers pay twice as much for life insurance and will die on average of 13-14 years earlier than non-smokers. It costs tobacco companies approximately 5 cents to produce a pack of cigarettes.

Many lung conditions are either caused or aggravated by cigarette smoke. It irritates bronchial airways and stimulates mucous production leading eventually to decreased elasticity and functional failure. Patients suffering from COPD, Asthma, Chronic Bronchitis or Emphysema have a much higher risk of dying when repeatedly exposed to smoke.
Smokers are also at greater risk for cardiovascular disease. Smoking damages blood vessels making them stiff and narrow, obstructing blood flow which results with elevated blood pressure, heart attacks, strokes, kidney failure or chronic skin changes.

Pregnant women exposed to tobacco smoke have increased risk of complications like miscarriage, premature birth, and brain and lung damage in developing baby. Sudden infant death syndrome is three times more likely if mother smoked during pregnancy.
Secondhand smoke is the smoke exhaled by smokers or given off by a burning cigarette or pipe. Inhaling secondhand smoke is as hazardous as smoking a cigarette. There is no safe level for secondhand smoke exposure established. People can inhale it at work, homes, cars or public spaces and have all the complications mentioned above.

Smoking tobacco is an addiction similar to heroin and cocaine. It can be successfully treated but the majority of cases require three or more attempts. Quitting smoking offers a chance of feeling better and living longer.  Studies have shown that five, common sense steps, provide the best chance for quitting smoking for good:

  1. Get ready: set a quit date and throw out all cigarettes and ashtrays from your home.
  2. Get support: tell your family, friends and doctor about quitting plans; search the internet for advice.
  3. Learn new behaviors: distract yourself from the urge to smoke; exercise or go for a walk.
  4. Get medication: combining medication like nicotine patches or Zyban with behavioral adaptation and family support quadruples your chances of success.
  5. Be prepared for relapse and difficult situations– most people try to quit a few times before   succeeding.

If you would like to learn more about quitting smoking call the Flushing Hospital Medical Center’s Smoking Cessation Team at 718-670-3146.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.