Pain Medicine and Addiction

Today in America we use 80% of the
narcotic medicine produced in the
world-this is disturbing based on...

read more

How to Combat a Bully

Signs that your child may
be a victim of bullying
can be subtle at first...

read more

Choosing the Right Doctor

Fall is just around the corner and
with that comes Open Enrollment-
the time during which many people...

read more

Make Breastfeeding Work

For years, we have heard about the
many benefits of breastfeeding-it
helps your baby's immune system...

read more

How to Spot a Head Injury

According to the CDC, emergency
departments throughout the United
States treat around 173,000 sport...

read more


Pain Medicine and Addiction: What You Need to Know

Alok Krishna, MD


Today in America we use 80% of the narcotic medicine produced in the world-this is disturbing based on two facts: First, Americans do not represent 80% of the world's population and second, we cannot be in that much pain that we have to use that much pain medicine.

Our country's use of narcotic pain medicine is creating a big challenge in the medical community. Younger, middle aged people as well as some older people are finding themselves addicted to pain killers. Many patients wonder what the difference between addiction and physical dependence is. Many who are addicted to pain medicine have physical dependence, increased tolerance, fear of withdrawal and, most importantly, psychological problems.

It is very important to understand that while no one should be in pain it also not acceptable to continue to use narcotic pain medicine without addressing the real problem. In addition, patients must understand that other pain treatments can and should be used in addition to narcotic medication, including ice pack, heating pad, acupuncture, exercise, eating habits, weight reduction and using non-narcotic pain medicines.

Most people who have used pain medicine in their life for various reasons have not become addicted to pain medicine. People who are using pain medicine for addiction purposes are using larger quantities and mixing with other narcotics and other drugs. Today there is an increase in the number of deaths due to drug overdose. This is more common in young adults and middle age population than in the elderly population. Narcotics are serious medication and one should only be taking them with proper physician advice.

How do you know if you addicted to narcotic pain medicine? Signs can include using more than prescribed doses of medication; visiting different doctors to get more of the same medication; frequenting emergency rooms to get pain medicine; your life is revolving around how to obtain the next dose of pain medicine; you cannot function normally without narcotic pain medicine; your family life is affected due to these medications; and/or if you are spending a disproportionate amount of money obtaining pain medicine.

If you believe you or someone you love may have an addiction problem or have physical dependence, know that there is help. You may be helped greatly with medications including Suboxone therapy, behavior modification, supportive care, counseling and addressing psychological problems directly.

It is also important to have a specific goal directed activity, counseling, and behavior modification plan. This process may take at least 9-12 months. Individual goals should be set and patients should understand that no one patient is the same and no one problem the same. Most important, an addictive personality has to be honest with him or herself before seeking help.

If you need help with a potential prescription drug dependency or addiction, visit www.infinitemedicine.com, or call Dr. Krishna's office 916.569.8585.

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How to Combat a Bully

James Cafarella, MD, Mercy Medical Group Pediatrician


Back to school time is nearly here and for most children this is a time of excitement and anticipation. However, for some kids the thought of returning to school brings feelings of fear and stress. While there can be many reasons for this, one increasingly common cause is bullying.

Teasing and even arguing is common among school age children. Even the occasional physical confrontation can occur and while that is cause for consequence, it may not be a sign of a bigger problem. But if a child is being repeatedly and intentionally victimized-that is bullying and it is a problem. Examples of bullying can include persistent and vicious teasing; poking or hitting; taking advantage of another child by extorting money, toys or food.

Signs that your child may be a victim of bullying can be subtle at first. Children who are shy or lacking in confidence are more likely to be bullied but they may also be slow to report it. Watch for a child who is fearful of going to school or participating in group activities involving other children. Ask your child questions about who they play with at school or who they sit with at lunch. If you believe there is a problem, ask your child if there are certain children who are unkind to them-but keep in mind that bullied children are often afraid of the repercussions of reporting the problem.

If you believe your child is the victim of a bully, take a deep breath and try not to overreact. Listen to what your child is saying and make sure he or she knows that you do not blame them for the situation. Take a step back and assess the situation before contacting the school authorities or other parents.

Talk to your child about what makes other kids act like bullies. Make sure your child understands that he or she is not the problem-that it is the bully who is to blame. Help your child understand that bullies usually act out because of bad feelings they have-either feeling insecure or confused or unhappy.

Before you act, talk through the options with your child. Make sure he or she understands that it is never ok to respond to a bully with similar behavior. Empower your child to take control of the situation by looking the bully in the eyes and telling him or her to stop and then reporting the behavior if it doesn't stop. Encourage your child to seek the support and company of other friends-bullies thrive on kids who are by themselves.

Finally, remember that your child's confidence has been shaken. Look for opportunities to recognize your child's strength and character whenever you can. Encourage your child to participate in activities that boost self esteem and encourage friendships with other children. Make sure your child has the confidence and character to stand up for himself when someone is mistreating him.

If you are a looking for a pediatrician for your child, visit the Mercy Medical Group website or call Dr. Cafarella's office at 916.409.1400.

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Choosing the Right Doctor for You


Fall is just around the corner and with that comes Open Enrollment-the time during which many people must choose healthcare options for themselves and their family for the coming year. Choosing a doctor can be overwhelming, but it is worth putting thought and time into this important decision.

One easy place to begin this process is with your friends. Talk to your neighbors, co-workers and anyone you trust... Ask who they trust their family's healthcare to and if they would recommend that physician. This can be especially helpful if you talk to other people who are in the same life stage as you-if you're new mom, ask the moms in your playgroup; if you're a retiree, ask the ladies you know through your social clubs; if you're an active, sports-minded person, talk to people at your gym.

You also need to determine what kind of doctor you need... For most people, their everyday healthcare needs can be managed by a primary care doctor-typically either a family practice physician or an internal medicine physician. For some people, their healthcare may need a more specialized focus. This may be the case for people older than 65 who may want a geriatrician to oversee their care. For women in their child-bearing years or entering menopause, an obstetrician/gynecologist may be appropriate. Of course, parents of young children typically want a pediatrician to oversee their children's care (although a family practice physician can typically care for family members of all ages).

If you find yourself facing surgery, ask your primary care physician for a referral to a recommended surgeon. (This referral process is required by many healthcare plans, including HMOs). If your particular procedure can be done in a minimally invasive manner, seek out a surgeon who handles both minimally invasive and open (traditional) procedures. If your procedure is complicated or unusual, you may want to find a surgeon who is a recognized expert for that procedure or one who has written or contributed to medical literature related to it.

Whether you are seeking a primary care physician or a specialist like a surgeon, it is important for you to know to which hospital(s) that physician admits patients or performs surgeries. Make sure that hospital is one that is respected, convenient and accepted by your insurance plans. Also, many surgeons now perform outpatient procedures at outpatient surgery centers that may or may not be covered by your insurance. Ask these questions before scheduling an appointment.

Finally, before deciding on a physician, you will want to ask yourself a few questions to determine which physician is the best fit for you. First-determine of the doctor's age is a factor to you. An older doctor has more experience but may retire before your family is done needing his services. Secondly, decide if you prefer a male or a female physician. This is an especially important question to consider when it comes to women's annual exams-however, keep in mind that many male physicians may have female Physician's Assistants who can carry out those exams if you prefer. Also, ask yourself if you need a physician who will be a collaborative partner or someone who is more of a leader when it comes to your healthcare.

Once you've answered these questions for yourself, meet with your potential physician and ask him or her questions-like how long do patients typically wait to get an appointment; does she keep paper or electronic records; how and when does he refer to a specialist; what is her policy on returning patient's phone calls or emails; how often does he take call; what are his beliefs on antibiotic usage, etc. And while you're asking these questions, pay attention to your rapport with the physician. Obviously her answers are important but so too is how you interact together. Chances are if you feel comfortable, you will be able to develop a good patient/doctor relationship.

If you or someone in your family is in need of a primary care physician or a specialist, visit our website to find a doctor near you.

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Make Breastfeeding Work for Your Baby



For years, we have heard about the many benefits of breastfeeding-it helps your baby's immune system, it helps prevent obesity in your baby's future, it even helps YOUR health! Earlier this year, researchers at Brown University used MRIs to show that babies who were breastfed exclusively for their first three months had better brain development in the areas that are linked to language and cognition. Also, a study published in the journal Obstetrics and Gynecology found that if 90% of American mothers breastfed, there would be 53,000 fewer cases of high blood pressure, 14,000 fewer heart attacks and nearly 5,000 fewer cases of breast cancer.

With research like this, it is hard to argue against breastfeeding. But unfortunately for many moms, breastfeeding isn't as easy as one would think. Learning this skill can be difficult for mom or for baby or both. It can be painful and frustrating and can lead to worries about whether your baby is healthy and thriving.

Fortunately, there are steps you can take to help make breastfeeding easier for the whole family. First-get the process started before your baby arrives! Sign up for a breastfeeding class at your hospital and have your partner go with you. By having your partner by your side, he will be able to help you remember what you learned once the baby arrives. Also, the support of an involved partner is very important when it comes to mastering the art of breastfeeding.

After your baby arrives, take advantage of the breastfeeding help available at the hospital. Whether it is a certified lactation consultant or a very helpful nurse, ask for help and get as many tips as you can before you leave to go home. Ask questions and have the staff observe you and the baby while you nurse. If something doesn't feel right, let the staff know. If you're worried about the baby, raise your concerns.

One easy but important tip that many new moms overlook is the importance of skin-to-skin contact. Keeping your naked baby on your bare chest is one of the best things you can do for bonding. (This is something dads can do too.) This skin-to-skin contact can also help facilitate breastfeeding by relaxing both baby and mom. This contact also triggers hormones that facilitate feeding, making the process easier.

Around the time you head home from the hospital, you may notice that your breasts are becoming very full and even painful. This means your milk has come in-but it can also mean discomfort. Be prepared and have some frozen peas on hand-these are the best and easiest ice packs for aching breasts. You can even tuck them into your nursing bra!

Finally, understand that breastfeeding is demanding. It requires your body to be well-rested, fueled with healthy foods, hydrated with lots of water, and just generally as relaxed as a new mom can be. Take care of yourself with rest and a healthy diet or you will not be able to take care of your baby with breast milk! Enjoy your baby and enjoy the incredible bond that develops during this special feeding time.

To learn more about the obstetric programs available at the Dignity Health hospitals in the Sacramento area, visit our website.

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How to Spot a Head Injury

Peter Skaff, MD, Neurologist


According to the CDC (Center for Disease Control and Prevention), emergency departments throughout the United States treat around 173,000 sport- and recreation-related traumatic brain injuries each year. That is a small amount compared to the 3.8 million sport and recreation-related concussions, or mild traumatic brain injuries, that are estimated to occur in the United States every year.

These numbers are on the rise, but fortunately, so is recognition of sport-related concussion among athletes, coaches, parents and physicians. Concussion is the result of direct or indirect physical force transmitted to the skull, which results in a primarily functional, rather than structural, injury to the brain. The sports in which concussions are most likely to occur are football, basketball, ice hockey, lacrosse and soccer. Even helmeted athletes can suffer concussions.

The sports that were related to the highest number of traumatic brain injuries were football, basketball and soccer.

What Are the Symptoms of a Concussion (mild traumatic brain injury)?

Signs and symptoms of concussion can be divided into four categories:

Physical Cognitive Emotional Sleep
  • Headache
  • Nausea
  • Vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue
  • Sensitivity to light
  • Sensitivity to noise
  • Numbness/tingling
  • Dazed or stunned
  • Feeling mentally "foggy"
  • Feeling slowed down
  • Difficulty concentrating
  • Difficulty remembering
  • Forgetful of recent information or Conversation
  • Confused about recent events
  • Answers questions slowly
  • Repeats questions
  • Irritability
  • Sadness
  • More emotional
  • Nervousness
  • Drowsiness
  • Sleeping less than usual
  • Sleeping more than usual
  • Trouble falling asleep

What Should I do if an Athlete Suffers a Concussion?

  1. Take the athlete out of the game.
    • Always look for signs that they are suffering from a concussion. And even though you may not be sure, it is safer to remove the player from the game.
    • There is no same-day return to play after a concussion.
    • A repeat concussion that occurs before the first one has healed can be extremely dangerous and sometimes even fatal.

  2. Make sure that the athlete seeks medical attention. Healthcare providers have specific ways to determine how severe a concussion is. Coaches can help by taking note of the following:
    • What actually caused the injury?
    • If the player was knocked unconscious, how long was the player in that state?
    • Was there memory loss?
    • Were there seizures?
    • Is this the first concussion the athlete has suffered? If not, how many others?

  3. Make sure parents know about concussions. Explain to parents that the athlete must see a healthcare provider as soon as possible. Make sure parents also know the signs and symptoms of concussions.

  4. Make sure the athlete does not play until the doctor says it is OK and the following conditions are present:
    • The athlete should be symptom-free at rest and with cognitive effort.
    • The athlete should not be taking any medications that would mask concussive symptoms.
    • The athlete should be back to baseline with regard to neurological and cognitive function.

To learn more about treatment of traumatic brain injury or other neurological injuries or conditions, visit the Dignity Health Neurological Institute website.

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