Freeman Medical Musings Blog

We know our children are having fun, but to adult ears, the noise is all but overwhelming. 

While children are certainly drawn to sensory-stimulating toys that light up and makes noises, these toys take away from the social engagement that play is meant to provide, meaning parents and children alike talk less when electronic toys are in use. Even toys marked as educational elicit “fewer adult words, fewer conversational turns [and] fewer parental responses than during play with traditional toys or books,” according to the American Academy of Pediatrics. Like sugar, these toys light up the reward centers in our children’s brains without providing any real value to help them grow.  

So, what’s a parent to do with Christmas around the corner and all the shiny, new, battery-powered toys on display? Our advice is to go old-school! And if that makes you think of wood grain building blocks and tinker toys, remember there are plenty of non-electronic toys that are also fun and exciting! Here are some examples:

Pretend play toys: Think Barbies, action figures, animals and dinosaurs. Many franchises have their own line of toys, including low-tech options, that your child will get excited about. These are a great option for toys that have a “wow” factor while still giving children the opportunity to use language and stories to learn about the world around them.

Manipulative toys: While this category does include those wood grain blocks, it also includes things like Legos, building kits, puzzles and trains. These toys foster children’s fine motor skills, and some can build early math skills, as well.

Art supplies: Crayons, markers, coloring books and paints all make great gifts that children can have fun with while building their creativity. If you want something more elaborate, art supply stores often have kits for activities you can do with your child. 

Experience gifts: Does your child love sea creatures? Give them tickets (or even a membership) for a nearby aquarium. Are sports more their thing? Consider tickets to a game. Art classes, martial arts classes, concert tickets or a “ticket” for a camping trip can all make great gifts that your child will be excited about!

In short, choose toys that spark your child’s imagination, give them the chance to explore their world and bond with others in their family. (And of course, make sure the toy is age-appropriate for your child.) In the process, you can save your sanity from the roar of noisy toys.

For more information about play and development, visit healthychildren.org for American Association of Pediatrics recommendations. Visit freemanhealth.com/pediatrics for more information about pediatric services at Freeman Health System.

As leaves fall and the air turns cooler, we know the holidays are fast approaching. In my house Christmas cheer has already begun as we put out our holiday village.

All the special treats and extra gatherings shared with loved ones may make eating during the holiday season a bit tricky while having diabetes. Remember the importance of striving towards feeling our best and keeping blood sugar under control throughout the holiday season. Keep healthy goals in mind and make the holidays more with respect to being with the ones we care about and enjoying the season overall versus focusing only on the food. There is so much to enjoy over the holidays and keeping diabetes controlled can be easier than you may think.

Some suggestions for navigating the holidays:

•    Avoid skipping meals or snacks before holiday gatherings, this may sabotage your goals.
•    Choose the foods you have looked forward to and enjoy them mindfully.
•    If you want more than one serving, consider portion size and take the second serving to go.
•    Enjoying more movement on days you are eating holiday favorites, such as a morning or evening walk.
•    Take time for yourself during the busyness of the holidays. Read a book, craft, listen to holiday music, or take a drive and look at holiday displays.
•    Be kind to yourself; do not judge or feel guilt when wanting things that taste good.
•    Test blood sugar often so you are aware of how the holidays are affecting your blood sugars.

Diabetes Plate Method
Use the Diabetes Plate Method to navigate your meal and keep carbohydrate portions in check while still enjoying them. Divide your plate into 3 sections, ½ the plate for non-starchy vegetables such as green beans, carrots, broccoli, and salad. The rest of the plate is divided into quarters. Fill one quarter with lean meats such as turkey or ham. The other quarter is for carbohydrate rich foods such as potatoes, stuffing, and cranberry sauce.

Remember what your personal blood sugar goals are. Continue to take medications as prescribed.
Try to remake a family favorite recipe or dish as a diabetes friendly version.

Replace one starchy food choice with a non-starchy vegetable on your holiday table.

Stay Moving...
Remember to include physical activities during the holidays with family and special friends. Physical activity does not only have to be going to the gym or exercising, being active can include many ideas. Going to a park or holiday display in your town and walking around or attend an outdoor Holiday Market. Look for activities and find events in your area to get out and about. There is also usually a Holiday Turkey Trot race or walk in many towns, sign up! Consider taking a family walk after a holiday meal, throwing the ball in the yard with children and grandchildren, a WII dance off, or playing active board games such as PICTIONARY. Memories are made through many moments.

Follow this link for more ideas and a step-by-step guide to managing your holidays.
https://diabetesfoodhub.org/blog/your-diabetes-friendly-holiday-toolkit

It’s no secret that one of the most recognizable faces in the Joplin region, Freeman Health System President and Chief Executive Officer Paula Baker, is a natural cook. She finds the activity relaxing, often drawing recipes from her private collection of 300-plus cookbooks. With the holidays approaching, Paula Baker has taken time from her busy schedule to publicize some of her favorite holiday recipes.
She hopes you enjoy them!

Happy Holidays!

Pumpkin Bread
5 eggs
1 1/4 cup vegetable oil
1 can (15 oz.) solid-pack pumpkin
2 cups flour
2 cups sugar
2 pkg. (3 oz. each) cook and serve vanilla pudding mix
1 teaspoon baking soda
1 teaspoon ground cinnamon
1/2 teaspoon salt

In a mixing bowl, beat the eggs. Add oil and pumpkin, beat until smooth. Combine remaining ingredients; gradually beat into pumpkin mixture. Pour batter into 5 greased 5x 1/2x2 inch loaf pans. Bake at 325 for 50-55 minutes or until a toothpick inserted near the center comes out clean. Cool in pans 10 minutes before removing to baking racks to cool completely. May also be baked in 2 greased 8x4x2 inch loaf pans for 75-80 minutes.

Baked Santa Fe Dip
1 8.75 oz. can whole kernel corn, drained
2 cups shredded cheddar cheese (8 oz.)
1 cup shredded M-J cheese (4 oz.)
1 4-oz. can diced green chili peppers, drained 
1/2 cup mayonnaise
2 teaspoons finely chopped canned chipotle chili pepper in adobo sauce
1/4 teaspoon garlic powder
1/2 cup chopped, seeded tomato (1 small)
1/4 sliced green onions (2) 
Tortilla chips and/or vegetable dippers

Preheat oven to 350. In a large bowl, stir together corn, cheddar cheese, M-J cheese, green chili peppers, mayonnaise, chipotle pepper and garlic powder. Spread mixture in an ungreased 9-inch pie plate. Bake, uncovered, about 25 minutes or until heated through. Meanwhile, in a small bowl, combine tomato and green onion. Sprinkle tomato mixture over baked cheese mixture. Serve with chips and/or vegetables. Yields 14 servings.

Peanut Butter Cake
2 cups flour
2 cups sugar
1 teaspoon baking soda
1/2 teaspoon salt
1 cup water
3/4 cup butter
1/2 cup peanut butter
1/4 cup canola oil
2 eggs
1/2 cup buttermilk
1 teaspoon vanilla
  
Preheat oven to 350. Grease a 15x1x1 in baking pan. In large bowl, whisk flour, sugar, baking soda and salt. In a small saucepan, combine water and butter; bring just to a boil. Stir in peanut butter and oil until blended. Stir into flour mixture. In a small bowl, whisk eggs, buttermilk and vanilla until blended; add to flour mixture, whisking constantly. Transfer to prepared pan. Bake 20-25 minutes or until a toothpick inserted in center comes out clean.

FROSTING
1/2 cup peanut butter
1/2 cup butter
4 teaspoons water
2 teaspoons vanilla
2 cups powdered sugar
Mix well and frost cooled cake

GLAZE OPTION
1/2 cup butter
1/4 cup creamy peanut butter
1/3 cup + 1 tablespoon milk
16 oz. powdered sugar
1 teaspoon vanilla   
Combine first 3 ingredients over medium heat. Bring to a boil. Remove from heat and stir in powdered sugar and vanilla, mixing until spreading consistency. Spread over warm milk.

Christmas Punch 
4 cups cranberry juice
2 cups pineapple juice
3 quarts Ginger ale, cold
1 tablespoon almond flavoring
1/2 cup sugar
1 teaspoon red food coloring (optional)
Combine all ingredients. Stir until sugar is dissolved and thoroughly mixed.

The Best Chicken and Dumplings
3/4 cup flour, divided
1/2 teaspoon salt
1/2 teaspoon ground pepper
1 broiler/fryer chicken (about 3 pounds) cut up
2 tablespoons canola oil
1 large onion, chopped
2 medium carrots, chopped
2 celery ribs, chopped
3 garlic cloves, minced
6 cups chicken stock
1/2 cup white wine or apple cider
2 teaspoons sugar
2 bay leaves
5 whole peppercorns 
DUMPLINGS
1 1/3 cup flour
2 teaspoons baking powder
3/4 teaspoon salt
2/3 cup 2% milk
1 tablespoon butter, melted
SOUP
1/2 cup heavy whipping cream
1 teaspoon minced fresh parsley
1 teaspoon minced fresh thyme
Additional salt and pepper to taste 

In a shallow bowl, mix 1/2 cup flour, salt and pepper. Add chicken, 1 piece at a time, and toss to coat; shake off excess. In a 6-quarrt stockpot, heat oil over medium-high heat. Brown chicken in batches on all sides; remove from pan. Add onion, carrots and celery to same pan; cook and stir 6-8 minutes or until onion is tender. Add garlic; cook and stir 1 minute longer. Stir in 1/4 cup flour until blended. Gradually add stock, stirring constantly. Stir in wine, sugar, bay leaves and peppercorns. Return chicken to pan; bring to a boil. Reduce heat; simmer, covered, 20-25 minutes or until chicken juices run clear. For dumplings, in a bowl, whisk flour, baking powder and salt. In another bowl, whisk milk and melted butter until blended. Add to flour mixture; stir just until moistened (do not overmix). Drop by rounded tablespoonfuls into a parchment-lined sheet; set aside. Remove chicken from stockpot; cool slightly. Discard bay leaves and skim fat from soup. Remove skin and bones from chicken and discard. Using 2 forks, coarsely shred meat into 1 to 1 1/2-inch pieces; return to soup. Cook, covered, on high until mixture reaches a simmer.  Drop dumplings on top of simmering soup, a few at a time. Reduce heat to low; cook, covered, 15-18 minutes or until a toothpick inserted in center of dumplings comes out clean (do not lift cover while simmering). Gently stir in cream, parsley and thyme. Season with additional salt and pepper to taste. 
 

The holiday season is a time for families to come together for fellowship, togetherness and the traditional “breaking bread.” 

Perhaps the two most popular times of the year where bread is broken (and broken again, and again) is Thanksgiving and Christmas Day. While the hugs and kisses go a long way, it’s the food that brings everyone together at a single table beneath a single roof. Perhaps the Italians said it best when they coined the phrase – “You can’t live a full life on an empty stomach.”

More times than not, during these two celebrated days of feasting, there is a favored dish that sparks more than a few warm memories from way back when.  

With these “warm memories” in mind, we recently asked a handful of Freeman Health System employees about their favorite holiday dishes and the precious memories tied to them. 
Below are their answers. 

Happy holidays, everyone! 

Kris Drake, Wellness Coordinator: “Our family has enjoyed wild rice casserole on Thanksgiving for as long as I can remember. The night before Thanksgiving, my parents, daughter, brother, sister-in-law, nieces and nephews would gather to make homemade pies and prep the casserole. What made it taste so special was having a chance to visit with family as we chopped the celery and green peppers as well as onions that went into the casserole and to reminisce of years gone by.”

Sarah Horine, Director of Public Relations: “I love stuffing! Mostly this is my favorite holiday food due to the feelings associated with indulgence. I have decidedly different versions of stuffing nestled in my core memory rotation. Each variation being offered by my grandmothers and my aunt; all three wonderful cooks I have been blessed to know over the course of my life. Although different in presentation, texture and taste, each version welcomes feelings of family, togetherness, comfort, laughter and love. 

“One version, in particular, is my favorite due to the significance of the recipe and experience associated with passing down the tradition of providing this small portion of nostalgia to our family. I spent three years living in West Texas. This was our first time away from family during the holidays. I wanted to provide my small family of three with the continued tradition and care provided through holiday meals. My preparation was simply to call my grandmother to get recipes! She shared her version of her stuffing recipe, meaning I received directions such as, “a bit,” “some,” and other vague ingredient measurements. I treasure, and can still hear, our laughter, and my grandmother’s occasional annoyance, during that conversation. My family was afforded the experience of tradition during that first, West Texas holiday meal. 

My grandmother has since passed away. I now have the honor of bringing “Grandma’s Stuffing” as I just so happen to be the only family member who ever received her recipe. Each year as I prepare the bread, I can vividly remember walking into her home to see trays of bread out drying during the lead up to a holiday dinner. I am taken back to her home when I smell the spices, now measured by heart, used to season the dish. When we serve the meal, I am honored when our loved ones express how it “tastes just like Grandma’s” with a sentimental smile. 

“Stuffing invades my senses and emotions, while reminding me of the tradition passed down to me: familial commitment of care for our loved ones.”

Lisa Nelson, Pink Door Boutique Coordinator: “It's a toss-up between sweet potato casserole and dressing. Sweet potato is like having dessert first and it's okay! Throw on some whipped topping later and it gets even better! My Mom could make the best dressing ever! My Dad always loved it on the dryer side, and then cover it with gravy, so I have always loved the corner or end pieces so it would be just a little bit crispy. Gets even better rewarmed. It makes me miss my Mom so much!  Good news is...my dear mother-in-law makes great dressing as well!!!”  

Brandy Miller-Turner, Development Office and CMN Manager: “Whenever I think of Christmas, the things that make me smile always begin with the memories of sweet enticing aromas, coming from a warm kitchen. 
“I had a grandmother who was a master at making Christmas candy and the very best Christmas cookies. We would fill the entire length of her massive kitchen with many varieties of candies, fudge and cookies to share with family and friends over the holidays. 

“My favorite treat to make is Magic Cookie Bars, also known as Seven Layer Bars. They are full of rich chocolate, crunchy graham cracker crumbs and flaked coconut along with sweetened condensed milk. I always love to dress my Magic Cookie Bars up for the holidays by adding some red and green M&Ms. This is such a fun way to give them a bit of color and added texture. Magic Cookie Bars include something for everyone and that’s part of the appeal along with being super easy to make!” 

Danae Taylor: Volunteer Services and Gift Shop Manager: “One of my favorite holiday foods is my Grandma’s chicken and noodles. After a grandma has passed, her recipes often become even more special, taking on a whole new depth of meaning. This recipe allows us to reconnect us to her memory and reminisce on the days of old through the familiar smells and rituals of her preparing the dish. When cooking her chicken and noodles, it brings back memories of her laughter and the warmth of my childhood home. Grandma’s recipes are just another way to keep her legacy alive.”

The holiday season is upon us. We expect it to be a time of joy, excitement, hope and spending time with the people we love. Unfortunately, it can also be a time of stress for many. The holidays can exacerbate financial, family and personal issues. This can take a toll on a person’s well-being mentally and physically.

In light of these concerns, it’s important to pay attention to how the holidays might be affecting you. Unfortunately, when the stress increases many are tempted to turn to unhealthy coping strategies such as:

•    Excessive drinking or substance use 
•    Overeating or eating too little 
•    Self-harm 
•    Anger or violence 
•    Sleeping too much or too little

Some of these unhealthy responses may have long-lasting and negative consequences. Therefore, it’s important to learn and put into practice healthy coping strategies. The following suggestions will help you cope with holiday stress more effectively. Remember – each person is unique, and taking the time to try many different things and figure out what combination of skills works for you is worth doing.

Manage Your Expectations 
Try to set realistic goals, and keep expectations for the holiday season manageable by not trying to make this “the best holiday ever.” Pace yourself. Be realistic about what you can and cannot do. With holiday commitments, it is okay to say “no” to a few, or all of them. It will help relieve some stress.

Make a Budget 
Financial strain is one of the leading causes of stress. Making a budget at the start of the season and sticking to it is one of the most effective ways to mitigate this stress. It helps prevent accidental overspending and ensures reasonable expectations. Try to remember that quality time and happy memories are generally worth more than expensive gifts.

Plan Ahead 
Between co-workers, friends and family, it's inevitable that some commitments will end up on the same day. Plan ahead, and prioritize only the holiday events that mean the most to you. Don’t try to attend everything else. Be realistic with how much you can handle this season.

Practice Self-Care
Schedule time for activities that make you feel good. Take a nap, read a book, go to the movies, listen to music you love or take your dog for a walk. It’s okay to prioritize alone time when you need to recharge.

Seek Support 
Lighten the load with a strong support system. Support can come from a lot of places. Many people turn to their friends and families, while others find it in a community or religious organization.  

Enlist the Help of Professionals 
Seeking professional help is an excellent choice when you feel overwhelmed and the stress is beginning to turn into a serious mental health issue. Ozark Center and Freeman Health System offer many resources for specific needs.

•    Crisis Hotline: 417.347.7720 
•    New Directions (for help with alcohol/drug issues): 417-347-7730 
•    Hope Spring for (adult counseling needs): 417-347-7567 
•    Will’s Place (for children and adolescent counseling needs): 417-347-7580 
•    Urgent Behavior Solutions (for urgent mental health care): 417-347-7800
 

A person is more likely to be struck by a car on Halloween than any other night of the year. It makes sense – it’s dark outside and kids are excited to trick or treat; they’ve waited all year for this night to arrive and to dress up as their favorite characters!

There are safety measures we can take, however, to keep our kids safe on the spookiest night of the year. When trick-or-treating, an adult should always accompany kids when moving from house to house. Stay in neighborhoods that you know. Cross the street at appropriate crossings, and make sure children are crossing with an adult. If available, it is statistically safer to attend community activities for Halloween such as popular trunk-or-treats events, which are often held in public parks or parking lots.

When moving from house to house, children should wear clothing that reflects light, and shoes and all accessories should fit well. Older children should travel with a buddy or in a group. Children should never enter a home without a parent accompanying them. Families and children should carry flashlights and glow sticks to make them more visible to drivers. Parents should also make sure they themselves wear light reflective clothing.

Many of us who grew up in the 70s and 80s have memories of the plastic masks held on by a small elastic band. No one could see, and they fogged up quickly. Thankfully, we have come a long way with costumes! When it comes to masks, make sure your child can easily see what’s in front of them. If using make-up instead of a mask, make sure it’s non-toxic; some kids with sensitive skin or eczema may have reactions. Additional ideas that won’t limit your child’s vision but bring creativity to a costume are wigs and hats. 

Remember, there’s safety in numbers when it comes to groups. If you can do your spooky activities when the sun is still up that’s the best time to head outdoors. Parents and guardians should stay with younger children at all times; even older teenagers should stay within a group.

When it comes to the coveted candy haul, have your kids wait until they are home to begin sorting out their candy. Have them wash their hands well – remember, your kids have been reaching into those candy bowls all night. You also want to think about the age of the child and potential choking hazards. Tampering with candy is rare but it can still happen. To be on the safe side, throw away any candy that looks like it has been unwrapped or altered in any way. Also, don’t let your kids go overboard on the spoils. Everyone enjoys a sweet treat but too much of a good thing can bring about a stomachache or even a toothache. Think about rationing out the treats so the kids can enjoy the treats over time.

Finally, if your child has any food allergies, remove those candies immediately. There is the Teal Pumpkin Project which is about making Halloween more inclusive for kids suffering from food allergies. A teal pumpkin or sticker in front of a home indicates non-food treats are being handed out that are safe for all trick-or-treaters. If you’re getting candy from homes that do not have a teal pumpkin, please go through the candy before your child enjoys the treats. Make sure there is nothing in there that will make them react.

The breast cancer treatments are over and now it’s time to return to work. Life after breast cancer means returning to some familiar things and also making some new choices. After a marathon of breast cancer diagnosis and treatment that may last six months to a year, women are eager to get back to a normal life again, and that often includes getting back to work. Transitioning from breast cancer treatment patient to breast cancer survivor is embracing the “new woman” and entering into the “new normal.”

Returning to work post-treatment can be an emotional experience for many women who often feel conflicted between wanting to go on with life and being able to cope with the daily pressures. On one hand, women look forward to returning to a work routine and on the other hand, they dread it. Adding to the awkwardness are the after-effects of treatment such as fatigue resulting from chemotherapy and/or the accumulated effects of other treatments as well as a phenomenon some people call “chemobrain” – mental changes such as memory deficits and the inability to focus.

Adding to the frustrating mix, co-workers tell survivors how they look and ask questions about treatment. How open women are with their co-workers about their breast cancer and health after treatment is a personal decision. Some co-workers will be understanding and offer help while others may be uncomfortable discussing it or resent that they had to take on extra duties on days when the person was absent. Others may ask intrusive questions about the breast cancer, the person’s health, why they’ve been gone or even avoid them. Based on the relationship with co-workers, women can decide if they want to share anything, what works best for them and their situation, think ahead about how they will handle other people’s reactions and have a plan for what and how much they want to share.

It’s important for women to make sure they’re medically cleared by their health care provider before returning to work. They can also talk with their employer about possible options, like flex-time, job sharing, working from home or other options that may help ease them back into the demands of a job. For some people, the transition to working full-time may be easy, and for others it may take some adjustment.

The benefits of going back to work include helping ladies keep their sense of who they are and how they fit in. It might even boost their self-esteem, not to mention their income. Returning to their job also reminds women that they have a life apart from breast cancer – they are a valued employee, a great boss or a trusted co-worker.

Sometimes breast cancer can make women feel isolated and lonely, and being around people can be a great comfort. Support groups, online chat forums and social media groups offer the chance to air challenges with others that have had breast cancer. This, too, helps with the healing process to speak openly and honestly about the post-surgery struggles.

The good news is, with time, little by little, most women start to feel like their regular selves once medications are completed and the exhaustion subsides. It takes time for the “new you” to settle in. Truly, time heals many wounds and having a job can divert attention away from the stressors of the breast cancer journey and allow women to refocus on other things in life and create their own “new normal.”

About the Author
Lesa Deardorff has worked at Freeman Health System for 37 years and served as director of radiology services for 21 years. She oversees the Freeman Radiology Department, which offers advanced technology and top-of-the-line ultrasound, x-ray, nuclear medicine, CT, PET/CT and mammography services. To learn more, visit freemanhealth.com/services/radiology or call 417.347.6611.
 

Can I let you in on an industry secret? Pumpkin pie is available any time of year. You can make your grandmother’s 24-hour salad in April. The splendor of sweet potato casserole can be appreciated as soon as the farmer finishes his harvest. And (hold onto your hats for this one) the savory notes of the family’s secret recipe for stuffing can be relished in July alongside hamburgers and fireworks. The magic of the holiday season is not in the food and need not be limited to a decadent meal. What draws us in are the tender memories and cherished traditions. The answer then lies in mindfulness, which can open us to a new manner of living – one that allows us to appreciate each moment of this season and cherish every day of the year as sacred. 

“Mindfulness” has reached buzzword status and can seem a practice of mystical proportions. In reality, mindfulness is simply living with intention and attention. It is living your life on purpose and becoming aware of every moment as it happens. Mindfulness allows you to turn your mind from your infinite to-do list and notice each bite you put in your mouth through each meal – without judgment. Mindful eating is often the first step on the journey toward mindfulness, providing an everyday practice with which to put these skills into fruition. If we allow it, mindfulness can also be a step away from a war over food and one toward being more present with those around you. It begins with each of your five senses, noticing and honoring each of the signals your body provides, from grumbling stomach to the nuances of fullness. It continues with self-compassion and trusting your intuitive wisdom, then meeting your needs with the resources available to you. Give yourself permission to be authentic, to strive for non-judgmental awareness of your experiences and to know you are truly doing the best you can.

Mindfulness allows you to be present with your eating and invites you to be more present with others. Become aware of the texture and flavor of your food and savor every moment. Find contentment with each meal, thus, taking steps toward seeing yourself as a whole person with flaws, light and purpose. Release the rules of dieting we are endlessly faced with, the common criticisms of flawed yet human family members and the need to do everything “right.” Begin with mindful eating and let go of worries about food and New Year’s resolutions to lose 50 pounds by Valentine’s Day, and embrace the peace and joy of the here and now. You deserve it.

Dr. Jenny Copeland, Clinical Psychologist, practices at Ozark Center in Joplin, MO. Dr. Copeland leads the Reconnect Eating Disorders treatment program, the first eating disorder program to develop in a community health center in the nation. Visit ozarkcenter.com to learn more about Ozark Center services.
 

If I polled a room today and asked how many individuals were allergic to penicillin or one of its siblings – such as amoxicillin – up to a quarter of those people would raise their hands. You may even be one of them. But have you ever wondered if that was true?

September 28 is National Penicillin Allergy Day, which celebrates the day Alexander Flemming discovered penicillin in 1928. The discovery of penicillin was so significant that it merited a Nobel Prize in 1945, and it’s no exaggeration that penicillin has save millions of lives.

More people report an allergy to penicillin than any other drug – up to 25 percent of the population. However, up to one-third of those individuals are unable to pinpoint their specific reactions, which isn’t surprising, considering as many as 75 percent of those reported reactions happened before they were 3 years old.

Many reported reactions – such as headache, diarrhea or even a family member with penicillin allergy – aren’t even the result of true penicillin allergies. Rash is the most commonly reported reaction, but it can be difficult to differentiate between rashes caused by an allergy or those caused by viruses, which are extremely common in young children.

So what’s the big deal? The solution seems simple: Avoid penicillin and we’ll be fine, right? Not exactly. The antibiotics used in place of penicillin are often less effective than penicillin antibiotics and carry a higher chance of infections such as Clostridium difficile, a serious diarrheal illness that can require hospitalization.

On top of that, the allergy is associated with longer hospital stays as well as drug-resistant bacterial infections such as methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), which can be difficult to treat.

What allergy  ‘challenges’ reveal

Up to this point in the article, you may have noticed that I use the term “reported allergy” instead of “allergy.” I do this because less than 5 percent of people who report penicillin allergies would truly be allergic if tested.

The American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology recommend actively challenging reported penicillin allergies.

These testing “challenges” can range from simply discussing reported reactions to skin pricks– in which a qualified physician injects a small amount of penicillin or one of its derivatives in the top layer of skin and looks for a reaction. Another challenge involves administering a dose of a penicillin to gauge a true reaction. All this testing can be performed safely, in an office setting safely. Less than 4 percent of individuals challenged have had reactions – usually mild ones such as a rash – with no reports of serious reactions, such as anaphylaxis.

Those who experience true reactions to penicillin can benefit from challenging. After five years, up to 50 percent will no longer be allergic to penicillin on testing, and this number increases to 80 percent after 10 years.

Challenging a reported penicillin allergy is well worth it, with some patients reporting savings of nearly $2,000 per person, per year, in healthcare costs.

Ask your physician or healthcare provider about your penicillin allergy and see if you would benefit from a direct challenge or referral to a board certified allergist. Freeman Health System is proud to be the region’s only hospital offering penicillin challenges for low-risk hospitalized patients.

References

Castells M, Khan DA, Phillips EJ. Penicillin allergy. N Engl J Med. 2019;381(24):2338-2351.
National Penicillin Allergy Day. NPAD. Published June 28, 2017. Accessed September 25, 2024. https://nationalpenicillinallergyday.com/

Stone CA Jr, Trubiano J, Coleman DT, Rukasin CRF, Phillips EJ. The challenge of de-labeling penicillin allergy. Allergy. 2020;75(2):273-288.

Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study. J Allergy Clin Immunol. 2014;133(3):790-796.

Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: A 2022 practice parameter update. J Allergy Clin Immunol. 2022;150(6):1333-1393.

Cooper L, Harbour J, Sneddon J, Seaton RA. Safety and efficacy of de-labelling penicillin allergy in adults using direct oral challenge: a systematic review. JAC Antimicrob Resist. 2021;3(1):dlaa123.

Sullivan TJ, Wedner HJ, Shatz GS, Yecies LD, Parker CW. Skin testing to detect penicillin allergy. J Allergy Clin Immunol. 1981;68(3):171-180.

Blanca M, Torres MJ, García JJ, et al. Natural evolution of skin test sensitivity in patients allergic to beta-lactam antibiotics. J Allergy Clin Immunol. 1999;103(5 Pt 1):918-924.

Getting a pre-participation sports physical exam is not just a good idea for student athletes – it’s a requirement. The Missouri High School Activities Association mandates that student athletes get an annual sports physical to compete in junior high or high school sports. Other neighboring states have that same requirement. Pre-participation sports exams are performed either by a student’s personal physician or by another professional medical provider. Exams can be completed at a medical office, designated sports clinic or an athlete’s school.

Medical providers check for several conditions:

•    Conditions that require treatment or a plan prior to sports participation
•    Orthopaedic conditions that need physical therapy or other treatment
•    Asthma, hypertension, anemia, etc.
•    Potentially life-threatening conditions that could occur during any sport
•    History of concussions to determine if student is still experiencing post-concussion symptoms

Parents need to provide the medical staff with the athlete’s medical history, as well as the family’s medical history before the physical exam takes place. After the medical provider has reviewed the student’s and family’s medical history, the physical exam will follow. Based on the family medical history, a student commenting on shortness of breath or heart palpitations during the exam will be referred to a specialist for further testing to pick up on potential heart diseases. Any prescriptions or over-the-counter medications the student is currently taking should be reported during the exam.

The physical exam usually includes:

•    Weight and height measurements
•    Blood pressure screening
•    Heart and lung checks
•    Ear, nose and throat examinations
•    Basic hearing and vision tests
•    Joint movement and muscle strength
•    Spinal alignment and posture

Sports physicals should be completed at least six to eight weeks before the student’s sports season begins. This allows time for additional testing and evaluation, if necessary. Parents have the right to choose which type of sports physical is right for their child. If an athlete has a medical condition or history of injury, the parent may choose the route of a more thorough physical exam through the family’s personal physician.

Although a sports physical exam may identify health problems not associated with physical activity, it should not be used to replace medical care or annual routine checkups with primary care physicians. Students are still encouraged to visit their primary care physician for regular checkups and for any conditions that need further medical treatment.

Pre-participation physical exams can help determine if a particular sport is safe for an individual student. Most students are cleared for sports participation through sports physical exams. Students requiring follow-up with a specialist often resume normal activities after ensuring they are able to safely participate in sports.

School sports play an important role in helping student athletes develop skills and learn values that can be used throughout their entire lives. Providing a sports physical exam is the first step to a season filled with learning, spirit and teamwork.

Robert Lieurance, MD, completed his medical education at the University of Arizona College of Medicine. He is board certified in orthopaedic surgery and fellowship-trained in sports medicine. Dr. Lieurance serves as the official orthopaedic team physician for Missouri Southern State University and Joplin High School.