E-Cigarettes And Vaping Q&A

According to the Center on Addiction, vaping has grown in popularity with the rise of e-cigarettes and other Electronic Nicotine Delivery Systems (ENDS). Several studies indicate that particles found in the “vapor” produced by these devices contain toxic chemicals which have been linked to respiratory and heart disease, as well as cancer. Despite these findings, some still believe that vaping is far less harmful than smoking traditional cigarettes. In fact, the opposite is true. This Q&A addresses this and other misconceptions people may have about vaping.

Q: What are ENDS or vaping devices?

A: Electronic Nicotine Delivery Systems are tobacco products that do not produce smoke. Some of the most commonly used terms used to describe these products are e-cigarettes, vapes and vaporizers. These devices are usually composed of a battery, heating element and a chamber which is often filled with liquid containing nicotine.  This liquid is heated by the device to release an aerosol often mistaken for water vapor. Vaping is inhaling and exhaling the aerosol produced.

Q: Are there negative effects associated with vaping?

A: The liquid found in vaping devices often contains nicotine which causes addiction and increases abuse potential.  Nicotine is toxic to the brain of developing fetuses. It also harms adolescent brain development.  The aerosol component of vaping devices has cancer-causing chemicals.  Cases of accidental poisoning by the liquids in devices are becoming more common. Defective products can cause explosions and fires.

Q: How do regular cigarettes compare to vaping devices?

A: Smoking a regular cigarette will produce smoke while delivering nicotine to the body.  The smoke is a harmful component that contains many toxic agents including but not limited to carbon monoxide and tar; both of which can cause cancer and other diseases.  E-cigarettes and other vaping devices contain fewer toxic chemicals when compared to regular cigarettes because there is no smoke.  However, they still contain significant levels of harmful substances such as nicotine, heavy metals like lead, volatile organic compounds, propylene glycol and other cancer-causing agents.

Q: Can e-cigarettes and other vaping devices be used to quit smoking?

A:   E-cigarettes are not currently approved by the FDA to quit smoking. The Centers for Disease Control and Prevention (CDC) deems that e-cigarettes have the potential to benefit adult smokers (non-pregnant) as a complete substitute for regular cigarettes and other smoked tobacco products, but more studies are needed to prove this. Recent CDC studies also found that most adults using e-cigarettes don’t quit smoking, instead, are using both products.

Q: Is there a rising epidemic in the use of vaping device among youth?

In the USA there are several laws put in place to regulate the use of vaping devices. Despite these regulations, the use of vaping devices is increasing among youth. Reports from the CDC indicate that 4.3% of middle school students and 11.3% of high school students have tried vaping in the past month.  Vaping devices are produced in various models, including those that look like flash drives. This makes it easier for students to mask its presence. Lack of legislation to stop advertising of vaping products, availability of multiple appealing flavors, easy access are all factors that have contributed to increased use of vaping devices among youth.

Nicotine and other toxic substances, delivered in the form of traditional cigarettes or ENDS are harmful to your health. The best way to avoid these toxic chemicals derived from tobacco use is to stop smoking or vaping.

If you are currently a smoker and would like to quit, please schedule an appointment to see your doctor. There are many resources available to help control cravings and decrease use.

To schedule an appointment with a Family Medicine Doctor at Jamaica Hospital Medical Center, please call 718-206-6942.

Yogaalakshmi Sundararajan M.D. -Family Medicine Physician

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.

Intimate Partner Violence

October is domestic violence awareness month. Here’s what you should know about this public health issue:

What is Intimate Partner Violence?

Intimate partner violence (IPV) involves four types of aggressive behavior that harms someone in a close relationship. An intimate partner can be a current or former boyfriend, girlfriend, fiancé or spouse. The violence can be as brief as one episode or it can continue on for years.

What are the four different forms of violence?

Physical Violence – this involves physical force used by a partner. Some examples include hitting, kicking, slapping, pushing, and the use of any weapons.

Sexual Violence – this involves forcing a partner to engage in any sexual act that is non-consensual. This can also include unwanted sexual messages or images via text message or social media.

Stalking – this involves watching, following, repetitive calling, incessant messaging or any form of unwanted and unsolicited attention from a current or past partner.

Psychological Aggression – this involves mental, emotional, or psychological harm caused by a partner who wishes to gain power and control over the other partner. Examples include threats, accusations, and coercion.

Who is affected?

The CDC reports that millions of Americans in heterosexual or same-sex relationships are affected by one or more forms of IPV every year.  1 out of 4 women and 1 out of 7 men report experiencing one or more forms of IPV in their lifetime.

What are the consequences of Intimate partner violence?

For the individual, IPV can cause physical injury, mental health issues (depression, PTSD), and chronic gastrointestinal and musculoskeletal issues. IPV can even result in death; the U.S. crime database reports that 1 in 6 homicide victims are killed by an intimate partner.

What can I do about it?

Encourage victims to speak up.  If you are a victim, talk to your doctor.  Your physician can help you to locate the resources needed to assist you.  Utilize resources such as safe havens or healthy relationship counseling that offer support to those affected by IPV.   For more information and to learn about services available, please visit CDC.gov/violenceprevention.

If you or someone you know suffers from intimate partner violence, tell your doctor immediately. To schedule an appointment with a Family Medicine Doctor at Jamaica Hospital Medical Center, please call 718-206-6942.

Sujal Singh D.O.

 

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.

Preventing Constipation

Constipation is a common problem among people of all ages. Often, those experiencing symptoms describe having hard or pebbly stools, having infrequent bowel movements or straining while trying to use the bathroom.  People may also complain of stomach pains, bloating, gas or being unable to have a full bowel movement.   These symptoms may vary with each individual.

Constipation can be caused by many different problems, but the most common reasons are a lack of fiber in your diet and not drinking enough water.  Certain medications or iron supplements can also contribute to constipation.

There are several things you can do to prevent constipation, one of which is making sure you are consuming enough fiber.  Eating enough fiber helps to soften your stool and helps your body to move waste through your digestive tract.  It is recommended that you eat 20 to 35 grams of fiber every day.

Fiber can be found in many vegetables; grains such as whole wheat, oatmeal, bran, brown rice; nuts; and fruits such as apples, cherries, peaches, and grapes.  Whole fruits are particularly helpful in preventing constipation because their sugars help to keep more water in the intestines which softens your stool. Prunes, raisins, and other dried fruits are often used to relieve constipation because they have high amounts of fiber and sugar. If you are diabetic, be careful when choosing the fruits you eat, as some are very rich in sugar.

Adopting other healthy habits can also reduce the occurrence of constipation. Exercise can help improve your bowel movements; moving your body promotes movement along your digestive system.  Using the bathroom around the same time every day is also beneficial and will help your body to develop a routine. Most people tend to go more frequently in the morning as the activity in their digestive tract peaks shortly after waking up. If you feel the need to have a bowel movement at other times throughout the day, it is best to go and not hold it in as this can also lead to constipation.

Laxatives (over-the-counter and prescription) are often used as a form of relief from constipation; however, it is important to keep in mind that the frequent use of laxatives is not recommended as your body may become dependent on them for bowel movements.

Just about everyone will have difficulty with going to the bathroom from time-to-time; however, if symptoms of constipation persist for more than three weeks, or if you are experiencing blood in your stools or stomach pain, you should see your physician.  There may be a more serious cause for your constipation.

Please do not hesitate to talk to your doctor if you are concerned about changes in your bowel movements.  To schedule an appointment with a Family Medicine physician at Jamaica Hospital Medical Center, please call 718-206-6942.

Dr. Wesley Cheng D.O. Family Medicine

 

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 Much Exercise Do We Need?

Physical activity is a vital component of healthy living. It is a well-known fact that being physically active reduces the risk of many chronic diseases and also improves quality of life.

Given the benefits, it is evident that it is important for everyone to keep fit and active. However, statistics show that most people living in the United States are not getting enough exercise. In fact, more than half do not meet the recommended guidelines for weekly physical activity.

According to the American Family Physician guidelines, each week, adults should participate in at least 150 minutes of moderate-intensity aerobic activity and at least two days of resistance training or 75 minutes of vigorous-intensity aerobic activity in addition to a minimum of two days of resistance training.

Aerobic exercises work on endurance and utilize large muscle groups. Examples include walking, stationary biking, swimming or dancing. An example of moderate-intensity activity is briskly walking, while vigorous intensity activity includes jogging or running. Resistance or strength exercises involve the use of resistance bands or weights (machines or free) and can be performed while doing simple activities such as carrying groceries.

For optimal health benefits, physical activity should be performed at high intensity with greater frequency and longer duration, but any activity is preferred over doing nothing at all.

Beginning an exercise routine or increasing levels of physical activity can be intimidating. Setting goals that include specific activities and instructions can make this process easier. Doctors recommend starting slowly and gradually working up to a level that meets physical activity guidelines.

To avoid injury, be sure to stretch prior to exercising in order to increase flexibility and preserve joint motions. You should discontinue exercising and rest if you experience the following warning signs: feelings of lightheadedness, chest pain, palpitations, blurry vision, or being unable to catch your breath. If you experience any of these symptoms, you should stop your exercise routine immediately and consult your doctor.

Remember to drink plenty of water while exercising, as this is essential in helping you to remain hydrated. It is also important that you make sure to eat healthily. Good nutrition combined with exercise can help you to maintain a healthy weight and reduce the risks of chronic illnesses.

You should speak with your physician before starting a new exercise regimen. Some activities may not be safe for people diagnosed with certain medical conditions. Your doctor can also share helpful resources to assist you in your journey of leading a healthier life.

To  schedule an appointment with a Family Medicine Doctor at Jamaica Hospital Medical Center, please call 718-206-6942

Dr. Colleen Hautzinger, Family Medicine

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.

Recognizing The Symptoms of A Stroke

Symptoms of a stroke Stroke is an all too common medical emergency that affects more than 795,000 people in the United States each year; of that number, 140,000 people die from complications.

According to the Centers for Disease Control and Prevention (CDC), a stroke occurs every four seconds and someone dies from stroke every four minutes.  Because the chances of an occurrence are high, there is a possibility that you may come in contact with a person while they are having a stroke.  Knowledge is key when helping someone in this situation.

Stroke can occur when there is a blockage of blood supply or bleeding in the brain. Both instances can lead to severe symptoms if not addressed with urgency.   When stroke occurs time equals brain: meaning for every minute without treatment 1.9 million neurons (the building blocks of the nervous system) may become damaged or die.

Time is essential when treating stroke. The sooner you recognize the warning signs, the sooner you can seek emergency care.  When it comes to recognizing stroke, all you have to remember is F-A-S-T:

  • Facial droop: one side of the face isn’t moving like the other. If you ask them to smile, it will appear lop-sided or crooked.
  • Arm weakness: one side may be weaker than the other, or they cannot raise both arms together. There may also be numbness or tingling of the arm or leg.
  • Speech difficulty: slurred speech, or speech that may not make sense. They cannot repeat a simple phrase or aren’t forming their words normally.
  • Time: if you notice any of these signs, call 9-1-1 immediately and remember the time you first noticed symptoms, this will be very important information when it comes to treatment.

Other signs of stroke may include a sudden severe headache, changes to vision, confusion, numbness/tingling, trouble walking or poor balance.

If someone you know has symptoms of stroke, CALL 9-1-1! Emergency medical staff can provide early diagnosis and treatment and ensure that the patient gets transported where they need to go as quickly as possible. Recognizing the signs of stroke early can save a life!

For more information about stroke and stroke prevention and treatment, you can go to www.cdc.gov/stroke or www.stroke.org or schedule an appointment with your doctor to discuss what risk factors you may have and what you can do to minimize your risk of stroke.

To  schedule an appointment with a Family Medicine Doctor at Jamaica Hospital Medical Center, please call 718-206-6942

Andrew Flowers, MD- Family Medicine

 

 

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.

Fruit and Vegetable Safety

I bet your doctor has talked to you at some point in your life about how important it is for your health to eat fruits and vegetables; they can help prevent stroke and heart disease, help you lose weight and even help to protect against certain types of cancer.  But one thing they probably didn’t mention is how important it is to pick and prepare fruits and vegetables properly to prevent food poisoning that can be caused by germs on your fresh produce.

This process all starts at the grocery store or market:

  • It is very important to choose produce that hasn’t been bruised or damaged. This creates an area where potentially harmful germs can grow.
  • Once you have your produce, keep it separated from raw meats in your cart, bags and refrigerator.
  • Make sure to keep pre-cut fruits and vegetables cold or refrigerated. They are less likely to grow harmful germs when kept cold.
  • Don’t be fooled! Read packages carefully as pre-packaged does not always mean pre-washed. There is still a risk of contamination.

Once you’re home, it’s important to:

  • Wash everything that will come into contact with your produce while you’re cooking; including your hands, cooking surfaces, utensils, and the produce itself. It is best to wash your fruits and vegetables under running water.
  • Make sure to remove any bruised or damaged areas of the produce.
  • Store all cut or peeled fruits and vegetables properly. They should be refrigerated within two hours of preparation if they are not going to be cooked.

Certain people have a greater chance of getting food poisoning and it is especially important to be careful when preparing food for them. Those people are the very young, adults older than 65 years old, pregnant women, or anyone with a weakened immune system.

Although most cases of food poisoning are mild, only lasting a few days, there are some more severe forms.  If you experience vomiting or diarrhea for more than three days, have a high fever greater than 101F, or see blood in your stool, you should talk to your doctor immediately.

With a little bit of new knowledge and care, you can protect yourself, enjoy a healthier diet and live a healthier life. Just remember to buy right, store properly, separate for safety and prepare safely.

For more information about current outbreaks of food poisoning related to food products, visit the CDC website at https://www.cdc.gov/features/foodsafetyquiz/

To schedule an appointment with a Family Medicine Physician at Jamaica Hospital Medical Center, please call 718-206-6942

Dr. Andrew Flowers, Family Medicine

 

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.

Healthy eating for people with diabetes

For people with diabetes, maintaining a healthy diet is crucial.  Although eating well-balanced meals is strongly encouraged, it is important to pay close attention to the carbohydrate portion of foods consumed as they become glucose when digested.

Glucose is a sugar needed to help our cells and organs function properly. In healthy individuals, the level of glucose within the blood is controlled so that it does not become too high or too low.  However, in people with diabetes, the body is unable to keep the glucose levels within the normal range. Frequent high levels of glucose within the blood is responsible for the complications that go along with diabetes including an increased risk for heart attacks, strokes, nerve damage, kidney damage, and many other problems.

To avoid the development of these complications and to help maintain normal glucose levels, people with diabetes should include foods that have low glycemic levels such as whole wheat bread, barley, carrots or lentils in their diets. Food such as white rice, white bread, pretzels or potatoes rank highly on the glycemic index and should be kept to a minimum or eliminated.

The glycemic index is a scale from 0-100 that gives us an idea of blood sugar response from a particular food. In general, foods that rank 55 or less are considered to have low glycemic levels and foods that rank 70 or more are high.  Anything in between these numbers is moderate.

While having diabetes doesn’t mean you have to follow a specific diet, it does mean you should remain mindful of what you eat.  Here are some recommended tips you can follow to help you along the way:

– Try to avoid or cut down on sweet drinks. Sugary drinks such as juice, soda, and energy drinks are very high in sugar and easily absorbed by the body so they will cause your blood sugar to go high quickly.

– Protein and fat in foods can lower the glycemic index (making it better for your blood sugar), but be careful you’re not eating too much because they are also rich in calories and can cause weight gain.

-Foods with polyunsaturated or monounsaturated fats such as lean meat, avocados, fish, and whole grain wheat are much better for you than food that contains saturated or transfats such as doughnuts, fried foods, and salami.

To schedule an appointment to speak with a doctor about managing your diabetes, please call the Jamaica Hospital Department of Family Medicine  at 718-206-6942.

Wesley Cheng D.O. Family Medicine

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.

HPV Vaccination Q&A

Q: What is HPV?

A: HPV stands for human papillomavirus. According to the Centers for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted infection in the United States. The virus can cause warts to develop and can lead to cancers that both men and women are susceptible to–such as cancer of the mouth, throat, anus, cervix, vulva, vagina and penis.

Q: How do people get HPV?

A: HPV is transmitted through close skin-to-skin contact, including various types of sexual activities.

Q: How common do we see HPV?

A: About one out of four people in the United States is currently infected. Three out of four people will get an HPV infection in their lifetime.

Q: What symptoms do people have?

A: Most people with HPV infection have no signs or symptoms.  In most cases, HPV goes away on its own. However, in other instances, symptoms can develop and can take years to present. Symptoms may include warts (small bumps or groups of bumps) or cancer in the back of the throat, tongue, cervix, vulva, vagina, penis or anus.

Q: How can I protect myself or my children from getting HPV?

A: There are vaccines available to prevent HPV infection. Depending on the age group, there are a series of two to three vaccinations that are administered over a period of time.   If doses are administered before the age of 15, there will be a total of 2 vaccines given 6 months apart.  For those ages 15 to 26, there are a  total of 3 vaccines given at 0, 1 and 6 months. All boys and girls are recommended to obtain a full series of the HPV vaccination. It is recommended to start at ages 11-12, but can be given as young as 9 years old.

Q: How effective is HPV vaccine?

A: HPV vaccine can prevent over 90% of cancers caused by HPV which is 30,000 cases of cancer each year.

Q: What is the most common side effect of the HPV vaccine?

A: It is a very safe vaccine. Like any other vaccines, most of the side effects are mild. The most common side effects are redness or swelling at the site it was given.  Additional side effects may include dizziness or fainting, which can be prevented by sitting or lying down when the vaccine is being given and remaining in that position for 15 minutes after administration.

Dr.  Pan San Chan, Family Medicine Physician

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.

National Bike Month – Stay Safe and Fit

National Bike Month begins on May 14th and culminates with Ride to Work Day on May 18, 2018.

Communities nationwide will participate in this week-long recognition good health and bring attention to the need of lessening toxic emissions that motor vehicles are having on our environment.

According to Bicycling Magazine, more than half of all Americans live less than 5 – 10 miles from work. By utilizing the extensive miles of bike lanes to and from your work destination, you could probable arrive at your destination in less than an hour.

Riding a bicycle to work can be a fun and effective way to get fit.  Cycling is beneficial for the cardiovascular system because it increases oxygen intake and stimulates the heart. Studies show that riding can increase energy levels by 20 percent and in one hour burn up to 488 calories when pedaling at 12 to 14 miles per hour.

Although a bicycle is an excellent fitness tool, it is also considered a vehicle.  Therefore, the rules of the road must be obeyed and a bicycle should be operated safely to prevent injuries and accidents. Statistics show that bicyclists face higher risks in crash-related injuries and deaths than drivers in a motor vehicle.

Follow these basic riding tips to ensure your safety and reduce the risks:

  • Always ride in the same direction as traffic and do not weave in between other vehicles.
  • Obey traffic laws and signals.
  • Do not listen to music or speak on cell phones while riding.
  • Wear a proper fitting helmet.
  • Never pass another vehicle on the right.
  • Always keep your hands on the brakes.
  • Stay aware of dangerous road hazards such as potholes and broken glass.
  • Use hand signals to show motorist where you are going.

So suit up, remember to wear your helmet and cycle your way to health and a cleaner environment!

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.

Is There a Benefit to Wearing a Fitness Tracker?

Generally speaking, if you are inactive your risk of  experiencing obesity, low energy, diabetes and hypertension is higher.  To combat these health issues, you can incorporate a brisk walk or run into your weekly activity.  The addition of this type of movement to your day may prevent or, in some cases, reverse health issues.

One of the ways some are finding it beneficial to keep track of their activity level is by wearing a “fitness tracker.”  Surprisingly, one of the first reports you may receive from your tracker is that you are not as active as you thought you were.

Most fitness trackers are a good way of monitoring your steps, calories, distance travelled, caloric intake, as well as your heart rate and sleep patterns.  They can be viewed as your “conscience” for personal accountability and motivation for a relatively low cost.

Some of the benefits of a fitness tracker include:

  • Encouraging physical activity – If you check your tracker and see that you are behind in your steps for the day, you may “step” up your game a bit and take a walk.
  • Measuring your heart rate – This feature can give you hard data on the effort you exert while doing a particular workout and/or task. It can give you a hint on the condition of your cardiovascular system by allowing you to see just how quickly your heart rate increases.
  • Providing insights on your sleep patterns – Sleep has a definite influence on your overall health. Fitness trackers that log sleep activity can help you address whatever is lacking in your sleep cycles.
  • Encouraging healthy eating – Fitness trackers can come equipped with apps that help you track your food and may help with weight loss.
  • Promoting interaction – Some fitness trackers allow the user to interact with other users, create group challenges and receive rewards for meeting goals.

There really isn’t a downside to tracking your activity, unless you take your fitness tracker off and it remains lost at the bottom of a drawer.

 

 

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.