The Facts About Male Infertility

Infertility is a diagnosis given to couples who have been unsuccessful at conceiving after a year of trying. Infertility affects approximately 15% of all couples and within this group male infertility issues contribute to 30% of all cases.

During Men’s Health Month, Jamaica Hospital wants to provide information about male infertility and offer treatment options for those trying to conceive.

 

The most common cause of male infertility is a varicocele, which is an enlargement of the veins within the scrotum that holds the testicles. Varicoceles are a common cause of low sperm production and decreased sperm quality.

Other causes include:

  • Age
  • A blockage in your reproductive system
  • Undescended testicles
  • Sperm that are abnormally shaped or that don’t move correctly
  • Hormone problems
  • Certain health conditions, such as cancer
  • An infection or sexually transmitted disease (STD)
  • Erectile dysfunction.

Sometimes the cause of male infertility is unknown. In these cases, it may be the result of genetics, lifestyle, or environmental factors.

A doctor can help find the cause of infertility. Your doctor will do an exam and review your medical history. A semen analysis will determine sperm count and quality. Another test your doctor may perform is a check of your hormone levels.

While you cannot always prevent male infertility, there are factors that can affect this condition that should be avoided. These include:

  • smoking
  • alcohol or drug abuse
  • emotional stress
  • obesity
  • Frequent hot tub use or wearing tight fitting underwear.

More than half of male infertility cases can be corrected. Treatment options depend on the root cause. Medicine can improve hormone levels or erectile dysfunction. Surgery can help correct physical problems, such as a varicocele. It also can repair blockages or other damage. Surgery is often minor and done as an outpatient procedure.

In cases where infertility cannot be cured, your doctor may suggest a form of assisted reproductive therapy, such as:

  • Intrauterine insemination (IUI). A man’s sperm is collected and inserted into the woman’s uterus. This procedure is done at the time of ovulation.
  • In vitro fertilization (IVF). This technique is more complex. A man’s sperm and a woman’s egg are fertilized in the lab. Then it is implanted back in the woman’s uterus.

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.

Tips to Successfully Transition Your Child Into Daycare

Placing your child in a daycare center is a reality for more and more working parents today.

The idea of leaving your child in the care of others for an extended period of time can be a frightening one to both you and your child. Many parents feel apprehensive about exposing their babies to a new environment, and the situation is only intensified as some children can experience separation anxiety at the thought of being away from their parents for the first time.

Below are a few tips to help both parents and children as they transition to this new daily routine.

  • Do your research – Before choosing a daycare environment, it is important for parents to do some investigation. Ask plenty of questions from other parents as well as from the daycare staff. It is also appropriate to ask to “sit-in” to observe the staff in action. By doing some due diligence, parents will feel less anxiety and more confident with their choice in a daycare provider.
  • Explain the situation to your child in advance – Sometimes it’s the unexpected that is most frightening to children. You can help the situation by preparing your child for what they will encounter at daycare. Explain to them everything that they will do during their day and everyone that they will meet. Picture books designed to outline the daycare experience to your child can also be a helpful tool
  • Try a gradual start – If your schedule will allow it, try easing your child into a daycare setting by enrolling them on a part-time basis. This can either be shorter sessions or for only a couple of days per week. After they get comfortable with their new surroundings, you can incrementally extend the experience. This gradual transition can reduce stress and anxiety for both parent and child.
  • Be organized – The pressure of transitioning into daycare can only be intensified when parents are running around at the last second as they look to get out the door. A chaotic environment takes a parents attention away from their child, who might need it. Prepare everything the night before so your trip to daycare can be a calm and relaxed one. Creating a check-list is always a good idea.
  • Have your child bring something familiar – A reminder of home will make those first few trips to daycare a little easier and provide comfort on difficult days for an anxious child. Ask your child if they would like to bring their favorite stuffed animal or a cozy blanket with them. These comfort items can reduce the stress associated with going to daycare.
  • Invent a goodbye ritual – Families should create a consistent way of saying goodbye to each other to help establish a fuss-free drop off experience. This could be a loving phrase, a secret handshake or special kiss that is shared just between a parent and a child. This ritual will make your child feel special and it will limit prolonged goodbyes.
  • Expect some tears – It can take anywhere from one day to a month for a child to adjust to daycare. During this transition it is perfectly natural for your child to cry when you drop them off. While this can be heartbreaking to parents in the moment, understand that children are resilient and a daycare experience can actually help them develop social and adaptation skills.

Following these tips can take what can be a tension-filled time in both your life and the life of your child, and make it into a positive and stress-free experience.

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.

Hurricane Season is Just Around the Corner – Are You Prepared?

Warmer temperatures are coming and we are all looking forward to them. While we typically associate the summer weather as a wonderful time to spend some time at the beach or with the family at a cookout, the summer months can bring with them some very dangerous weather conditions, namely hurricanes.

Hurricane season in the Atlantic region officially begins on June 1.  Defined by their torrential rain and heavy winds, hurricanes have the ability to cause massive devastation.  On average, 12 hurricanes make landfall the United States each year, and with so many major storms hitting different parts of the country in recent years, including Super Storm Sandy, which ravaged the New York area in 2012,  it is very important to be prepared for the next potential storm.

With a long history of providing relief to those devastated by hurricanes, including sending personnel to assist the victims of Hurricanes Katrina and Maria, Jamaica Hospital Medical Center is experienced and knowledgeable about how to properly prepare for such an event and would like to share the following tips with our community:

  • Stay informed by making sure you receive emergency notifications. There are many downloadable apps that can provide you with important information.
  • Know your community’s evacuation plan in advance and identify the appropriate evacuation routes and potential safe shelters.
  • Create an emergency notification plan for your family. This will help you contact one another and get back together if you are apart when a storm arrives.
  • Prepare a “go bag” in the event you need to evacuate in a hurry. Contents of a go bag should include a flashlight, batteries, cash, first aid supplies and medications as well as critical documents.
  • If you do not need to evacuate but there is a potential for prolonged power outages, make sure to have three to five days of water and non-perishable food items on hand for each member of your family.
  • Prepare your home by reinforcing all exterior doors and windows, securing or bringing in any loose objects outside your home, cutting down any damaged tree limbs, and repairing damaged gutters to prevent leaks.
  • While sometimes flooding is unavoidable, do your best to protect valuables by placing them in secure containers or relocating them to higher elevations.
  • If you have purchased a generator, be sure to use it correctly. Remember to keep them outdoors, keep them at least 20 feet away from windows and doors and try to protect them from moisture.

By being prepared and following these tips, you can help keep your home and your loved ones safe from disaster.

For more information, please visit https://www.ready.gov/hurricanes

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.

Learn the Facts About Oral Cancer

Oral cancer, or mouth cancer refers to a group of cancers that can develop anywhere in the mouth, including the lips, tongue, cheeks, gums, tonsils, floor of the mouth, hard and soft palate, salivary glands, sinuses and throat.

Oral cancer usually appears as a growth or sore in the mouth that does not go away and it can be life threatening if not diagnosed and treated early. According to the Oral Cancer Foundation, over 51,000 people in the U.S. will be newly diagnosed with oral cancer in 2018.

The most common symptoms of oral cancer include:

 

 

  • Swelling or thickening of the skin or lining of the mouth
  •  Development of lumps or bumps on the lips, gums, or other areas inside the mouth
  • Sores that bleed or do not heal
  • Unexplained bleeding in the mouth
  • Numbness or loss of feeling of the face, mouth, or neck
  • Difficulty chewing or swallowing
  • Jaw pain or stiffness
  • Hoarseness, chronic sore throat or change in voice
  • A change in the way your teeth or dentures fit together

According to the American Cancer Society, men face twice the risk of developing oral cancer as women. Cigarette smokers are six times more likely than nonsmokers to develop oral cancers. Those who use chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips. In addition, oral cancers are about six times more common in those who consume excessive amounts of alcohol. People who have a family history of cancer, have a weakened immune system or who have the human papillomavirus virus (HPV) are also at a greater risk of developing certain types of oral cancers.

To avoid developing oral cancer, it is recommended that you stop, or do not start using any form of tobacco, whether it is smoked or chewed, drink alcohol only in moderation, chose a healthy diet rich in vitamins and antioxidants, perform self-examinations of your month once a month, and see your dentist regularly.

As part of your routine dental exam, your dentist will conduct an oral cancer screening. This includes feeling for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.

If diagnosed with oral cancer, treatment options include surgery to remove the cancerous growth, followed by radiation therapy and/or chemotherapy to destroy any remaining cancer cells.

Make an appointment with your dentist immediately if you have any persistent signs and symptoms of oral cancer. If you do not have a dentist, make an appointment at Jamaica Hospital’s Dental Center by calling 718-206-6980.

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.

Learn the Facts About Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening condition for those living with diabetes. It occurs when the body doesn’t produce enough sugar (glucose) due to a lack of insulin.

Under normal conditions, insulin serves to help glucose enter the cells that make up our muscles and tissues and provide them with the energy they need.  However, when the body can’t produce enough insulin, glucose remains in the bloodstream and fatty acids called ketones begin to build-up. These ketones can eventually spill over into the urine, leading to DKA.

If you have diabetes or you’re at risk of developing diabetes, learn the warning signs of diabetic ketoacidosis — and know when to seek emergency care. DKA signs and symptoms can develop quickly and can include:

  • Excessive thirst
  • Frequent urination
  • Blurred vision
  • Flushed, hot, or dry skin
  • Loss of appetite or abdominal pain
  • Nausea and vomiting
  • Weakness or fatigue
  • Confusion
  • Shortness of breath

Diabetic ketoacidosis can lead to many health complications including low blood sugar (hypoglycemia) levels, low potassium (hypokalemia) levels, and swelling in the brain (cerebral edema). If left untreated, the risks can become much greater. Diabetic ketoacidosis can lead to loss of consciousness and even fatality.

There are many different reasons for DKA to occur. One of the most common causes is the existence of a severe infection or other illness, such as pneumonia or a urinary tract infection. These types of infections can cause the body to produce high levels of hormones that counter the effects of insulin.

Another common cause of DKA for people who are insulin dependent is either missed or inappropriate insulin therapy, which can leave the body with not enough insulin. Other contributing factors for the onset of DKA include extreme dehydration, trauma, heart attack, or alcohol or drug abuse.

The best way to prevent DKA is to commit yourself to managing your diabetes by living a healthy lifestyle and regularly monitoring your blood glucose and ketone levels.  If you find that your levels are not what they should be, act quickly and consult with your doctor about adjusting your dosage or seek emergency care.

To schedule an appointment with a doctor at Jamaica Hospital, please call 718-206-7001.

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.

Jamaica Hospital Introduces Robotic Pet Therapy to Provide Comfort to Patients

Being hospitalized can be a difficult situation for many. In addition to dealing with being sick or injured, patients struggle with feelings of depression, stress and loneliness. To help them cope with these emotions, Jamaica Hospital has recently implemented an innovative pilot program that is receiving very encouraging feedback.

Under the guidance of Dr. Sharon Wexler, PhD, RN, nurse researcher at Jamaica Hospital, a study is being conducted at the hospital to determine the benefits of robotic pets on hospitalized older adults (65 and older). These patients were selected because they are among the group most likely to demonstrate feelings of depression or loneliness during hospitalization.

According to the robotic pet program, patients receive a free, lifelike, battery-powered cat or dog with an audible heart beat to care for and play with. These pets interact with the patients by purring or barking, snuggling, turning their heads, opening and closing their eyes, wagging their tails, moving their paws, and showing their bellies. The pets, which come with a collar, identification tag, and grooming brush, cost approximately $100 and are single patient use only, so patients get to take them home with them once they are discharged.

Some may ask why use robotic pet therapy when actual pet therapy is available?  The answer is Jamaica Hospital, like many other hospitals across the country does recognize and utilize live pet therapy for our patients. While pet therapy has been widely proven to improve the spirits of patients and potentially improve clinical outcomes, there are some limitations to this service. Unfortunately, traditional pet therapy services are not available 24 hours a day. In addition, some patients may have a fear of animals or be allergic to them. By introducing robotic pet therapy in addition to traditional pet therapy as an intervention, Jamaica Hospital now offers our patients a technologically advanced and effective additional service to boost their outlook and recovery process.

Prior to using realistic looking robotic pets, the hospital had older patients care for an avatar virtual service animal by using a tablet computer. The results were extremely positive as these patients exhibited increased cognition levels and reported fewer feelings of loneliness and depression, making the decision to continue with the robotic pet service an easy one.

While robotic pet therapy has been utilized at many extended care facilities, Jamaica is the first hospital to explore the potential of this service in an acute care setting. The hospital has already enrolled dozens of patients into this program, which began only a couple of months ago, and early indications are very promising, with patients expressing very positive feedback about their experience.  The hospital looks forward to the continuation and expansion of this program in the future.

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.

What is a Peptic Ulcer and How do they Develop?

Peptic ulcers are open sores that develop in certain parts of your digestive tract.  They occur when the protective layer of mucus that lines those areas erodes due to the buildup of acids.  If left untreated, these ulcers can lead to internal bleeding and other complications.

There are two types of peptic ulcer disease that are classified based on where they develop. When an ulcer forms on the stomach lining, it is referred to as a gastric ulcer.  A duodenal ulcer is the name for an ulcer that appears at the top end of the small intestine.  You can have ulcers at any age, but your chances of having one increases with age.

Peptic ulcers generally develop for two reasons:

  • Bacteria – One common type of bacteria, known as Helicobacter pylori (or H. pylori) is a main cause for peptic ulcers. While as many as 50% of us carry this type of bacteria, most people infected with H. pylori do not get ulcers. For some however, it can raise the amount of acid produced, break down the protective mucus layer, and irritate the digestive tract.
  • Pain Relievers – Another cause for ulcers is prolonged use of pain relievers, such aspirin or medications that contain ibuprofen or naproxen or other nonsteroidal anti-inflammatory drugs (NSAIDs). These medications block your body from making a chemical that help protect the inner walls of your stomach and small intestine from stomach acid.

Smoking cigarettes and drinking alcohol are also contributing factors in the development of ulcers. It is a common misnomer is that stress and spicy foods can a lead to this condition.  The fact is that while they are not factors in the formation of ulcers, they can make an existing condition worse.

Some people can have a peptic ulcer and not experience any symptoms. However, if symptoms are present, the most common is a burning pain or discomfort between the naval and breastbone. The pain can last for a few minutes or a few hours, and may come and go for many days or weeks.

Other symptoms may include:

  • Bloated feeling
  • Burping
  • Difficulty breathing
  • Lack of appetite or weight loss
  • Feeling faint
  • Nausea
  • Bloody or dark stool
  • Vomiting

See a doctor if you experience any of these severe symptoms or if your pain does not go away with over the counter antacids. Your physician can diagnose a peptic ulcer by conducting an endoscopy. During this test, a thin, flexible tube is inserted down your throat and into your stomach and small intestine. The tube has a camera at the end to check the lining for ulcers.

Once confirmed, your doctor can prescribe certain medications designed to help protect the lining of the stomach or small intestine so the ulcer can heal.

To schedule an appointment with a Gastroenterologist at Jamaica Hospital, please call 718-206-7001.

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.

Know the Facts About the Measles

The measles virus has received a great deal of attention recently in New York City due to an infected tourist potentially exposing many residents in the five boroughs.

As the closest hospital to John F. Kennedy International Airport, where millions of foreign travelers fly in and out of each year and because we serve one the most ethnically diverse populations in the nation, Jamaica Hospital wants to provide our community with some very important information about the measles virus.

While vaccination programs have largely eliminated the measles in the United States, it is still common in other parts of the world with over 90,000 reported deaths attributed to the disease worldwide each year according to the Centers for Disease Control and Prevention (CDC).  In fact, most U.S. cases of the measles result from an unvaccinated international traveler exposing U.S. residents to the virus.

The measles virus is highly contagious and is spread through the air when an infected person sneezes or coughs.  Fever is typically the first symptom, followed by cough, runny nose and red eyes. Soon after, those infected will develop a rash of tiny red spots. The rash starts on the face and spreads to the rest of the body. Symptoms usually present ten to 14 days after exposure. Those with the disease can develop even more serious complications, and it is especially dangerous for young children.

The best way to prevent becoming infected is to get the MMR vaccine, which prevents against measles, mumps and rubella. The CDC recommends children receive two doses, the first between 12 to 15 months of age, and the second at four to six years old. Teens and adults should also be up-to-date with their MMR vaccination.

The MMR vaccine is safe and highly effective. The recommended two doses have proven to be 97% effective in preventing the measles virus.  While the MMR vaccine is recommended for everyone, it is especially important for those individuals who travel internationally or are exposed to travelers from foreign countries .

If you are experiencing symptoms consistent with the measles, seek medical attention immediately, but call your doctor or local hospital before arrival to prevent infecting others.

To learn more about the MMR vaccine, or to schedule an appointment to become vaccinated at Jamaica Hospital’s Ambulatory Care Center, please call 718-206-7001.

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.

Regulating Your Child’s Screen Time

More and more parents are reporting not seeing their child’s face enough as they are constantly hidden behind various electronic devices.  This is a concern that previous generations of parents did not have to deal with, leaving today’s mothers and fathers wondering how to regulate their child’s screen time activity.

First off, it’s important to note that not all forms of electronic media are created equal. There are many educational games, apps and videos that children can play and watch that support and benefit their development. Many experts actually suggest that it is not the quantity, but the quality of a child’s screen time that should be taken into consideration.

That being said, the American Academy of Pediatrics has offered guidelines for childhood screen usage. They discourage children younger than 18-24 months of age from participating in electronic media use, except for video chatting.  If parents wish to introduce digital media games or apps at these ages, they should make sure that it is done in a supervised setting and that the content is educational and interactive.  Parents of children from two to five years of age should limit their child’s screen time to one hour a day of high-quality programming.  As children grow, the content and amount of media they are exposed to is harder to determine and is not a “one size fits all” model. Parents should customize parameters based on the maturity level and social skills of their children.

It is also recommended that parents understand that they need to remain involved in their child’s online habits and enforce certain rules to ensure that screen time doesn’t affect other aspects of their lives. Parents are encouraged to carve out time for unplugged and unstructured play and create tech-free zone and times.  In addition digital media should be off limits at dinner time and while children are doing their homework. Another tip is for parents to limit their own screen time to set a good example for their children.

When making decisions about screen time, parents should be aware of the following issues that can result from too much screen time, including:

  • Obesity
  • Irregular sleep patterns
  • Behavioral problems
  • Lack of social skills
  • Violent behavior

It is also recommended that parents understand that they need remain involved in their child’s online habits and enforce certain rules to ensure that screen time doesn’t affect other aspects of their lives. Parents are encouraged to carve out time for unplugged and unstructured play and create tech-free zone and times.  In addition digital media should be off limits at dinner time and while children are doing their homework. Another tip is for parents to limit their own screen time to set a good example for their children.

Managing a child’s use of electronic devices will be an ongoing challenge for today’s parents. By staying active and engaged in their screen habits, you can avoid them falling into the traps associated with digital media and ensure they develop a well-rounded childhood experience.

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.

Congenitial Heart Defect Awareness Week – Know The Facts About CHD

Every year, February 7th to the 14th is designated as Congenital Heart Defects (CHD) Awareness week. This annual week of recognition was created to raise awareness about CHD and to empower all patients and families affected by this condition.

Congenital heart defects are problems with the heart’s structure that are present at birth. These defects can involve:

  • The interior walls of the heart
  • The valves inside the heart
  • The arteries and veins that carry blood to the heart or the body

Congenital heart defects are the most common form of birth defect. They affect eight out of every 1,000 newborns. Each year, more than 35,000 babies in the United States are born with this condition.

There are many different forms of defects that can range from minor with no symptoms to complex with life-threatening symptoms. Minor defects often do not require any treatment or are easily fixed. However, those babies born with complex congenital heart defects require special medical care soon after birth.

Unfortunately, doctors often do not know why congenital heart defects occur. Heredity may play a role in cases. Children who have genetic disorders, such as Down syndrome, are often more likely to have congenital heart defects. In fact, half of all babies who have Down syndrome have congenital heart defects. Smoking during pregnancy also has been linked to several congenital heart defects.

Even though many children born with congenital heart defects do not require treatment, some do. Doctors can treat children with CHD with either catheter procedures or surgery. Thankfully, through advances in medicine, thee diagnosis and treatment of complex heart defects has greatly improved over the past few decades. As a result, almost all children who have complex heart defects survive to adulthood and can live active, productive lives.

Through continued education and support, we hope to conquer CHD.

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.