Winter Dehydration

Dehydration in the winter may seem less likely than in the summertime, but it is still a risk. According to the U.S. National Academies of Sciences, Engineering, and Medicine, the recommended amount of daily fluid intake is around 15.5 cups for men and 11.5 for women. For many of us, it might be harder to reach these quantities during the winter months.

Some causes of winter dehydration include:

  • Indoor heat
  • Bundling up in too many layers
  • Lack of thirst
  • Fluid loss from respiration
  • More frequent urination

There are many signs of dehydration, including:

  • The color of your urine
  • Constipation
  • Fatigue
  • Dry mouth and chapped lips
  • Dry skin
  • Headaches
  • Difficulty concentrating
  • Irritability
  • Feeling faint or dizzy
  • A rapid heart rate

Here are some tips for staying hydrated in the winter:

  • Drink warm fluids if it is too difficult to drink cold water when it’s cold outside.
  • Infuse plain water with flavor, by adding flavorings such as a wedge of lemon or lime, other pieces of fruit, or unsweetened water enhancers.
  • Carry a reusable water bottle with you to encourage daily hydration.
  • Eat homemade soups and water-rich fruits and vegetables to help increase fluid intake
  • Avoid drinking caffeine as it can contribute to dehydration.
  • Swap drinking an alcoholic beverage for a mocktail.
  • Make hydration a routine by drinking a certain amount of water daily.

If you have symptoms of dehydration, consult a physician immediately. Severe cases can lead to complications and potentially death. For less severe cases, you can schedule an appointment with a physician at Jamaica Hospital Medical Center’s Ambulatory Care Center, by calling (718) 206-7001. If you are experiencing an emergency, call 911.

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.

Integrative Health Month

January is Integrative Health Month. It raises awareness of the need for collaborative care among various disciplines to treat the whole person instead of a symptom-only approach.

Integrative health uses an evidence-based approach to treating a patient’s mind, body, and soul. Because physical, emotional, mental, and spiritual needs are all involved, integrative health combines these therapies.

The relationships between you and your healthcare providers are important in integrative health. You are equal partners in your healing process, as integrative health aims for well-coordinated care among different providers and specialists.

A variety of healthcare providers delivers care through integrative health, including:

  • Physicians
  • Chiropractic doctors
  • Holistic mind-body psychotherapists
  • Acupuncturists
  • Chinese herbal therapists
  • Tai chi practitioners
  • Yoga practitioners
  • Massage therapists
  • Nutritionists
  • Chefs (culinary medicine)

Integrative health physicians don’t replace your primary care provider or specialist. They work with all members of your healthcare team to heal your mind, body, and spirit. Their expertise lies in preventing and managing chronic diseases not in treating acute medical problems. You should see your primary care or emergency medicine physician for acute and medical emergencies.

Many people can benefit from integrative health including those who are healthy. People with chronic or complex conditions may especially find the approach helpful. Integrative health can help you find relief for many medical conditions, including:

  • Autoimmune diseases
  • Acute and chronic pain
  • Breathing disorders
  • Headaches and migraines
  • Cancer and cancer-related side effects
  • Chronic fatigue
  • Cold/flu symptoms
  • Digestive disorders
  • Infertility
  • Menopausal symptoms
  • Menstrual issues
  • Mental and emotional health issues
  • Obesity
  • High blood pressure
  • Sleep issues

Integrative health techniques support the body’s natural ability to heal. They help reduce stress and promote a state of relaxation that leads to better health. Integrative health can help you achieve optimal health when you engage in your own healing and feel empowered to make lifestyle changes. Adding integrative health to your healthcare routine can help you regain control of your well-being.

To learn more about Jamaica Hospital Medical Center’s integrative health services, events, or classes, or to schedule an appointment, please call us at (718) 206-5675.

 

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.

POTS (Postural Orthostatic Tachycardia Syndrome)

Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart to beat faster than normal when you transition from sitting or lying down to standing up.

Each word of “postural orthostatic tachycardia syndrome” has a meaning:

  • Postural – related to the position of your body
  • Orthostatic – related to standing upright
  • Tachycardia – a heart rate over 100 beats per minute
  • Syndrome – A group of symptoms that happen together

Your autonomic nervous system normally balances your heart rate and blood pressure to keep your blood flowing at a healthy pace, despite your body’s positioning. However, if you have POTS, your body can’t coordinate the balancing act of blood vessel constriction and heart rate response, meaning your body can’t keep your blood pressure steady and stable. This causes a variety of symptoms, including:

  • Dizziness or lightheadedness, especially when standing up, during prolonged standing in one position, or on long walks
  • Fainting or near fainting
  • Forgetfulness and trouble focusing (brain fog)
  • Heart palpitations or a racing heart rate
  • Exhaustion/fatigue
  • Feeling nervous or anxious
  • Shakiness and excessive sweating
  • Shortness of breath
  • Chest pain
  • Headaches
  • Nausea
  • Bloating
  • A pale face and purple discoloration of your hands and feet if they’re lower than the level of your heart
  • Disrupted sleep from chest pain, a racing heart rate, or excessive sweating during sleep

POTS symptoms often get worse in the following situations:

  • Being in warm environments, such as in a hot bath or shower, or on a hot day
  • Standing frequently, such as when you’re waiting in line or shopping
  • Participating in strenuous exercise
  • When you are sick from a cold or an infection
  • Having your period

You can develop POTS suddenly or it can develop gradually. Symptoms vary from person to person. They may happen immediately or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

Researchers aren’t sure what causes POTS. They currently believe there are multiple causes, which have been put into different subtypes of POTS, including:

  • Neuropathic POTS – this happens when peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in your legs and abdomen
  • Hyperadrenergic POTS – this happens when your sympathetic nervous system is overactive
  • Hypovolemic POTS – reduced blood volume can lead to POTS. Low blood volume can cause similar symptoms that may overlap with neuropathic and hyperadrenergic POTS

There is also growing evidence that suggests POTS might be an autoimmune disease, meaning the immune system attacks healthy tissue for unknown reasons.

POTS can be difficult for healthcare providers to diagnose due to the many symptoms that can occur over time. People with POTS may have symptoms for months or years before they are finally diagnosed with the condition.

To confirm a POTS diagnosis or rule out other possible causes for your symptoms, your healthcare provider will ask questions about symptoms, medications, and medical history, and they will also perform a series of tests.

A tilt table test is the main way providers diagnose POTS, as it measures your heart rate and blood pressure as you change your posture and position. A healthcare provider may order other tests to help determine a diagnosis, including:

  • Blood and urine tests for causes of POTS and conditions that mimic POTS
  • QSART (a test that measures the autonomic nerves that control sweating)
  • Autonomic breathing test (a test that measures your blood rate and pressure response during exercise
  • Skin nerve biopsy

Unfortunately, there is no cure for POTS. However, healthcare providers use strategies to manage the symptoms. Treatment is highly individualized based on your symptoms and what works best for you. The main forms of treatment include:

  • Exercise and physical activity
  • Diet and nutrition

There is nothing you can do to prevent developing POTS. But there are steps you can take to try to prevent flare-ups by knowing what your triggers are, including:

  • Maintaining a consistent temperature
  • Avoiding prolonged standing
  • Avoiding alcohol

If you are experiencing any POTS-related symptoms, you can schedule an appointment at Jamaica Hospital Medical Center’s Cardiology Department by calling (718) 206-7100. If you are experiencing an emergency, please call 911 right away.

 

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 Medical Center Now Offering Inspire® Therapy for Obstructive Sleep Apnea

Queens, NY— Jamaica Hospital Medical Center is the only hospital in Queens to offer Inspire therapy, a breakthrough treatment option for obstructive sleep apnea (OSA) for those who cannot use Continuous Positive Airway Pressure (CPAP) therapy.

OSA affects 22 million Americans and when left untreated, it can cause vehicle and workplace accidents, worsening mood and memory, stroke, heart attack, and even death. It occurs when the airway collapses during sleep and blocks oxygen flow to the brain. The brain senses a lack of oxygen and wakes the body up just long enough to breathe, then falls asleep. This cycle repeats throughout the night and causes poor, disruptive sleep.

Inspire works inside the body with a patient’s natural breathing process to treat sleep apnea. Mild stimulation opens the airway during sleep, allowing oxygen to flow naturally. The patient uses a small handheld remote to turn Inspire on before bed and off when they wake up.

Inspire’s safety and efficacy were evaluated during the STAR clinical trial. Five-year STAR trial outcomes show that patients using Inspire experience significant reductions in sleep apnea events and significant improvements in quality-of-life measures. Over 150 peer-reviewed publications on Inspire show results consistent with those seen in the STAR trial.

“In our practice, we see many patients who have stopped using or are unable to tolerate CPAP,” said Jamaica Hospital Medical Center. “Inspire represents a significant advancement in treating sleep apnea. It is clinically proven to reduce sleep apnea events and has a high level of patient satisfaction and high therapy adherence. We are excited to offer this promising therapy to sleep apnea patients who struggle with CPAP.”

Our team of otolaryngologists offers effective treatment for many common conditions affecting the ears, nose, and throat. These conditions cover various levels of severity; some, such as certain allergies and hearing problems, may pose a distracting annoyance that makes your day-to-day activities more challenging, while others, such as sinus infections, ear infections, and sleep apnea, may develop more serious complications without prompt diagnosis and treatment.

To learn more about Inspire at Jamaica Hospital Medical Center, please visit Jamaicahospital.org or call 718-206-7110 to make an appointment with an ENT doctor.

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.

Thyroid Awareness Month

January is Thyroid Awareness Month.

Thyroid disease is a medical condition that keeps your thyroid from making the right amount of hormones. The thyroid is a small, butterfly-shaped gland at the front of the neck under your skin. As a part of the body’s endocrine system, it controls many of your body’s important functions by producing and releasing thyroid hormones and controlling the speed of your metabolism.

There are two main types of thyroid disease, hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid). They each have several conditions that can cause them.

Conditions that can cause hypothyroidism include:

  • Hashimoto’s disease – this is a lifelong autoimmune condition that can cause hypothyroidism. It is the most common cause of hypothyroidism in countries with widely available iodized salt and other iodine-enriched foods.
  • Iodine deficiency – the thyroid needs iodine to make the thyroid hormone, so a lack of the mineral in your diet can lead to hypothyroidism. It is the most common cause of hypothyroidism in countries that don’t have iodized salt widely available. It often causes goiters also known as an enlarged thyroid.
  • Congenital hypothyroidism – sometimes, babies are born with a missing or underactive thyroid. “Congenital” means present from birth. About one in every 2,000 to 4,000 babies have congenital hypothyroidism.

Conditions that can cause hyperthyroidism include:

  • Graves’ disease – this is a chronic autoimmune condition that causes an overactive thyroid. It is the most common cause of hyperthyroidism.
  • Thyroid nodules – these are abnormal lumps on your thyroid gland. If the nodules are hyper-functioning, they can lead to hyperthyroidism.
  • Excessive iodine – when you have too much iodine in your body, your thyroid makes more thyroid hormones than you need. You may develop excessive iodine by taking certain medications.

Some conditions can cause both hypothyroidism and hyperthyroidism at different times, including:

  • Thyroiditis – which is the inflammation of the thyroid gland. It typically causes temporary hyperthyroidism at first and then temporary or chronic hypothyroidism.
  • Postpartum thyroiditis – this is a relatively rare condition that affects some birthing parents after pregnancy. An estimated 5% of people may experience this after giving birth. It typically causes hyperthyroidism first, followed by hypothyroidism. It is usually temporary.

There are a variety of thyroid disease symptoms. Unfortunately, symptoms of a thyroid condition are often similar to the signs of other medical conditions and stages of life, making it difficult to know if the symptoms are related to a thyroid issue or something else.

Symptoms of hypothyroidism include:

  • Slower-than-usual heart rate
  • Fatigue
  • Unexplained weight gain
  • Feeling sensitive to the cold
  • Dry skin and dry coarse hair
  • Depression
  • Heavy menstrual periods

Symptoms of hyperthyroidism include:

  • Faster-than-usual heart rate
  • Difficulty sleeping
  • Unexplained weight loss
  • Feeling sensitive to the heat
  • Clammy or sweaty skin
  • Feeling anxious, irritable, or nervous
  • Irregular menstrual cycles or lack of periods

Many factors can put you at a higher risk of developing a thyroid condition, including:

  • Being assigned female at birth (AFAB). People AFAB are five to eight times more likely to have a thyroid condition than people assigned male at birth (AMAB)
  • Have a family history of thyroid disease
  • Have Turner syndrome
  • Take a medication that is high in iodine
  • Live in a country or area that doesn’t have iodized table salt, which can lead to iodine deficiency
  • Are older than 60 years of age, especially if you are AFAB
  • Have received radiation therapy to your head and/or neck

Having an autoimmune disease also increases your risk, especially if you have:

  • Pernicious anemia
  • Type 1 diabetes
  • Celiac disease
  • Addison’s disease
  • Lupus
  • Rheumatoid arthritis
  • Sjögren’s syndrome

Thyroid disease can be diagnosed using blood and imaging tests after a healthcare provider performs a physical exam.

Treatment for thyroid disease depends on the type of condition and the cause. The goal is to return your thyroid hormone levels to a healthy range. Hyperthyroidism is treated with antithyroid drugs, radioiodine therapy, beta-blockers, and surgery. Hypothyroidism is treated with thyroid replacement therapy.

If you’re experiencing symptoms of any thyroid disease, you can call and make an appointment with Jamaica Hospital Medical Center’s endocrinology service, at 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.

The Importance of an Annual Exam

Improving one’s physical health is often a go-to New Year’s resolution. The best way to do this is by scheduling a routine medical check-up appointment. Even if you feel fine, it is a good idea to see your healthcare provider to ensure you don’t have any underlying health issues.

There are several reasons to get a physical exam, including:

  • It can prevent illnesses
  • It monitors the risk of chronic disease
  • It identifies illnesses that don’t have symptoms
  • It monitors your weight, blood pressure, heart rate, and basic body chemistry
  • It helps adjust your lifestyle that is suitable for your age
  • It helps keep an ongoing relationship with your healthcare provider

To schedule an appointment with a physician at Jamaica Hospital Medical Center’s Ambulatory Care Center, 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.

Making Your Mental Health a Priority for the New Year

Anxiety and depression are mental health issues that many people face daily. As we begin a new year, it is important to identify any mental health issues you are experiencing, the potential causes of those issues, and what you can do to improve them.

Some steps you can take to make positive changes for your mental health include:

  • Improving your physical health – your mental and physical health are closely connected as they can impact each other. Exercising regularly, eating a balanced diet, and getting a good night’s sleep can greatly improve your mood, outlook, ability to focus, and cope more effectively when mental health challenges arise.
  • Recognizing the positive things in your life – if you begin to have negative emotions or thoughts, it is important to recognize and be grateful for the positive things you have in your life.
  • Developing healthy and effective coping mechanisms – coping mechanisms are an important tool for those who experience mental health issues. They allow you to adjust how you process things that distress you, making them easier to deal with. Some healthy coping mechanisms include:
    • Finding ways to resolve what is causing the distress
    • Looking at the problem(s) from a different point of view
    • Talking to someone in your support system

You can make positive, effective changes to improve your mental health this year with the help of a psychiatrist at Jamaica Hospital Medical Center’s Mental Health Clinic. To schedule an appointment, please call (718) 206-5575.

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 Help Keep Your New Year’s Resolutions

At the end of every year, we make lists of the goals we want to accomplish and/or the resolutions we want to make for the New Year. However, New Year’s resolutions are sometimes hard to keep. Here are some tips to help you keep your New Year’s resolutions:

  • Select one goal that you want to achieve instead of many
  • Plan how you intend to achieve that goal
  • Don’t be too ambitious with your goal, as it is best to keep it simple
  • Break your goal into smaller, more manageable parts
  • Pick a goal that involves a new activity
  • Try to learn from past difficulties in accomplishing your goal
  • Don’t get discouraged if you have setbacks
  • Keep a daily record of your progress
  • Pick a goal where you can measure the results

Achieving a goal you made as your New Year’s resolution is always easier when you have the support of friends and family. Let people know what you hope to achieve and enlist others who can be supportive. Additionally, give yourself some positive reinforcement as you work towards a goal.

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.

15 Foods to Add to Your Diet to Boost Your Brain Health

The brain is the command center of the body. It processes information and sends messages controlling everything your body does from thoughts and emotions to memory and motor skills.

As we age, the brain experiences physiological changes that affect memory, focus, and word recall. Fortunately, we can combat some of these changes with our diet, which plays a major role in keeping our minds sharp and maintaining our mental function.

Brain foods are foods that can benefit brain health. They contain various nutrients that keep the brain functioning well. They include:

  • Omega-3 fatty acids
  • B vitamins
  • Vitamin E
  • Vitamin C
  • Vitamin K
  • Selenium
  • Iron
  • Choline

Eating a diet rich in these nutrients can help fight off common brain-related conditions and symptoms often associated with age. These nutrients may help with:

  • Brain development
  • Proper signaling of neurotransmitters
  • Processing and understanding new information
  • Memory
  • Protein balance
  • Reducing the risk of brain-related conditions linked to inflammation, such as depression and dementia

Here are 15 foods to add to your diet that are rich in essential nutrients:

  1. Eggs
  2. Fatty fish
  3. Berries such as blueberries, raspberries, and strawberries
  4. Broccoli
  5. Mushrooms
  6. Walnuts
  7. Turmeric
  8. Coffee
  9. Leafy greens
  10. Green tea
  11. Dark chocolate
  12. Fermented dairy
  13. Avocados
  14. Certain fruit juices such as pomegranate, grape, and cherry juice
  15. Whole grains

Remember, no food on its own will magically transform your brain. However, eating brain foods regularly can keep your brain sharp and maintain your cognitive ability as you age. Maintaining an overall healthy eating pattern is important to reap the health benefits of these nutrient-rich foods.

 

 

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 Causes Lymph Nodes to Swell?

Lymph nodes are part of the lymphatic system and a vital part of the body’s immune system. Swollen lymph nodes are your body’s natural reaction to illness or infection. They act as filters that help rid the body of germs, cells, or other foreign matter that passes through your lymph fluid.

Your lymphatic system is a network of organs, vessels, and lymph nodes throughout the body. Many lymph nodes are located in the head and neck region, the armpits, and the groin where they frequently swell.

When lymph nodes swell, it is a sign that something is wrong somewhere in your body. When they first swell, you might notice:

  • Tenderness and pain in the lymph nodes
  • Swelling that may be the size of a pea or kidney bean, or even larger in the lymph node

Depending on the cause of the swollen lymph nodes, other signs and symptoms might include:

  • Runny nose, sore throat, fever, and other indications of an upper respiratory infection
  • General swelling of lymph nodes throughout your body. When this happens, it can indicate an infection.
  • Hard, fixed, rapidly growing nodes, indicating possible cancer
  • Fever
  • Night sweats

The most common cause of swollen lymph nodes is an infection, particularly a viral infection, such as the common cold. Other possible causes of swollen lymph nodes include:

  • Common infections
    • Strep throat
    • Measles
    • Ear infections
    • An infected (abscessed) tooth
    • Skin or wound infections, such as cellulitis
    • HIV
  • Uncommon infections
    • Tuberculosis
    • Certain sexually transmitted diseases, such as syphilis
    • Toxoplasmosis- a parasitic infection resulting from contact with the feces of an infected cat or eating undercooked meat
    • Cat scratch fever- a bacterial infection from a cat scratch or bite
  • Immune system disorders
    • Lupus
    • Rheumatoid arthritis
  • Cancers
    • Lymphoma
    • Leukemia
    • Other cancers that have spread to the lymph nodes

To diagnose what is causing your swollen lymph nodes, your healthcare provider may need:

  • Your medical history
  • A physical exam
  • Blood tests
  • Imaging studies
  • A lymph node biopsy

Swollen lymph nodes caused by a virus usually return to normal after the viral infection ends. Treatment for swollen lymph nodes from other causes depends on the cause:

  • Infection- antibiotics are the most common treatment for lymph nodes caused by bacterial infections. If your swollen lymph nodes are due to an HIV infection, you’ll receive specific treatment for that condition.
  • Immune disorder- if your swollen lymph nodes are caused by certain conditions, such as lupus or rheumatoid arthritis, treatment is directed at the underlying condition.
  • Cancer- swollen lymph nodes caused by cancer require treatment for the cancer. Depending on the type of cancer, treatment may involve surgery, radiation, or chemotherapy.

To make an appointment with an ENT doctor at Jamaica Hospital Medical Center, please call 718-206-7110.

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.