EverCare Medical Associates / Anthony Haralabatos NP

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Salem, NH
EverCare Medical Associates / Anthony Haralabatos NP

Primary Care and Urgent Care Medicine. EverCare Medical Associates also offers occupational health

EverCare Medical Associates provides you and your family Urgent and Primary Care. We create a personal environment with your P*P for direct communication, un-rushed, personalized medical visits to help with all your medical care.

01/22/2023

Non-drug Measures for Cough and Cold Symptoms

This year has seen a spike in respiratory viruses … which over-the-counter remedies for cough and cold symptoms are best?
First step is the non-drug options like fluids, cool-mist humidifiers, saline nasal spray, ice chips for sore throat, etc.…and handwashing!
Avoid OTC (over the counter) cough and cold meds for kids under 6...Except analgesics like acetaminophen (Tylenol) or ibuprofen (Advil).

For a bothersome cough try Honey… up to 2 teaspoons seems to work well – but Avoid it in kids under 1 year due to botulism risk.

Guaifenesin (Mucinex, Robitussin DM, Robitussin 12 Hour Cough & Mucus Relief) haven’t been shown to work better than warm water to thin secretions or reduce congestion…. But at least it’s safe.

Studies with dextromethorphan (Triaminic Cold and Cough, Robitussin Cough, Vicks 44 Cough and Cold) are mixed about whether it reduces cough. - Keep in mind that dextromethorphan can interact with psychiatric medications such as serotonergic meds (SSRIs).

Just to clarify…data suggest oral or nasal antihistamines (astepro)...or nasal steroids (flonase) ...don’t help congestion, runny nose, or sneezing due to colds.

Echinacea, elderberry lack good evidence and can be expensive.

And finally, avoid an intranasal decongestant (Afrin) as it can cause a rebound swelling and not recommended for anyone with prostate or blood pressure problems.

04/05/2021

Understand the Role of New drug for for Acne - Winlevi
A new drug called Winlevi (clascoterone) 1% cream will be the First topical androgen receptor inhibitor for treating acne.

Think of Winlevi’s role as similar to spironolactone or oral contraceptive for females. It’s a “hormonal” option that can be used regardless of gender.

But don’t get too excited.

There’s no good evidence that twice-daily Winlevi is more effective than other topical or oral acne meds in patients 12 and older.

Plus, there are no data about adding Winlevi to other acne meds...and it can cause skin irritation even when used alone.

Be aware that systemic effects (amenorrhea, hyperkalemia, etc.) seem rare...although HPA axis suppression can occur after just 2 weeks of regular use. And long-term safety data are lacking.

Winlevi costs about $550/60 g. Expect insurance payer rejects.

Continue to start with benzoyl peroxide for acne...with or without a topical retinoid (adapalene, etc.) or topical antibiotic (clindamycin, etc.).

Save oral antibiotics for moderate to severe acne...or when topicals aren’t enough. Or add spironolactone or an oral contraceptive instead of an antibiotic for acne related to me**es.

Think of switching to Winlevi for moderate acne when topical combos don’t do the trick...AND if you want to avoid an oral med.

03/29/2021

How to soothe a sore throat.

Most sore throats resolve within a week according to research studies which is why most doctors do not recommend antibiotic too soon.

BUT … symptoms such as a temp of 100.4°F or higher, trouble swallowing or breathing, or a rash...are a different story and can be signs of bigger problems!

We emphasize fluids and rest. Rely on remedies such as ice chips...warm broth...hard candy...or a saltwater gargle. A hot shower or cool-mist humidifier may also help.

We also suggest plain honey to coat the throat...up to 2 teaspoons at bedtime or as needed...especially if the patient also has a cough. But REMEMBER to avoid honey in kids under 1 year due to botulism risk.

The honey in “hot toddies” is likely why they may help...not the alcohol.

Use OTC acetaminophen (Tylenol) or an NSAID (Advil) if needed.

Keep in mind that lozenges, sprays, or gargles may give short-term relief and work faster than oral analgesics. But there’s no evidence that one product is most effective...or works better than non-drug measures.

If you prefers a lozenge or topical, there are different options...most have a mix of ingredients. And possible risks.

For example, menthol (Vicks VapoDrops, etc) or pectin (Halls Breezers, etc) are “soothing” ...and benzocaine (Cepacol, etc), dyclonine (Sucrets), or phenol (Chloraseptic spray, etc) are “numbing.”

But benzocaine product labels warn of rare methemoglobinemia. Recommend avoiding these in kids under 2.

Remind patients that sugar-free lozenges can cause diarrhea...due to sugar alcohols (sorbitol, etc…).

Some supplements (slippery elm, zinc, etc) are thought to coat the throat. these likely aren’t harmful...but there’s no good evidence they help.

09/18/2019

All those vitamins and supplements you've been taking probably aren't worth it...

Vitamin supplements, a multibillion-dollar industry, are one of our favorite prescriptions.

Tired? Take an iron supplement or B 12.

Sad? ...Classic vitamin D deficiency

Surprise, surprise: Vitamin supplements had little impact on heart conditions, including heart disease, and lifespan as a whole.

Every time scientists have compared taking a supplement of something versus getting it through food, getting it through food wins every time

01/24/2019

Lots of questions on Concussion recovery time for children and adolescents:

Most children and adolescents (over 80 percent) recovered from their concussion within one (1) month.

However, recovery took longer in adolescent FEMALE patients, among whom less than half reached full recovery by 3 months.

*Patients with persistent concussion symptoms not improving after 21 days warrant referral to a physician with specific expertise in managing concussions.

12/19/2018

Food Allergy Linked to Increased Multiple Sclerosis Activity:
For patients with multiple sclerosis (MS), food allergy is associated with a greater number of attacks and with a higher likelihood of brain lesions, according to a study published online December 2018.
Specificaly those in the food allergy group had a 1.38 times higher rate for cumulative number of attacks.

12/13/2018

The US Food and Drug Administration approved the use of a human papillomavirus vaccine called Gardasil 9 for men and women between the ages of 27 and 45. The FDA previously approved the HPV vaccine for people age 9 to 26.

The approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,- the HPV vaccination potential to prevent more than 90 percent of cancers.

06/22/2018

Get Married; you might live longer!. Unmarried people face elevated risk of heart disease, mortality
A study in the journal Heart found individuals who were single, divorced or widowed had a 42% higher risk of cardiovascular disease, compared with married people.
The findings, based on 34 studies across the world involving more than 2 million participants ages 42 to 77, also showed people who were not married faced greater risks for coronary artery disease and CAD- or stroke-related mortality.

06/08/2018

New rabies immune globulin products will lead to questions about rabies post-exposure prophylaxis.

About 40,000 patients/year in the U.S. will get rabies post-exposure prophylaxis...to prevent central nervous system infection and death.

Be ready to treat after a bite from certain wild animals, especially bats, foxes, or raccoons...or a suspected rabid dog or other domestic animal. UNprovoked attacks may be a sign of rabies.

Wash the wound immediately with soap and running water for 15 min. Follow with povidone-iodine...it may help kill the virus.

Repeat the vaccine 3, 7, and 14 days later.

Keep in mind to you will also need antibiotics, tetanus, etc.

And report possible exposures to your local health department.

06/08/2018

"whiter, brighter, and more radiant eyes."...new product? nope just marketing hype!

We usually think of brimonidine as an Rx eye drop for glaucoma (Alphagan P)...or a topical gel for redness due to rosacea (Mirvaso).

Now brimonidine 0.025% ophthalmic solution will be promoted to help eyes appear "whiter, brighter, and more radiant."

But there's no proof Lumify works better than other OTC decongestant drops, such as tetrahydrozoline (Visine Original, etc).

Address

52 Stiles Road Suite 110
Salem, NH
03079

Telephone

+16036854609

Website

http://evercaremedicalassociates.com/

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EverCare Medical Associates / Anthony Haralabatos NP

01/22/2023

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