January is National Cervical Cancer Month and it’s a good time to focus on the importance of cervical cancer prevention.  The bad news about cervical cancer is that in its early stages there are typically no symptoms.  The good news is that with the HPV (human papilloma virus) vaccine, it’s largely preventable.  And regular screening for HPV and Pap tests can detect precancerous conditions when treatment is likely to be highly successful.

First, if you or your child is between 9 and 26, the HPV vaccine is an important tool for prevention.  Some adults up to 45 years old may also decide to get the vaccination after speaking with their doctor.

Next, be sure to get screened annually, even if you’ve had the vaccine, beginning at age 21 and until you are 65.  The recommendation for most women is to be screened every 3 years, or 5 years if you have both HPV and PAP screening and both results are negative. After 65, women with no history of abnormal Pap tests or cervical cancer can consult with their physician about the need for further screening.

During the pandemic, many women put off getting screened because they didn’t want to risk COVID-19 exposure or had difficulty getting an appointment.  Over the past two years, ChesPenn has worked with the American Cancer Society to catch our patients up on cancer screenings, including screening for cervical cancer.  Our clinicians have also strongly encouraged parents to keep up with their children’s well child visits and immunizations.  In addition, adults have also been encouraged to stay current with all recommended immunizations.

The experience of one of our new patients brings home the importance of both HPV vaccination and timely screening. In April, Christina (not her real name) came to ChesPenn as a new patient.  She received a Pap test and screening for HPV, which  revealed that she had HPV.  Dr. Kimberly Arkebauer, our OB/GYN provider, performed a colposcopy (a procedure that allows detailed examination of the cervix) and recommended a loop electrosurgical excision procedure (LEEP), an outpatient procedure that removes potentially cancerous cells from the cervix.  Christina had recently immigrated from South America and was uninsured.

Christina met with DaNesha Mack, our Complex Care Team Lead, who helped her apply for insurance and helped her apply for emergency medical assistance.  The LEEP procedure was performed and determined that Christina did not have cervical cancer.  Because of her HPV status and the presence of some abnormal cells, Christina will have a follow-up Pap and colposcopy to ensure she stays healthy.  Our hope is that in the future other women can avoid the kind of scare Christina had to endure by getting vaccinated and keeping up with their Pap screenings.

Dequacia Catlin is a nursing student in her senior year at Lincoln University.  In 2022, she received an email from the university inviting her to apply for an internship with Americorps’ Public Health Nursing Fellowship. She was selected and placed at ChesPenn’s Center for Family Health at Coatesville in October.

Dequacia remembers that her interest in nursing goes back 10 years. “When I started in community college I majored in criminal justice, but it didn’t feel like my niche.  In 2012 I took a Certified Nursing Assistant (CNA) course and when we had our clinicals I liked it.  I started working at the hospital as a CNA.”  Later she went on to enroll in Lincoln University’s Bachelors program in nursing.

“In the beginning my academic experience was a little tough.  You start with the prerequisites and then you’re thrown into this program where you are required to critically think.  But as I learned and did some tutoring, my grades got better.”  Her grades were critical to her success.  Lincoln requires a B average to remain in the nursing program. She shared that, “ I’ve been on the Dean’s List every semester.  I’ve been really grateful to Lincoln University because they push their students.”  They push us to learn clinical reasoning and judgement.”  She’s also enjoyed the friendship and support of the staff.  “ChesPenn has been really great to me.  I’ve learned things.  I really like it.  I can learn here.”

Dequacia has encountered surprises and some challenges along the way.  She’s learned a lot about what it means to provide care in a vulnerable community. “Some things have surprised me as far as interacting with the patients.  Just seeing the diverse community that comes here –  no matter who they are or whether they speak  English or not we’re able to communicate with them and give them the best care possible. I really love that ChesPenn is  able to relate to the patients.   They really trust the staff – the front desk staff are so open.  That makes a difference in a person’s life.  I feel that ChesPenn goes beyond to make the patient feel like a person.  In other places I’ve seen the patient is more like a number, but here, they know their name, their children, their family.”  She also acknowledged the challenge of contacting patients who often rely on prepaid phones or who may take time to get back to us.

An avid traveler, Dequacia has visited countries in Latin America and the Caribbean and has studied in Ghana.  In her travels, she’s seen the impact of health disparities in in the regions she has visited.  Her experience has inspired her ambition to pursue a career in public health.  And she has very specific goals – first, to work at the county level in health and human services while she works on a master’s degree in public health, then a role at the CDC and on to the World Health Organization.

Even Dequacia’s leisure time is dedicated to community service.  She belongs to Chi Eta Phi Nursing Sorority.  When she’s not in school she often volunteers in the community.

ChesPenn nurse Kenisha Parks has served as Dequacia’s mentor at ChesPenn.  She has been impressed with the Americorps nurse internship program and especially with Dequacia.   “You don’t run across those kind of students all the time” she commented. “ The patient comes first with her always.  She’s going to go a long way.” We’re proud to be part of her journey.

Alex Kocsik can’t remember the exact moment she decided on a career in healthcare, but by age 13 she knew she would become a doctor.  She volunteered as a Candy Striper in high school and simply continued her career path from there.  She liked the stepwise trajectory from college to medical school to residency.  It gave her a clear goal to work toward at each stage of her education.

Going into medical school, she could see herself choosing any field of medicine but primary care.  It seemed generic to her.  But in her third year rotation in medical school at Crozer she spent four weeks at ChesPenn’s Upper Darby health center.  Alex remembered about that time that “It clicked in an instant.  I would go home each day and feel good about the work I did.  The days went by faster.  I felt that I could make an impact and was connecting with people.  What I didn’t realize about myself was that it wasn’t just the medicine – it was the human aspect of medicine that I wanted and family medicine makes that very easy.”

Now, in her first year of residency, Alex is a part of Crozer’s Family Medicine Residency Program and will be spending even more time at our Upper Darby site.  Her love of patient-centered care will serve her and her patients well.  Alex is keenly aware of the challenges faced by patients living in poverty.  She understands that, for example, prescribing a medication or referring her patient to a specialist they can’t afford can be a disservice.  Too often, patients are shamed for social determinants of health that are not in their control.  Building a relationship based on an understanding of the patient’s needs and limitations is far more likely to result in a better health outcome.  Patients begin to unlearn much of their dread of visits where they feel blamed for their poor health.

According to Alex, “There is nothing like connecting with somebody who previous to you was afraid of the medical world, or had negative encounters and getting to introduce them to what good medicine can look like and what patient-centered medicine can look like.  I’ve had so many encounters where at the end the patient said ‘Oh that wasn’t so bad’.”

One of her first patient encounters at Upper Darby stands out in Alex’s memory.  She saw a mother and daughter who were 80 and 50 respectively.  They had multiple comorbidities – high blood pressure, high cholesterol, and the mom had some additional chronic illnesses.  They were out of all their medications and hadn’t seen a doctor in years.  She remembers, “Even as a student I was able to spend some time with them, refer them to the doctors they needed for specialty care, get their prescriptions filled, and reassure them that there was somebody there to help them.  At that moment, I knew this was what I wanted to do.”

Alex’s commitment to her patients hasn’t gone unnoticed.  Dr. William Warning, Director of the Family Medicine Residency Program made this observation, “Alex has a gift in building strong interpersonal relationships and excellent rapport with patients and families.

She partners with patients to meet them where they are in their medical and personal situation.  She is a strong advocate for overall patient wellbeing and works with the patients to incrementally meet their goals.”

The Family Medicine Residency Program is a three-year, progressive training.  We’ll check in with Alex each year during her residency and our hope is that when she graduates, she’ll join the ranks of family medicine physicians making a difference in the lives of patients who need their care the most.

For many of us, lead poisoning in children feels like an obsolete issue.  Haven’t we banned lead in paint for decades?  How would a child be exposed in this age of child-proofed homes and regulation of toxic chemicals in products designed for children?  Sadly, lead poisoning is hardly a thing of the past.  One in 40 children ages 1-5 years old has blood lead levels that are considered unsafe.  Lead paint is still on the walls in too many older buildings, often in neighborhoods where low-income families live.  In fact, it’s estimated that 80% of houses and apartments in Delaware County are likely to have lead paint.  Children living in highly industrialized areas may pick it up from the soil.  Other sources include water from old lead pipes, food stored in bowls glazed with lead-based glazes, art supplies such as solder for stained glass, and even some imported candies and herbs.

Symptoms of lead poisoning include:

• loss of appetite
• feeling tired or irritable
• poor growth
• nausea and vomiting
• constipation
• stomach pain
• joint pain and muscle weakness
• headaches

Lead testing is also recommended for kids who live in an older home or whose parent has a hobby or job that involves being around lead. Any child who might have been exposed to lead should get tested.

How Is Lead Poisoning Treated?

The most important part of treatment is preventing more exposure to lead. The doctor will ask about the home to try to identify possible sources of lead. If a child has lead poisoning, all siblings should be tested.

Calcium, iron, and vitamin C are important parts of a healthy diet and also help decrease how much lead the body absorbs. The doctor may recommend a multivitamin with iron for a child who doesn’t get enough of these important nutrients in their diet.

Kids with high lead levels and symptoms of lead poisoning may need care in a hospital to get a medicine called a chelator (KEE-lay-ter). The chelator helps remove the lead from the body.

The effects of lead on development may not show up for years. Doctors will closely follow the development of children with lead exposure at all regular checkups.

Because there is no safe level for lead, try to protect kids from it. To help prevent lead poisoning:

• Ask your doctor about having your kids tested for lead exposure.
• Get your home checked for lead if it was built before 1978.
• Get your water tested. Call your local water department to find a laboratory that will test your water for lead.
• Regularly clean floors, windowsills, and dusty surfaces clean with a wet cloth or mop.
• Wash your kids’ hands and toys often.
• Remove or wipe shoes before coming into the house.
• Keep kids away from soil around old homes and busy roads.
• Fix areas with peeling or chipped paint, such as windows and porches.
• Follow safe practices when removing lead-based paint hazards. Find a lead-safe certified contractor for home renovations.
• Serve a variety of healthy foods, such as dairy products, lean meat and beans, and fruit and vegetables.

For more information, including resources for lead removal, go to https://www.childrenfirstpa.org/issues/child-health/lead-poisoning/

Open enrollment for insurance through the Health Insurance Marketplace® begins November 1 and continues through January 15, 2023.  During this time, you can enroll in, re-enroll in, or change a 2023 health plan through the Health Insurance Marketplace®. Coverage can start as soon as January 1, 2023.

ChesPenn’s Certified Application Assisters can help you get insured through Pennie, Pennsylvania’s health insurance program.

Call 484-462-0028 to get on the road to better health!

November is COPD Awareness Month – and not coincidentally, The Great American Smokeout is on November 17.  COPD, or chronic obstructive pulmonary disease, is an umbrella term for emphysema and chronic bronchitis.  Smoking is its primary cause.

COPD can progress for years undiagnosed.  Some of the first symptoms are shortness of breath, chronic cough or wheezing, chest tightness, and sudden tiredness.  While many people are not diagnosed until their 40s or later, cases in individuals as young as 20 have been confirmed.

If you’ve ever had a friend or loved one with COPD, you know the suffering it causes.  Breathing becomes harder by the year.  It becomes impossible to go out of the house without portable oxygen, and eventually even to get around at home without continued access to oxygen.  Flare-ups can mean visits to the emergency room when it suddenly becomes impossible to catch a breath, even with oxygen and breathing treatments at home.  The strain on the heart often leads to congestive heart failure.  It’s a terrible disease and terrible to watch for friends and loved ones.  There is no cure, and treatment options are limited.

There is one easy way to prevent COPD – don’t smoke and if you do, stop. Now.  ChesPenn offers smoking cessation counselling with free nicotine replacement under the Southeastern Pennsylvania Tobacco Control Project (SEPA).  Anyone interested in the program can contact Tina Beahm, Community Health Educator, at 610-485-3800 Ext. 687.  Find additional smoking cessation resources through the PA Free Quitline:  1-800-QUIT-NOW or https://pa.quitlogix.org/en-US/Enroll-Now .

November 17 is a great occasion to begin the journey to healthier lungs and a longer life!

When you go in for a medical visit you probably think “I’m going to see my doctor” not “I’m going to see my medical assistant.”  But your medical assistant can be just as important to your care as your doctor.  They take your vitals, get your history, and may administer vaccines.  You and your doctor both depend on their training and dedication to make sure you get the care you need.

At ChesPenn, Ashlee Mathis trains and supervises all of our medical assistants.  Twenty years ago, she started her career at what was at that time Crozer’s Center for Family Health at Upper Darby.   This site eventually became the location of Crozer and ChesPenn’s collaboration to provide family medicine residency training in a community health center setting.  Ashley worked for Crozer for 17 years, becoming the Clinical Manager for the Residency Program.  She then spent 5 years in Population Health where she developed the training programs for Crozer’s Family Medicine MAs.

In 2019 Ashlee joined ChesPenn as Clinical Support Manager, leading MA staff across all three sites.   She was drawn to ChesPenn in part by the extraordinary resources we can offer to patients.  “What I love most is the community we serve and resources we can provide.  Talking to patients who came here as kids and now bring their kids.  And the resources – social services, behavioral health dental care – you don’t get that in most primary care practices.  It’s a dream to have all of those services.”

Ashlee was also excited about the payment model at ChesPenn, especially the fact that uninsured patients can pay on a sliding fee scale.  “When I first interviewed that was a big motivator,” she shared.  “Because I worked in population health – I’ve seen the challenges for patients who are uninsured – what is available to them and what isn’t.”

The consensus among Ashlee’s coworkers is that she is a strong, supportive leader, partner, and mentor.  Lead Medical Assistant Angie Moore described her as “a team player who is wise and is so many wonderful things.  She takes care of us; she makes sure we’re ok.  She communicates well.”  Office manager Elide Marquez Romero added, “Ashlee’s willing to do anything that the patients need.    She cares about the patients.  We work great together – we’ve joked that just the two of us could run the whole office if we had to.”

When asked about the challenges of her role she pointed to the staffing issues that ChesPenn shares with other healthcare organizations in the current workforce market.  “I think our biggest challenge is staffing but that’s not specific to ChesPenn – that’s everywhere.  The providers have been very accommodating – they and the nurses help us out.  We just work together as a team to overcome the challenges.”

ChesPenn has recently received funding to launch a training program for medical assistants.  Ashlee is looking forward to the start of the program.  “I’m excited about the possibility of starting a MA training program.   This could open up opportunities for kids in the schools as well as for us. MAs are actually relatively new – only 20 or so years – and the training and scope of care have really expanded.  It’s a great opportunity for someone coming out of high school to get started in healthcare.”

Ashlee’s experience as a trainer and leader makes her the perfect person to lead this new training initiative, building ChesPenn’s ability to train and develop generations of young healthcare professionals for the future.

According to researchers at Johns Hopkins Children’s Center, the incidence of pediatric diabetes has increased significantly since the beginning of the pandemic.  Compared with rates in previous years, the number of diagnoses among Black youth doubled during the first year of the pandemic, and the number of diagnoses among Hispanic youth almost doubled.   This is especially bad news for ethnic minority families in economically challenged communities, which have historically had higher rates of diabetes.

ChesPenn pediatricians have especially noted a significant increase in prediabetes among their patients, mostly connected to the dramatic increase in obesity among children and youth since the beginning of the pandemic.  Prediabetes is a warning families can heed that children are either becoming insulin resistant or are not producing enough insulin to metabolize the sugar in their system.  Families who can catch this process early can avoid the need for life-long medication and the serious health consequences that come with diabetes.

Dr. Jenna Higgins, Pediatrician at The Center for Family Health at Eastside, shared that she and her colleagues focus on healthy life choices for children who are at risk of diabetes.  According to Dr. Higgins, “We don’t focus on weight. But healthy eating habits and more activity.  We try to suggest one or two healthy changes so families don’t get overwhelmed.  Things like not eating in front of the TV or switching juice or soda for water can make a big difference and are relatively easy changes to make.”

Risk factors to be aware of include:

• Overweight
• Having a family member with type 2 diabetes.
• Being born to a mom with gestational diabetes(diabetes while pregnant).
• Being African American, Hispanic/Latino, Native American/Alaska Native, Asian American, or Pacific Islander.
• Having one or more conditions related to insulin resistance.

If your child is overweight and has any two of the risk factors listed above, talk to your doctor about getting his or her blood sugar tested.

Like all good dental practices, we encourage our patients to begin bringing their children in as soon as they have their first tooth, and to make sure the whole family has a cleaning and check-up every six months.  Often, we think about this in terms of preventing dental pain and preserving healthy tooth function.  But it’s important to remember that dental hygiene is about much more than appearance or even the ability to chew comfortably. Good hygiene, including brushing, flossing, and regular cleaning, keeps teeth and gums healthy.  A healthy mouth is essential to your overall health.  Infections in the mouth can travel through the bloodstream and cause illness elsewhere.  They make it more difficult to keep diabetes under control.  Poor dental health increass the risk for poor birth outcomes. Sealants for children provide additional protection by preventing cavities.

As a community health center, ChesPenn’s focus is always on prevention wherever possible.  Our Public Health Dental Hygienists are avid educators.  They work with medical staff to ensure children have their first visit as soon as their teeth come in.  They go out into the community to teach and screen for dental disease.

Dental Hygiene Fun Facts:

Fact #1: Fones School of Dental Hygiene opened in 1913 as the first dental hygiene school in the country.

Fact #2: The first bristle toothbrush was introduced in 1948; before that, animal hair was widely used.

Fact #3: Tooth enamel is the hardest thing in the human body.

Fact #4: Tooth decay is the second most common disease in the United States.

Fact #5: Regular dental cleanings can prevent heart attacks.

Six Steps for Proper Brushing and Flossing:

1. Get the right angle – ensure you tilt the brush at a 45-degree angle
2. Gently move your toothbrush back and forth but be sure you are not too rough.
3. Cover all surfaces of your mouth including inside, outside, top, and bottom.
4. Spend about 30 seconds on each quadrant of your mouth.  Many electric toothbrushes will time this for you.
5. Don’t forget to brush your tongue as well. A lot of bacteria lives on your tongue, so brushing that away will not only help get rid of the bacteria, but also give you fresher breath.  If that’s uncomfortable, you can try a tongue scraper.  They are less likely to trigger gag reflexes.
6. Don’t forget to floss!

October is National Dental Hygiene month.  If you haven’t seen your hygienist, make an appointment.  And thank your hygienist for protecting your whole health.

For a fun introduction to brushing for your kids, watch “Teach Me How to Brushy,” put out by The Oregon Dental Hygiene Association.  It’s an oldie but goodie.

https://www.youtube.com/watch?v=5ugQLL65BKc

Chelsea Spiegelhalder’s family has deep roots in Coatesville.  Her grandmother was a nurse at Coatesville Hospital long before it became Brandywine Hospital.  Her father was a pharmacist.  All of her family members have volunteered in local organizations and in their church. Chelsea herself has served on the Board of Directors of a local nonprofit.  Many of her patients know her or her family because of their work in the community.  That relationship often makes it easier for patients to trust Chelsea’s advice about managing their health.

Chelsea’s father was diagnosed with Type 1 diabetes when he was 7.  In part because of her dad’s experience, her passion is providing care to patients with diabetes.  In her view, while it is a complicated disease, the treatment does not have to be.  Communication and education are key – and the whole family has to be involved.  Managing diabetes means lifestyle changes that work best when the patient’s family adopt them together.  Because Type 2 diabetes, the most common form, runs in families, these changes can benefit everyone in the family.  Chelsea shared that the ability to provide telehealth visits that began during the pandemic has been a real asset in caring for patients with diabetes.  Especially for new patients, getting the right medication dosages can take some trial and error and a short telehealth visit to discuss blood sugar levels and make adjustments can be just as effective as visiting in person.   Patients can often fit these visits into their day, even at work, without having to travel to ChesPenn.

October 6 – 10 is National Physician Assistant Week.  It’ to s a good time to reflect on the contributions made by physician assistants (Pas) to the health of the community.  PAs provide preventive health services, diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider PAs are highly trained, licensed professionals who work collaboratively with a physician as part of a team approach to healthcare.  As such, they are often patients’ primary health providers, consulting with the team physician as needed in complex care cases.  This model expands our ability to provide quality care while managing healthcare costs.

Since she joined ChesPenn in 2009, Chelsea’s family has grown.  She has three children under 6 and has adjusted her schedule to ensure a healthy work-life balance.  But her passion for community health is undiminished.  She shares her pride in her work with her children, instilling her love of community service in them even at their young ages.  Chelsea’s dedication to caring for others embodies ChesPenn’s spirit.