R E E K I C S C Reaching Out For A Healthy Future

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1 RE EK I th y Ou g in ch Rea Fu tur e CR S OW H C tf or A He al

2 Symptoms of Tick-borne Illness Many tick-borne diseases can have similar signs and symptoms. If you have been bitten by a tick and develop the symptoms below within a few weeks, a health care provider should evaluate the following before deciding on a course of treatment: YOUR SYMPTOMS The geographic region in which you were bitten Diagnostic tests, if indicated by the symptoms and the region where you were bitten The most common symptoms of tick-related illnesses are: Fever/chills: With all tick-borne diseases, patients can experience fever at varying degrees and time of onset. Aches and pains: Tick-borne disease symptoms include headache, fatigue, and muscle aches. With Lyme disease you may also experience joint pain. The severity and time of onset of these symptoms can depend on the disease and the patient's personal tolerance level. Rash: Lyme disease, southern tick-associated rash illness (STARI), Rocky Mountain spotted fever (RMSF), ehrlichiosis, and tularemia can result in distinctive rashes: In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite. It may be warm, but is not usually painful. Some patients develop a tional EM lesions in other areas of the body several days later. The rash of (STARI) is nearly identical to that of Lyme disease, with a red, expanding "bulls eye" lesion that develops around the site of a lone star tick bite. Unlike Lyme disease, STARI has not been linked to any arthritic or neurologic symptoms. The rash seen with Rocky Mountain spotted fever (RMSF) varies greatly from person to person in appearance, location, and time of onset. About 10% of people with RMSF never develop a rash. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles. The red to purple, spotted (petechial) rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60% of patients with the infection.

3 In the most common form of tularemia, a skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin. In about 30% of patients (and up to 60% of children), ehrlichiosis can cause a rash. The appearance of the rash ranges from macular to maculopapular to petechial, and may appear after the onset of fever. Tickborne diseases can result in mild symptoms treatable at home to severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decreases the risk of serious complications. So see your doctor immediately if you have been bitten by a tick and experience any of the symptoms described here. Tick Removal If you find a tick attached to your skin, there's no need to panic. There are several tick removal devices on the market, but a plain set of fine-tipped tweezers will remove a tick quite effectively. H O W T O R E M O V E A T I C K 1. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. 2. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. 3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water. 4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/ container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers

4 Why you should be tested for pre-diabetes and diabetes One-third of adults with diabetes don't know they have it, according to the National Institutes of Health. Even though the prevalence of diagnosed diabetes in the United States has risen to 6.5 percent of adults age 20 and older, the percentage of adults with undiagnosed pre-diabetes or diabetes hasn't changed. The NIH says that you are at greater risk of developing pre-diabetes and type 2 diabetes if you: Are age 45 or older Have a family history of diabetes Are overweight Have an inactive lifestyle Are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska native, Asian American, Pacific Islander) Have high blood pressure: 140/90 mm/hg or higher Have HDL cholesterol less than 35 mg/dl or a triglyceride level 250 mg/dl or higher Have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds Have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system Have dark, thickened skin around neck or armpits Have a history of disease of the blood vessels to the heart, brain, or legs So, if you're age 45 or older, ask your healthcare provider about testing for diabetes or prediabetes. If you're younger than 45 and overweight, and have another risk factor, you should also ask about testing. If you have pre-diabetes you can often prevent or delay diabetes if you lose a modest amount of weight by cutting calories or increasing physical activity. If you're overweight and lose just 5-7 percent of your body weight, you can lower diabetes onset by 58 percent. That's why early detection is so important.

5 Water is essential to good health, yet needs vary by individual. These guidelines can help ensure you drink enough fluids. How much water should you drink each day? It's a simple question with no easy answers. Studies have produced varying recommendations over the years, but in truth, your water needs depend on many factors, including your health, how active you are and where you live. Although no single formula fits everyone, knowing more about your body's need for fluids will help you estimate how much water to drink each day. Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired. You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you're pregnant or breast-feeding. Exercise. If you exercise or engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. An extra 1.5 to 2.5 cups (400 to 600 milliliters) of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour (for example, running a marathon) requires more fluid intake. How much additional fluid you need depends on how much you sweat during exercise, and the duration and type of exercise. Intense exercise. During long bouts of intense exercise, it's best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be lifethreatening. Also, continue to replace fluids after you're finished exercising. Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Further, altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves. Illnesses or health conditions. When you have fever, vomiting or diarrhea, your body loses additional fluids. In these cases, you should drink more water. In some cases, your doctor may recommend oral rehydration solutions, such as Gatorade, Powerade or CeraLyte. You may also need increased fluid intake if you develop certain conditions, including bladder infections or urinary tract stones. On the other hand, some conditions, such as heart failure and some types of kidney, liver and adrenal diseases, may impair excretion of water and even require that you limit your fluid intake. Pregnancy or breast-feeding. Women who are pregnant or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink about 10 cups (2.3 liters) of fluids daily and women who breast-feed consume about 13 cups (3.1 liters ) of fluids a d

6 West Nile Virus (WNV) Fact Sheet What Is West Nile Virus? West Nile virus infection can cause serious disease. WNV is established as a seasonal epidemic in North America that flares up in the summer and continues into the fall. This fact sheet contains important information that can help you recognize and prevent West Nile virus. What Can I Do to Prevent WNV? The easiest and best way to avoid WNV is to prevent mosquito bites. When outdoors, use repellents containing DEET, picaridin, IR3535, some oil of lemon eucalyptus or para-menthane-diol. Follow the directions on the package. Many mosquitoes are most active from dusk to dawn. Be sure to use insect repellent and wear long sleeves and pants at these times or consider staying indoors during these hours. Make sure you have good screens on your windows and doors to keep mosquitoes out. Get rid of mosquito breeding sites by emptying standing water from flower pots, buckets and barrels. Change the water in pet dishes and replace the water in bird baths weekly. Drill holes in tire swings so water drains out. Keep children s wading pools empty and on their sides when they aren t being used. What Are the Symptoms of WNV? Serious Symptoms in a Few People. About 1 in 150 people infected with WNV will develop severe illness. The severe symptoms can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. These symptoms may last several weeks, and neurological effects may be permanent. Milder Symptoms in Some People. Up to 20 percent of the people who become infected will have symptoms which can include fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days to as long as several weeks. No Symptoms in Most People. Approximately 80 percent of people who are infected with WNV will not show any symptoms at all, but there is no way to know in advance if you will develop an illness or not. How Does West Nile Virus Spread? Infected Mosqui- toes. WNV is spread by the bite of an infected mosquito. Mosquitoes become infected when they feed on infected birds. Infected mosquitoes can then spread WNV to humans and other animals when they bite. Transfusions, Transplants, and Mother-to-Child. In a very small number of cases, WNV also has been spread directly from an infected person through blood transfusions, organ transplants, breastfeeding and during pregnancy from mother to baby. Not through touching. WNV is not spread through casual contact such as touching or kissing a person with the virus. How Soon Do Infected People Get Sick? People typically develop symptoms between 3 and 14 days after they are bitten by the infected mosquito. How Is WNV Infection Treated? There is no specific treatment for WNV infection. In cases with milder symptoms, people experience symptoms such as fever and aches that pass on their own, although illness may last weeks to months. In more severe cases, people usually need to go to the hospital where they can receive supportive treatment including intravenous fluids, help with breathing, and nursing care. What Should I Do if I Think I Have WNV? Milder WNV illness improves on its own, and people do not need to seek medical attention for this infection though they may choose to do so. If you develop symptoms of severe WNV illness, such as unusually severe headaches or confusion, seek medical attention immediately. Severe WNV illness usually requires hospitalization. Pregnant women and nursing mothers are encouraged to talk to their doctor if they develop symptoms that could be WN What Is the Risk of Getting Sick from WNV? People over 50 at higher risk to get severe illness. People over the age of 50 are more likely to develop serious symptoms of WNV if they do get sick and should take special care to avoid mosquito bites. Being outside means you re at risk. The more time you re outdoors, the more time you could be bitten by an infected mosquito. Pay attention to avoiding mosquito bites if you spend time outside, either working or playing. Risk through medical procedures is very low. All donated blood is checked for WNV before being used. The risk of getting WNV through blood transfusions and organ transplants is very small, and should not prevent people who need surgery from having it. If you have concerns, talk to your doctor.

7 What Is CDC Doing About WNV? CDC is working with state and local health departments, the Food and Drug Administration and other government agencies, as well as private industry, to prepare for and prevent new cases of WNV. Some things CDC is doing include: Coordinating a nation-wide electronic database where states share information about WNV Helping states develop and carry out improved mosquito prevention and control programs Developing better, faster tests to detect and diagnose WNV Creating new education tools and programs for the media, the public, and health professionals Working with partners to develop vaccines. What Else Should I Know? West Nile virus infects birds. In nature, West Nile virus cycles between mosquitoes and birds. Some infected birds can develop high levels of the virus in their bloodstream and mosquitoes can become infected by biting these infected birds. Some, but not all infected birds get sick and die of disease. One way health officials conduct surveillance for West Nile virus is by testing local birds. Finding dead birds may be a sign that West Nile virus is circulating between birds and the mosquitoes in an area. By reporting dead birds to state and local health departments, you can play an important role in monitoring West Nile virus. State and local agencies have different policies for collecting and testing birds, so check with your county or state health department to find information about reporting dead birds in your area. If you find a dead bird: Don t handle the body with your bare hands. Contact your local health department for instructions on reporting and disposing of the body. They may tell you to dispose of the bird after they log your report. For more information, visit or call CDC at 800-CDC-INFO (English and Spanish) or (TTY).

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9 Don't Take a Vacation From Your Healthy Habits This Summer! Choose waterr workouts and make a splash as you get fit and strong. Add color, variety, and flavor to your meals with fruits and vegetables. Visit the park, the swimming area, pow wows and walk for hours without realizing it. When the sidewalks sizzle, get moving indoors with a fun fitness video or DVD. Start a small garden in your yard or in a community patch to exercise, grow healthy food, and have fun with family and neighbors. Plan a weekend hike through a park, a family softball game, or an evening walk around your neighborhood. Fuel your summer with nutrient-rich foods like whole grains, fat-free or low-fat milk and cheese, seafood, lean meats, poultry, eggs, beans, nuts, and seeds. Drink plenty of water before, during, and after exercise, especially when the temperature soars. Strengthen your muscles at least twice a week with push-ups, pull-ups, or lifting weights Beat the heat with an early morning activity. Go for a walk or bike ride while watching the sun come up. Neva Zephier, MPH Health Education Ft Thompson Health Center

10 Justin Lyle Carlow Born: 05/18/15 08:51 p.m. 7 lbs., 2.0 oz long Parents: Justine and Michael Carlow Pretty Heh aka Wih opeca Win Drapeau Born: 05/10/15 2:43 a.m. 8 lbs., 5.0 oz long Parents: Cheyenne Long and Gary Drapeau

11 What Can the Managed Care Nurse Do For You Coordinate Care after hospitalization with your Primary Provider Assist you getting quality health care at Indian Health Service and specialty facilities Answer questions about Discharge Instructions after hospitalization Assist with home medical equipment needs Collaborates with nurses, social workers, physicians, caregivers and the patient to ensure care is managed at highest level. Communicates and facilitates care along a continuum with effective resource management. Assist with coordination of future appointments (scheduling, referrals, Dr. orders prior to appointment). Education on health care needs. Any questions you may have regarding your Health Care Needs Call Sherry Lulf,RN at and she will gladly assist you Family Enrichment Program Every Monday, 10:00 a.m.-2:30 p.m., the Denver II screenings are done by Janelle Stewart. Transportation is provided for Ft. Thompson community only. These screenings are done every three months on the children. Diapers, formula, books and goodie bags are offered and distributed according to age of child. The bags are donated items that we received for the National Relief Charities, Rapid City, SD. If you have any questions please call, Lynn Harrison, Office Manager at

12 The Mission of the Fort Thompson Indian Health Center is to raise the health status of the American Indian to the highest level possible. The Vision of the Fort Thompson Indian Health Center is to provide quality, accessible, safe and comprehensive health services sensitive to the needs of the American people. The Fort Thompson Indian Health Center values a healthy Native American population attained in cooperation with the community and the people we serve by providing quality health promotion/disease prevention and comprehensive primary care services F t. T h o m p s o n H e a l t h C e n t e r p h o n e n u m b e r s Medical Appointments: Dental Appointments: Optometry Appointments: Behavioral Health Appointments: CHR Office: Immunization Clinic: Pharmacy: