Wednesday, December 28, 2016

WELLNESS WEDNESDAY: Post Holiday Blues - It's Real

Did you have a wonderful Christmas?  But are now feeling  blue and finding it difficult to function normally in your daily routine?  It is not only during the holidays that sadness or depression can increase. After the holidays, many people feel a letdown.

Symptoms of holiday letdown include:

  1. Fatigue from overextending ourselves, hectic schedules
  1. Loneliness from the sudden emptiness when family friends have all gone home
  1. Sadness when life returns to normal drudge
  1. Reduced motivation since the energy of the season has disappeared
It is not hopeless! After the holidays we can:

  1. Prolong the joy. Bring the positive feelings and uplifting mood into the new year. Plan a party or get-together. Throw a Super Bowl Party or Valentine dinner.
  2. Continue the gift giving. Pay-it-forward during your daily life. Give the gift of time to an elderly neighbor, offer to babysit for a young parent, serve food at a local shelter.
  3. Embrace the winter. Even though you may want to stay indoors out of the winter weather, you can find activities to tackle that you won't want to do when the weather improves in the Spring and summer. Clean your garage or closets. Organize drawers.
  4. Enjoy your inside time. Treat yourself to a movie binge. Catch up on your reading. Choose activities that meet your interests.
  5. Eat away blues. Choose foods that boost serotonin – the feel good neurotransmitter - such as bananas, poultry, dairy produce and peas.
  6. Put Christmas away. Pack up the Christmas tree and decorations, before you go back to work. Leaving them up is a constant reminder of things that need to be done.
Please contact a provider if you need help with controlling the holiday blues.

Monday, December 19, 2016


 Often we look forward to the holidays when we are able to  spend time with family and friends but all too often the anticipation and excitement is overwhelmed by feelings of depression, better known as holiday blues. 
Symptoms can include headaches, insomnia, uneasiness, anxiety, sadness, intestinal problems, and all to often,  conflict.
There are several reasons the holiday season can change moods and cause anxiety, including over drinking, overeating, and increased fatigue. Spending inordinate amount of time shopping, cooking, traveling, entertaining out of town guests, and office parties; all can cause extra financial burdens.
Here are some ways to prevent problems:
1. Be reasonable with your schedule. Do not overbook yourself into a state of exhaustion--this makes people cranky, irritable, and depressed.
2. Decide about priorities and stick to them.
3. Remember that holidays CAN cause feelings of loneliness, sadness, frustration, anger, and fear.  Be prepared to fight the negative mood.
4. When family visit,  it is easy to recall resentments.  Stay in the present.  This is not the time to remind family of mistakes in their past, but can be a time to renew relationships.
5. Don't expect the holidays to be just as they were when you were a child. We are no longer children.
6. Plan to volunteer at a homeless shelter or work with underprivileged or hospitalized children or elders.   It's hard to feel blue when reaching out to help others.  
7. Plan to take a drive and look at the holiday decorations. Look at people's Christmas lighting on their homes.
8. Do not over-indulge in alcohol. This will exacerbate depression and anxiety. 
9. Create time for yourself, for physical and mental wellness. Try aerobic exercise, yoga, massage, spiritual practices or taking walks.
10. Remember to always face each day with hope and determination.  Choose to think of the glass as half full.  
If you do find yourself overwhelmed by the holiday blues, reach out to your healthcare provider for help.  
Provider's are on call 24 hours daily/7 days a week at Patient Centered Care.

Wednesday, December 7, 2016

WELLNESS WEDNESDAY: Sleepless in New Hanover County, Part 3

Prescription sleep medicines fall into one of several classes. In determining which sleep medicines may be right for you, your provider will consider your medical history, your insomnia symptoms, other medications you are taking, and the way the medicine works in the body.

NON-BENZODIAZEPINES. This is the newest class of sleep medicines. The currently available products have a short half-life, which means they are eliminated from the body quickly. Because of this, they are not likely to cause daytime sleepiness. They are also “selective,” which means they target specific receptors that are thought to be associated with sleep. (Examples: Sonata, Ambien)

BENZODIAZEPINES. This class includes both long-acting medicines (which can linger in the body and potentially cause daytime drowsiness) and short-acting medicines (which do not stay in the bloodstream as long). Many benzodiazepines were originally formulated to treat anxiety. (Example: Klonipin, Valium)

ANTIDEPRESSANTS. Providers may prescribe antidepressants to promote sleep, although none of these medicines are specifically approved for this purpose.

Nonprescription sleep medicines usually contain antihistamines which may induce drowsiness that lasts into the next day. Many cold and allergy medicines contain antihistamines ( like diphenhydramine hydrochloride - Benedryl), which is why they can make you feel sleepy.

Over the counter (OTC) sleep medications can interact with other medicines you may be taking, so you should consult your provider or pharmacist before using one of these sleep aids.

Melatonin. Although melatonin is widely sold as a sleep aid, it remains controversial in medical circles. Because melatonin (a hormone) is classified as a dietary supplement, it has not undergone the rigorous clinical testing that medicines do.

Herbal sleep aids. Herbal remedies for sleep problems include chamomile, valerian root, hops, lavender, and passionflower. Like melatonin, these herbal remedies have not undergone extensive testing. Herbal remedies are generally considered safe; however, there are some that can be harmful under certain circumstances. (Example: You should not use chamomile if you are pregnant or if you are taking blood thinners.)

Important: While dietary supplements and herbal remedies may sound harmless, they can have significant side effects or drug interactions. Before trying these alternative sleep aids, talk with your provider.

Questions to ask about sleep aids
You should discuss ANY sleep aid you are planning to take — whether prescription or nonprescription — with your provider.
  • How long can I take this medication?
    Before taking any sleep aid, ask about the duration and frequency of its use.
    Prescription sleep medicines are usually prescribed for 7 to 10 days. Your provider may recommend that you use a prescription sleep aid for more than 10 days after he or she reassesses your particular sleep problems.
  • Am I at risk for becoming addicted to this medicine?
    If taken as prescribed, sleep medicines usually do not cause dependence (addiction). If you have been dependent on alcohol or other drugs in the past, you might have a greater chance of becoming addicted.

Side effects
In general, the most common side effects of sleep medicines include dizziness, lightheadedness, daytime drowsiness, diarrhea, and difficulty with coordination. With some prescription medicines, however, the risk of these side effects is very small.
Here are some ways to ensure your treatment is as safe and successful as possible:
  • Use only as directed.
  • Never use alcohol while taking any sleep medicine.
  • Tell your provider if you are taking any other medicines, including those you can buy without a prescription.
  • If you experience any unusual behavior changes or thought patterns after starting on a medicine, report it to your provider.
  • When you first start taking any sleep medication, use extreme care while doing anything that requires complete alertness, such as driving a car or operating machinery. See whether the medicine has any effect on you the next day.

Online Resources:

This is the last Part of Sleepless in New Hanover County.  If you stll have questions, contact Patient Centered Care for an appointment with a Provider.  

Wednesday, November 30, 2016

WELLNESS WEDNESDAY: Sleepless in New Hanover County Part 2

Tips for shift workers
If you need to get a good night's sleep during the day, one of your biggest challenges may be dealing with the sunlight. Here are some suggestions:
  • If possible, work in brightly lit areas during your shift.
  • When you drive home in the morning, wear sunglasses. Limiting light to your eyes tricks the brain into thinking it’s getting close to nighttime.
  • Make sure your bedroom is absolutely dark. If any daylight is creeping in through the curtains or shades, drape a thick towel or blanket over the window. You might also consider wearing a “sleep mask.”
General Tips:
  • Limit the amount of time awake in the bed
  • Limit any naps during the day.
  • Avoid clock-watching
  • Avoid caffeine after 2pm and alcohol after 6pm
  • Keep a regular wake time and bedtime
  • Light exercise should be encouraged
  • Only use bed for sleep, no TV or reading. If unable to sleep in 20 minutes, get up, go to another room and return to bed only when feeling sleepy.
  • Try relaxation therapy, such visualization.
  • Avoid stressful activities in the evening.
Tips for staying alert
If you’re dealing with a sleep deficit, these tips may help get you through a sluggish day:
  • Eat breakfast. You’ll need the energy it provides.
  • Avoid a “sugar rush.” You might get a lift from eating candies, cakes, and other high-sugar foods, but you’ll crash pretty quickly. Instead, eat meals and snacks that combine complex carbohydrates and protein.
  • Move around. Stimulate your body by taking a brief walk outside or around the office; you’ll feel more alert.
  • Vary your activities. Don’t focus on the same task for long periods of time.
  • Get chilly. A surge of cold air might perk you up. Depending on the season, you could turn on the air conditioning, open a window, or take a brisk walk outside.
Come back next week for our final chapter of Sleepless in NHC; learning about medications for sleep.  Call the office for a consultation if you are experiencing sleep problems. 

Wednesday, November 16, 2016

WELLNESS WEDNESDAY: Sleepless in New Hanover County - Part 1

Sleepless in New Hanover County? Dealing with Insomnia

Prepare for sleep
Setting the stage for a good night’s sleep can help you get your mind and body into “sleep mode.”
  • Relax your body. To reduce muscular tension, try techniques such as meditation, progressive relaxation or even taking a warm bath.
  • Unwind mentally. About a half hour before going to bed, enjoy a low-key activity such as reading or listening to music.
  • Once in bed, try to stop worrying. Avoid solving your problems from your bed. Before going to bed, make a list of problems and “next steps” for the following day.
  • Try a high-carb snack. A light snack that is high in carbohydrates, such as a plain bagel, might help you relax.
  • Avoid heavy, spicy, or high-sugar foods.

Follow a schedule
Go to bed and get up at the same time every day — even on weekends. Creating this routine can help condition your mind and body to expect sleep at a regular time.

Do a bedroom checkYour bedroom may not be as conducive to sleep as it could be. The following strategies can make your bedroom more sleep-friendly:
  • Block out noise. Or better yet, eliminate it. Even if you fall back to sleep after noise wakes you, the quality of your sleep can be compromised. Turn off radios, televisions, or stereos in the bedroom (and other rooms as well). If you can’t control the noise, try earplugs.
  • Reduce light. The issue isn’t merely how light affects your eyes. Light also affects the way your brain produces hormones that regulate your sleep cycle. Even a minimal amount of light can disrupt your sleep. Possible solutions: Ask your sleep partner to read in another room; wear a “sleep mask”; use heavy shades or other window treatments that keep the room very dark.
  • Adjust the room temperature. If you are too warm or too cold, you are less likely to sleep soundly. Adjust the thermostat, your sleep clothes, or your bedding; open or close a window.
  • Move the clock. If you have insomnia looking at the clock can make you anxious. Therefore, it’s best to keep it out of view.
  • Have your pet sleep somewhere else. If your dog or cat sleeps in your bed, your chances for sound sleep are jeopardized. Have your pet sleep on the floor, or get your pet its own cushion and place it in another room.
  • Address your partner’s sleep problems. A bed partner who snores, tosses and turns a lot, talks while sleeping, or gets up often can affect your own sleep. In some cases, using earplugs or adding “white noise” (from a fan or similar humming appliance) can help. If your partner gets up a lot, make sure he or she sleeps closest to the door. If your partner tosses and turns, consider a larger bed, or even separate beds.
Come back next week for General Tips, Tips for Shift Workers and Tips for staying alert.
Patient Centered Care - Adult and Geriatric Medical Practice

Thursday, November 10, 2016


A survey was conducted online among adults 18+ living in the U.S. by Harris Poll on behalf of the American Psychological Association which indicated 52 percent of American adults report that the 2016 election was a very or somewhat significant source of stress. Election stress is exacerbated by images on social media and verbal aggression both of which heighten frustration. Comments that are hostile or instigative, are dividing families, workplaces, and communities.

Don't fall into the pit of negativity.
  1. Watch how you react to what you hear and see.

Although it is normal to be upset, be respectful toward others. Pay attention f you have children around. Children can become frightened by what you say.
  1. Don't ignore your stress.
Stress can cause all kinds of problems including a bad mood. To help yourself feel better, take the steps you need to reduce your stress in a healthy way.
  1. Remember, someone else's opinion is only their opinion.
Some people are happy with the results. When we feel differently, their comments can feel like a personal attack; however, their opinion likely has nothing to do with you. Everyone is entitled to their opinions. Respect their opinion.
  1. Take action.
If your candidate isn't headed to the White House, focus on what you can do in your community to get involved. Find a cause and volunteer.  Stay in touch with your local representatives.  
  1. Remember there is a future.
Just because your candidate did not win does not mean there is no hope. There is no definitive evidence that the next four years will be disastrous. Although there will be a grieving process to pass through, every day life will continue just as we know it.   

Wednesday, November 2, 2016


November is Pancreatic Cancer Awareness month. Pancreatic cancer is considered the deadliest major cancer with a five year survival rate of only 8%. To see a decline in death rates for pancreatic cancer, more people need to know about the disease. And November is a great time to get started by educating yourself about the symptoms and risk factors

Warning signs:
Pancreatic cancer may show only vague, unexplained symptoms. If you experience one or more of these, contact your provider to discuss the possibility for developing pancreatic cancer.
  • Pain – usually in the abdomen or back
  • Loss of appetite
  • Jaundice – yellowing of the skin or eyes
  • Weight loss
  • Nausea
  • Change is stool
  • Recent onset diabetes

Risk Factors for developing Pancreatic Cancer
Although the exact cause is unclear, there are certain risk factors that can increase your chance of developing the disease.
  • Family history – if your Mother, Father, Sibling or Child had pancreatic cancer, then your risk increases 2-3 times
  • Diabetes – long term diabetes increases your risk to develop pancreatic cancer
  • Pancreatitis (or hereditary pancreatitis) causes an increased risk for pancreatic cancer
  • Smoking is a significant risk factor and may be the cause 20-30 % of exocrine pancreatic cancer cases
  • African American or Ashkenai Jews have a higher incidence of pancreatic cancer
  • Pancreatic cancer risk increases with age; with most cases presenting over than age 60
  • There have been more men diagnosed with pancreatic cancer than women
  • A diet high in red and processed meats is thought to increase the risk for pancreatic cancer; however a diet high in fruits and vegetables may decrease the risk
  • Obesity increases the risk by 20% compared to normal weight people

If your family presents with risk factors, consider meeting with a genetic counselor. A genetic counselor will explain how a genetic mutation may contribute to increased frequency for developing pancreatic cancer. A genetic counselor can identify a family at higher risk and help the family interpret information about the disease. If you would like to meet with a genetic counselor, contact our office for an appointment.

Wednesday, October 26, 2016


As the seasons change we have to protect our bodies in order to stay healthy. Winter is the time of year to slow down, rest, reflect, restore energy in preparation for Spring! Follow these self-care tips for a healthier winter:
  1. Keep your neck covered and warm with a scarf, especially on windy days. 
 (Wind enters the body mainly through the base of the neck; so to help prevent seasonal colds and flu, it’s smart to keep the neck covered with a warm scarf.)

  1. Eat the rainbow.
   (Although it’s not really the season for certain fruits and veggies, make sure you’re filling yourself with lots of colorful produce! Whether it’s frozen or fresh, produce is the most important health tool money can buy. Eating a wide variety of fruit and vegetables will ensure you get all the essential vitamins and minerals you need, which is especially important in the winter when there is less sunlight and less time outside.)

  1. Wash your hands often.
(It’s simple hand washing that can stop germs from spreading from one person to another and throughout an entire community. It’s one of the easiest, most effective ways to avoid getting sick.)

  1. Get lots of sleep.
(Cranking up the heat may seem like a cozy way to however as we sleep, our body acclimates to the room temperature and if we lower our body temperature in a cooler room, we are likely to sleep better. Optimal temperatures tend to range between 68 and 72 degrees).

  1. Leave time for relaxation, reflection and stress-reduction daily.
Comprised of organs, tissues, cells and cell products that all work together to fight harmful substances causing infection and disease, the immune system is the body’s form of defense. Stress keeps more than 40 percent of adults lying awake at night. To help ensure you get the recommended seven or eight hours of sleep, cut back on caffeine, remove distractions such as television or computers from your bedroom and go to bed at the same time each night.

  1. Laugh with your family and friends!
(Seasonal Affective Disorder is a REAL THING! And it can affect a lot more than just your mood. Fatigue, irritability, depression, anxiety, and even physical discomfort can result from the changing of the seasons. The best way to beat the winter blues is to get outside daily.)

  1. Practice easy stretching exercises.
(Exercise is important all throughout the year, but even more so in the winter when we are more sedentary. A regular workout routine will boost your immunity, reducing your risk of cold and flu, and improving your mood and raising your energy.)

  1. Soak up the sunshine on on sunny winter days.
(To improve mood and recharge, make an effort to get outside in the light and fresh air at least once a day. Not only is it good for replenishing your vitamin D needs which is a key nutrient that aids our Immune system. Most people become deficient in vitamin D during the winter).

Self-care can help keep you well during the  winter; however, if you do find yourself with an illness, we are available to help.  Contact the office for an appointment.  Also, don't forget to get your flu vaccine!!

Wednesday, October 19, 2016

WELLNESS WEDNESDAY: When Are We Contagious

Acute bronchitis is a chest cold that occurs when the bronchial tubes get irritated and inflamed, producing mucus that makes you cough. It can be the result of a bacterial infection, but most frequently is the result of a virus. For the most part, bacterial bronchitis and airway inflammation are not contagious; however, what precedes a bout of bronchitis is a viral infection of the upper airway, a COLD, and of course, colds are contagious. Patients should think of acute bronchitis as more a symptom of an illness rather than an illness itself.

In addition to acute bronchitis, more than 12 million Americans suffer from chronic bronchitis, which is one form of chronic obstructive pulmonary disease (COPD). This condition is typically brought on by cigarette smoking, and is not contagious.

The flu is a contagious respiratory illness caused by influenza A or B viruses. Flu appears most frequently in winter and early spring. The flu virus attacks the body by spreading through the upper and/or lower respiratory tract. The common cold and flu are both contagious viral infections of the respiratory tract. The flu virus is spread from person to person through respiratory secretions. Cold and flu have similar symptoms; however, the flu is much worse.

Both cold and flu cause coughing, headache and chest discomfort; however, with the flu, you will run high fever for several days, and have body aches,fatigue and weakness. Symptoms of the flu also tend to come on abruptly. Complications from colds are typically minor, but a severe case of flu can lead to serious illnesses such as pneumonia. Many types of cold viruses are known, and new strains of flu evolve every few years. Both diseases are viral, so antibiotics cannot cure a cold or flu.

Pneumonia is an infection that causes the lung’s air sacs to fill up with fluid. Pneumonia is the result of bacteria. Coming in contact with someone suffering from bacterial pneumonia, imposes a risk for those bacteria to be transmitted to you, although that might not necessarily cause you to develop pneumonia. There are also types of pneumonia that are viral rather than bacterial, and those viruses are more contagious. Pneumonia stops being contagious when coughing stops, usually soon after the initiation of appropriate antibiotics.

When to call your Provider:
Those at risk for serious complications include:
  1. people over the age of 50
  2. pregnant women
  3. children under the age of 2
  4. those with weakened immune systems due to HIV/AIDS, steroid treatment, or chemotherapy
  5. people with chronic lung or heart conditions
  6. people with metabolic disorders such as diabetes, anemia, or kidney disease
  7. people living in long-term care facilities such as nursing homes
If your symptoms do not improve, if they worsen, or if you have:
  1. trouble breathing
  2. severe sore throat
  3. persistent fever
  4. chest discomfort
Call us with questions or concerns. 

Wednesday, October 12, 2016


Here’s what you need to know to make an informed decision when it comes to genetic testing.

Have any of your relatives had cancer?
Does your family history raise some red flags?
The best person to test first is usually the person with cancer.

Most Cancer cases are not related to family history.
  • 5 to 10% of cancer cases are related to genetics
  • Genetic testing is a tool to identify individuals at increased risk for developing certain cancers because of family history
  • You can inherit an abnormal gene from either one of your parents
  • Inheriting a gene linked to cancer increases your risk to develop disease
  • Breast, colorectal,ovarian,prostate, pancreatic and endometrial cancers sometimes run in the family
But most cancers are related to lifestyle choices like smoking, not exercising and eating unhealthy foods.

Know your Family's cancer history.
  • Speak with relatives to fill in as much information as possible
  • Especially speak to first- and second-degree blood relatives
  • Watch for family members:
    • who have cancer before age 50
    • with the same type of cancer
    • who have two or more different cancers
    • who have a rare cancer such as male breast cancer or sarcoma
    • who have the BRCA1 or BRCA2 mutation
Carefully consider the decision for genetic testing.
  • a benefit of knowing is the ability to work with your provider to monitor and address your cancer risks
  • to help prevent cancer or find it early, when it’s most treatable
  • remember the decision will impact your family, since your test results may forecast their cancer risks, too
  • understand that group insurance plans are prohibited by law from using genetic information to discriminate
Important to remember: a gene mutation does not mean you will definitely get cancer just as not having a gene mutation will not guarantee that you won’t get cancer

Phyllis Everett, NP-C is an Adult Nurse Practitioner, certified as an Advanced Practice Nurse in Genetics. Phyllis graduated from Duke University in 2005. Since that time, she has worked in the field of hematology and oncology. Now affiliated with Patient Centered Care, Phyllis is available to provide cancer risk evaluation.

If you are interested in learning more, contact our office.

Wednesday, October 5, 2016


When hurricanes are in the forecast, many demonstrate panic and fear the worst about the coming storm. The uncertainty of what a storm could cause may provoke anxiety. When we hear news of universities and cities initiating mandatory evacuation orders, the fear becomes a reality. It is very difficult to remain calm when our environment seems to be in control of our lives. Even if you are not affected by a mandatory evacuation, you still are faced with possible loss of electricity, decisions that have to be made to assure you have enough food and water to last the duration. Watching the weather forecasts on the TV or online helps some people feel calmer; for others it provokes greater anxiety. Know which one you are and adjust your behavior accordingly.

To alleviate some of the worry:
Be prepared.
Being prepared will make you feel better about the uncertainty; allows you to feel
confident that you did all that is necessary to weather the storm. Being prepared means stocking up on a reasonable (3-5 days per person) amount of food and water (5 gallons per person), having batteries for flashlights and matches for candles. Being certain you have the necessary prescription medications and a first aid kit; blankets and personal care items (hand cleaning wipes, as well as cleaning wipes). Have easy access to your fire extinguisher and if possible, have a battery operated radio. Turn freezers and refrigerators to coldest settings. This will help keep the food cold longer if you do lose power. Fill your bathtub with water so you will have water to flush toilets. But don’t go overboard. Hurricanes generally clear the area within a day, and major damage from roadways is cleared usually a day or two later.
Have a Family Plan
Many families live close by one another; others may be geographically separated. . Phone systems may not be able to function, and the Internet may be unavailable, so you need to plan ahead with extended family and friends. Be sure older parents or college student know how and when to hear from you and when they will contact you. The Internet may be more accessible than other means, so a posting to one’s wall or t witter could let others know you made it through safe.
Accept the Inevitable
It is easy to feel out of control when faced with nature’s fury. Nature is stronger than man, and all we can do is button down and hope for the best. Keep windows shut, move and store items from your yard or porch. Remember that an item left outside can become a flying object in high winds. Strong winds can send projectiles through windows and cause injury. If your windows aren't boarded up, stay away from them. Stay indoors and make sure your pets are indoors too! Don’t go out during the storm.
Know when you need to evacuate
Identify where you would go, if evacuation is mandatory. Be sure your vehicle has a full gas tank. If the area loses power, ATMs won't work, banks and gas stations will be closed. Be sure to have cash on hand to get you through a few days. Know what the
safe evacuation route is; a route where low-lying areas likely to flood can be avoided. If you choose to remain behind, you put yourself and your family at risk. You also endanger any first responder who has to rescue you if the situation gets dangerous.

Lastly, don't forget about your neighbors, young and old, who may need assistance preparing for the storm, or help with preparing for evacuation.

As always, Patient Centered Care personnel are available to answer questions or concerns. 

Wednesday, September 28, 2016

Wellness Wednesday: Managing Stress

Understanding the types and sources of stress, short term and long term, internal and external, are an important part of stress management. Stress is our body's reaction to the demands of the world and stressors are events or conditions in our surroundings that may trigger the stress.

Main Types of Stress:
Acute stress, known as the fight-or-flight response, is a quick and often an intense response. Acute stress will not likely cause a problem for a healthy person; however, severe acute stress can cause mental health problems such as post traumatic stress disorder or symptoms, such as tension headaches, stomach problems or even serious health issues, such as a heart attack.

Mild acute stress can actually be good for us, motivating and energizing us. The problem occurs when stressors pile up and don't resolve. This develops into chronic stress and can lead to chronic health problems. Effective stress management involves identifying and managing both acute and chronic stress.
Stress Management:
Effective stress management starts with identifying sources of stress and developing strategies to manage them. One way to do this is to make a list of situations, concerns or challenges that trigger your stress response.
  1. External Triggers:
  • environmental (we are experience that with world events today)
  • life changes (marriages, divorces, deaths)
  • unpredictable events (demotion at work, cut in pay)
  • social (relationships with family, co-workers, friends)
  • workplace (deadlines, emails, phones)
Strategies to manage external stressors include lifestyle factors such as eating a healthy diet, being physically active and getting enough sleep. Not all stress stems from things that happen to us. Often a stress response is self-induced. Those feelings and thoughts that pop into your head and cause you unrest.
    2. Internal Triggers:
  • fear
  • uncertainty
  • loss of controlled
  • belief
Fear, attitude and expectation are our lifetime companions. It may take some effort to make changes. Strategies to manage internal stressors include re-framing your thoughts and choosing a positive mindset, challenging negative thoughts, using relaxation techniques, and talking with a trusted friend or counselor.

Recognizing a problem is the first step toward solving it. By identifying and understanding the source of your stress, you are better able to manage it. Manage it, not eliminate it may be the only goal because stress is a fact of life.  

Patient Centered Care, PLLC provides psychiatric diagnostic evaluation and medication management.  Psychiatric Nurse Practitioner, Tamatha Arms provides excellent, personalized care in a pleasant setting.  Call us  for help managing your life stressors.  

Monday, September 26, 2016

Do you know what a Nurse Practitioner is?

You’re definitely not alone if you don’t know what a Nurse Practitioner (NP) is. Even though NPs have been around for 50 years now, many people in the U.S. still aren’t sure what we do.   NPs are nurses who have received medical training.  Part of the confusion can be due to the many letters you see behind an NP name -- and there are many.  With every degree or specialty certification, the NP will receive new initials which represent new qualifications and expertise the NP has earned.  

The minimum education for an NP is a 4 year Baccalaureate Nursing Degree, 2 year Master's Degree, and optional 1.5 - 4 year Doctoral Degree.  The highest degree an NP can achieve is a doctorate degree.  That degree could be a PhD (Doctor of Philosophy) or a DNP (Doctorate of Nursing Practice).  There may also be initials designating the degree, such as MSN (Master of Science in Nursing) or MPA (Master of Public Administration).  The degree designation might  follow their name; however,  some choose to lead with their professional designation, APRN (Advanced Practice Registered Nurse) or NP (Nurse Practitioner).   

The credentials for the American Certification Credentialing Center (ANCC) certified NPs is NP-BC preceded by a letter indicating the particular specialty,
·  Family nurse practitioner:    FNP-BC
·  Adult nurse practitioner:      ANP-BC
·  Adult-gerontologic primary care NP: AGPCNP-BC
·  Acute care nurse practitioner:           ACNP-BC
·  Adult-gerontologic acute care NP:    AGACNP-BC
·  Pediatric nurse practitioner (primary care):   PNP-BC
·  Gerontological nurse practitioner:     GNP-BC
·  Psychiatric and mental health nurse practitioner:    PMHNP-BC 

The American Association of  Nurse Practitioners (AANP) certified NPs are granted the designation of NP-C, or nurse practitioner-certified
·  Family nurse practitioner:     FNP-C
·  Adult-Gerontologic nurse practitioner:   A-GNP-C
·  Adult nurse practitioner:    ANP-C
·  Gerontological nurse practitioner:    GNP-C

The most important part of any initials are the NP.  That lets you know you are with a Nurse Practitioner.  There are more than 222,000 NPs in the US.   Nurse Practitioners and physicians both diagnose, treat, and manage acute and chronic diseases; order and interpret lab and diagnostic tests; and prescribe medications.  The care and knowledge each profession uses overlaps and is complementary. 

Depending on the state, some NP’s may (1)  practice independently (or autonomously), (2)  practice collaboratively with a physician, or (3) work under the direct supervision of a physician.   Patient Centered Care, PLLC (PCC) is a Nurse Practitioner owned primary care practice, following patients age 13 yo and older, in Wilmington, NC.   PCC is an autonomous NP practice.  The NPs collaborate with physicians (although they are not present in our office).    Our website is
or follow us on facebook:
PCC providers are:  
Deborah Adams-Wingate, MSN, AGNP-C
Tamatha E. Arms, DNP, PMHNP-BC, AGNP-C

Hope this clears up any confusion related to Nurse Practitioners.  If you still have questions, contact us.  If you are looking for safe, high-quality, knowledgeable, cost-effective, and sensitive care which emphasizes YOU as a person, give us a call 910-799-6262.

Wednesday, September 21, 2016


September is recognized as Prostate Health Month as well as Prostate Cancer Awareness Month.
Prostate Health Month provides an opportunity to increase awareness around the health issues that are associated with a man’s prostate: BPH (Benign Prostatic Hyperplasia), prostate cancer and prostatitis.   You should know what your prostate is and what it does.

BPH is the medical term for an enlarged prostate (the prostate is the male sex gland that produces the fluid for semen [3].   The prostate is small, about the size of a walnut and surrunds the urethra, a tube that takes urine from the bladder to the oenis.  The urethra also carries semen during ejaculation.  The prostate gland grows during puberty and then doesn't change much until age 40 when  it begins growing again and may continue to grow with age.  An enlarged prostate is not cancerous and is the most common prostate health problem among men over 50.[1]  Half of all men between the ages of 50 and 60 will develop it, and by the age of 80 about 90% of men will have BPH.[2]

Symptoms may include:
  • Frequent, often-urgent need to urinate, especially at night
  • Need to strain or push to get the urine flowing
  • Inability to completely empty the bladder
  • Dribbling or leaking after urination
  • Weak urine stream
Prostate cancer is the most common cancer in men. It is the 2nd leading cancer killer of men, behind lung cancer. It is generally very slow growing and most men die with prostate cancer (meaning that they die of some other cause) rather than from it.  There are almost 2.8 million men living with prostate cancer in the USA.
In its early stages, prostate cancer usually doesn’t cause symptoms.   As the disease progresses, symptoms may develop that can be similar to the symptoms for BPH and/or prostatitis.
Symptoms can include:
  • Chronic pain in the hips, thighs, or lower back
  • Difficulty urinating
  • Painful / burning urination
  • Blood in the urine / semen
  • Trouble getting an erection
While no one knows how to prevent prostate cancer, there may be ways to reduce your risk:
  • Eat healthy – and choose a low-fat diet
  • Eat plenty of fruits, vegetables, and whole grains
  • Maintain a healthy weight
  • Stay physically active
  • Don’t use tobacco
  • Get regular checkups
Prostatitis is the most common prostate problem for men under 50 and about 50% of all adult men will be treated for it in their lifetime.  Prostatitis is an inflammation of the prostate that may be caused by an infection.
Symptoms of prostatitis are similar to those of BPH and prostate cancer. They can include:
  • Occasional discomfort in the testicles, urethra, lower abdomen, and back
  • Discharge from the urethra, especially during the first bowel movement of the day
  • Blood or urine in ejaculate
  • Low sperm count
  • Sexual difficulties
  • Fever
  • Aching muscles
  • Chills
  • Fatigue
  • Frequent and/or painful urination

[1] NIH Publication No. 14-3012. Prostate Enlargement: Benign Prostatic Hyperplasia. August 2014.
[2] American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). P4. Revised 2010.
[3] American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). P9. Revised 2010.