Health Care and Spinal Cord Injuries

Your spine allows you to help stand up straight and do some pretty amazing movements. It also aids in the control of your ability to feel pain. The �cord� is that nerve that runs from top to bottom through the middle of your vertebrae and connects with the nerves in your body. If the spinal cord is injured, the affects can be debilitating not only physically but also psychologically to the individual, and often to the family. Your world instantly changes.

Learning that you, a family member or friend has gotten a spinal cord injury is devastating and overwhelming news, according to the Christopher & Dana Reeve Foundation. The best way to combat your feelings of helplessness and confusion is to arm yourself with information on what a spinal cord injury is, and what it means in terms of short-term planning and long-range goals.

According to this website,, the spinal cord is about 18 inches in length and extends from the base of the brain, surrounded by the vertebral bodies, down the middle of the back, to about the waist. The nerves that are situated within the spinal cord are called upper motor neurons (UMNs) and their function is to carry the messages back and forth from the brain to the spinal nerves along the spinal tract.

The spinal nerves that branch out from the spinal cord to the other parts of the body are called lower motor neurons (LMNs). These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin such as pain and temperature, and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement, per the info on the Apparelyzed site.

The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems. Much more detail about spinal cord injuries can be found at the Apparelyzed website.

According to the National Spinal Cord Injury Association (NSCIA), any damage to the spinal cord is a very complex injury. People who are injured are often confused when trying to understand what it means to be a person with a spinal cord injury (SCI). Will I be able to move my hands? Will I walk again? What can I do? Each injury is different and can affect the body in many different ways.

Damage to the spinal cord can occur from either a traumatic injury or from a disease to the vertebral column. In most spinal cord injuries, the backbone pinches the spinal cord, causing it to become bruised or swollen. Sometimes the injury may tear the spinal cord and/or its nerve fibers. An infection or a disease can result in similar damage. After a spinal cord injury, all the nerves above the level of injury keep working like they always have. From the point of injury and below, the spinal cord nerves cannot send messages between the brain and parts of the body like they did before the injury.

The doctor or specialist examines the individual to understand what damage has been done to the spinal cord. An X-ray shows where the damage occurred to the vertebrae. The doctor does a "pin prick" test to see what feeling the person has all over his body (sensory level). The doctor also asks, "what parts of the body can you move?" and tests the strength of key muscle groups (motor level). These exams are important because they tell what nerves and muscles are working.

A person's injury is described by its level and type. The level of injury for a person with SCI is the lowest point on the spinal cord below which there is a decrease or absence of feeling (the sensory level) and/or movement (the motor level), according to NSCIA. A significant amount of information about SCI can be located on this site:

According to the Paralyzed Veterans of America, Immediately after a spinal cord injury, the spinal cord stops doing its job for a period of time called �spinal shock.� The return of reflexes below the level of injury marks the end of spinal shock. At this time, a doctor can determine if the injury is complete or incomplete. If the injury is incomplete, some feelings and movement may come back. Rehabilitation usually begins immediately.

The individual will be instructed in strengthening exercises, new styles of movement, and the use of special equipment. If additional recovery of feeling or movement does not occur, a rehabilitation team will help the individual to develop new goals. More material on this subject can be found at their website:

Traumatic injury to the spinal cord, according to the Centers for Disease Control (CDC), can result in neurologic impairments in any body system controlled by the affected nerves, including musculoskeletal (resulting in incomplete or complete paraplegia or tetraplegia), respiratory, urinary, or gastrointestinal. Long-term complications from SCI also include any psychological side effects, such as depression and anxiety. The CDC has statistics about SCI that are very interesting:

         About 200,000 people are currently living with SCI in the United States.
         Annually, 15 to 40 new cases per million people�or 12,000 to 20,000 new patients�are estimated to occur.
         Alcohol has been found to play a major factor in 25% of spinal cord injuries.

         Average annual medical cost: $15,000�$30,000 per year
         Estimated lifetime cost: $500,000�more than $3 million, depending on injury severity

         Motor vehicle accidents: 46%
o    Use of a seatbelt can reduce the odds of a spinal cord injury by 60%
o    Use of a seatbelt and airbag combined can reduce the odds of injury by 80%
         Falls: 22%
         Violence: 16%
         Sports: 12%

         Males account for 80% of spinal cord injury patients.
o    Most new SCI cases occur in persons younger than 30 years old; an estimated 50%�70% occur in those aged 15�35 years.
         Estimated racial/ethnic distribution:
o    White: 65%
o    African American: 25%
o    Hispanic: 8%
o    Other: 2%

Spinal cord injury (SCI) is an important contributing factor to morbidity and mortality in the United States. More info can be found at this site:

Adjustment to paralysis is a process of changing one's thoughts and feelings and is something that takes time. The goal of adjusting is to rebuild one's identity and to find a new balance in relationships. The stages of adjustment can include grieving, taking control, talking about your disability, taking care of yourself, and looking ahead, according to the Christopher & Dana Reeve Foundation.
Depression is a serious medical disorder that affects your thoughts, feelings, physical health and behaviors as well as other aspects of your life. Depression can cause physical and psychological symptoms. It can worsen pain, make sleep difficult, cause loss of energy, take away your enjoyment of life and make it difficult for you to take good care of your health.

Other symptoms include oversleeping, change in weight, loss of interest or pleasure, and/or negative thoughts. Depression is common in the spinal cord injury population--affecting about 1 in 5 people. If you are concerned that you may be suffering from depression, please speak with your physician. A lot of information about SCI can be found at this website:
Spinal Cord Injuries happen frequently every year, and they are dangerous. If you or a loved one has suffered an SCI, see your doctor regularly to monitor your treatment and ongoing rehabilitation. You also may need to secure mental or spiritual counseling on occasion if you suffer from any emotional trauma from time to time. This health care situation is serious, and it should be handled by trained professionals who can help you deal with the affects long term if your recovery is not immediate or within a short period of time.

Until next time.

Emergency Retina Surgery - Office Closed!!

I will be undergoing emergency retinal surgery on Jan 29th and will be unable to do any work for at least 10 days during the recovery period.  I anticipate I should be back to work right around 2/10 however the final decision will be up to the doctor.

Please refrain from contacting me while in recovery as I will not be able to talk on the telephone nor conduct normal business sctivitites.

Thank you.


Health Care and Hip Replacement

Over time your joints can age and movement can become painful, especially in your hips. Older men and women are more susceptible to this type of health difficulty. Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, you should consider information that can help you understand the benefits and limitations of total hip replacement.

 If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting, according to the American Academy of Orthopaedic Surgeons.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities. First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. More info can be found at the AAOS site:

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery, according to the National Institutes for Health. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery. According to the Centers for Disease Control and Prevention (CDC), 332,000 total hip replacements are performed in the United States each year.

In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.

Today, a person�s overall health and activity level are more important than age in predicting a hip replacement�s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson�s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip.

People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes. More info can be found at this website:

According to John Hopkins Medicine, as with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

         Blood clots in the legs or lungs
         Need for revision or additional hip surgery
         Nerve injury resulting in weakness or numbness

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure. A significant amount of information, including how to prepare for surgery, what happens during the surgery in the hospital, and recovery, can be found at this website:,P07674/.

Some surgeons, however, are performing another type of hip surgery, according to the New York Times, called anterior hip replacement. The surgeon makes the incision at the front of the hip instead of through the buttocks or the side of the hip. This approach permits the doctor to reach the hip socket without cutting through major muscle groups.

 Proponents claim that the procedure results in less pain and fewer complications for patients than standard hip replacement. There is more and more data that patients recover quicker, discontinue use of a cane or walker sooner, and have a quicker return to a normal gait. Proponents note that because the operation spares muscles, patients don�t need to limit their movements during the recovery period.

Surgeons who perform the procedure also say the anterior position makes it easier for them to use fluoroscopy, a real-time X-ray technique that allows doctors to precisely position the implanted artificial hip. That, in turn, may allow artificial hips to last longer. And since the major muscle groups of the hip are left untouched, there appears to be a lower risk that the artificial joint might pop out, or dislocate. Conventional hip replacement techniques have a dislocation rate of about 1 percent. Preliminary studies suggest that the rate following anterior surgery may be less than one-third of that, according to the NY Times.

Yet reports of the benefits are mostly anecdotal, based on surgeons� experience. No large randomized studies have been done comparing the outcome of anterior surgery with other approaches. And there are downsides. Anterior hip replacement often takes longer to perform and can result in more blood loss. Some patients experience temporary numbness in the thigh afterward.

Because the operation is tricky to perform, there is a steep learning curve for physicians, which partly explains why it hasn�t been taught as widely as other approaches in medical schools. Special operating tables have been designed that make the surgery easier to perform, but many medical centers don�t have them. Even surgeons who perform the new procedure are quick to say that it isn�t �minimally invasive,� the term often used in marketing materials. More info on this procedure can be found at this site:

According to NPR, what patients really need is knowledge. The Internet is great for providing information, but it lacks a context in which to interpret that. How does a patient sift through all the information and make an informed decision? And, patients should investigate hip replacement information on a reputable website.

One key question to ask an orthopedic surgeon is about the number of times he or she performs this procedure in a year. Like most things in medicine, practice makes perfect. And being expert means performing a surgery at least 100 times a year. Once patients have found a doctor, they should talk the physician which technique is best, given the patient's history and preferences.

All techniques have improved over the years, with fewer complications and faster recovery times. Plus, all approaches to hip replacement have gotten less invasive over time because of medical practitioners� understanding of anatomy, more sophisticated surgical tools and instruments that allow better access with a smaller incision. All the surgical approaches are less invasive than they were seven to 10 years ago. More info can be found at this site:  

Hip replacement surgery should not be taken lightly. Consult your doctor and any specialist recommended about your particular situation. You may or may not be a good candidate. Only a medical professional can guide you to make that decision. Do your research well. Once chosen, then remember to follow all the advice given for both pre-op and post-op recovery.

Until next time.


Health Care and Gasoline

In case you don�t know, gasoline is a dangerous and highly flammable liquid that can have some devastating effects on your health if improperly used. Knowing the right way to handle gasoline and the awareness of its potential hazards is critical to having not only respect for the liquid itself, but also the best way to counter any threats to your overall health.

Gasoline is a complex mixture of over 500 hydrocarbons that may have between 5 and 12 carbons. Smaller amounts of alkane cyclic and aromatic compounds are also present. Virtually no alkenes or alkynes are present in gasoline, according to Elmhurst College.

Gasoline is most often produced by the fractional distillation of crude oil, which is separated into fractions according to different boiling points of hydrocarbons of varying chain lengths. This fractional distillation process yields approximately 25% of straight-run gasoline from each barrel of crude oil.

According to HealthLine, gasoline is considered dangerous for your health because it is poisonous. Exposure to gas�either through physical contact or inhalation�can cause health problems. The effects of gasoline poisoning can harm every part of the body. It is important to practice and enforce safe gas handling to prevent poisoning. Inappropriate gasoline exposure warrants a call for emergency medical help. Swallowing gasoline can cause a wide range of problems to vital organs. Symptoms of gasoline poisoning may include:

         breathing difficulties
         throat pain
         burning in the esophagus
         abdominal pain
         vision loss
         vomiting (with blood)
         bloody stools
         severe headaches
         extreme fatigue
         body weakness
When gasoline comes into contact with your skin, you may experience red irritation or burns. Perhaps one of the greatest risks of gasoline is the harm it can do to your lungs when fumes are inhaled. Direct inhalation can cause carbon monoxide poisoning, which is why you shouldn�t run a vehicle in an enclosed area, such as a garage. Long-term exposure in the open can also damage your lungs. Pumping gasoline into your gas tank isn�t generally harmful. However, accidental liquid exposure can harm your skin. Accidental gasoline consumption is far more prevalent than intentionally swallowing the liquid. Much more info can be found at this site: .

Gasoline can easily enter your body when you breathe in air or drink water that is contaminated with gasoline. No information is available on how much gasoline enters your body when it gets on your skin. When products like gasoline get on your skin, however, they enter your body more slowly than when they are taken into your mouth. Some of the chemicals in gasoline, such as benzene, are expected to penetrate the skin more easily than some of the other chemicals in gasoline, according to the Centers for Disease Control.

Most of the gasoline that you breathe in or swallow is breathed out unchanged, but some of it can enter your blood rapidly. Gasoline in your blood travels throughout your body. When the chemicals in gasoline reach your liver, they are changed into several different chemical substances. Most of these new substances travel in your blood until they reach your kidneys and then leave your body in urine. However, some of the new substances formed in the liver do not leave your body as rapidly, according to the CDC. More info can be found at this site:

According to the State of Wisconsin Department of Health, immediately or shortly after breathing a high amount of gasoline, a person may experience nose or lung irritation, feel dizzy or have a headache. When swallowed, gasoline will cause stomach irritation. Drinking gasoline or inhaling concentrated vapors can result in death. The following health effects can occur after several yearsof exposure to low levels of gasoline in air or in water:

1.    Organ Systems: People can experience damaged nervous system or lungs.

2.    Cancer: There is no evidence that exposure to gasoline causes cancer in humans. However, long term exposure to high levels of benzene, a component of gasoline, may increase a person's risk of leukemia.

More info about this subject is available at this website:

According to the New York Times, if someone has gasoline poisoning, the National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions. Or, you can call 911 if you have an immediate emergency. The NPCC is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible. More details can be found at this website:

Not only is gasoline poisonous, it is highly flammable and can cause serious injury due to burns if you accidentally catch on fire. According to this site by the National Fire Protection Association, here are some safety tips:

--Keep gasoline out of children's sight and reach. Children should never handle gasoline.

--If fire does start while handling gasoline, do not attempt to extinguish the fire or stop the flow of gasoline. Leave the area immediately, and call for help.

--Do not use or store gasoline near possible ignition sources (i.e., electrical devices, oil- or gas-fired appliances, or any other device that contains a pilot flame or a spark).

--Store gasoline outside the home (i.e., in a garage or lawn shed) in a tightly closed metal or plastic container approved by an independent testing laboratory or the local or state fire authorities. Never store gasoline in glass containers or non-reusable plastic containers (i.e., milk jugs).

--Store only enough gasoline necessary to power equipment and let machinery cool before refueling it.

--Never use gasoline inside the home or as a cleaning agent.

--Clean up spills promptly and discard clean-up materials properly.

--Do not smoke when handling gasoline.

--Never use gasoline in place of kerosene.

--Use caution when fueling automobiles. Do not get in and out of the automobile when fueling. Although rare, an electrical charge on your body could spark a fire, especially during the dry winter months.

--Only fill portable gasoline containers outdoors. Place the container on the ground before filling and never fill containers inside a vehicle or in the bed of a pick-up truck.

--Follow all manufacturers� instructions when using electronic devices (those with batteries or connected to an electrical outlet) near gasoline.

Gasoline related burns are a significant cause of thermal injuries each year in the United States, according to the National Institutes for Health (NIH). Most victims are male with a mean age of 27 years; average burn size was 25% total body surface area. The majority (59%) of gasoline-related burns are the result of inappropriate or unsupervised use of gasoline. The general public is largely unaware of the dangers of gasoline, and further education in this area is needed.

If you think your health has been affected by exposure to gasoline or gasoline additives, contact your health care professional. Be careful around this toxic chemical. It has long lasting effects if you have extended exposure to it, or if you have an accident. BE CAREFUL!

Until next time.

Anthem & Health Net CA Premium Payment Extended to 1/31

Anthem Blue Cross just announced that individual & family plan premiums for January 1 effective dates will be extended from the 1/15 cutoff to 1/31/14 cutoff.

That gives everyone with Anthem another 2 weeks to pay the January premiums.   This applies to both Covered CA enrollments and to private market off-exchange enrollments.


Update:1/16/2014 -- Health Net has also announced the same change of deadline to 1/31/14 for premium payments.

Health Care and ADHD

Do you know someone who appears to be a little �scatter-brained�? That person can�t seem to keep a logical thought connected from beginning to end without going off in multiple directions at the same time. Or perhaps they are really hyper-active and full of constant energy, unable to sit or stand still for more than a few seconds. Maybe that even describes you! And, possibly, they may have a kid who constantly �bounces off the walls�, or who are unable to sit still in their seat at school. They, or you, may have attention deficit hyperactivity disorder�ADHD.

According to the NIH (National Institutes for Health),
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). ADHD has three subtypes:

Predominantly hyperactive-impulsive:
--Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
--Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
Predominantly inattentive:

--The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
--Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
Combined hyperactive-impulsive and inattentive:

--Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
--Most children have the combined type of ADHD.
People with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active�especially children. Although ADHD can't be cured, it can be successfully managed and some symptoms may improve as a child ages, according to the Centers for Disease Control:

ADHD usually appears first in childhood, but can also now be diagnosed in adults (as long as some symptoms were present in the individual's childhood, but simply never diagnosed), according to this website, where more detailed material is also available:
Recent steps forward in our understanding of ADHD include:

ADHD is about three times more common among boys than girls.
The symptoms of ADHD do not always go away � up to 60 percent of child patients retain their symptoms into adulthood. Many adults with ADHD have never been diagnosed, so may not be aware they have the disorder. They may have been wrongly diagnosed with depression, anxiety, bipolar disorder or a learning disability.

ADHD has been identified in every nation and culture that has been studied.
ADHD can be difficult for everyone involved to deal with. As well as the difficulty of living with the symptoms, wider society may face challenges. Some experts have linked ADHD with an increased risk of accidents, drug abuse, failure at school, antisocial behavior and criminal activity. But others view ADHD in a positive light, arguing that it is simply a different method of learning involving greater risk-taking and creativity. ADHD is often accompanied by:

         Learning disabilities (in children & teens)
         Speech or hearing problems (in children & teens)
         Obsessive-compulsive disorder
         Behavioral problems such as oppositional defiant disorder (ODD) or conduct disorder (CD) (in children & teens)
Exactly what causes ADHD has not been pinpointed, though many practitioners believe neurobiological or genetic elements play a role. In addition, numerous social factors such as family conflict or poor child-rearing practices, while not causing the condition, may complicate the course of ADHD and its treatment.

According to the Wall Street Journal, it's no longer shocking to hear of children with attention-deficit hyperactivity disorder�and others simply facing a big test�taking ADHD medicine to boost their performance in school. But new studies point to a problem: There's little evidence that the drugs actually improve academic outcomes.

Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called "cognitive enhancers" because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.
However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren't any different in kids with ADHD who take medication compared with those who don't. (Typically, studies take into account accommodations schools provide kids with ADHD, such as more time to take tests.)

Other studies have shown that kids who take ADHD medication and study early for an exam tend to do just as well, if not better, than kids without ADHD. But those who take medication and study at the last minute don't do any better. Together, these findings suggest that medication alone isn't enough to improve academic performance. The medicine may help with focus, but it doesn't help with deciding what to focus on, experts say. Rather, it needs to be coupled with skills training, such as learning how to organize or prioritize. More story details can be found here:
People with ADHD can be very successful in life, according to the professional organization CHADD. But without appropriate identification and treatment, ADHD can have serious consequences, including school failure, depression, conduct disorder, failed relationships, and substance abuse. Early identification and treatment are extremely important. - See more at:

Finding a way to help with ADHD, or to receive proper diagnosis, should be done with a registered mental health counselor or physician. Research the options for care and management of this disorder, and talk with support groups that can assist you with information.
Until next time.


Health Care and Extreme Cold

When the temperature dips to very low temperatures, the time to take precautions is at hand. No matter where you live, if your body is not conditioned to be in temperatures below freezing (32 degrees Fahrenheit), you are going to have a hard time dealing with extreme cold. And, when the thermometer dips into the below zero degree range, you cannot survive too long with exposure to those conditions.

According to, for those that go outside, multiple layers of lightweight clothing are recommended by the Red Cross�as well as hats, mittens, gloves and a scarf to protect your lungs.  People should also be on the lookout for early signs of frostbite, as the very young and the very old are most susceptible.  Those with limited blood circulation like smokers or with increased blood circulation to the face � like alcoholics � are also at an increased risk for developing frostbite, per the University of Michigan Health System (UMHS).

The areas most vulnerable to developing frostbite are your hands, feet and head. Without proper care and attention, frostbite could lead to permanent nerve and tissue damage. Though there are no set conditions for frostbite, a wind chill in addition to subzero temperatures decreases the time it takes for a person to develop frostbite on dry, exposed skin.
However, skin does not have to be exposed to develop frostbite. Wet hands or feet accelerate the loss of body heat and the onset of frostbite.  The first sign of frostbite is numbness, according to the UMHS. The skin can then turn red, and may feel like it�s burning. Eventually, skin will turn pale white�when it�s reached a more serious state and needs to be tended to immediately.  To warm up hands and feet, it�s best to use body heat or warm water.

However, holding your hands over an open flame is not advised. If you're in the early stages of frostbite, you won�t be able when the flame is doing more harm than good � which could cause long-term damage.  If you aren't able to warm up after half an hour or so, you seek medical attention immediately. In addition to frostbite, officials are asking for people to look out for signs of hypothermia, which include uncontrollable shivering, memory loss, drowsiness and exhaustion.
According to ABC News Channel 5 in Cleveland, Ohio, here are some tips to endure winter weather During Winter Storms and Extreme Cold:

1. Stay indoors during the storm.
2. Walk carefully on snowy, icy, walkways.

3. Avoid overexertion when shoveling snow. Overexertion can bring on a heart attack�a major cause of death in the winter. If you must shovel snow, stretch before going outside.
4. Keep dry. Change wet clothing frequently to prevent a loss of body heat. Wet clothing loses all of its insulating value and transmits heat rapidly.

5. Watch for signs of frostbite. These include loss of feeling and white or pale appearance in extremities such as fingers, toes, ear lobes, and the tip of the nose. If symptoms are detected, get medical help immediately.
6. Watch for signs of hypothermia. These include uncontrollable shivering, memory loss, disorientation, incoherence, slurred speech, drowsiness, and apparent exhaustion. If symptoms of hypothermia are detected, get the victim to a warm location, remove wet clothing, warm the center of the body first and give warm, non-alcoholic beverages if the victim is conscious. Get medical help as soon as possible.

7. Drive only if it is absolutely necessary. If you must drive: travel in the day; don�t travel alone; keep others informed of your schedule; stay on main roads and avoid back road shortcuts.
8. Let someone know your destination, your route, and when you expect to arrive. If your car gets stuck along the way, help can be sent along your predetermined route.

9. If the pipes freeze, remove any insulation or layers of newspapers and wrap pipes in rags. Completely open all faucets and pour hot water over the pipes, starting where they were most exposed to the cold (or where the cold was most likely to penetrate).
10. Maintain ventilation when using kerosene heaters to avoid build-up of toxic fumes. Refuel kerosene heaters outside and keep them at least three feet from flammable objects.

11. Conserve fuel, if necessary, by keeping your residence cooler than normal. Temporarily close off heat to some rooms.
12. If you will be going away during cold weather, leave the heat on in your home, set to a temperature no lower than 55�F.

You can read more information about winter preparedness here:
The National Weather Service warns how long you can be exposed to certain temperatures before it will result in frost bite. For example, a temperature of 0�F and a wind speed of 15 mph creates a wind chill temperature of -19�F. Under these conditions frost bite can occur in just 30 minutes. Additionally, and surprisingly, hypothermia can occur at any temperature lower than normal body termperature. Factors like age, body fat, alcohol consumption, and especially wetness can affect how long hypothermia takes to strike. If you fall into water, the situation becomes drastically more dangerous.

For example, in water 32.5 degrees Fahrenheit or colder, you might not survive more than 15-to-45 minutes. You'll undergo shock within the first two minutes and some functional disability before 30 minutes, according to the US Coast Guard. Read more: .

Extreme cold is deadly. Prepare yourself in advance of any weather conditions that may lead to this type of environment, and protect yourself as much as possible when extremely cold temperatures arrive. If you know someone who needs help, do your best to provide a way to keep them protected. It�s your life. Keep it warm and safe.

Until next time.

New Medicare cards are coming starting in April

The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state aft...