As summer begins, it’s time to get out and enjoy the sunshine!  However, sun exposure can be dangerous, and we all need to be diligent about proper protection.   Unfortunately, a vast majority of both melanoma and non-melanoma skin cancers come from damage caused by the sun, but there are many ways to protect ourselves from these complications.

Mother applying sun screen lotion on her child???‚¬?„?s body

Sunscreen is a very important method to protect our skin from dangerous UV rays.   Effective sunscreens, labeled as “broad spectrum” protect from both UVA and UVB rays.   Sunscreens are categorized based on their SPF, which stands for Sun Protection Factor.  These values range from 4 up to over 100, but the general consensus among experts is that an SPF sunscreen of 15-30 will do a sufficient job at protecting the skin from damaging UVB rays and that SPF higher than 50 doesn’t offer much additional benefit.   However, there is no downside or potential harm to using a higher SPF sunscreen, so it’s fine to use if that is what’s in the cabinet.

It is especially important for parents and caregivers to protect children from excess sun exposure and sunburns, and to teach them proper sun safety.   The American Academy of Pediatrics recommends that children less than six months of age be kept out of direct sun completely.   However, sunscreen can be applied in small amounts to exposed areas of the skin, especially on the face.  In children older than six months, sunscreen should be applied to all exposed areas of the body, 15 minutes before going out in the sun, and should be reapplied every two hours, or more frequently if they are swimming.   Sunscreens containing zinc oxide are best for areas more susceptible to burning, including the cheeks, nose, and tops of ears.

In addition to sunscreen, protective, tight-weave clothes should be worn whenever possible when out in the sun.  It is possible to overheat, however, so clothing should be lightweight and light colored.   Hats with a brim are also advisable, to protect the top of the head, ears, and back of the neck.  Remember, “baseball hats” don’t offer any protection to the tops of the ears or the back of the neck!  Eyes are also sensitive to the UV rays from the sun, so sunglasses are recommended.  Children should have properly fitting sunglasses as well.

It is also best to sit under cover, and not in direct sunlight, whenever possible.  Trees provide great shade.  The sun’s rays are strongest between 10am and 4 pm, so limiting time outside during these hours will lessen sun exposure as well.   It is also important to remember that the UV rays from the sun penetrate through clouds, so it is still possible to get burned on overcast, cloudy days.  If you’re going to be outside at all, it is best to protect yourself with sunscreen and clothing.

Make sure to stay hydrated as well – sweating and higher body temperatures lead to increased fluid loss, so it takes even more water to stay properly hydrated.   Remember, you are with your skin every day, so if you notice a mole or rash that looks abnormal, be sure to bring it to your doctor’s attention immediately.

Enjoy the beautiful NH summer, but protect your skin from problems in the future by wearing (and re-applying) sunscreen, keeping your skin covered with tight-weaved clothing, staying in the shade, wearing sunglasses, and drinking water.

The Skin Cancer Foundation and have excellent tips.











Dr. Andrea Berry
Family Medicine, Mid-State Health Center

Here are some helpful reminders about health and safety during the holidays and the winter months ahead.

  1. Wash your hands often. Keeping hands clean is one of the most important steps you can take to avoid getting sick and spreading germs to others. Wash your hands with soap and clean running water for at least 20 seconds (the time it takes to sing the “Birthday Song”). If soap and water aren’t available, use hand sanitizer.
  2. Cover your cough. Help stop the spread of germs that make you and others sick by covering your mouth and nose with a tissue when you cough. Put your used tissue in the waste basket. If you don’t have a tissue, sneeze or cough into your upper sleeve, not your hands.
  3. Stay warm. Cold temperatures can cause serious health issues, especially in infants and older adults. Stay dry and dress warmly in several layers of loose-fitting clothing.
  4. Manage stress. Stress can have a negative influence on the overall state of your health and wellbeing. Avoid over-commitment and over-spending. Try to find a balance between work, home, and play. Get support from family and friends. Plan ahead. Keep a relaxed and positive outlook.
  5. Be smoke-free. Avoid smoking and breathing other people’s smoke. If you smoke, quit today! Call 1-800-QUIT-NOW, or talk to your healthcare provider for help. Being smoke-free would be a great gift.
  6. Get check-ups and vaccinations. Exams and screenings can help find problems before they start. They can also help find problems early, when the chances for treatment are better. Vaccinations help prevent diseases and save lives. Schedule a visit with your healthcare provider for a yearly exam. Ask what vaccinations and tests you should get based on your age, travel plans, medical history, and family health history.
  7. Eat healthy and be active. Think balance and moderation. You can enjoy all the holidays has have to offer the healthy way. Choose fruit as a festive substitute for candy. Offer to bring a healthy alternative to a holiday party. Avoid food at parties and focus more on good conversations. Avoid consuming alcoholic beverages. Find fun ways to stay active, such as dancing to your favorite holiday music. Be active for at least 2 ½ hours a week. Help kids and teens be active for at least 1 hour each day.
  8. Handle and prepare food safely. As you prepare holiday meals, keep you and your family safe from food-related illness. Wash hands and surfaces often. Avoid cross-contamination by keeping raw meat, poultry, seafood and eggs (including their juices) from prepared food and eating surfaces. Cook foods to the proper temperature. Refrigerate promptly. Follow safety and preparation guidelines for all foods as indicated on the packaging.
  9. Prevent Injuries. Injuries from falls often occur around the holidays. Use a step stool to instead of furniture when hanging decorations. Children are at high-risk for injuries. Keep a watchful eye on your kids when they’re playing. Keep potentially dangerous toys, food, drinks, household items, choking hazards (like coins and hard candy), and other objects out of a child’s reach. Learn how to provide early treatment for children who are choking. Make sure toys are used properly.
  10. Prevent fire hazards. Most residential fires occur during the winter months. Keep candles away from children, pets, walkways, trees and curtains. Never leave fireplaces, stoves, or candles unattended. Don’t use generators, grills or other gasoline- or charcoal-burning devices inside your home or garage. Install a smoke detector in your home. Test and change the batteries regularly.

Enjoy the season and be safe, healthy and happy through the holidays.

Article adapted from the Centers for Disease Control and Prevention -Office of Women’s Health “Holiday Health and Safety Tips” the full version is available here.

The Health Insurance Marketplace is gearing up for the third open enrollment period beginning November 1, 2015 and ending on January 31, 2016. Are you ready? Would you like some help?

Through the Health Insurance Marketplace (Marketplace) you will be able to apply, compare options and find out if you are income eligible for assistance to lower premiums and reduce out-of-pocket cost – similar to last year. There are some changes; three of the five plans will provide coverage to all 26 hospitals in the State of NH and several plans will also offer some degree of multi-state coverage.

The Health Insurance Marketplace will continue to offer premium tax credits to help reduce the monthly insurance premiums. The amount of the credit is calculated based on your income and household size. The credit can either be applied to reduce your monthly premium or received when you file your income tax return. It is your choice! Additionally, your income level and household size may also qualify you for cost sharing reductions in out-of-pocket expenses like co-payments, deductibles and co-insurance. It is important to keep your income and family size updated in the Marketplace to ensure you are receiving all the cost-saving measures you are entitled to.

The ACA resulted in the formation of the New Hampshire Health Protection Program, (NHHPP).  NHHPP contracts with several insurance companies providing health care insurance to approximately 50,000 families and individuals in New Hampshire who, prior to the ACA, were not eligible or couldn’t afford insurance. By using or, you can easily find out if you are eligible for reduced-cost or free insurance through this program, thus keeping your health insurance as affordable as possible. If you are already enrolled in the NHHPP, as of December 31, 2015 you will also participate in the Premium Assistance Program unless you are Medically Frail or receive health insurance through your employer and already participate in the Health Insurance Premium Program (HIPP).  Enrollment will begin on November 1, 2015. Coverage will begin January 1, 2016.

Whether you are new to the Marketplace or re-enrolling go to; the insurance carriers will continue to have Bronze, Silver, Gold and Platinum plans for you to compare, but remember only Silver plans will reflect any income eligible savings in the form of premium and cost sharing reductions.  Changes to income and family size need to be reported through the Marketplace and can affect cost by causing adjustments to cost sharing reductions and/or advance premium tax credits, both in the premiums you pay as well as your overall out-of-pocket cost which is why it is important to review your options each year After you’ve reviewed your options, you may decide to keep your current plan and if you’ve had no income or household size changes, you don’t need to do anything else and your current insurance company and the Marketplace will send you renewal information around Nov. 1st.

Get a head start by updating or creating an account on now, then the only thing left to do during open enrollment (November 1st, 2015 – January 31st, 2016) will be to select a plan.

If you have any questions, the call center at is free and always available at 800-318-2596. If you would like someone to help you explore your options, Mid-State offers assistance to the community at no cost at its offices in Bristol and Plymouth.  Mid-State is also offering Marketplace assistance in a variety of outreach locations in the region including Bristol, Lincoln, New Hampton, Warren, Ashland, Wentworth, Groton, Alexandria and Plymouth.  Just call 603-536-4000 x 1450 to get started.

Between November 1st and January 31st, Mid-State will host several enrollment fairs throughout the region:

Warren             Joseph Patch Library               Saturday, November 7th                       10:30 am- 12:30pm

Plymouth         Mid-State Health Center           Saturday, November 14th           9:00 am- 1:00 pm

Bristol              Mid-State Health Center           Saturday, December 5th                         9:00 am- 1:00 pm

Lincoln                Lincoln Public Library             Saturday, January 9th                 10:30 am-1:30 pm

Make window shopping for health insurance a priority this holiday season, whether online, at an outreach location or an enrollment fair. Get connected, ask questions, and then make an informed choice, it is really that easy! Let health insurance and the security it provides be the gift you give yourself and your family; have a safe, happy and healthy holiday season!

Colorectal cancer is a cancer that develops in the large intestine or rectum. In New Hampshire, about 35 out of 100,000 people develop this cancer each year. Both the incidence and mortality from this cancer have decreased 3% over the last decade. Around 75% of 50 to 75 year old people in New Hampshire are up to date with getting screened. Catching the cancer early means less extensive treatment is needed. Even better, detecting precancerous polyps can prevent the development of colon cancer.

Symptoms of colorectal cancer include bright red rectal bleeding, black tarry stools, unexplained anemia, abdominal pain, weight loss, change in bowel habits (diarrhea or constipation, change in size or caliber of stools), tenesmus (feeling of incomplete emptying) and rectal pain.

All adults should undergo colon cancer screening starting at age 50 or earlier, depending on their risk of developing this cancer. The optimal screening depends on your preferences and risk of developing colon cancer. Let’s review the types of screening tests available.

The simplest, least invasive, least expensive, but not necessarily the most effective, test is screening the stool for blood. These stool cards (called guiaic tests) are designed to detect microscopic amounts of blood in the stool. Once a year guiaic testing reduces the risk of dying from colorectal cancer by up to one-third. But, because polyps seldom bleed, they are not likely to pick them up. Also, only 2 to 5% of people with a positive stool test actually have colon cancer. A positive guiaic test should be followed by a colonoscopy to check for cancer or polyps.

Colonscopy involves using a thin, lighted tube to directly see the lining of the rectum and large bowel. Your colon needs to be “cleaned out”, ie, prepped, by consuming medication that causes diarrhea. You receive a mild sedative drug before the procedure. Polyps and some cancers can be removed during the procedure. Colonoscopy detects most small polyps and all large polyps and cancers, and greatly reduces your risk of developing and dying from colon cancer. Disadvantages are the cost, the inconvenience of the prep, and the small risk of having serious bleeding or a tear in the colon wall during the procedure. Because the procedure requires sedation, you will need someone to drive you home afterwards, and you should not plan to return to work the day of the test.

What about virtual colonoscopy – will this test save you from the discomfort of having colonscopy? This test uses a CT scanner to take images of the entire bowel, and the 2- and 3-D images allow the radiologist to see if polyps or cancer is present. Its advantages are that it does not require sedation, is noninvasive, the entire bowel can be checked, and polyps are found about as well as with regular colonoscopy. But, you have to “prep” your bowel just like for the regular test, and it exposes you to radiation that may have long term effects. If abnormal areas are seen, you will need to have “real” colonoscopy to check them out and take a tissue sample (biopsy). Virtual colonscopy may also find abnormalities other than polyps or cancer, and these may require further testing. Also, not all insurance companies cover this test. So, virtual colonscopy may not be the answer to your prayers to avoid regular colonscopy.

People with an average risk of colon cancer should begin screening at age 50. Colonscopy can be done every 10 years, unless something is found that requires follow up sooner. “Virtual” colonscopy can be performed every 5 years. Stool testing every year is your other options.

For those at increased risk of colorectal cancer, screening may need to start at an earlier age, occur more frequently, and include colonoscopy as a higher priority test. People with a first degree relative (parent, sibling or child) with colorectal cancer or adenomatous polyps before the age of 60 should begin screening at age 40 or 10 years younger than when their relative was diagnosed. Colonoscopy, repeated every 5 years, is recommended. Some families have genetically based colon cancer syndromes , such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer (HNPCC or Lynch syndrome). People with this family history need aggressive screening and are best managed by a physician with clinical expertise in these syndromes. People with inflammatory bowel disease (ulcerative colitis or Crohn’s disease) also are at increased risk, with screening dependent on how much of the bowel is involved and how long they have had the disease.

So, remember that everyone who has a colon is at risk of colorectal cancer and get screened!

Dr. Diane Arsenault, MD, FAAFP, HPM, HMDC
Family Medicine, Mid-State Health Center

Health insurance is a contract between you and an insurance company to pay for part of your medical costs when you get sick or hurt. It also includes free preventive care such as vaccines and check-ups, which are part of your “health maintenance.” Health maintenance includes visits with your primary health care provider to discuss health habits, family history, as well as any questions or concerns you may have. It includes screening tests such as pap smears, mammograms, cholesterol testing, colon cancer screening, which can help with early detection.

During your office visits remember to write down instructions from your provider, healthy living tips and schedule any follow-up visits required. Fill your prescriptions when they are due so you don’t run out.

Choosing your health care provider is important when planning your health care needs. It is a good idea to ask questions and research a provider to find one that best suits you and your requirements. Make sure you feel comfortable working with them over time. Think of things that will be important to make you feel comfortable when you are choosing a provider. Remember that it is okay for you to find another provider if the one you have chosen does not seem to be a good fit for you. Your insurance will have a provider directory that will list all providers accepting your plan.

Understanding your health coverage and benefits is important. Terms such as co-payments, co-insurance, deductible amounts and out of pocket expenses can be confusing. Someone at your health plan will be able to explain these terms and how they apply to your policy. The information on your card includes a phone number so you can call to ask questions when you are in need of assistance. You should know how much it is going to cost you to visit your doctor if you get sick or hurt, as well as how much it will cost you if you have to go to an Emergency Room. Always have your insurance card available. Remember to keep your card in a secure and safe place.

It is important to know when you should visit your primary care physician and when you should visit the Urgent Care or Emergency Room. You should make appointments with your primary care provider when you are sick or hurt and only visit an Urgent Care or Emergency Room when you are very sick or have a life-threatening situation. It could cost you more money out of pocket to visit an Emergency Room than it would to go to your normal provider. You may end up waiting for a longer time in an Emergency Room and the provider you see may not know you. Your primary care provider has access to your full medical record and will be able to help you long-term.

For most people, the last day to enroll in a 2015 Marketplace plan was February 15, 2015. But in some cases you may still be able to get coverage this year. If you have certain life changes – like having a baby, getting married or losing health coverage, you may qualify for a Special Enrollment Period. If you do, you can enroll in a Marketplace plan outside the annual Open Enrollment period. Also, members of a federally recognized Indian tribe and Alaska native shareholders can sign up or change plans once per month throughout the year.

You may be able to enroll in coverage through Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost health coverage. You can apply any time during the year, and if you qualify you can enroll immediately.

There has been an additional Special Enrollment Period for individuals and families who did not have health coverage in 2014 and are subject to paying a fee or “shared responsibility payment” when they file their 2014 taxes. This special enrollment period will allow those individuals and families who were unaware or didn’t understand that there would be a fee if they didn’t have insurance for 2014. These individuals or families will be able to purchase health insurance coverage from March 15 through April 30. If they do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes next year. In order to qualify for this Special Enrollment Period, they must attest that when they filed their 2014 tax return they paid the fee for not having health coverage, and that they first became aware of the fee after February 15, 2015, in connection with preparing and filing their 2014 taxes.

If you are newly insured and need help figuring out where to start; or you need to explore your Marketplace insurance options including Special Enrollment Period, we are here to help! Please contact Mid-State Health Center’s Enrollment Coordinator at 603-536-4000 Ext: 1450, or e-mail us:

Take advantage of being insured to get healthy, remain healthy and live a happy, long life!

Karla Wagner
Marketplace Outreach & Enrollment Coordinator, Mid-State Health Center

If you answered great, you probably have wonderful sleep hygiene consisting of sleep rules and rituals. Many of us find it difficult to follow our sleep rules with modern day temptations and distractions like social media, gaming, caffeine drinks, responsibilities and expectations despite knowing and experiencing the importance of a good night’s rest. A litany of research and many a persons has found a consistent lack of sleep increases the risk of physical health problems such as obesity, diabetes, high blood pressure as well as mental illnesses including anxiety and depression. Insufficient sleep is associated with decreased reaction times, which is correlated with traffic and work place accidents as well as a decrease in work productivity. And don’t forget the social implications of being tired and irritable.

Poor sleep hygiene is usually indicated by daytime sleepiness and/or sleep disturbances. If you are having difficulty with your sleep it is important to evaluate your sleep routine in order to identify the problem such as; not being able to get to sleep, waking and being unable to fall back to sleep or non-restorative sleep (restless sleep and feeling tired after waking). If you are having sleep difficulties it is useful to pinpoint the problem which can usually be done by tracking your sleep habits in a daily journal.

Good sleep hygiene practices can prevent the development of sleep problems. Developing a routine around your bedtime is an important part of the process of creating healthy sleep habits to ensure you are well rested and ready for the next day. Here are some tips to help you improve your sleep hygiene:

The internet is filled with articles and recommendations for a good night’s rest. Like all aspects of health, sleep health and practices are very personal and need to be individualized. Your sleep hygiene practices should also be dynamic, taking into account the recent days activities and events while also preparing for the following day. This is especially important for those individuals who work second and third shifts. What works for a friend or partner may not work for you and if it’s not broken, don’t fix it. While researching for this article one recommendation I came across was to make your bedroom pet free for better sleep. The thought of sleeping without my dog curled up at my feet breaks my heart and stresses me out. Although that article did offer a few good tips that I will be trying out that one is not for me.

Like all habits, sleep habits can be difficult to change. Remember Rome was not built in a day and with practice and consistency these rituals will develop into habits over time. Celebrate all the small successes, ask for help and be patient and compassionate with yourself on your journey to a better night’s sleep and hence a more awakened life.

Mid-State is accepting new medical and dental patients of all ages and encourages anyone interested in learning more about Mid-State’s clinical team and its services to explore our website.

Joe McKellar, LiCSW
Behavioral Health Services, Mid-State Health Center

“I can still remember it—lying on the bottom of the pool, looking up at the surface of the water, and not being able to get there,” says Tim (actual name withheld for privacy), as he tells the story of his near-drowning, as a 6-year-old day-camper one New Hampshire summer nearly ten years ago.

“I slipped from the shallow end to the deep end. It happened really fast. My buddy noticed I wasn’t with him at the Buddy Check. They did Buddy Checks during swim time every two minutes. I don’t know how long I was underwater.”

His mother, Debbie (actual name withheld for privacy) shares “It’s the phone call no parent ever wants to get. The one where the person on the other end of the phone tells you that your child was pulled from the bottom of the pool unconscious; that a by-stander administered CPR; that your child is on the way to the hospital in an ambulance.”

“My husband and I spent the night at the hospital,” she continues, “holding our son’s hand while he vomited huge amounts of water, watching and waiting to see if his condition would stabilize. It was touch-and-go all night as to whether or not he would survive.”

She takes a deep breath. “For us, things turned out alright. He recovered and is fine. But not every family is so lucky. We want everyone to know that accidental drowning can be prevented and that seconds count if a potential drowning incident does happen.”

Tim and Debbie’s story is frightening and, unfortunately, it is not uncommon. According to the Centers for Disease Control and Prevention, drowning ranks fifth among the leading causes of unintentional injury death in the United States and for every child who dies from drowning, another five receive emergency department care for nonfatal submersion injuries.

As we kick off the summer season, there are some basic prevention strategies to avoid having a negative experience in the pool or lake:

  1. Making sure swimmers have at least basic swimming skills, to reduce the risk of accidental drowning. Participating in formal swim lessons for both adults and children is a sensible prevention strategy for improving individual and family water safety.
  2. Wear a US Coast Guard approved life-jacket. Air-filled or foam toys are not safety devices. Don’t use air-filled or foam toys, such as “water wings”, “noodles”, or inner-tubes, instead of life jackets. These toys are not life jackets and are not designed to keep swimmers safe.
  3. Paying close attention to people and activities in and around the water, especially children. Drowning can happen very quickly, before anyone nearby realizes what is happening. Practicing close supervision at poolside or on the shore can alert you to a dangerous situation or a person in trouble while there is still time to take action to prevent a tragedy.
  4. Using the Buddy System, so that everyone shares responsibility for staying safe and being aware. Pairing up with a buddy is an especially effective way for children to learn to pay attention and be alert to others in and around water.
  5. Learning CPR. An immediate response with basic life support CAN save a life.

For more information and other tips on water safety, visit the Centers for Disease Control and Prevention’s Water Safety page.

Alan Rosen, MD
Family Medicine, Mid-State Health Center

“ESCAPE FIRE tackles one of the most pressing issues of our time: what can be done to save our broken medical system? The film examines the powerful forces trying to maintain the status quo in a medical industry designed for quick fixes rather than prevention, for profit-driven care rather than patient-driven care. After decades of resistance, a movement to bring innovative high-touch, low-cost methods of prevention and healing into our high-tech, costly system is finally gaining ground. Award-winning filmmakers Matthew Heineman and Susan Froemke follow dramatic human stories as well as leaders fighting to transform healthcare at the highest levels of medicine, industry, government, and even the US military. The film is about a way out. It’s about saving the health of a nation.”

Source: Escape Fire Movie

The hour-long PBS documentary film NH Health Care: Is there Good News? sheds light on health care innovations and opportunities in our own state, to make health care more affordable and accessible while ensuring good health outcomes. Mid-State Health Center was prominently featured as a successful example of the Medical Home Project. In addition to being aired on NHPTV, the national version of this film, US Health Care: The Good News, was viewed around the state this fall at a series of free screenings followed by discussion panels. It serves as a means to continue the discussion of how we can improve health care and reduce costs at the same time.

To view the program, or watch a special segment with Dr. Kelsey speaking about the merits of electronic health records, visit NH Public Television.

Kathie Stringham, Mid-State Health Center’s Patient Support Specialist wrote an article this month to highlight the importance of making an Advance Care Plan.

Check out her article here: Advance Care Planning Article