What is the coronavirus disease?

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The coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a virus that was first identified during an investigation into an outbreak in Wuhan, China.

How does COVID-19 spread?

It is not clear yet how easily coronavirus spreads from person-to-person. Human coronaviruses most commonly spread from an infected person to others through:

How can I protect myself and others?

There are steps you can take to reduce your risk of getting sick from viral respiratory infections, and help prevent transmitting infections to others, including:

To learn more about COVID-19 visit:

NH State Summary

CDC Situation Summary

CDC Frequently Asked Questions

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 healthychildren.org have excellent tips.











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

mother and daughter brush my teeth

According to the Partnership for Healthy Mouths, Healthy Lives, there are “more than 16 million kids suffering from untreated tooth decay in the U.S.” This chronic condition “causes kids to miss 51 million school hours and their parents to lose 25 million work hours annually.” Tooth decay can lead to pain, sleep disturbances, difficulty eating, social anxiety, infection and possible long-term effects like tooth loss. Taking action to prevent dental decay can not only improve your child’s smile, but also impact their overall health and well-being.

Babies aren’t born with cavity-causing bacteria they receive those germs from the saliva of their caregivers. Each time we share a spoon, or food, or place a pacifier in our mouths, we transmit our own oral bacteria to the baby. Caregivers should reduce saliva sharing to prevent transmission of germs.

In addition, caregiver’s of children need to maintain healthy mouths by practicing good oral hygiene and keeping up with regular dental visits.

Preventing tooth decay starts with a thorough oral hygiene routine at home. Children need instruction and supervision to learn the basics of good oral health. Modeling good oral hygiene behavior, showing enthusiasm and helping them develop an oral health routine is very important. As early as possible, begin an oral hygiene regimen with your children. From birth, wipe their gums with a soft, moist washcloth after feedings. As soon as teeth appear (usually between 6-10 month), brush with a child-sized toothbrush and small smear of toothpaste. Dental professionals agree you should brush your child’s teeth two times daily with fluoride toothpaste for two minutes using a soft-bristled toothbrush. Many children need help brushing and, after taking their turn, should have their teeth brushed by a caregiver. Replace your child’s toothbrush every three months, and each time s/he gets sick. Do not rinse out with water or eat after brushing. We want the fluoride from the toothpaste to have time (at least 30 minutes) to work to strengthen the teeth. The early stages of tooth decay are reversible and fluoride acts to remineralize tooth structure that has been weakened. The most important time to brush your child’s teeth is right before bedtime so that plaque does not sit on the teeth throughout the night. Flossing daily is also an important component of good oral health. Utilize flossers designed for children to help them develop their skills.

In addition to hygiene, nutrition plays a crucial role in oral health so it’s important to eat a healthy, balanced diet, avoiding sugary and acidic foods. Provide children with healthy snacks and avoid sippy cups filled with juice between meals. Encourage drinking water instead! Encourage the use of regular cups early and often. Do not put your baby to sleep with a bottle filled with juice or milk.

Another important piece of the oral health puzzle is visiting a dentist regularly. You should schedule your child’s first dental visit by their first birthday. Early detection of problems, preventative services like cleanings, and counseling from a dental provider can have profound impacts on a child’s oral health. During your child’s visits, ask about preventative treatments like fluoride varnishes and sealants.

We can all set a good example by showing enthusiasm for visiting our own dental providers and discussing dental visits in a positive way.

Our team at Mid-State Health Center in Bristol is excited to open the doors to a brand-new dental clinic so that we may partner with the community to improve oral health. Our dental services are currently offered to established patients of a Mid-State medical provider to support treatment of the “whole” patient. If you have questions, concerns or would like more information about our services, please call or make an appointment.

For more information visit: Mid-State’s Dental Services, mychildrensteeth.org, or www.healthymouthshealthylives.org.










Dr. Kelly Perry, DMD
Dental Director & Family Dentist – Mid-State Health Center

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

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

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