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Annual Physicals Are Necessary for Children and Teens

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

This question comes up all the time: “My child is up to date on shots. What is the need for a check-up?” Shots are not the only reasons for annual check-ups. In fact, the American Academy of Pediatrics recommends yearly physicals from ages two to six years, at eight and ten years, and then annually thereafter. Here are important reasons why.


Young Children. While children between ages two and six are usually not big eaters, it is still important to look at their growth and diet. Kids who are overweight by age five are much more likely to be overweight as teenagers and adults. This predisposes them to all the related adult health risks such as diabetes, high blood pressure, heart disease, and strokes. By plotting weight, height, and Body Mass Index (BMI), we can be sure they are growing appropriately.

Young children develop rapidly. Children need to be screened for language development and fine and gross motor problems that, if found, can be addressed before the child starts school.

During well visits we can also reinforce car or booster seat use and gun and water safety. Accidents, including drowning, are the leading cause of death for kids two to six.

Teens. Adolescence has its own set of problems for parents and teens. Puberty comes at different times for different kids, which can cause concerns of growing too soon or not soon enough. The doctor can talk about what to expect during puberty: increased appetite, moodiness, increased sleep requirement, and, for girls, periods. Discussions can be started about peer pressure, cigarettes, alcohol, drugs, driving, and difficulties at school. Your doctor may want to speak with your teenager in private.

Also, the doctor will screen your child for curvature of the spine (scoliosis), anemia, high cholesterol, diabetes, depression, and other familial diseases.

New Vaccines. And while you may think that your child is up to date on vaccines, recommendations are changing all the time. In the last two years, new vaccines for meningococcal disease (Menactra) and human papilloma virus (Gardisil) have been recommended for eleven- to twelve-year-olds. A second chicken pox vaccine is now required for kindergarten. Just last year, flu shots were recommended for all children between six months and eighteen years.

Taking your child to his or her physician works for health in so many ways. Make an appointment today.

Ask Dr. Nancy: A Picture May Not Always Be Worth a Thousand Words

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Everyone who is part of the CHP network wants patients to have good clinical outcomes. The crucial first step for any medical problem is talking to the patient, and the second step is examining the patient. The easiest way to get off on the wrong track is to skip or short-cut these essentials.

While technology has helped in the diagnostic process, all technology has limitations and needs to be considered in light of the first two steps or, specifically, what the patient is experiencing.

A suggestion often seen on a report of a CT scan, x-ray, or MRI is that the ordering physician correlate (compare to see if it makes sense) the imaging findings with the clinical situation of the patient. The reason this is such a good idea is that oftentimes abnormalities are seen on imaging studies that have nothing to do with the patient’s symptoms, or the imaging study cannot be used to make a definite diagnosis. Let’s look at some examples.

Knee Pain: An article published in the New England Journal of Medicine in September, 2008, showed that when knee MRIs were done in middle-aged and elderly persons, a cartilage tear was found in 63% of people with knee pain, BUT 60% of people in the same age group without knee pain also had a cartilage tear. The take-home message? Just because you have a cartilage tear doesn’t mean it has anything to do with your knee pain. Clinical correlation is the key.

Multiple Sclerosis: A study, published in the British Medical Journal in 2006, compiled the results from 29 previous clinical studies that assessed MRI results along with patient outcomes. Its findings were that, with a first episode of a neurological symptom, MRIs had “limited utility for both ruling in and ruling out multiple sclerosis.” The most important information came from the clinical course of the patient. With regard to multiple sclerosis, a second episode of neurological symptoms occurring at least a month after the first episode is necessary to make the diagnosis.

Low Back Pain: Low back MRIs (noted in the back pain article) are another example of how imaging studies can potentially lead down a path of treatment that may not yield good clinical results: “65 out of 100 adults without any back pain have abnormalities such as arthritis and bulging discs.” These imaging results make early clinical correlation problematic and can lead to inaccurate associations between chronic asymptomatic findings and acute pain.

COPD: The final example is Chronic Obstructive Pulmonary Disease (COPD), also called chronic bronchitis and emphysema. If COPD becomes severe, changes may appear on a chest x-ray, but for mild and moderate cases, the chest x-ray can easily appear normal. The way to diagnosis COPD is, once again, the duration of the patient’s symptoms, such as cough, along with pulmonary function testing (PFT) to measure the function of the lungs, rather than viewing the anatomy of the lungs. So the next time you hear from someone who smokes that they are fine because their chest x-ray is normal, ask them if they have had the appropriate history and testing that diagnoses COPD. As with many medical conditions, earlier diagnosis of COPD leads to more treatment options. Not being able to breathe is a bad outcome.

It’s not that there is anything wrong with images; it’s just that a picture doesn’t tell the patient’s story. Patients have to do that, and the best place to start is with your primary care physician. The last thing that anyone wants is to treat a radiological abnormality but end up with no relief from an underlying medical condition because the image told a different story. Remember, too, that keeping track of your symptoms in a diary—knowing the details of what you are experiencing—is invaluable to getting to the right next step.

Help for You and Your Aching Back

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Back and neck pain happen commonly, and if you haven’t had an episode yet, it’s likely there is one in your future. The bad news is it can hurt a lot; the good news is that fewer than 1 out of 100 people with new-onset back pain has a serious condition such as infection, fracture, or cancer. Also, human backs have the capacity to heal themselves. Even if a disc is herniated, studies have shown that the condition tends to regress over time, with partial to complete resolution after six months in two-thirds of people.

To give CHP members improved treatment options for back and neck pain, early in 2008 we opened the network to include the Back and Neck Program through the Center for Orthopedics and Sports Physical Therapy (COSPT). We are receiving positive feedback from members and physicians regarding the success of this exercise program, which reduces pain, improves function, and teaches patients how to strengthen their backs to avoid future episodes of pain.

The January and November 2008 issues of HealthLine, posted here, have more details. If you and your PCP feel that the Back and Neck Program may be appropriate for you, you can make an appointment by calling

(850) 656-1837.

Another tool in the tool box for back pain is Health Coaching. Excellent DVDs from the Foundation for Informed Decision Making are available at no additional charge, explaining what research shows about acute (recent onset) and chronic low back pain. In addition, the Health Coaching Dialog Center web site, accessible via, has a “health crossroads” module under the Health Information tab, providing great information about how to get better. CHP wants you to be able to choose the course of action most likely to lead to healing. Specifically, we want you to participate in informed decision making to better understand the risks and benefits of available choices. You can obtain the DVDs on back pain and other conditions by calling a Health Coach at (850) 383-3400. On a national level, increasing numbers of patients are discovering that education, support, and conservative therapy provide relief from painful symptoms, while reducing the need for habit-forming pain medication and surgery. Several groups, such as the American College of Physicians and the American Pain Society, have produced evidence-based clinical guidelines that encourage patients to seek conservative care from their physicians, keep active, and take over-the-counter pain medication.

Unless serious symptoms are also present, such as incontinence or fever, imaging studies are not recommended unless, after six weeks, the pain is still severe and not improving with active participation in conservative care. The reason is that 65 out of 100 middle-aged to older adults with no back pain show abnormalities such as bulging discs and arthritis on imaging studies. The older you are, the greater the chances that your back x-ray or MRI is already abnormal even though you have no symptoms. The take home point is that you do not want to undergo procedures directed to a problem that isn’t the cause of your pain.

In order to facilitate evidence-based care for neck and back pain, requests for outpatient MRIs of the cervical and lumbar spine will require precertification by Capital Health Plan. This will be phased in starting February 16, 2009. The most important test for back pain is evaluation: taking a history and performing an appropriate physical exam. These will be required elements prior to imaging.

If you are suffering with sudden onset or persistent back or neck pain, you should contact your primary care physician for evaluation and management. After evaluation, your PCP may elect to help you manage your pain in a number of ways, including referral to the Back and Neck Program at the Center for Orthopedic and Sports Physical Therapy and to a Health Coach.

Antibiotics: Do I Really Need One?

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

True or false: Green mucus is indicative of a bacterial infection that requires an antibiotic.

FALSE. Green mucus does not mean that an infection is bacterial, as this can also occur with a viral infection. Since antibiotics do not work on viral infections, green mucus does not necessarily mean that you need an antibiotic.

True or false: If a cold lasts longer than a week, an antibiotic is typically needed.

FALSE. Research shows that cold symptoms often last longer than one week.

True or false: Antibiotics may not help you get better, but they can’t hurt.

FALSE. The misuse of antibiotics not only contributes to antibiotic resistance (making these drugs less effective when you truly need them), but it can also lead to serious side effects.

Cold and flu season is upon us, and many patients will mistakenly head to their doctor for an unnecessary antibiotic. Before you head to the doctor hoping to leave with an antibiotic in hand, consider the information below to help ensure safe and appropriate antibiotic use.

Who do antibiotics help? Antibiotics only kill bacteria—they do NOT kill viruses. Since most illnesses (for example, the common cold, most coughs/bronchitis, the flu, and most sore throats) are caused by viruses, antibiotics may not get rid of the infection or make you feel better any faster. In fact, there’s only a 1 in 4,000 chance that an antibiotic will help most acute upper respiratory infections.

What are the risks associated with antibiotics? Antibiotics, like other drugs, have side effects that can range from being a nuisance to being more serious. For example, did you know that 1 in 4 patients taking an antibiotic will experience diarrhea, 1 in 50 patients will experience a skin reaction, and 1 in 1,000 patients will end up in the emergency room? In addition, inappropriate antibiotic use promotes more resistant infections which may make these agents less likely to work when you truly need them.

How do I know when to call my doctor? Some symptoms that require contacting your physician are fever over 100.5º, shortness of breath, skin rash, and an extremely sore or red throat with white or yellow patches. However, when in doubt, call your doctor to see if an antibiotic is needed, but don’t be disappointed if you don’t receive a prescription. By avoiding an unnecessary antibiotic, you’ll be doing your part to ensure antibiotics remain effective when you truly need them to work.


Source: Antibiotic overuse. Pharmacist’s Letter/Prescriber’s Letter 2008: 24(10):241006.

Welcome Dr. Natosha Canty

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan is pleased to welcome Natosha Canty, M.D., M.P.H., to our skilled team of primary care physicians. Dr. Canty is board certified in family medicine. A familiar face in Tallahassee, she earned a bachelor of science degree in biology and a master’s degree in public health at Florida A & M University, before pursuing her medical degree at Florida State University in Pensacola. She completed her residency with the Tallahassee Memorial Healthcare Family Medicine Residency Program. After assisting in CHP Urgent Care for a few months, Dr. Canty is now practicing at the Governor’s Square Health Center. We are thrilled to have her.

Sedentary Kids? Not These Champs!

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

The CHP Champions program is off to a thriving start for 2009. Hearing the Champions buzz for several years, and seeing more children involved, the community wants to learn more. Parents are asking: “What is the Champions program? Where is it offered? How can my child get involved? Is it really free?” CHP loves those questions.

Already 6,000 Students. CHP Champions, in a nutshell, offers children the opportunity to experience a healthy lifestyle today and tomorrow—while having fun—through regular fitness activities. The program began in August 2006 with voluntary, free physical activities before or after school in nine local elementary schools. Our goal was expanding the program to all students in Leon, Gadsden, Jefferson, and Wakulla counties by fall 2010. CHP Champions is now in all local counties: 54 sites, well over 6,000 regularly participating students, and more than 150 coaches. These men and women not only lead energetic, enjoyable activities, but also set positive role examples for our children. With the support of community partnerships, Champions is well on its way to meeting that 2010 goal.

Community Involvement. The program’s success stems from the key support of area school districts and community organizations. Wakulla County Senior Citizen Council, working with Wakulla County Schools, offers Champions in after-school programs of four elementary schools. The Boys and Girls Clubs of Jefferson County conduct Champions for elementary and middle school students. Gadsden and Leon counties’ school districts offer the program in all after-school elementary programs, as well as in part of the middle-school physical education curriculum. Leon County Schools has expanded Champions to ninth-grade high school students taking the required HOPE class.

Alex Stemle, vice-president of CHP Champions, says, “The collaboration of the Champions program and middle and high school teachers has allowed the schools an opportunity to creatively address the Sunshine State Standards for Florida Department of Education, while increasing the quality of workout sessions through moderate to vigorous physical activity.”

For More Information. Each school and community organization participating in CHP Champions has a “Champions contact.” This staff member can provide all enrollment information, program times, and dates. You can also contact Alex Stemple at 850-671-3278 or The goal of CHP Champions is to offer this free and fun program to all children who want to join in.

Silver Stars 2009

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan and Tallahassee Senior Services proudly sponsor the premier senior recognition event in our community each year—Silver Stars. The Silver Stars Celebration recognizes older adults who have made outstanding contributions to our community or achieved significant accomplishments since reaching age 60. Nominations are sought from the community each year for individuals who are models of active aging, inspiring others to live well and be involved in our community.

Previous Silver Stars include community advocates, executive directors, volunteers, caregivers, senior athletes, and entrepreneurs. The common thread is exemplary service to others and our community. Last year’s Silver Stars included Gladys Davis, Moira Desloge, Dr. Jack Golden, Bob Keller, Ed and Violet Mason, Harriette McCarter, Johnnie Ransom, and Charlie Yates.

The 2009 Silver Stars Celebration will take place Thursday, April 30, at the FSU University Center. For more information, contact CHP Medicare Marketing at 850-523-7452 or Tallahassee Senior Services at 850-891-4000.


Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

A Healthy To-Do List for 2009

Do you know that CHP is offering a new benefit, Posit Science InSight®, to members 65 and older in 2009? Do you remember the many other benefits of your membership? A good way for Capital Health Plan members, both new and old, to begin 2009 is to look over the following list. Take advantage of these benefits and tools, maximize your membership, and Live Well!

  • Health Coaching: For questions and educational materials, you can telephone a health coach 24 hours a day, 7 days a week, at 850-383-3400 or 1-888-372-6608 (TTY users call 1-888-277-1586).
  • Primary Care Physician: The most important decision you can make is choosing a Primary Care Physician (PCP). If you have not chosen one yet, please check here for a list of those currently accepting new patients.
  • CHPConnect: Sign up for your secure online electronic personal health record (see instructions for new users).
  • Savvy Senior Programs: Attend one of CHP’s four monthly Savvy Senior Programs, which meet in Leon, Gadsden, Jefferson, and Wakulla counties. See the Medicare Event Calendar for more information.
  • Posit Science InSight®: Sign up now to receive your brain fitness benefit, exclusively for members age 65 or over, at no extra cost. Call toll-free 1-877-582-1852, 9:00 a.m. to 8:30 p.m., Monday through Friday, to order your copy of the software (TTY 850-383-3534 or 1-800-955-8771).
  • Eyeglasses: Schedule your annual routine eye exam. Take advantage of the $150 eyeglass benefit available to Medicare Advantage members every two years.
  • Fitness Reimbursement: Join a health and fitness center. Medicare Advantage Plan members can receive a $150 per year reimbursement for health and fitness center membership.
  • CHP Urgent Care: If you want to avoid long wait times and high copayments and do not have a debilitating or life-threatening injury, consider calling CHP’s Urgent Care Center. Urgent Care is open 11 a.m to 10 p.m., Monday through Friday, and 9 a.m. to 8 p.m. on the weekends. Call for an appointment at 850-383-3382.
  • Medicare Advantage Plan Meetings: If you are not yet a member of CHP Retiree Advantage, CHP Advantage Plus, or CHP Preferred Advantage, come to an informative meeting. See the Medicare Event Calendar for dates and RSVP by calling 850-523-7333.

For more information about Capital Health Plan’s programs, contact Member Services at 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-800-955-8771), 7 days a week, from 8 a.m. to 8 p.m. Capital Health Plan is a health plan with a Medicare contract. Benefits, formulary, pharmacy, network, premium, and/or copayments/coinsurance may change each year. Please contact Capital Health Plan for details.

What’s Your Number?

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Do you know your numbers? Your blood pressure numbers, that is. If you don’t, find out by visiting your primary care physician. Keeping your blood pressure in normal ranges is one of the most important things you can do to stay healthy.

What Is Ideal—and Why? Your blood pressure ideally should be less than 130/80. High blood pressure puts stress on the blood vessels, which accelerates aging of the circulatory system and leads to an increased risk of kidney disease, stroke, and other circulatory problems. Also, the heart has to work harder to maintain the higher pressures and can ultimately wear out sooner, leading to congestive heart failure.

Numbers Too High? If you already have high blood pressure, take your medicine as the doctor has prescribed (for most people this means every day) and get 30–45 minutes of regular daily exercise. If you are overweight, attempt to achieve a 10% weight loss.

Keep the Math. Use the grid we’ve provided each time your pressure is checked. Simply cut it out, slip it in your wallet, and record the date and your numbers. If you have questions about high blood pressure or other medical problems, the CHP Health Coaches are standing by ready to assist you. You can reach a coach at 850-383-3400 any time of the day or night.

Name: Goal Blood Pressure: 130/80
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