As we journey through life, we find ways to cope with those challenges. We learn how to deal with life – from our families, friends, communities, and work places. Sometimes what used to work does not fit the current situation, or the obstacle seems too great to overcome.
Although many go through life for months, even years, free of difficulty, everyone, at some point, is likely to be part of a crisis (physical, mental, or emotional, or all three). Often, our family and friends are enough to help us through; when it isn't, sitting down with a professional can ease the burden.
You know you need a professional when your usual way of doing things no longer works. You may notice a disruption in your steady state: too much or too little sleep, too much or too little eating, isolation, lack of energy, inability to concentrate, irritability, using alcohol or drugs, and thinking of hurting yourself or someone else. When you experience any of those for a few weeks, or when they interfere with your life (home, work, social), it is time to reach out to a professional.
How do I know what kind of behavioral health professional I should contact?
When you are referred, or self-refer, to one of the clinics at WRNMMC, the person accepting the referral will have a good sense of where to get you started; for example, your symptoms may suggest seeing a psychotherapist first, or perhaps a psychiatrist.
Psychiatrist: a physician (M.D.) who has been through medical school and is board certified in psychiatry; can prescribe psychiatric medications (such as antidepressants).
Social worker: has a master's degree in social work (M.S.W.) and, in order to practice psychotherapy, is licensed to practice (L.C.S.W.C., or L.I.C.S.W., or L.C.S.W.).
Psychologist: has a doctorate in psychology (Ph.D.) and can practice psychotherapy; psychologists have further training in administering testing.
The three professions have similar training in child development, family dynamics, relationship matters, diagnosis, and treatment. Regardless of which you initially contact, seasoned professionals will steer you in the right direction if they think you might be better served with a different profession or expertise.
Individual psychotherapy (sometimes called "one-on-one") is where most people start therapy. It is a private setting where a person may bring up difficult or emotional issues. Group psychotherapy includes one or two psychotherapists with three or more (up to about nine) patients. The group setting allows patients to interact with another and, under the guidance of the therapist(s), explore relationship patterns. Your individual therapist may refer you to a group if it seems a good fit, or if you request to join a group. Feel free to discuss the possibility with your therapist.
Emergency Room FAQ
What is triage?
What is the Fast Track?
Why do I keep repeating myself?
Why am I waiting?
Can you treat my pain?
Why am I not getting antibiotics?
I’m being discharged – what now?
What should I do after I leave?
WHAT IS TRIAGE?
Triage is the process used to determine how soon you need treatment based on the severity of your illness or injury. Triage allows the most seriously ill or injured patients to be treated first. Triage begins at the check-in window. NOTE: Due to the triage process, we cannot estimate the length of your stay. We appreciate your understanding and patience.
NOTE: If your PCM wants to be contacted during treatment, please understand that this can only take place AFTER your consultation with an ED physician.
WHAT IS THE FAST TRACK?
The Fast Track is a division of the ED that specializes in treating urgent care concerns. Urgent care is typically less complex than emergency care, and usually takes less time. When your condition is not life-threatening but requires treatment within 24 hours, you need urgent care. Examples of urgent care concerns are:
asthma/upper respiratory conditions
WHY DO I KEEP REPEATING MYSELF?
Your safety is our priority. Repeating your name, symptoms and circumstances to multiple staff members helps us uncover important and helpful details about your condition. Be involved. Use these opportunities to ask questions. If something doesn’t “sound right,” please speak up and let us know!
WHY AM I WAITING?
Wait times are affected by the number of our patients and the severity of their illnesses or injuries. Tests or consults can also affect wait times. In fact, some tests require periods of fasting so please do not eat or drink anything while you wait unless you have permission from a doctor or nurse.
NOTE: For the safety and privacy of all patients, please wait in your treatment room and try not to spend time in the hallways or other common areas.
CAN YOU TREAT MY PAIN?
We want you to be as comfortable as possible. Common pain therapies include acetaminophen, ibuprofen, naproxen, trans-dermal medication patches, hot/cold compresses and splints. We avoid using opioids (narcotics) whenever possible. If an opioid is required for effective pain control, only the lowest effective dose is used.
NOTE: You may not be able to drive for up to six hours after receiving certain pain medications.
WHY AM I NOT GETTING ANTIBIOTICS?
Antibiotics only work on bacterial infections. Common conditions like colds, sinus and respiratory infections are usually viral infections and will not respond to antibiotics. In fact, taking antibiotics when they’re not necessary may worsen your condition. Your provider will know if antibiotics are appropriate for your diagnosis.
NOTE: Inappropriate use of antibiotics can be harmful to your health and cause your body to become immune to them in the future.
I’M BEING DISCHARGED – WHAT NOW?
Once a provider has informed you of your discharge, please wait to review and sign your discharge paperwork. Please do not get dressed until given permission to do so.
We may need to contact you during the next 48 hours, so please give us the best phone number to reach you during this time. Be sure to let us know if you have any questions or concerns before you leave. Understanding your discharge plan is an important part of recovery.
NOTE: You may need an escort if you took any medications during your stay that can cause drowsiness or impairment.
WHAT SHOULD I DO AFTER I LEAVE?
Follow your discharge plan. Complete any medication therapy as prescribed. Contact your Primary Care Manager (PCM) or referring clinic as instructed. If you experience any complications, contact your PCM immediately or return to the Emergency Department.
Please provide feedback regarding your care experience at: http://go.usa.gov/x8yRd
NOTE: The Emergency Department is not a substitute for primary care. It is important for your long term health to establish and maintain a relationship with a Primary Care Manager.
JIA is the childhood chronic arthritis that is days in and days out. Like adult onset arthritis, arthritis in children is caused by inflammation of the lining of the joint capsule, called synovium.
Synovium is supposed to be with a thickness of 2-3 cell depth covering over a loose connective tissue matrix. In joints with arthritis, synovium is quite expanded and thickened due to influx of thousands of blood borne cells like neutrophils and lymphocytes for reasons poorly understood. These influx cells remain in the synovium, release inflammatory mediators like IL-1 (interleukin-1) and TNF (tumor necrosis factor), which results with swelling of the joint.
Clinically, the child may feel discomfort and stiffness of the affected joints. The child may also experience morning stiffness. Please keep an eye on the duration of morning stiffness as it may correlate with disease activity.
1. Pauciarticular JIA
Usually affects toddlers and school age children
Girls more than boys
Involves up to 4 joints (usually large joints – knees and ankles)
Can cause inflammation of eyes as well (uveitis)
If child is ANA positive, it may mean there is increased risk for developing uveitis
2. Polyarticular JIA
Can happen in young children as well as teens
More than 4 joints are affected that can be small and large joints of hands and feet as well as knees, ankles, wrists, elbows
Usually affects joints in symmetric fashion (i.e. both hands may have arthritis)
Rheumatoid factor can be positive among the teens with arthritis, which can indicate child is likely to carry arthritis into the adult life
These children can also develop uveitis and also need regular follow up by eye doctor (ophthalmologist)
3. Systemic onset JIA
Can cause fever, rash, and arthritis
Children can be very ill with systemic JIA
Please keep a fever diary including duration and time of the day
It would be very helpful to document rashes with a digital camera
4. JIA with axial pattern i.e. spondyloarthopathy pattern
Usually effects the spine and the joints around the spine like hips, shoulder, and knees
Can also lead to inflammation of tendons at the site of attachment to the bone (enthesitis)
This type of arthritis can run in families and can be associated with HLA B27 (Human leukocyte antigen type B, subtype 27)
JIA with bowel disease
Individuals with inflammatory bowel disease can develop arthritis
These children need to be followed closely by the GI service
Please let your physician know if you have any stomach concerns, weight loss, or changes in bowel habits
5. JIA with psoriatic skin disease
Psoriasis can lead to arthritis which may be before, after or along with development of skin rash
There is usually family history of psoriasis
Patients will be followed closely by dermatologist as well (skin doctors)
Systemic Lupus Erythematosus (SLE)
Lupus affects 1 out of 100,000 children at ages less than 16 years of age
Females are affected almost 10 times more commonly than males in adults
The diagnosis of lupus is based on history, physical exam, and laboratory values
The main course of treatment is steroids that are usually combined with DMARDs.
There are a couple of things I like to emphasize: Lupus is a serious disease and may involve risk for long-term organ damage and disability. Few suggestions to patients and families:
Establish close follow ups with your rheumatologist
Please have good compliance to medicationsKeep a diary of concerns
It is so important to have positive attitude, and allow your child to keep up with peers at school and home.
Use sunscreen at all times!! Avoid excessive sun exposure.
It always helps to develop healthy eating habits and regular exercise routine.
Most importantly, please see a doctor right away or Emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. visit if there is any fever!!
This is a rare disease that affects about 1 out of 200,000/300,000 children a year
Causes inflammation in the skin and muscles manifesting with rash and weakness
It can be dangerous if it causes trouble swallowing and breathing or there are severe abdominal concerns.
The skin rash is very sensitive to sun exposure. Use sunscreen at all times!
These children are treated with steroids and DMARDs for a minimum of 12-24 months.
Your rheumatologist may work closely with Dermatology (skin doctors) and physical therapist.
This is a disease that can be found in different forms among children
Also called systemic scleroderma if it affects most of the skin as well as lungs, GI tract and kidneys
Systemic scleroderma usually causes Raynaud’s of hands, the skin over the hands can be puffy and shinny, the patient may have fatigue, joint pain, shortness of breath, difficulty swallowing, diarrhea or constipation, and weight loss.
Patients with systemic scleroderma are followed by rheumatology, pulmonary (lungs), cardiology (heart), GI, and nephrology (kidney) doctors.
It can be form of more limited disease affecting only small patches of skin; if the skin patch is round it is called “Morphea” and if the skin patch is linear then it is called “linear scleroderma.” Morphea or linear scleroderma usually, but not always, is not associated with any organ involvement.
How do I apply for a military neurosurgery residency?
The first step is contacting your service-specific specialty leader. Each branch of the military has a consultant to the Surgeon General. These individuals are your points of contact for training and pursuing a career in neurosurgery. It is also HIGHLY recommended that you interview with the WRNMMC Neurosurgery Department. You can contact the NCC Neurosurgery Program Director to learn how.
Who can apply for residency at NCC?
Any active duty USU/HPSP student in good standing in either allopathic or osteopathic accredited medical schools.
How many neurosurgery residents train across the military per year?
The NCC has one position. There are other VA-sponsored programs at the University of Florida (1) and the University of Texas Health Science Center at San Antonio (1). Full civilian deferments are given on a year-to-year basis depending on the needs of each service.
Do I have to visit and interview at NCC, Bethesda?
It is HIGHLY recommended that you rotate and interview at the NCC program. We are unique in that we are the only active duty military program. The core faculty at WRNMMC/NCC include senior Neurosurgeons within the Army and Navy, and may provide recommendations to train in VA-DoD sponsored programs and/or civilian programs (i.e. ERAS)
How many Residents does the NCC program take per year?
Currently, the NCC Program trains one resident per year and is service indiscriminate.
What makes the NCC unique?
The NCC training program is designed to train both a competent and technically proficient neurosurgeon and military officer. Our military-unique curriculum includes courses and didactics that are important during a military career. Each graduate is expected to be completely independent, reliable, and capable of providing excellent and efficient neurosurgical care in the most austere environments.
When does the ‘military match’ happen?
The results of the JSGMEB are published at midnight (0000) 15 December each year. This is earlier than the ‘civilian’ match which occurs in the third week of March each year.
Are you age 50 or above?
Beginning at age 50, both men and women should follow one of these five screening options: African American men/women should begin at age 45.
Fecal occult blood test; all positive tests should be followed by a colonoscopy every 5 years
Every 5 Years
Double-contrast barium enema
Every 5-10 Years
People should begin screening earlier or have screening more often if they have any of the following colon cancer risk factors:
a strong family history of colorectal cancer or polyps, meaning a parent, sibling or child who developed cancer or polyps younger than age 60
families with hereditary colorectal cancer syndromes
a personal history of colorectal cancer or polyps
a personal history of chronic inflammatory bowel disease
Both surgeries have excellent outcomes and safety profiles. Each surgery has its own set of potential complications, and clinical selection criteria. In general, the clinical selection criteria are less stringent for PRK than LASIK; the procedure for PRK is easier and quicker compared to LASIK, but the post-operative recovery period for PRK requires more time and is more painful for the first 24-48 hours compared to LASIK. If the outcomes are expected to be similar between PRK and LASIK with respect to your prescription, we will tentatively schedule you for PRK. We will finalize the decision after all the clinical data is evaluated at the pre-operative exam and you have had an opportunity to discuss the procedure with us.
Please refer to our Refractive Surgery Center page for more information.
No. The Refractive Surgery Center is only available to active duty members with adequate service time remaining as required by their respective service. Refractive surgery is limited to active duty service members because it is considered a readiness procedure.
As with any surgery, the predictability decreases and the potential for complication increases with subsequent surgery. If you are interested in a “touch up, ” i.e. an enhancement, you should follow the same process under the “How do I apply for refractive surgery at WRNMMC?” Your eye doctor must note the type of refractive surgery you had, and when, on the “Date of Eye Examination” line.
In general, you should not consider an enhancement if you still have any side effects from the initial surgery, you rarely wear glasses or contact lenses to improve your vision, or your vision has not been stable for at least 1 year. Enhancements are typically considered only after at least 1 year has passed since your last refractive surgery.
Refractive Surgery is an elective procedure intended to enhance warfighter vision capabilities. Surgery is not guaranteed for everyone. Several factors can influence patient selection. Our average wait time varies from 1 to 3 months.