Football Foodie Contest Kickoff

Saturday, 21 October, 2017
Football Foodie

Our Football Foodie Contest officially kicked off this Sunday! Doctor Glodowski and Alan enjoyed watching their Red Zone Football and eating food as they awaited input on next week's menu. Here's a recap of their day:

Though recovering from our Panther’s loss Thursday night, we know the show must go on.

Looks like there are a couple of interesting games on tap this weekend. The way this season is going, as they say, “on any given Sunday…”

The teams we drew for this past Sunday (10/15) were the Indianapolis Colts and the Philadelphia Eagles. So those are the two cities that we chose our food from.

Red Zone, which shows snippets of all the games being played is particularly good for Justin and me (and perhaps for many of you, as well). Because of our life paths, each of us roots for several teams. We have an especially difficult time when these teams play each other. Both Justin and I grew up in the suburbs of New York City, and began our football lives as NY Giant fans. But life has a way of moving one around. So, Justin supports the Giants, The Pittsburgh Steelers, the Oakland Raiders and the San Francisco Forty-Niners. After the Giants, I moved to the New England Patriots. We are now, of course, both Panther fans, and bleed Carolina Blue. Red Zone will show us the best plays from all our teams’ games.

But for now, and for food, we’re looking to the Colts and the Eagles. One note to add this week. My wife is away for the weekend, and we’re on our own. I am not a cook, so we’re going simple, and I’m invoking a Mulligan. In our context, a Mulligan means buying appropriate prepared food linked to our pick cities from an outside source, such as a restaurant or market.

A perfect example is one of this week’s teams -- the Eagles. The Philadelphia Cheesesteak Sandwich is certainly the signature dish from the City of Brotherly Love. There are a bunch of good recipes for this specialty, one of which we’ll share. But it would require stepping away from the TV for half an hour, and that would be a disaster. I’ll be buying Philly Cheese steak sandwiches from Jersey Mike’s instead (which was recommended by a couple of Philadelphia natives I know), and then using it to make a Philly Cheese Steak Salad.

According to Philadelphia's official tourism website, South Philadelphia hot dog vendor Pat Olivieri invented the cheesesteak in the 1930s. According to the legend, he decided to grill some beef from the butcher and put it on an Italian roll. A cab driver caught a whiff and asked for a steak sandwich.

football foodie Doctor GWord spread rapidly through the cabbie rumor mill, and drivers from all over the city soon visited Olivieri for steak sandwiches. Olivieri eventually opened up Pat's King of Steaks on 9th Street and Passyunk Avenue. Philadelphia Magazine says cheese was added to the mix in the '40s by Pat's manager Joe Lorenza.

But what's an iconic figure in the City of Brotherly Love without a fierce, but friendly, rivalry?

Geno's Steaks, located on the north side of the corner of 9th and Passyunk, was started in 1966. When Joey Vento saw the name "GINO" painted on a broken door in the back of his shop, he changed the "I" to an "E," and the cheesesteak joint became Geno's. Some believe that Vento was actually the first to put the cheese in cheesesteak.

Regardless, Pat's versus Geno's is the Yankees versus Mets of the Philadelphia food scene, and you are most likely going to end up picking sides and defending your choice.

Here we go.

Philadelphia Cheesesteak


  • 1 loaf Italian bread, or French bread or 2 large hoagie or sub rolls
  • 1⁄2 lb deli roast beef , (very rare, sliced wafer thin, or you can use a frozen rib-eye roast shaved on an electric slicer)
  • 1 white onion, thinly sliced
  • 1 green bell pepper, thinly sliced (optional)
  • 2 tsp garlic, minced
  • 1⁄2 lb provolone cheese, thinly sliced, OR, according to some partisans Cheese Wiz
  • 1 extra-virgin olive oil, for grilling
  • 1 salt
  • 1 marinara sauce (optional topping)
  • 1 black pepper


  1. Heat a griddle or a large saute pan over medium-high heat.
  2. When hot, cover bottom with olive oil.
  3. Add the onions and bell pepper and cook, stirring, until carmelized, which will take about 6 to 8 minutes.
  4. Add the garlic, salt and pepper, and cook for about 30 seconds.
  5. Then, push the mixture off to one side of the griddle.
  6. Add the meat to the hot part of the griddle.
  7. Cook, continuously flipping the meat over and slightly chopping the meat into slightly smaller pieces with 2 spatulas, until the meat is not pink, which should take about 2 minutes.
  8. Mix the meat and the carmelized onions and bell pepper together.
  9. Divide into 2 portions, and top both portions with the cheese to melt.
  10. If using Italian or French bread, cut the bread in half, crosswise, and slice lengthwise to open for the 2 sandwiches.
  11. Hollow out some of the soft white bread part from inside and place face down on top of the meat and cheese.
  12. When the cheese is melted, and with 1 or 2 spatulas, flip the sandwiches over and add topping, such as marinara sauce or ketchup, if desired, and serve immediately.

Recipe originally inspired by with 5-star rating

But, as I said, making this would take me away from the game, so we’re buying the sandwiches and using them this way…

Buy the sandwiches, bring them home and remove the bread. Refrigerate the meat and such until needed. About five minutes before eating, warm the sandwich ingredients in a medium oven. Meanwhile, divide a bag of readymade salad mix evenly between 2 bowls. Divide the hot mixture evenly over the bowls of salad, and serve immediately. If you’re feeling adventurous, throw in a couple of tomato slices.

football foodie AlanIndianapolis was harder. The web said the favorite food was fried pickles (I don’t believe it). But I kept hunting, and one recipe jumped off the screen…

Justin’s Hoosier Daddy Chili. With a name like that, how could I not choose it as an accompaniment to the cheesesteak.

According to a couple of sources, it was developed by Justin Swarens of Sellersburg, Indiana. Unfortunately, Justin’s origin and fate has been obscured by the mists of the web. But here’s his recipe.

Justin’s Hoosier Daddy Chili


  • 1 Pound ground beef
  • 1 medium onion, chopped
  • 1 Teaspoon red pepper flakes
  • 1 Tablespoon ground cumin
  • 2 (10.75 ounce) cans condensed tomato soup
  • 2 (14.5 ounce) cans chicken broth
  • 1 (14.5 ounce) can crushed tomatoes
  • 5 Tablespoon chili powder
  • 1 Teaspoon ground black pepper
  • 1 Teaspoon salt
  • 2 (15.5 ounce) cans pinto beans, drained (optional)


  1. Crumble the ground beef into a soup pot over medium-high heat. Cook and stir until evenly browned. Drain off most of the grease. Add onion, red pepper flakes, and half of the cumin; cook and stir until onion is tender.
  2. Pour in the tomato soup, chicken broth, and crushed tomatoes. Season with chili powder, salt and pepper. Simmer for 30 minutes. Pour in the beans, and season with remaining cumin and cayenne pepper; simmer for another 30 minutes. Now enjoy.

The recipe can be found at

A note: this was a little on the hot side for me, so you can add a couple of teaspoons of sugar or equivalent sweetener to cut the heat (or reduce the chili).

A note on the foraging for the beer from Philadelphia and Indianapolis: Searching locally for beers from these cities was generally unsuccessful. I went to or called beer and wine shops. Many stores have their beers arranged by the type of beer, IPA, Belgian ale, Seasonal, etc, and by country, but not by cities. I was able to find many breweries from Philadelphia and Indianapolis but could not find those breweries’ products in our local stores. Everyone I spoke with was very friendly and helpful, even suggesting going to other stores than their own. I went or called Totally Wine, Pharmacy Bottle and Beverage, Triangle Wine and Great Grapes. Found a brewery from Easton, PA, Weyerbacher, the Merry Monks which was close to Philadelphia. Since I could not find the Indianapolis beer, we went with Sam Adams Octoberfest. Can’t go wrong there. Next week are the Los Angeles Chargers and the Cleveland Browns. Any thoughts?

Next Week’s Teams: Los Angeles Chargers and Cleveland Browns

Football Foodie Fun

Saturday, 21 October, 2017
Football Foodie

How Football Foodies Began

By: Alan Copland, Generations Family Practice COO

Several years ago, Dr. Glodowski and I began an enjoyable custom. Since I have NFL Red Zone on my cable service, he came over every Sunday and we glutted ourselves on six solid hours of NFL highlights, live. Following the action of each game is engaging, as it is constantly switching from game to game to catch the best plays, but all in all, having solid action and no commercials feels worth it.

Last year we added a new custom to our ritual: choice of eats and beer. We put the names of each team in the league on strips of paper and put them in a hat. Every Sunday we drew two teams from the hat. The rule was that the food we would serve (picture two grown, hungry men sitting on a couch for six hours with ample beer) had to be related to the city that the teams drawn came from. For example, the Packers would require food known or loved by folks in Green Bay, Wisconsin – fondue and/or brats is the answer for that one. We can get esoteric – Cincinnati’s food was Skyline Chili (a chili recipe including chocolate, which was not bad) which comes from a locally well-known chain in the Cincinnati area,. The dishes could be cooked in our kitchen, or purchased locally or via the web (as long it was available Sunday afternoon). The beer also had to originate from one of the target cities (and often came from both). We became "Football Foodies."

Why are we sharing this story?

football foodie guys

We thought that some of you might like to get in on our fun by helping us choose what to eat (We will try not to blame you for the Monday morning GI issues tasting the cuisine). To sweeten the deal, we decided to turn it into a Football Foodie Contest! Every Sunday, for four weeks in a row, we’ll draw the cities for the following week and let you know what they are. Check Facebook (make sure to Follow Us) on Sunday evenings. LIKE that week's Contest Post AND COMMENT with your culinary suggestions for those cities. We’ll choose from the recipes you suggest, and prepare and devour (hopefully) an appetizer and a main course. EVERY WEEK WILL HAVE A WINNER! The winning entries for each week will receive a $20 Gift Certificate to a local eatery of our choice.

We will compile the names of ALL ENTRIES for the four week period and hold a GRAND PRIZE DRAWING. Everyone who submits a recipe will be entered for a chance to WIN a pair of tickets to the Carolina Panthers / Green Bay Packers game in Charlotte on December 17, 2017!!

Each week, to make it more fun, we’ll share with you the food choices for the coming Sunday and maybe a little history of that dish. We will also save the names of the folks whose recipes we sampled and have a surprise for each of you at the end of the season.

Here is an example to get you started...

Two weeks ago, we drew the Minnesota Vikings and the Tampa Bay Buccaneers. After racking our brains, and with some help from Google, we came up with Booyah for the Vikes and Tampa Bay Grits for the Bucs.

Booyah comes from northern Minnesota and Michigan. It is a beef/chicken/vegetable soup/stew. According to Wikipedia, it is a thick stew, probably of Belgian origin, found throughout the northern/ mid-western states. Since it is normally made in 30-gallon “Booyah kettles”, big pots simmered all day over an open fire (we cheated), it is also the name of an Autumn party at which the main entertainment is Booyah.

Tampa Bay Grits are a shrimp and sausage grits recipe from the West Coast of Florida. There seems to be a good variability in the recipe, and it is served in several noted restaurants in the Tampa area. Seems like a great football meal to us.

These are very different dishes from different cuisines, yet oddly, combined with the brews of the afternoon -- Florida Cracker Belgian style white ale (Cigar City Brewing) and Edmund Fitzgerald Porter (Great Lakes Brewing Company) -- they were perfectly matched.

Can’t wait for next week’s kickoff!

And the recipes with their sources...



  • 2-1/2 lbs. bone-in, English-style short ribs, trimmed, meat and bones separated (I used bone-in beef chuck short ribs)
  • 2-1/2 lbs. bone-in chicken thighs, trimmed
  • Salt
  • Pepper
  • 1 T. vegetable oil
  • 2 yellow onions, chopped fine
  • 2 ribs celery, minced
  • 8 c. low sodium chicken broth
  • 2 bay leaves
  • 4 c. shredded green cabbage
  • 1 28-oz. can diced tomatoes
  • 8 oz. rutabaga, peeled and cut into ½” pieces
  • 1 lb. russet potatoes, peeled and cut into ½” pieces
  • 3 large carrots, peeled and sliced ¼” thick
  • 1 c. frozen peas
  • 1 T. freshly squeezed lemon juice


  1. Pat beef and chicken dry with paper towels and season with salt and black pepper. Heat oil in Dutch oven over medium-high heat until just smoking. Brown beef on all sides, about 10 minutes; transfer to plate. Cook chicken until browned all over, about 10 minutes; transfer to plate. When chicken is cool enough to handle, remove and discard skin.
  2. Pour off all but 1-1/2 teaspoons fat from pot. Add onions and celery and cook over medium heat until softened, about 5 minutes. Stir in broth and bay leaves, scraping up any browned bits. Add beef, beef bones, and chicken, and bring to boil.
  3. Reduce heat to low and simmer, covered, until chicken registers 175° F, about 30 minutes. Transfer chicken to bowl. When chicken is cool enough to handle, shred into bite-size pieces, discarding bones. Cover chicken and refrigerate. Continue to simmer stew until beef is tender, about 1-1/4 hours longer. Transfer beef to plate. When cool enough to handle, shred into bite-size pieces, discarding fat. Remove beef bones and bay leaves. Strain broth through fine-mesh strainer; discard solids. Allow liquid to settle, about 5 minutes, then skim off fat and return liquid to pot.
  4. Add shredded beef, cabbage, tomatoes, rutabaga, 1-1/4 teaspoon salt, and 1 teaspoon pepper to liquid and bring to boil. Reduce heat to medium-low and simmer until rutabaga is translucent around edges, about 15 minutes. Stir in potatoes and carrots and cook until vegetables are tender, about 20 minutes. Add chicken and peas, and simmer until heated through, 2 to 3 minutes. Off heat, stir in lemon juice. Season with salt and pepper to taste. Serve

Recipe from




  • 1 package mild or beef smoked sausage
  • 2 tablespoons olive oil
  • 1 large bell pepper, thinly sliced
  • 1 large green or yellow pepper, thinly sliced
  • 1 medium yellow onion, peeled and sliced
  • 4 cloves garlic, minced
  • ¼ Cup white wine
  • Grits Ingredients
  • 1 ½ cups water
  • ¼ cup heavy cream (if calories and fat content are an issue for your family, low-fat half and half can replace this ingredient)
  • 1 clove finely minced garlic
  • 2 tablespoons butter (again, if dietary concerns are a worry for your family, margarine can be used as a substitute)
  • 1 teaspoon each of chopped fresh herbs, such as basil, oregano, parsley and thyme (our personal favorites are basil, sage, dill, and oregano. Feel free to experiment with different combinations of spices. We encourage fresh spices though, jarred can be too strong in flavor)
  • 1 tablespoon olive oil
  • 1 ½ cups milk (you can use skim milk for this step. It saves calories and still contains all of the nutrients of 2% milk)
  • 1 cup stone ground white cornmeal (the layman’s term is grits. We promise you that once you have grits, you will never look back)
  • Salt and pepper to taste
  • ½ cup grated parmesan cheese (we suggest getting this fresh from the deli section of your local supermarket)


  1. Prepare grits in a large saucepan. Start by combining the herbs, garlic oil and 1 tablespoon butter or margarine. On low heat, stir for about 3 minutes.
  2. Gradually stir in water and milk. Bring to a boil over medium-high heat. Be careful heating the milk so it doesn’t burn.
  3. Gradually whisk in the cornmeal. You want to do this slowly and consistently. You don’t want grits recipe that is clumpy. Reduce heat to low. Cook and stir for 5-6 minutes until the grits have a thick texture like oatmeal.
  4. Next stir in the cream and remaining butter. Mix until well blended. Add in the fresh Parmesan cheese, salt, and pepper. Slice the Uncle John’s Pride Hot Country Sausage into pieces. In a large skillet, heat olive oil over medium-high heat. Cook sausage until it is browned, approximately 5-7 minutes. In the same skillet, add the peppers, onions, and garlic. Saute for 2-3 minutes. Slowly stir in the wine. Cook and stir until onions and peppers are tender and the wine has reduced. Spoon the prepared grits onto plates. Top with sausage, peppers, and onions. Garnish with a drizzle of olive oil and additional Parmesan cheese.

Recipe from

football foodie

What Can a Parent Do if They Think Their Child is Being Bullied?

Saturday, 21 October, 2017
is your child being bullied

Children being bullied is an important topic among parents these days. While the rates of bullying are not increasing, more study of the issue has led to a higher awareness of this public health problem. We dove into bullying in our October newsletter. Here, we’ll explain what steps parents can take to address bullying.

If Your Child is Bullied

In cases of bullying, children may not ask for help. One study indicated an adult was notified 40 percent of the time. Children who are bullied may not tell someone because they feel weak or feel like a tattletale. Others want to handle it on their own to regain control. They may fear backlash from the bully or fear further social isolation from peers.

To help your child, you must first determine if he or she is being bullied, but it’s best not to ask directly. You can ask about bullying at school in general. You can also ask about his/her friends, who he/she sits with at lunch or on the bus. Ask about kids who might leave your child out of activities or if anyone teases him/her in a mean way.

Parents and teachers must address bullying if it occurs, so if your child is being bullied, tell them you love them and want to help and that they can talk to you about any problems. Do not tell them to “let it go” or “suck it up.”

Next, speak with school officials, starting with the teacher. He or she knows more about what’s going on between students. If you don’t feel teachers are addressing the problem, you can speak to the principal.

In an interview with the American Psychological Association, bullying expert Susan Swearer said, “First, they must tell the student(s) who are doing the bullying to stop. They need to document what they saw and keep records of the bullying behaviors. Victims need to feel that they have a support network of kids and adults. Help the student who is being bullied feel connected to school and home. Students who are also being bullied might benefit from individual or group therapy in order to create a place where they can express their feelings openly.”

In other words, help your child identify groups he/she can turn to for help. You can also work with him or her on ways to deal with bullies. If you are worried your child is feeling depressed or socially isolated, speak to a counselor.

If You Think Your Child is the Bully

No one wants to think of their child as hurting others, but of course, we must consider that our children are not perfect. If your child is the bully, let your child know that bullying is harmful to others and can have legal consequences. Model positive behavior at home. Address and discipline any mean behavior. You may also have your child speak to a counselor or therapist who can help him/her figure out why they bully. Many children with low self-esteem bully to feel better about themselves.

Discuss bullying with your child’s pediatrician here at Generations Family Practice during your next visit or contact us for an appointment now.


We love this infographic from E-learning Inforgraphics about Bullying

is your child bullied

Understanding and Addressing Childhood Obesity

Saturday, 21 October, 2017
childhood obesity

Childhood obesity is on the rise. According to the Centers for Disease Control (CDC), the percentage of children with obesity in the United States has more than tripled since the 1970s. Today, about one in five school-aged children (ages 6–19) is obese.

Why This Matters
As you know, excess weight can cause many health problems, especially in children, who can suffer from asthma, sleep apnea, bone and joint problems, type 2 diabetes, and risk factors for heart disease, hypertension, early puberty, and orthopedic problems.

Children who are overweight or obese are more likely to suffer bullying, which can lead to social isolation, depression, and a lower self-esteem, along with eating disorders and behavior and learning problems. Finally, children who are obese are apt to remain so into adulthood, which further risks their health, leading to heart disease, diabetes, and cancer.

Defining Childhood Obesity
Children grow at different rates and in different ways, so a child who looks larger than his peers may not be overweight or obese.

You probably have heard of Body Mass Index or BMI. To calculate BMI, divide weight in kilograms by the square of height in meters. A child is considered overweight if his/her BMI is at or above the 85th percentile, but below the 95th percentile for children and teens of the same age and sex. A child is obese if his/her BMI is at or above the 95th percentile. (This is different than how we categorize overweight and obesity in adults, who are no longer growing.)

There have been some changes in obesity rates due to more awareness of the issue. Despite those declines in the early 2000s, from 2011-2014, the prevalence of obesity remained about the same. About 17 percent of children and adolescents aged 2-19 years are obese — which is 12.7 million people.

Risk Factors
Poor diet and lack of exercise can cause childhood obesity. Genetics can also play a role. Some children overeat for psychological reasons, to cope with emotions or to fight boredom. Sleep also plays a role; children who lack a bedtime routine and do not get enough sleep are often heavier than their peers.

Socioeconomic status may lead to childhood obesity in households where less-healthy food is cheaper, quicker to prepare, and won’t spoil easily. According to statistics, children in low-income households are far more likely to be overweight or obese.

childhood obesity complications


Prevention and Cures
September is National Childhood Obesity Awareness Month. Managing childhood obesity starts at home but extends to the community. One of the best approaches is to improve the eating and exercise habits of your entire family. Parents can encourage their children to eat healthy and get physical activity in many ways:

As a community, we can work to reduce the rate of childhood obesity. Here are some of the ways communities are addressing the problem:

  • The Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Child and Adult Care Feeding Program (CACFP) help low-income families buy more nutritious foods.
  • Schools can help by creating policies and practices that support healthy eating, regular physical activity, and by providing opportunities for students to learn about and practice these behaviors.
  • Childcare providers can encourage regular physical activity and healthful eating.

If you have concerns about your child’s weight, contact our pediatric providers to discuss your child’s weight and whether it’s cause for concern.

It's Flu Shot Time

Saturday, 21 October, 2017
flu shots available

Influenza season is just around the corner! Time to protect yourself and your loved ones by getting your flu shot.

This year, Generations Family Practice will be offering vaccines for all patients ages 6-months and older. For our youngest patients (6-25 months) Fluzone will once again replace the Flumist for increased effectiveness. Flucelvax quad is available for those patients age 4-years and older. This is the first FDA approved flu vaccine made from cells instead of chicken eggs, antibiotic free, preservative free and latex free and offers the same protection as traditional egg-based flu vaccine. We will also have the high-dose flu vaccine for patients age 65-years and older.

All vaccines are available NOW. Call our office to schedule your flu vaccine today! Established patient walk-ins are also welcome as a nurse visit, Monday through Saturday during regular office hours.

Want to know more about the flu shot and what’s new this year? Here is a great piece by Live Science outlining what you need to know!

Flu Shot Facts & Side Effects

The seasonal flu shot is a yearly vaccine administered to protect against the flu, or influenza.

In the United States, flu shots are recommended for everyone ages 6 months and older, according to the Centers for Disease Control and Prevention.

The flu can be a very serious illness, especially in young children, adults ages 65 and over, those with underlying health conditions, and pregnant women.

The flu shot is the best way to protect yourself and family from the flu, the CDC says.

Strains of the flu virus are constantly changing, so a new flu vaccine is made each year. Scientists make the vaccine before the flu season starts by predicting which flu strains are likely to be the most common during the upcoming season.

"Since the flu virus frequently drifts in its genetic composition, you have to reformulate the vaccine, and this is one of the reasons that people have to [get a flu shot] on an annual basis," said Dr. William Schaffner, a preventive medicine and infectious disease expert at Vanderbilt University School of Medicine.

What kinds of flu shots are there?
Flu shots protect against three or four strains of flu virus. Trivalent flu vaccines protect against two influenza A strains -- H1N1 and H3N2 -- and one influenza B strain. Quadrivalent flu vaccines — offered for the first time in the 2013-2014 flu season — protect against the same strains as the trivalent vaccine, as well as an extra influenza B strain.

In addition to the standard-dose flu vaccine given through a needle, flu shots are available in several different forms, including a high-dose version for those ages 65 and older, a small-needle version (intradermal flu vaccine) for people ages 18 to 64, an egg-free version that's grown in animal cells rather than hen's eggs and is approved for people ages 4 and older, and a nasal spray, which is approved for healthy people ages 2 to 49.

There is also a needle-free flu shot, delivered by a so-called jet injector, which uses a high-pressure stream of fluid to inject the vaccine, the CDC says. It is approved for adults ages 18 to 64.

Flu vaccines for the 2017 to 2018 season
The composition of the 2017-2018 flu shot will be slightly different from last season's flu shot. Specifically, there will be a different strain of the H1N1 virus in this season's flu shot, compared with last season's shot. According to the CDC, the 2017-2018 trivalent flu shot will contain the following strains of the flu virus:

• A/Michigan/45/2015 (H1N1)pdm09-like virus – This is the H1N1 component that is different from last year's flu shot.
• A/Hong Kong/4801/2014 (H3N2)-like virus – This is the H3N2 component that is the same as last year's flu shot.
• B/Brisbane/60/2008-like (B/Victoria lineage) virus – This is the influenza B strain component that is the same as last year's shot.

The 2017-2018 quadrivalent vaccine will also contain a second influenza B strain called "B/Phuket/3073/2013-like (B/Yamagata lineage) virus," which was also included in last season's quadrivalent vaccine.

Just like the last flu season, the flu nasal spray is not recommended for anyone during the 2017-2018 flu season. This is the second year in a row that the CDC has omitted the nasal spray from the list of recommended flu shot types. This decision was based on data showing that the nasal spray was not very effective at preventing flu from 2013 to 2016, the CDC says. In addition, omitting the nasal spray during the 2016-2017 flu season did not affect the overall percentage of Americans who received a flu shot that season, according to American Academy of Family Physicians. It's not clear whether this recommendation will change in future seasons.

In addition, the CDC clarified that pregnant women may receive any of the flu vaccines recommended for their age group, except the nasal spray (also called the live attenuated influenza vaccine, or LAIV.) This means pregnant women can receive either "inactivated" (killed) flu vaccine, or the "recombinant" flu vaccine, which is produced without the use of chicken eggs and can be given to people with egg allergies. Previously, the CDC had said pregnant women should receive the "inactivated," but did not mention use of recombinant vaccines.

When should you get a flu shot?
Exactly when the flu season starts and ends is unpredictable, so health officials recommend that people get their flu shot in early fall, preferably by the end of October, the CDC says. Flu activity typically peaks in January or February.

"We'd like to get as many people protected against influenza before influenza becomes active in communities across the country," Schaffner said.

Most flu vaccines are given before Thanksgiving, Schaffner said, but people can still get their shot throughout the winter months. Each season's flu shot expires in June of that year, but Schaffner said that he would consider it "too late" to get a flu vaccine after March, unless a person is traveling to the Southern Hemisphere (where the flu season will be starting).

After vaccination, it takes a person about two weeks to build up immunity against the flu.

People can visit the CDC's HealthMap Vaccine Finder to find flu shot locations, although they should call the location ahead of time to see if they have the vaccine in stock.

How effective is the flu vaccine?
The effectiveness of the seasonal flu vaccine depends upon several factors, including how well the flu strains in the vaccine match the strains in circulation. Some studies show that when strains in the vaccine are a good match with the ones that are circulating, vaccinated individuals are 60 percent less likely to catch the flu than people who aren't vaccinated, according to the CDC.

Flu vaccine effectiveness can also vary depending on the person being vaccinated — the vaccine tends to work best in healthy adults and older children, and less well in older adults.

For instance, a 2013 study from the CDC found that the year's flu vaccine was not very effective in adults ages 65 and over: Older people who got the vaccine were just as likely to visit the doctor for flu symptoms as those who did not get the vaccine. But other studies suggest that individuals who do get sick develop less serve symptoms if they are vaccinated. A 2013 study published in the journal Clinical Infectious Diseases found that people who got the flu shot were less likely to be hospitalized with the flu.

There are some studies that suggest the high-dose flu vaccine provides better protection for older adults. The high-dose flu vaccine contains four times the dose of the standard vaccine, Schaffner said. A 2014 study in the New England Journal of Medicine found that the high-dose vaccine provides 24 percent more protection against the flu than the standard dose, Schaffner said.

Are flu vaccines safe for pregnant women?
Yes. Studies show flu vaccines are safe for women in any stage of pregnancy, the CDC says.

There are several reasons why it's important for pregnant women to get a flu shot, Schaffner said.

"Pregnant women, when they get influenza, have a tendency to get a more severe disease," and are at increased risk for complications and hospitalization from the disease, Schaffner said.

In addition, flu vaccination in pregnancy helps to protect the baby against flu during the first six months of life, when the baby is too young to receive a flu shot, Schaffner said. The mother "passes that protection on to her newborn baby," Schaffner said.

What are the side effects?
According to the CDC, mild side effects from the flu shot include soreness, redness or swelling at the injection site, low-grade fever and aches. Only about 1 percent to 2 percent of people who get a flu shot will have fever as a side effect, Schaffner said. Rare but serious side effects can occur, including allergic reactions. Symptoms of serious side effects include difficulty breathing, swelling around the eyes or lips, hives, racing heart, dizziness and high fever. If you experience serious side effects, you should seek medical care immediately, the CDC says.

For children, side effects from the flu nasal spray can include runny nose, wheezing, headache, vomiting, muscle aches and fever. For adults, side effects include runny nose, headache, sore throat and cough. These side effects last a short time compared to the actual flu illness, the CDC says.

Can you get the flu from the flu shot?
"It's a myth that you can get flu from the flu vaccine," Schaffner said.

The viruses in the flu shot are killed, so people cannot get the flu from a flu vaccine. However, because it takes about two weeks for people to build up immunity after they get the flu vaccine, some people may catch the flu shortly after their vaccinated, if they are exposed to the flu during this time period.

Some people may also mistakenly attribute symptoms of a cold to the vaccine, Schaffner said.

The nasal spray vaccine contains a "live attenuated" flu virus, but the virus is weakened so that it cannot cause the flu. The viruses in the nasal spray can't replicate in the warm temperatures of the lungs and other parts in the body.

However, because temperatures in the nose are colder, the virus causes a small infection in the nose. This infection does not cause symptoms in most people, but in some people, it causes symptoms such as runny nose and sore throat, Schaffner said.

This local infection will prompt the body to make antibodies against the flu virus, Schaffner said. "That provides better protection against the real flu, which is of course, is a virus that can make you seriously ill," Schaffner said.

Who should not get a flu vaccine?
Children younger than 6 months cannot get a flu shot. Those who've had a severe allergic reaction to a flu vaccine in the past should generally not be vaccinated, the CDC says.

You should not get the flu vaccine if you have a high fever. (You should wait until the fever is gone.)

However, if you have minor illness, like a mild cold or a headache, you can still get a flu shot, Schaffner said. "The vaccine does perfectly well in those folks."

By Rachael Rettner, Senior Writer, Live Science

7 Tips for Beach Safety

Saturday, 21 October, 2017
beach safety
In the Triangle, summer means trips to the beach! Nothing ruins a vacation like a trip to the emergency department. Stay safe with these 7 beach safety tips:

Beach Safety Tips

  • Beware of rip currents. A rip current is water flowing away from the shore. The water flow can be up to 8 feet per second, faster than an Olympic swimmer! Avoid them. But if you get stuck, relax, then swim parallel to shore. Here is more information about rip currents and here is a handy chart.
  • Understand beach warning flags. Lifeguards watch most of our area beaches during peak season, and they will post warning flags. A red flag means the water is hazardous and only strong swimmers should go in. Two red flags indicate swimming is prohibited. A yellow flag means use caution; there are dangerous currents and undertows. A green flag means all clear. Some beaches use blue and purple flags to warn of sharks or jellyfish.
  • Part of beach safety includes keeping an eye out for sharks. Sharks aren’t always a problem in North Carolina, but we do see them off the coast sometimes. National Shark Week is in July, and it’s not just time to binge watch the Discovery channel. Keep safe by monitoring the beach warning flags. If all is clear, try to swim in a group, don’t stray too far from shore. You can also lower your risk by not swimming at night, dawn, or dusk. Don’t enter the water if you are bleeding and don’t wear shiny jewelry.
  • Seek shelter during storms. Summer storms can be exciting but may come with damaging winds, hail, and lightning. According to the National Weather Service, most lightning deaths occur during leisure activities such as boating, camping, fishing, and bicycle riding. While it’s inconvenient to stop what you are doing and seek shelter, especially if you are out on a lake, it’s important to do so. 


  • Protect your skin from the sun. Sunburn isn’t just uncomfortable; on average, a person’s risk for melanoma doubles if he or she has had more than five sunburns. Wear hats and sunscreen of at least SPF 30 when you are out. Reapply sunscreen after swimming or sweating and every hour. At the beach, plant an umbrella or tent so you can take breaks in the shade. Keep in mind tents will not block all the sun’s rays though, so you’ll still need to reapply sunscreen.
  • Avoid food poisoning. Food on the beach will get warm quickly. Temperatures between 40 degrees and 140 degrees is known as the “danger zone” for cooked food. At those temperatures, food can only be left out for two hours. But if it’s a hot day, say 90 degrees, you only get one hour. Prevent bacteria from forming by putting things back in the cooler when you are done.
  • Stay hydrated. While many people enjoy alcohol at the beach, the combined heat and sun will dehydrate your body faster. Plus, alcohol can make your skin more sensitive to light, which means a higher risk of sunburn. Experts recommend drinking 8 ounces of water after every alcoholic beverage. 
Our team at Generations Family Practice hopes you have a happy, safe summer and practice these beach safety tips on your next vacation!

Keep an eye on your child's eye health

Saturday, 21 October, 2017
child's eye health

Your child’s eye health is just as important as every other part of him. Some eye conditions are treatable while young, but irreversible once a child reaches his teen years.

Only 2 percent of parents would wait for symptoms before taking their child to the pediatrician or dentist for the first time. Yet 24% of parents expect their child to have symptoms before visiting an eye doctor.1

One in four children has an eye problem that can interfere with learning and behavior. Sixty percent of students identified as “problem learners” have undetected vision problems. That’s why it’s important to get regular eye exams for your children even if they don’t complain about things looking fuzzy. If your child plays sports, you have even more reason to get regular checkups.

August is Children’s Eye Health and Safety Month. Let’s take a look at all things eyes.

The First Eye Examchild eye health
Your child’s first eye exam will take place at the pediatrician’s office, unless your doctor refers your child to an ophthalmologist. The first exam will take place as an infant, with a recheck sometime between six months and 1 year old. Your pediatrician will again check your child’s eyes around age 3, examining vision and eye alignment.

Later Exams
Once your child is old enough to read an eye chart, he should be tested to make sure he can focus at far, middle and near distances. Most of the time, children are slightly farsighted, but will not require glasses. Once a child starts school, he should be screened every two years by a pediatrician, school nurse, or ophthalmologist. A screening is a basic check, and many schools perform these tests each year. If your child shows any eye trouble, he will be referred to an ophthalmologist for a full vision exam. If your child requires vision correction, he will need an annual eye exam.

Signs Your Child Has Vision Problems
Watch your child’s eyes as she focuses to make sure they align normally. If they turn inward or if your child appears to have a lazy eye (amblyopia), make an appointment with an eye doctor. Such problems are more easily corrected if they are addressed early.

Some children don’t realize they are having eye trouble. Watch for squinting, headaches, or complaints. Some less obvious signs include:

  • A short attention span for activities
  • Losing his/her place while reading
  • Avoiding reading, drawing, or other activities that require up close sight
  • Turning his/her head to the side to see better. (In cases of astigmatism, this makes it easier for them to focus.)

If you wear glasses or contacts, your child has a greater chance of requiring vision correction.

Common Childhood Eye Conditions and Diseases
While vision is an important part of how a child learns, the eyes have other problems that may appear during childhood. Here are some of the more common conditions that require an ophthalmologist exam:

  • Amblyopia - As mentioned above, this is more commonly known as “lazy eye.” This refers to an eye that has not developed normal sight and affects two or three out of every 100 people in the U.S. In cases of amblyopia, the eye may always appear misaligned, or may just drift off sometimes. In this cases, the brain shuts down signals to that eye, so the child only uses the better-seeing eye.
  • Ptosis - If you notice a drooping upper eyelid that covers the eye, your child might have ptosis. This can block her vision.
  • "Cloudy" eyes - Children can get cataracts, too, as well as other conditions that may cause an eye to appear cloudy.

There are also diseases that may affect the eye. If you notice any of these, contact your pediatrician first and he or she will decide whether further eye care is needed.

  • Conjunctivitis (pink eye) - You’ve probably experience this at some point. Pink eye is caused by a viral or bacterial infection, but either way, it’s quite contagious. Allergies might also cause pink eye, and that is not contagious. Watch for the red or pink color, extra discharge or tears, and itchy or uncomfortable eyes. In cases of a viral infection, you may see other symptoms such as fever, runny nose, or sore throat. (Help stop the spread of conjunctivitis.)
  • Chalazion - This occurs when a gland in the eyelid becomes clogged. It looks like a small lump on the eyelid. While not caused by infection, seek a doctor’s care to correct it.
  • Stye - Infected eyelash follicles cause red, sore bumps near the edge of the eye known as styes.
  • Cellulitis - This is an infection that requires urgent medical care. Sometimes it’s local to the eyelid, but cellulitis might also be caused by an upper respiratory infection or a general infection related to trauma. In cases of cellulitis, the eye appears red and painfully swollen; it may even swell shut. The eye may appear to be pushed forward or have trouble seeing. Your child may also have a fever.
  • Blocked Tear Duct - If the eye cannot drain tears normally, the blockage may cause an infection. Symptoms include watery eyes or tears running out of the eyes. Some babies are born with this, but the cases usually resolve themselves. Your doctor might also recommend a massage technique to help.

Sports Protection
Different sports require different types of eye protection. The American Society for Testing and Materials (ASTM) has set standards for each of these, and the equipment you need will be labeled ASTM followed by a combination of numbers and letters such as F803. Here is the list, according to the American Academy of Ophthalmology:

  • ASTM F803: Eye protectors for selected sports (racket sports, women's lacrosse [see the U.S. Lacrosse website for more details], field hockey, baseball, basketball);
  • ASTM F513: Eye and face protective equipment for hockey players;
  • ASTM F1776: Eye protectors for use by players of paintball sports;
  • ASTM F1587: Head and face protective equipment for ice hockey goaltenders;
  • ASTM F910: Face guards for youth baseball; and
  • ASTM F659: High-impact resistant eye protective devices for Alpine skiing.

Other Eye Notes
You can prevent many other eye problems and injuries. Here are a few final tips for keeping your child’s eyes safe.

  • Have your child wear sunglasses while outside. The sunglasses should be labeled 100% UV protection to cover both UVA and UVB rays.
  • Be sure your child gets some outdoor play regularly while young, which helps develop his/her eyes.
  • Keep all fireworks away from your children. Bottle rockets, especially, which have been banned in many states, have caused a lot of eye injuries.
  • Teach your children to protect their eyes by wearing safety glasses or goggles for activities such as lawn mowing and household repairs.
  • Only use age-appropriate toys and avoid projectile toys, BB guns, and pellet rifles.

If you have questions about your child’s eyes or vision, contact your Generations Family Practice pediatrician today.

New Generations Office Announcement

Saturday, 21 October, 2017
new office

We are thrilled to announce plans for a new Generations office! On July 12, 2017, the Generations Family Practice providers converged to sign one of the steel beams to be used in the construction of our new building! The 'Preston Walk Medical Office Building,' in Cary NC, is set to open early 2018. The new space, less than a mile from our current office, will include the following:

  • Three times the space
  • Imaging (X-Ray) on-site       
  • Space specifically designed to maximize patient/provider interaction and maximize personal, individualized care
  • New Skin Centre
  • Increased staff
  • Easier check-in
  • More comfortable waiting spaces
  • New medical devices to improve care and seamlessly integrate with electronic medical record system and other resource in the healthcare continuum

Keep an eye out for continued coverage of construction and updates on both our website and Facebook page as we grow!


Know about Group B Strep to Protect Your Infant

Saturday, 21 October, 2017
Group Strep B

You’ve heard of strep throat and have probably had it at least once. But have you heard of Group B Strep? Did you know that it can threaten the lives of unborn or just born babies?

July is International Group B Strep Throat Awareness Month. Whether you’re pregnant or know someone who is, here is what you need to know.

What is Group B Strep?

Group B Strep (GBS) “is a type of bacteria that is naturally found in the digestive and lower reproductive tracts of both men and women,” according to Group B Strep International. About 1 in 4 pregnant women carry this bacteria. It is not related to strep throat.

Not every baby born to a mother with GBS will become ill; the rates are 1 in 200. However, the bacteria can infect your baby during pregnancy, during birth, or set in later. GBS can cause miscarriages, stillbirths, preterm labor, or cause your water to break prematurely. Some babies get meningitis, pneumonia, or sepsis, all of which can be fatal. Some babies survive but end up blind, deaf, have mental challenges, or cerebral palsy. GBS affects about 1 in every 2,000 babies in the United States.

What You Can DoGroup B Strep

Most women do not experience any symptoms, but some show signs similar to a yeast infection. Women are now tested for Group B Strep during each pregnancy. If you test positive, your doctor may prescribe antibiotics.

Visit your doctor if you have any symptoms of a bladder or urinary tract infection or vaginitis/yeast infection. Call your doctor if you experience less movement in your 20th week or have an unexplained fever.

Know that you have GBS and remind all your medical team members, especially during labor. You will be put on IV antibiotics, which often include penicillin, so alert your doctor about any allergies. 

Watch for GBS symptoms in your baby, including:

  • High-pitched, shrill crying, moaning, whimpering, or grunting as if constipated
  • Feeding poorly, refusing to eat, not waking for feedings
  • Irritability, vomiting, listless, stiff, uncontrollable jerking
  • Blue, gray, or pale skin, blotchy or red skin
  • Fever or low temperature

Although GSB is scary and can have terrible results, knowing what to do can make all the difference in your baby’s life. You can learn more from the American Pregnancy Association and March of Dimes.

Scoliosis and Your Child

Saturday, 21 October, 2017
Scoliosis, a condition you don’t often hear about. is the reason behind your child's pediatrician checking their back. 

Scoliosis and What You Need to Know

  • Scoliosis is a spinal deformity, a sideways curvature that can occur in both males and females. The curve may be an S curve or a C curve.
  • This curvature may be mild, but in severe cases can be disabling and can reduce the amount of space in the chest, making it difficult to breathe.
  • It typically begins to appear between ages 10 and 15, during the growth spurt just before puberty. However, it can appear in people younger and older.
  • In most cases, there is no known cause.
  • Some schools perform tests, but many do not, which is why your pediatrician should examine your child’s back during regular visits.
  • What to watch for: uneven shoulders, one shoulder blade that appears more prominent than the other, an uneven waist, or one hip higher than the other.
  • Treatments include braces or surgery, but depend on the severity and type. Treatments are more effective the sooner they begin.
If you believe your child may have this curvature, contact us right away for a checkup.