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Bronchiolitis and RSV: What Helps, What Doesn’t

by Dr. Nathan Boonstra – Blank Children’s Hospital Pediatric Clinic

RSVBronchiolitis season is quickly approaching. There’s a lot of worry, frustration, and confusion about bronchiolitis, so I’m going to try to clear the air, so to speak.

Bronchiolitis Is Not Bronchitis

Bronchiolitis and bronchitis sound so similar that they are easy to mix up, but they’re fairly distinct. Bronchitis is usually caused by a viral infection of the larger airways, while bronchiolitis is mainly a problem of the bronchioles – smaller branching airways in the lungs. Bronchiolitis has a distinctive set of symptoms, and the biggest symptom is the production of lots and lots of wet mucus. This is the biggest problem with bronchiolitis, that the mucus makes it hard for kids to move air through their airways. Some kids wheeze with bronchiolitis, but most do not.

What is RSV?

RSV (Respiratory Syncytial Virus) is just the name for the most common virus that causes bronchiolitis. We can test for RSV easily, but testing doesn’t mean much except that we are a little more confident in what we are dealing with. If a child looks and acts like bronchiolitis, the care is the same whether they are positive for RSV or not. As Doc Smitty over at Cook’s Children discusses, it’s just not that important to test.

Most kids get bronchiolitis at some point, but the younger you are, the harder it can be on you. It’s a frustrating illness because there’s no traditional vaccine for it, and because it is caused by a virus, not bacteria, antibiotics just aren’t any good. This is one of those illnesses that makes kids miserable, and is hard to watch, but there just isn’t a medicine that makes it get better faster. It’s a lot of waiting and supporting the body while it fights the disease off by itself.

What can you do at home?

  • Suction, suction, suction! Suctioning the nose and mouth is the mainstay of treatment for bronchiolitis. The better you can keep the airway clear, the better the child can breathe. You can use the traditional bulb suction, but there are a lot of products out there than might do better. Many of my parents swear by the NoseFrida, though a number are grossed-out by the fact that you’re basically using your mouth to suck through a tube to get your baby’s snot out. Isn’t parenting great?
  • Humidified air can loosen the mucus and make it easier to remove, and not block your child’s breathing as much.
  • Watch for signs of dehydration or increased work of breathing. If your child is worsening, you should talk to your child’s doctor. If your child appears dehydrated, or is working harder to breathe, using extra rib muscles or flaring their nostrils with each breath, it’s time to go to the emergency room.
  • Do not use cough medicines. If your child has asthma, you can talk to your child’s doctor about whether to try your child’s asthma medication, but most cases of bronchiolitis don’t improve with inhalers or nebulizers.
  • Prevent the spread by practicing good hygiene. This disease is spread by saliva and mucus, so make sure hands are washed frequently, noses are covered when coughing, and you’re not taking your child out in public while they are coughing or febrile.

In the Hospital

About three percent of infants with bronchiolitis need care in the hospital. Premature babies, and infants with other medical conditions, are more likely to be hospitalized. Bronchiolitis caused by RSV is more likely to need hospitalization than bronchiolitis from other viruses. Now this can a very frustrating kind of hospital stay, because even on the floor, there isn’t a magic way that makes kids get better faster. A lot of inpatient care for this illness still involves supporting the body while the child fights off the illness themselves.

The hospital team can:

  • Do deep suctioning with a machine to remove the mucus that is obstructing the airway, so that your child can breathe more easily.
  • Provide oxygen if it’s needed, so that the air that gets to the lungs has more oxygen for the body, and the child can breathe a little easier.
  • Give the body fluids or nutrition either through a tube through the nose to the stomach, or with an IV, if needed. Eating requires a lot of energy, and it can be hard to breathe at the same time. This can give the body the chance to take a break from that stress and focus on breathing.
  • Monitor for complications and intervene if any develop. Kids with bronchiolitis can develop secondary infections like pneumonias that need additional care. Or they may need more help breathing if things get worse.

I know families can get frustrated and feel the doctors aren’t doing enough, when really they are doing everything that has been shown to be helpful.

Some things that aren’t shown to be helpful in most cases of bronchiolitis include:

  • Antibiotics. Unless the doctor suspects there’s a bacterial infection at the same time, like an ear infection or pneumonia, antibiotics just won’t help your child get better. We all want antibiotics to fix things like this, but in this case it won’t help, and may cause problems, like antibiotic resistance or side effects.
  • Steroids. Medications like prednisone, which we give commonly for asthma exacerbations, aren’t shown to be helpful either, even though children can sometimes wheeze with bronchiolitis.
  • Bronchodilators. Airway-opening medications like albuterol, which in the past had given for bronchiolitis on a trial basis, are not shown in the literature to be helpful.

The AAP recommends against all these things except in special circumstances. You can read more about these recommendations here.

It’s very normal to want to have as much as possible done for your sick child when they are in the hospital, but some things just don’t help and may have side effects, which is why hospital pediatricians follow expert guidelines for the treatment of diseases like bronchiolitis. They want your child to get better as much as you do.


Firework Safety: What You Need to Know to Stay Safe this Fourth of July


The Fourth of July is quickly approaching, bringing with it all of our favorite summertime activities…cookouts, pool parties and fireworks! Keep yourself and your family safe this year by following these tips.

  • Obey local laws. Before you grab your fireworks on the 4th, make sure you are aware of any local laws in your area. Many towns have different guidelines, so it’s a good idea to research your local laws and regulations before lighting off any fireworks.
  • Read the caution labels. Some fireworks work differently than others, even if they look similar. To avoid injury, make sure you read all important labels before lighting any fireworks.
  • Keep fireworks away from children. This may seem like a no-brainer, but kids are quick and things can get a little hectic during gatherings with friends and family. If your kids are of an age where some fireworks may be appropriate, you may want to start off with something that doesn’t shoot or fly off the ground. Always make sure there is a responsible adult around to supervise children while they are near fireworks.
  • Wear safety glasses. Fireworks can be fun to watch but if you are the one lighting them, it may be necessary to take some extra precautions. Wear protective eye gear to avoid injuries to your eyes while lighting fireworks.
  • Don’t try to re-light a firework. Duds happen. It’s very important to remember to never try to re-light a firework that didn’t work the first time. If you come across a firework that doesn’t light, leave it where it is for 20 minutes and then soak it in a bucket of water.
  • Dispose of fireworks properly. After the fun is over, you need to dispose of your used fireworks properly. Soak them in water and place them in a metal bin or trash can, away from any combustible materials. Let them sit for at least 24 hours.
  • Protect your pets: Our pets are part of our family, so it’s important to keep them safe as well. Make sure you never bring them to a firework show, even a small one. Keep them in a secure interior room of your home so they aren’t as exposed to the loud noises, and make sure they have their identification tags on them in case they run away.

Have a Happy and Safe 4th of July!

Myrtue Medical Center provides high quality, cost-effective health care services to improve the well being of the people we serve. Call us today at (712) 755-5161 or visit our website to learn more.


Swallowing Disorders Common Complication From Stroke, Parkinson’s, and Other Medical Conditions in Adults

Communication for AllWith swallowing disorders affecting 300,000–600,000 people yearly in the United States, and the impact of these disorders on daily life multifaceted and potentially severe, it is critical that all Americans understand the treatment options available to them should they or a and loved one experience difficulty swallowing.

Swallowing disorders, also called dysphagia, can affect a person’s ability to eat, drink, and take medicine. These disorders are diagnosed and treated by speech-language pathologists, making May—which is Better Hearing & Speech Month—an opportune time for Shelby County residents to learn more about this common problem.

“A person’s ability to swallow seems effortless, but in reality, this is a very complex process with much room for error,” explains Myrtue Medical Center Rehab Services Speech-language pathologist Edie Shetler. “Roughly 50 pairs of muscles and many nerves work to receive food into the mouth, prepare it, and move it from the mouth to the stomach. People who experience difficulty swallowing can be at risk for serious health repercussions, reduced enjoyment of eating, and even social isolation. It’s important for people to know that treatment for these disorders is available and can greatly improve their quality of life.”

Swallowing disorders are often caused by stroke or brain injury, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, and amyotrophic lateral sclerosis (ALS). They can also result from problems that affect a person’s head or neck, such as cancer, injuries, or surgery.

“We want people to know that in many cases, treatment can help fully restore a person’s ability to eat and drink—allowing them to enjoy food to the degree they did prior to injury or disease. People who experience stroke and other conditions can go on to live many decades, making effective treatment for swallowing so important.”

If you have concern for yourself or a family member, contact Myrtue Medical Center’s Rehab Services, Edie Shetler at 712-755-4342.

Gallbladder Health and What it Means to You

Like many things in life, most people don’t pay much attention to certain organs in their body, until they start causing issues. The gallbladder is no exception. The gallbladder is the small sac-shaped organ beneath the liver, in which bile is stored after secretion by the liver and before release into the intestine. The gallbladder is part of the biliary system, which includes the liver and the pancreas. The biliary system, among other functions, transports bile and digestive enzymes. Bile is a fluid made by the liver to help in the digestion of fats. Several issues can arise and cause considerable pain if left untreated. Thankfully, gallbladder treatment is typically minimally invasive and you can lead a normal, healthy lifestyle afterward. Here some common gallbladder problems, symptoms, and treatment.

Gallstones (Cholelithiasis)

Gallstones typically do not cause any problems, in fact, up to 20 percent of adults in the United States may have gallstones, yet only 1-3 percent of people actually develop symptoms. Cholesterol stones make up a majority of all gallstones. These stones usually form when there is too much cholesterol in the bile. Gallstones can vary in size from a grain of salt to the size of a golf ball. As you can imagine, the larger stones are typically the ones which cause symptoms.

Anything that increases the level of cholesterol in the blood, increases the risk of gallstones. A healthy diet and exercise can reduce your risk of developing gallstones.

Typical symptoms include:

  • Sudden and intense pain in your upper abdomen, especially after a high-fat or large meal
  • Pain in your right shoulder
  • Vomiting or nausea
  • Back pain between your shoulders

When to see a doctor:

  • When you are having pain so severe you are unable to sit or be comfortable
  • Yellowing of your skin and/or eyes
  • High fever and chills


Treatment for gallstones generally only occurs when the individual is experiencing symptoms and can require surgery and dietary changes.

bendorfThe surgical procedure, called cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. The procedure is minimally invasive and is usually done in an outpatient setting under anesthesia.
Dr. David C. Bendorf, MD specializes in general surgery, including the removal of the gallbladder. Myrtue Medical Center – General Surgery

Other less common gallbladder problems can include gallbladder cancer, inflamed gallbladder, perforated gallbladder which can be caused from untreated gallstones, bile duct infection, and chronic gallbladder disease, just to name a few. Oftentimes, symptoms of gallbladder problems include pain that comes and goes and can range from mild to severe, and frequent pain.

BernalIf you suspect a gallbladder pain please visit Dr. Alexander B. Bernal, MD. Dr. Bernal holds a Gastroenterology clinic at Myrtue Medical Center the first Monday and third Thursday of each month.  Gastroenterology is a specialty within internal medicine that focuses on digestive diseases. Gastroenterology concentrates on the diagnosis and treatment of diseases involving the esophagus, stomach, small intestine and large intestine (colon), liver, gallbladder and pancreas.  Dr. Bernal is experienced in performing upper and lower endoscopies. Myrtue Medical Center – Specialty Clinics




Petersen Family Wellness Center Celebrates 25th Anniversary of National Senior Health & Fitness Day®

2018 Logo2018 Event Theme: “Active Today…Healthier Tomorrow!”

Petersen Family Wellness Center (PFWC) will join an estimated 1,000 local groups to celebrate the 25th Anniversary of National Senior Health & Fitness Day® (NSHFD) on Wednesday, May 30, 2018 to help promote active, healthy lifestyles through physical activity, good nutrition, and preventive care.

As an official event site, the Petersen Family Wellness Center (PFWC) will hold a health fair, physician presentations and other activities on Wednesday, May 30th from 8:00-10:30 a.m. Admission will be free to all non-members of the PFWC for this event.

According to Todd Alberti, Director of the PFWC, “Our Senior Health and Fitness Day is a wonderful opportunity for seniors to make, renew, and revitalize their commitment to live healthier lives through better health and fitness.”

The Senior Health and Fitness Day will include:

  • Health Fair booths promoting wellness for seniors
  • Three physician speakers discussing the following:
    • Heart Health by Dr. Smer, Cardiologist at CHI Health and Myrtue Medical Center Specialty Clinic
    • Colon Health by Dr. D. Bendorf, General Surgeon at Myrtue Medical Center
    • Maintaining Your Mobility by Dr. Davidson, Family Physician at Myrtue’s Harlan Clinic
  • Healthy snacks
  • Cooking Demonstration
  • Prizes and Giveaways

Join us on Wednesday, May 30th from 8:00-10:30 a.m. at the Petersen Family Wellness Center for a morning of health, education and well-being.

Dr. Scott Markham Honored as Emergency Room Provider

MarkhamAt the 23rd annual Iowa Emergency Nurses’ Association (ENA) Conference, Dr. Scott Markham was recognized with the Emergency Provider Award. Recipients of the Emergency Provider Award are Emergency Department (ED) physicians or mid-level providers who consistently demonstrate excellence in emergency room care and they have made significant contributions to the profession of ED nurses.

Dr. Markham actively fills the roles of ED Medical Director, Trauma Medical Director, EMS Medical Director, Shelby County Coroner, and ACLS instructor. He has been instrumental in maintaining Myrtue’s Level 4 Trauma designation and encouraged the continuation of the Trauma Nursing Core Course program being taught in our rural location of Harlan. He is a strong advocate and promoter of community involvement. Dr. Markham has most recently become co-sponsor of the community Stop the Bleed campaign and is an advocate for providing Narcan to law enforcement and EMS responders.  In addition, he is a Board Member of the Shelby County Medical Corporation and the Ambulance Commission of Shelby County.

“Dr. Markham is a constant role model, mentor and patient advocate in the ER.  The ER Staff values his experience and is grateful that he shares his knowledge to improve patient outcomes.  Dr Markham is a valuable member of the ER team and is fully deserving of this award,” said Jenny Lefeber, Manager of the Emergency Department at Myrtue Medical Center.

The Emergency Nurses’ Association (ENA) mission is to advocate for patient safety and excellence in emergency nursing practice. They are the global emergency nursing resource and advocate for Safe Practice and Safe Care.


Shelby County Public Health Takes Holistic Approach to Mental Health and Well-being

PH WeekAbout one in every five U.S. adults experience mental illness in a given year. Additionally, one in five youth aged 13-18 will experience a severe mental disorder at some point in their lives. Despite the prevalence of mental health illness, less than half receive behavioral health care to address this important health care need.

At the forefront of today’s behavioral health concerns is an epidemic of opioid addiction, which kills 91 Americans each day, overwhelming law enforcement, health and child protective systems. This epidemic is the main factor driving the recent decline in average American life expectancy.

Shelby County Public Health recognizes the need for access to holistic care, including behavioral health support. Some Public Health initiatives that focus on mental health promotion includes:

  • Our partnership with Behavioral Health to provide Mothers and Babies Support Groups in Shelby County.
  • Collaboration with Behavioral Health to create “Lean into Life”, a local widower/widow support group.
  • Opioid Overdose Training for Law Enforcement and Responders
  • Adverse Childhood Experiences (ACES) Community Conference on the lifelong impact of ACES on the entire health spectrum.
  • Shelby County Wellness Alliance partnership, including the “Feel Better” component to improve holistic wellness in Shelby County.
  • Improving access to behavioral health services for people experiencing mental illness as needed.
  • Working with the newly-created Shelby County Prevent Child Abuse Council to provide education and programming that strengthen families.

With the support of Myrtue Medical Center, the Shelby County Board of Health and our community partners, Shelby County Public Health continues to advocate and promote access for mental well-being as part of a healthy lifestyle.  Working together, we can build healthier communities and eventually, the healthiest nation, changing our future for generations to come.

NAMI Southwest Iowa Announces Meeting

namiThe National Alliance on Mental Illness (NAMI) – Southwest Iowa is developing as an affiliate in the nine-county Southwest Iowa Region – Mental Health and Disability Services (MHDS). All consumers and stakeholders are invited to attend an informational meeting on Friday, April 6, 2018 from 10 am – 12 pm. The meeting will be held in the Auble Conference Room at Myrtue Medical Center, 1213 Garfield Avenue, Harlan.

NAMI envisions a world where all persons affected by mental illness can experience resiliency, recovery and wellness. NAMI values support, education, advocacy and research.

For more information, contact MMC Behavioral Health at 712.755.5056.

Hungry for Health: Eating Towards a Happier You


Each year in March, the Academy of Nutrition and Dietetics asks that we focus our attention on the importance of making informed food choices. The 2018 National Nutrition Month theme is “Go Further with Food” – a nutrition education and information campaign to raise awareness on eating real food to enjoy a healthy life.

Food IS Fuel

So consider this: the human body is a finely-tuned biological machine, capable of incredible feats of strength, intelligence, memory, powers of deduction, learning, balance – the list goes on. Like any finely-tuned machine, clean and constant fuel – in our case, food, in the form of protein, carbohydrates, good fats, vitamins, and minerals – needs to be readily available and ingested. If not, this machine will slow down, perform poorly and ultimately, stop running.

One Size Does NOT Fit All

Just as every person is unique, so are their dietary needs. Athletes, students, parents, vegetarians/vegans, people on the go – no matter your situation, everybody needs to eat right for their lifestyle.  The key is finding a way to get nutrient-rich foods into your body. Whole grains, low-fat dairy, lean meats, whole fruits and vegetables, and plenty of protein are common factors among all healthy diet plans.

Don’t Believe the Hype

Certain food and drink have been unfairly demonized. The truth is they can be very healthy. The key, however, is moderation.

  • Coffee: This delicious brew is high in antioxidants. Studies also show that coffee drinkers live longer, and have a reduced risk of type 2 diabetes, Parkinson’s disease, Alzheimer’s, and numerous other diseases.
  • Saturated Fat: Although it is true that saturated fat raises cholesterol, it also raises HDL (the “good”) cholesterol and changes the LDL from small to large, which is linked to a lower risk of heart disease.
  • Eggs (including yolks): Whole eggs, also referred to as “nature’s multivitamin”, one of the most nutritious foods on the planet! Studies show that they have no effect on blood cholesterol in the majority of people, and the yolk is where almost all of the nutrients are found. Telling people to avoid consuming the yolk is among the worst pieces of advice in the history of nutrition.

Here’s to making healthy and nutritious choices when meal planning and at snack time. You’ll have more energy and be in a better mood because of it!

For information about Myrtue Medical Center and all of our medical and health services, visit our website, or call (712) 755-5161.

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