Know the Symptoms of Bell's Palsy

Tuesday, 19 June, 2018
bell's palsy
While Bell's Palsy isn’t a common condition, it is a scary one that can come on quickly in children. That’s why we recommend parents know what to watch out for.
About 40,000 Americans get Bell’s Palsy each year, mostly between the ages of 15 and 60. It can also effect much younger children. It occurs when nerve trouble paralyzes one side of the face. In some people, this causes pain. Bell Palsy makes a person look different because one side of his or her face is either frozen or sags.
Doctors aren’t sure what causes Bell’s Palsy, but most believe it can be caused by anything that irritates the facial nerves. It may be brought on by a serious injury, the flu, diabetes, Lyme disease, ear infections, or viruses.

Bell's Palsy Symptoms May Include:

  • Symptoms might show up at once or take a few days to appear, one or a few at a time. Here is what to watch for:
  • twitching, weakness, or stiffness on one side of the face
  • half of the face drooping (especially one corner of the mouth)
  • trouble closing one eye
  • dryness in one eye
  • difficulty speaking, eating, or drinking
  • headache
  • pain behind or in front of one ear
  • loss of taste at affected parts of the tongue
  • changes in the amount of saliva in the mouth
  • hearing sounds louder in one ear
  • If these symptoms appear, go to the doctor immediately. He or she will perform tests to confirm its Bell’s Palsy.
The good news about Bell’s Palsy is that it doesn’t last; the facial nerves repair themselves usually within two weeks to six months. There aren’t any specific treatments for this condition, except those to help a person feel better while they wait for the symptoms to clear. A doctor might recommend facial massages or eye drops. Symptoms might go away quite suddenly or disappear one by one.  Most people regain full facial strength and expression.

Is It Bell's Palsy or a Stroke?

People affected by Bell’s Palsy often feel worried they have had a stroke, which is when a blood vessel inside the brain is clogged or bursts. People who have strokes often have facial problems that appear similar to Bell’s Palsy to the untrained eye. However, a stroke usually weakens or paralyzes the lower half of the face, while Bell’s Palsy affects one side of the face. Additionally, strokes may affect the arm or leg or one side of the body, while Bell’s Palsy only affects the face.
However, it’s important to go see a doctor immediately if you have these symptoms so a doctor can confirm the diagnoses. If it is a stroke, every second counts for the best recovery. 

When should my kids get the HPV vaccine?

Tuesday, 19 June, 2018
hpv vaccine

January is Cervical Health Awareness Month, which means it’s a good time to talk about the HPV vaccine. The vaccine was released for use in June 2006. While it has already been available for over 10 years and has been given to over 80 million people, the HPV vaccine is one of the newer vaccines and thus raises a lot of questions, including concerns about its safety. 

All About the HPV Vaccine

Is it safe?
Yes, the vaccine itself is very safe and quite effective. Clinical trials have shown that HPV vaccines provide close to 100 percent protection against cervical pre-cancers and genital warts. And all vaccines go through years of rigorous testing before they are released for use.

Here are some other common questions answered:

What is HPV?
HPV, or human papillomavirus, is a very common sexually transmitted virus. It’s so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most get it and pass it on without knowing they have it. About 80 million people, or one in four, are currently infected in the United States.

Why is it a problem?
The HPV infection can cause many types of health problems in both men and women. In women, the virus causes cervical, vaginal, and vulvar cancers. Men with HPV can get penile cancer. Both genders can also get anal cancer, cancer of the back of the throat, and genital warts. These health problems may later lead to fertility issues.

My child is young and nowhere near being sexually active. Why do we need the vaccine now?
The preteen years at ages 11 or 12 are best for the vaccine. For the vaccine to work most effectively, all doses must be given before any exposure to HPV. Plus, the vaccine produces a more robust immune system response if the doses are given at this time.

Christine Macomber, MD, Generations' pediatrician on staff explains her reasoning for administering the vaccine to her own children. "With the gardasil vaccine, I have been given the opportunity to reduce my children’s risk of getting a cancer with low risk intervention. Two of my children have already received the vaccine series; the other two will when they are eligible.”

My teen hasn’t had the vaccine yet. Is it too late?
Teen boys and girls who did not start or finish the HPV vaccine series when they were younger should get it now. In general, young women can get the HPV vaccine through age 26, while young men can get vaccinated through age 21.

hpv vaccineHow is it administered?
The vaccine is given in a series of two or three shots, spaced out during a period of several months - depending on the age at which the series is started.

What are the side effects of vaccination?
Some people have no side effects. Those who experience them usually report mild side effects, such as a sore arm where the shot was given. Brief fainting spells may occur after any medical procedure, including vaccinations. Other side effects include a fever, headache, nausea, muscle, or joint pain. HPV vaccine does not cause HPV infection or cancer.

Why is this vaccine not mandated for school entry?
Each state determines which vaccines are required for school entry. In North Carolina, this vaccine is not required, but it is recommended.

Other questions?
If you have more questions about the vaccine, contact us to schedule an appointment. We’ll be happy to address any of your concerns.

Maggy Award Winner Three Years in a Row!!

Tuesday, 19 June, 2018
Maggy Awards

For the THIRD year in a row, our very own Dr. Melanie Mintzer was recognized as a Maggy Award Winner! Just as exciting is the fact that Dr. Justin Glodowski earned Honorable Mention in the class of Best Doctor. This is his second year to be honored with this recognition. The Maggy Awards are presented each year by Cary Magazine. More than 11,000 area residents vote for their favorite service heroes, and we’re proud that our doctors were chosen. We would like to say ‘Thank you’ to our patients for recognizing Dr. Mintzer and Dr Glodowski! Learn more about the awards or see the full list of winners.

The Truth About Testosterone Replacement Therapy

Tuesday, 19 June, 2018
testosterone replacement therapy

Most people have heard of menopause and know that women experience it as they age. But did you know that men also go through a process during which they lose hormones? Let's take a look at testosterone replacement therapy. 

Sometimes called andropause, the process in men isn’t as swift; these changes take place gradually. This hormone loss can cause some side effects, which is why many more men are asking about testosterone replacement therapy. But TRT is not for everyone.

The Effects of Testosterone Changes

Men begin to lose testosterone at a rate of about 1 percent a year starting at age 40. The changes in their reproductive system occur mainly in the testes. The mass of testicular tissue decreases; the levels of testosterone may remain the same or decrease gradually. The testes continue to produce sperm, but at a slower rate, and the tubes that that carry sperm may become more elastic. While some men experience problems with erectile function, men are often still able to father children even into old age.

These changes also affect urinary function. About 50 percent of men experience an enlarged prostate as some of that tissue is replaced with scar-like tissue. This can cause problems with slowed urination and ejaculation.

Reduced testosterone can also cause:

  • changes in sleep patterns
  • emotional changes, such as low self-confidence or lack of motivation
  • physical changes, like increased body fat, reduced muscle bulk and strength, and decreased bone density
  • reduced sexual desire, or low libido
  • fewer spontaneous erections
  • impotence (erectile dysfunction)
  • infertility

Testosterone Replacement Therapy

TRT is also known as Androgen replacement therapy (ART) and involves the prescription of testosterone either by injections, patches, or skin creams. (There is a pill form, but it poses hazards to the liver.) This therapy is often prescribed to those with hypogonadism, a condition in which the body doesn't produce enough testosterone. Many men who try TRT report improvements in energy levels, sex drive, quality of erections, and have been shown to have higher bone density and muscle mass.

Testosterone Replacement TherapyThe Problems with TRT

Some men are asking for testosterone to counteract some of the unpleasant side effects of normal hormone loss. On their own, low testosterone levels caused by aging do not need treatment and TRT is not recommended for this use. TRT can have side effects, and the long-term risks aren’t fully known yet because there have not been any large extended studies on its use. Experts studying this approach have concerns that such therapy might stimulate the growth of prostate cancer cells. TRT can worsen sleep apnea, cause blood clots, and congestive heart failure. Some men experience increased breast size, decreased testicular size, mood swings, or acne. However, others argue more research is needed before dismissing TRT as an aid.

Cost is another factor when considering TRT. Testosterone injections are the least expensive option, but they still cost between $150 and $400 per month and must be administered by your doctor every few weeks. Patches, gels, creams, and similar methods often cost between $200 and $500 per month.


If you are experiencing the side effects of decreased testosterone, speak to your Generations Family Practice doctor. He or she can perform tests to confirm whether your testosterone changes are due to aging or another cause and determine the best approach, whether it’s TRT or other hormone therapies.

Contact us to learn more.

Coping while caring for your elderly parents and your children

Tuesday, 19 June, 2018
Caring for elderly parents and your children

Many adults today find themselves stuck in a stage sometimes called “the sandwich generation.” These adults are still raising their children, but are also caring for elderly parents living in their home.

November is National Family Caregivers Month, and this year’s theme is “Take Care To Give Care.” It’s easy to see why: caregiving for two groups can be stressful and difficult. Many men and women stuck in the middle suffer higher levels of stress and stress-related illnesses. According to the Caregiver Action Network, these adults are twice as likely to suffer depression.

Their message: Take care of yourself so you can continue to take care of others! Finding time for just you or for you and your partner is difficult.

Taking Care of Yourself While Caring for Elderly Parents:

  • Schedule a date night with your partner at least once per month. Your date doesn’t have to be a fancy dinner. Even taking a walk together is a nice way to take a break.
  • Schedule time for yourself every week. This time might be your morning yoga or jog. Maybe it’s a hobby you love to do. Put this time on the calendar and make sure everyone knows that time slot is off limits.
  • Don’t be afraid to ask for help. There are services that offer babysitting and elder care, and if you can’t afford those, consider turning to a neighbor or family member. Make a list of a few people you can call just for those times when everything goes wrong.

caring for elderly parentsThe Effect on Children

According to a 2009 National Alliance for Caregiving survey, more than one-third of caregiving families had children under age 18 living at home. The survey also showed that 1.3 million American children participated in caregiving activities. Studies have shown living with grandparents can have a positive effect on both the older and younger generations, but it can also cause stress for both groups.

Here are some tips for helping your children become a positive force in your parents’ lives (and vice versa):

  1. Balance their involvement. You, the parent, must find your own balance in caring for both groups. But as the parent to your children, you must also be watching that your children aren’t overburdened with care responsibilities. Children who take on roles helping care for their grandparents may be taking time away from school work, extracurricular activities, and even playtime. They may feel burdened by this, but afraid to speak up.
  2. Avoid assignments. Taking care of their grandparents isn’t the same as taking out the trash and should not be assigned the same as a household chore. By asking if they want to help, you give your children the option to say no. Praise them if they choose to assist, but avoid making them feel guilty when they don’t.
  3. Find kid-only time. Be sure your children don’t feel neglected as you work to care for your parents. Take time each week to play with your children, take them out, spend time with them alone, away from grandparents.

Questions about caring for elderly parents and children? Generations Family Practice offers comprehensive services so we can help you with everything from checkups and illness to therapy and skincare. Call us today to find out how we can assist you.

Wellness for Generations Newsletter - October 2016

Tuesday, 19 June, 2018
wellness for generations october 2016 newsletter

Fall time is the ideal time to check off "To-do" items like getting your flu shot and checking your fire alarms. Generations can help with this and more in our October newsletter! Click here to read it now.

A small taste of what's inside:

Flu Season: Help Your Kids Get Past the Flu Shot


Flu season is approaching and that means it’s time for both children AND adults to get a flu shot. And this year, it will be a shot — even for children. The Centers for Disease Control and Prevention has recommended against the use of FluMist, the nasal spray version of the flu vaccine, because studies have shown it is not effective.


flu shotShots are often a scary thing for kids, especially since they get so many of them while they are young. Here are some tips for getting through the shot:


  1. Don’t lie. If your child asks, don’t tell them they aren’t getting a shot or that it won’t hurt. This could ruin their trust in you. Explain that shots protect them and it will hurt, but only for a few seconds.

  2. Don’t overhype. If your child doesn’t ask in advance, don’t talk about the shot all week. It may make him anxious and build the incident up in his mind. 

  3. Distract. Check with your doctor about applying an anesthetic cream before the shot. During the shot, hold your child’s hand, make funny faces, or do whatever you can to help him or her get through it.

  4. Comfort. Provide hugs and a comfortable lap to sit in after the shot is done while your child calms theirself. Some doctors don’t recommend pain relievers afterward, but some do, so check with your doctor about using Motrin or Tylenol.

About Our Flu Vaccines

At Generations Family Practice, we have flu vaccine available for ages six months and older.


  • Fluzone is available for children ages 6 month to 35 months of age.

  • Flucelvax Quad is available for ages 4 years and older. Flucelvax is the first FDA-approved flu vaccine made from cells instead of chicken eggs. It is also antibiotic free, preservative-free and latex-free. This vaccine offers the same protection as the traditional egg-based flu dose.

  • For ages 65 and up, we provide a high-dose flu vaccine.

Patients are welcome to walk in for their flu shot as a nurse visit Monday through Saturday during regular business hours. We can also administer the vaccine during a scheduled office visit. For more information, give us a call at 919-852-3999.


What to Do if Someone You Know is the Victim of Domestic Abuse 

Seeing someone you care about get hurt is hard. It’s natural to want to help or to “fix” it. But that’s not always the best approach.


October is Domestic Violence Awareness Month. On average, nearly 20 people per minute are physically abused by an intimate partner in the United States, according to the National Coalition Against Domestic ViolenceOne in four women and one in four men have been victims of some type of physical violence by an intimate partner within their lifetime. In North Carolina, there were 108 domestic violence-related homicides in 2013.


If you’re witnessing domestic violence or suspect a problem, you may want to call the police. But according to the National Domestic Violence Hotline,calling the police may not be the right solution. Instead, try these steps:


  • Be supportive and listen. It’s important to acknowledge they are in a scary situation. Your friend may have trouble talking about the abuse; they need to know someone is available who believes them and will hear what they have to say.

  • No judgement. There are many reasons people stay in abusive relationships. Judgement will not help.

  • Encourage activity. The more support someone feels they have outside the abusive relationship, the more likely he/she is to leave.

  • Encourage him/her to develop a Safety Plan.

  • Encourage him/her to find support and guidance from programs in your area. Offer to go with them to police or support groups. Call the Domestic Violence Hotline at 1-800-799-SAFE (7233) to get more information.

  • More advice for those witnessing domestic violence.

Domestic Violence Resources

InterAct of Wake County is the local organization that helps those suffering domestic violence. Here is a nice list of other Wake County domestic violence groups. Or you learn more about domestic violence and how you can help:


Fire Prevention Week Begins October 9

Tuesday, 19 June, 2018
fire prevention

Half — yes, 50 percent! — of all U.S. home fire deaths occur at night between the hours of 11 p.m. and 7 a.m., when people are most likely to be sleeping. That’s why National Fire Prevention Week October 9-15 is the perfect time to check the smoke alarms in your home.

According to the National Fire Protection Association, a lot of people have misconceptions about their smoke alarms, which can save lives — but only if they work. About 60 percent of home fire deaths occur in homes with no smoke alarms or alarms that don’t work. When smoke alarms fail, missing or dead batteries are usually to blame.

When was the last time you check your smoke alarm? Here are steps you can take to make sure your family is safe:

  • Change the battery on your smoke detector every time we spring forward or fall back for Daylight Saving Time.
  • Smoke alarms should be tested once per month.
  • Smoke alarms should be replaced every 10 years. To find out how old a smoke alarm is, look at the date of manufacture on the back of the alarm; the alarm should be replaced 10 years from that date.

Fire Prevention Resources

Fire Prevention Week is organized by NFPA to commemorate the Great Chicago Fire of 1871. The NFPA has some useful resources on its website for parents and teachers, like the infographic and video below, plus fun quizzes and more!

fire prevention tips


Sparky the Fire Dog® shows how to find out the age of a smoke alarm. Courtesy of the National Fire Protection Association.

Stop Fighting with Your Teenager: Tips & Guidance

Tuesday, 19 June, 2018
stop fighting with your teenager

Shouting, yelling, disagreements — these may all leave you concerned about how to stop fighting with your teenager. it’s all part of the package when your child is no longer a child, but is not yet an adult.

Whether it’s eye rolling, big sighs, the silent treatment, or outright shouting, constant arguing that stems from conflict during this time can turn your happy house upside down. So what can you do?

First, it’s important to note that the teenage years are when we gain abstract reasoning and the ability to consider multiple viewpoints. According to research, the best approach is to take advantage of this, helping your teenager use problem solving to resolve disputes instead of attacking or withdrawing.

It Begins with You

You may want a quick fix when figuring out how to stop fighting with your teenager, but the best tactics require thought and effort.

Guiding our teens in this way is a challenge and in truth, more about how we react to them than what they do to incite the argument. And that’s often the place to start: self-examination. As parents, how we handle our not-yet-adult children can start or stop an argument.

Debbie Pincus, author of The Calm Parent, says you must ignore the gauntlet your children throws down when they refuse to do as you asked.

“If you are going to preserve your integrity at this point and care for your own emotional wellbeing—and be the leader in your family—what would you do next? The answer: Stop participating. At this moment, the best thing to do is state your well thought-out position one more time—and then walk away.”

Stay on Your Teenager's Team

A pause can make a big difference, according to Dr. Marlo Archer, who encourages parents to take advantage of what their teens say as a way to open discussion about serious topics. Pausing and then taking time to listen to what your child is saying underneath his or her comments can help you stop an argument before it starts.

“Your silence instead of an immediate punitive response can allow them to focus on what’s going on in their own head. When you’re yelling at them, they don’t have any room in their head to feel badly about they just behaved.”

Remaining calm is difficult, especially as we watch our children make mistakes. But Pincus argues that sometimes, we must let them, as part of their education and transition toward adulthood. Of course, we need to prevent some mistakes, the ones that affect their health and wellbeing. But by staying on your child’s team, not seeing him or her as the enemy, you’ll have a lot more success in helping them navigate the pitfalls and become a happy and healthy adult.

Stop Fighting with Your Teenager

More questions? Still at a loss for how to stop fighting with your teenager? Give us a call if you are having trouble communicating with your tween or teen.


The Zika Virus and Summer Travel

Tuesday, 19 June, 2018
zika virus and pregnancy

What should you know about the Zika Virus if you are pregnant or planning to become pregnant?

If you are pregnant or trying to become pregnant, a far-off vacation seems like a good idea: a babymoon time when you and your husband can travel together one last time without children. And of course, summer is the perfect time to finally get to that white sand beach and turquoise water.

But news of the Zika virus may have you wondering: is it safe?

It’s a question many are asking, including Olympic athletes on their way to Rio, Brazil. American cyclist Tejay van Garderen dropped out of consideration because his wife is pregnant.

While you may not want to skip your trip, pregnant women and those trying to become pregnant should consider all the facts before traveling to certain parts of the world - and now in some areas of the United States.

Infection and Symptoms

People become infected with the Zika virus through the bite of a mosquito. A man can also pass the virus to his partner during sex. A pregnant woman can pass Zika to her child during pregnancy or delivery.

Zika’s most common symptoms are fever, rash, joint pain, and conjunctivitis (red eyes). Zika rarely requires hospitalization or causes death. In adults, it’s usually a mild illness lasting for several days. Some people may not realize they’ve been infected.


There is a lot not known about Zika at this time. According to the Centers for Disease Control, it is uncertain whether a woman who contracts the Zika virus will give it to her baby, or if she does, whether the child will develop any birth defects.

What we do know is that Brazil has experienced a significant outbreak of Zika virus and since then, more babies have been born with microcephaly. Scientists studying the issue have concluded that there is a link, though other things also cause microcephaly.

Microcephaly is a condition where a baby’s head is much smaller than expected because the baby’s brain has not developed properly during pregnancy or has stopped growing after birth. Babies born with microcephaly may experience several problems after birth including:

  • Seizures
  • Developmental delays
  • Intellectual disability
  • Problems with movement and balance
  • Feeding problems, such as difficulty swallowing
  • Hearing loss
  • Vision problems

Where (Not) to Travel

Summer fun can be found in many places, making it fairly easy to avoid risky areas. If you are concerned, it’s best to avoid the following:

  • Miami, FL (recent out breaks)
  • Commonwealth of Puerto Rico
  • The U.S. Virgin Islands
  • American Samoa
  • Africa
  • Southeast Asia
  • Pacific Islands
  • Brazil

Outbreaks are occurring in many other areas as well, and it’s best to check the CDC’s travel page for the latest information.

Generations Family Practice now offers a lab test for Zika. Please note that not all insurers cover it. Learn more about Zika and pregnancy from the CDC and speak to your Generations’ provider about any concerns you have regarding Zika or other travel risks this summer. 

Why are so many people dying of accidental drug overdoses? The truth behind prescription drug misuse and how to avoid disaster.

Tuesday, 19 June, 2018
drug overdose

Prince’s death has highlighted a problem in America: the risk of drug overdoses. You’ve likely heard many celebrity names during the years — from Elvis and Judy Garland to Heath Ledger and Amy Winehouse.

In fact, you might think of drug abuse as either a celebrity problem or a problem for lower-income people. Instead, death from drug overdoses has increased at an astonishing rate among all socioeconomic levels and ethnic groups in the past few decades. According to the New York Times, “the number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day.”

Many of these overdoses are from opioids, a class of drugs that includes heroin and fentanyl, the medication that led to Prince’s drug overdose. Other examples of opioids are: morphine, methadone, Buprenorphine, hydrocodone, and oxycodone. You might recognize them by their brand names including OxyContin®, Percocet®, Vicodin®, Percodan®, Tylox® and Demerol® among others. The Times reports that opioids were involved in more than 61 percent of deaths from overdoses in 2014.

Often, these drugs are obtained legally. Many people are prescribed opioids for chronic pain. According to an analysis published in the JAMA Internal Medicine, the majority of opioid prescriptions are written by family physicians and general internists.

This year, the Centers for Disease Control (CDC) issued new guidelines about when to prescribe such medications. Right now in the physical therapy community, a hashtag #ChoosePT is working to create awareness about other ways to treat chronic and acute pain without turning to drugs.

“As doctors, our goal is to promote healing and recovery for our patients,” said Dr. Melanie Mintzer of Generations Family Practice. “While this means treating pain, we do not want to cause addiction to narcotics as a side effect, which can create an unnecessary chronic disease for some patients. It is a delicate balance and we are committed to identifying the causes of pain and treating them with multi-modality interventions to prevent addiction or accidental drug overdose.”

As we, the medical community, work to do better, we must also do more to educate those who might misuse these drugs. Those who choose to misuse prescription drugs for recreation may be obtaining them from someone else and may not have been informed of their dangers. There is a stigma associated with drug use that leads many people not to discuss it or try to get more information about it.

Avoiding disaster means attacking the problem on multiple fronts, including:

  • Teaching everyone never to mix opioids with other sedatives.
  • Making it easy to access naloxone, an inexpensive drug that reverses the effects of opiate overdoses.
  • Carefully considering whether stricter drug punishments are truly the solution.

As your doctors, we hope that you’ll come to us with any questions or concerns about prescription drug use for yourself or family members.