October is Mental Health Awareness Month

Tuesday, 23 January, 2018

A healthy body also includes a healthy mind. But those with mental health struggles often face misunderstanding and harsh judgement that may cause them to hide their illness and avoid seeking help. 

As the Mental Health Foundation observes, “by failing to treat people with mental health problems with dignity we make it more difficult to ensure that everyone takes steps to safeguard their wellbeing and to seek help, as it can lead to self-stigma, low confidence, low self-esteem, withdrawal and social isolation.”

Mental health illnesses include a range of illnesses from depression and posttraumatic stress disorder to ADD and schizophrenia. All of these illnesses are not uncommon. In 2013, there were an estimated 43.8 million U.S. adults (18.5%) with some type of mental illness in the past year. According to the CDC, approximately 13 percent of children ages 8 to 15 had a diagnosable mental disorder within the previous year.

World Mental Health Day is October 10, and this year mental health organizations are striving to bring dignity to illnesses often cast in shadow. Generations Family Practice is happy to assist patients in finding the appropriate mental health care. Call us today to get the help you deserve.

Here are some startling facts related to Mental Health in America~


Q&Ped - Conquering lice fast!

Tuesday, 23 January, 2018
Lice removal

As a mother of four school-age children, a notice from the school nurse that lice is in a classroom fills me with angst: the hair treatments, the laundry, the other children! Then the pediatrician side of me calms me down. Lice will not hurt my family. They are annoying bugs and getting rid of them can be a nuisance, but soon they will be a thing of the past.

Why my child?

Lice are tiny insects (2-3mm long) that are very contagious, both through direct head-to-head contact and sometimes indirectly by sharing hats, combs, etc. Because lice are small, they can be hard to find unless you really are looking for them. The most obvious sign of head lice is an itchy scalp, although it can take a few weeks of lice being present before the itching begins.

Now what?

Now that you know someone in your family has lice, let’s treat it. The most common treatment is over-the-counter creams/lotions/shampoos. It is important to use them as directed. Most of the OTC treatments will need to be repeated in about 10 days. If your child still has head lice after two OTC treatments, contact your doctor. There are also prescription medications for lice treatment.

Monitor your other children for signs of head lice.

Perform head checks on your other children and even yourself! Nits (lice eggs) are small white or yellow-brown specks that are firmly attached to the hair within about a 1 cm of the scalp.  They can be distinguished from eczema or dandruff because dandruff and eczema can easily be moved. Examine the hair in small sections at a time, paying particular attention to around the ears and the back of the neck. Consider doing regular lice checks on your children during the school year.


No need to throw away any beloved stuffed animals. Wash your child’s sheets, clothing, hats, stuffed animals — any items worn within the past 3 days — in hot water in the washing machine and dry on the high heat setting to kill any remaining lice. If items cannot be washed, they can be dry cleaned or placed in a sealed bag for two weeks.


Health Musts for Women of Every Age

Tuesday, 23 January, 2018
Womens' health musts

Once upon a time your biggest health concern was acne. But as women age, our health needs change. You probably know that of the most important checkups you get is your annual pap smear, starting as a late teen for most of your adult life.

As you reach your 40s, you hit another milestone: the start of mammograms every two years. According to the American Cancer Society, breast cancer deaths have decreased 34% since 1991, thanks in large part to regular mammogram screenings.

Here is a Quick List of health musts for women of each age group:

  • 20s  - Annual physicals, annual pap smears. Get an HPV vaccine
  • 30s - Check your blood pressure. Hypertension often develops starting in your 30s.
  • 40s - Schedule your first mammogram. Get a Type 2 diabetes screening.
  • 50s - Get screened for colon cancer.
  • 60s - Schedule a bone density test and begin taking calcium. 

See the full list below. Click on the image for larger view.

No matter your age, regular exercise, good nutrition, and plenty of sleep are a large part of staying healthy. Your health routine should include regular dental cleanings, a yearly flu shot, eye exams, and a skin check with a dermatologist. Schedule regular physicals with your Generations Family Practice Doctor so we can help you stay on track for a long, healthy life.



Q&Ped - Tick watch

Tuesday, 23 January, 2018
Tick safety for your family

First, how wonderful it is that your children are outside – getting fresh air and vitamin D, enjoying creative play, and getting exercise. But along with the benefits come annoying bugs and insects: mosquitoes, bees, and ticks to name a few. Unfortunately, some of those ticks can transmit diseases such as Lyme disease and Rocky Mountain Spotted Fever.

Fortunately, finding a tick on your child in North Carolina does not necessarily mean that your child has been infected with any kind of disease. Deer ticks, the ticks that can transmit Lyme disease, need to be embedded on a person’s body for 36 hours before they are actually able to transmit disease. Dog ticks can transmit RMSF only if embedded for more than 24 hours.

Active tick season in our area is from April to September/October. During that time, you can take precautions to prevent a tick-borne disease:

  1. Do daily tick checks. If you are checking your child daily for ticks and remove them, the tick is not embedded long enough to transmit disease.
  2. Use repellant on exposed skin and clothing. Choose one with 20-30% DEET. Be sure to use the product according to the directions and wash it off at the end of the day.

If you find a tick on your child, you do not need to panic. With tweezers, grasp the tick close to your child’s skin and pull up with a slow and even pressure. It is okay if parts of the tick remain behind; the body is able to work it out, much like a splinter. The bite area should be observed for the next 30 days. Watch for a very distinct, expanding red rash that may look like a bull’s-eye. Call your doctor if your child develops flu-like illness or rash. Antibiotics or other treatments may be recommended.

[For more information, check out these Web sites - and]

Are your child's eyes ready for school?

Tuesday, 23 January, 2018
August is Children's Eye Health and Safety Month

It's almost back-to-school time and you're prepared with your child's enrollment forms, orientation schedules, and immunizations--but what about their eyes? August is Children's Eye Health and Safety Month—a great signal for you to get your child's eyes checked before school starts.

Join us as we observe Children's Eye Health and Safety Month in partnership with Prevent Blindness America and the American Academy of Ophthalmologists.

Most children have healthy eyes. But there are conditions that can threaten good vision. Because you can't always "look" into your child's eyes to tell if they have eye health problems, set up some time today for an eye exam:

  • Your child's eyes should be examined during regular pediatric appointments and vision testing should be conducted around age three.
  • Parents should be aware of signs that may indicate their child has vision problems, including:
  1. Wandering or crossed eyes
  2. A family history of childhood vision problems
  3. Disinterest in reading or viewing distant objects
  4. Squinting or turning the head in an unusual manner while watching television
  • Talk to your child's pediatrician if you suspect your child has any of the eye diseases below:
  1. Amblyopia (lazy eye)
  2. Strabismus (crossed eyes)
  3. Ptosis (drooping of the eyelid)
  4. Color deficiency (color blindness)
  5. Refractive errors (nearsightedness, farsightedness and astigmatism)

Let's Talk Eye Safety:

Use this month to discuss the importance of eye safety with your children. More than 12 million children suffer from vision impairment, and eye injuries are one of the leading causes of vision loss in children [Nearly 25 percent of school-aged children have vision problems. Of children ages 3 to 5, close to one in 20 has a problem that could result in permanent vision loss if left untreated. The American Academy of Ophthalmology estimates that 80 percent of preschoolers do not receive vision screenings.] There are an estimated 42,000 sports-related eye injuries each year and the majority of them happen to children.

Children should:

  • Wear protective eyewear while participating in sports or recreational activities
  • Play with are age-appropriate toys. Avoid toys with sharp or protruding parts

One of the best ways to ensure your child keeps his/her good vision throughout life is to set a good health example.

To find more information about Children's Eye Health and Safety, visit: or

[Article taken from]

Navigating coverage, bills and networks

Tuesday, 23 January, 2018
insurance benefits explained

Many of our patients are fortunate to have some form of health insurance. The Affordable Care Act opened the door for many to get health insurance that they previously couldn’t access. Whether you have a marketplace plan through the Affordable Care Act, a private insurance plan or even Medicare, your plan may require that you share the costs of the health care services you receive. Often we are asked questions about insurance coverage. We know it’s a complicated subject that keeps us all on our toes. And, of course it changes every year for most of us. We recently sat down with Generations insurance specialist Shenik R. Pinder, CPC, CPCO, MA to discuss some of the questions she frequently hears from patients.

Why do I have a bill?

The simple answer is that when health insurance only covers part of the cost of a medical procedure or service, the portion not covered by insurance is the patient’s responsibility. The much longer answer involves discussing copayments, deductibles and coinsurance.

Regardless of the type of health insurance you have, coverage levels vary from plan to plan even within the same health insurance company. Coverage amounts are determined and set by the entity that is paying for the plan, such as an employer who is offering a private health insurance plan as a benefit to its employees.

In most situations, a patient will have to pay a copayment at the time of service. This could be $15, $25 or even up to $100, depending on the plan. In addition to the copay amount, a patient might have a plan with a deductible. A deductible is the amount you are responsible for paying before the health plan begins to pay.  For example if the deductible for your specific plan is $1,000, your plan won’t pay for any care until you have paid $1,000 out-of-pocket for covered health care services. Even after your deductible is met, the plan may not cover health care costs completely. Your plan might also require co-insurance, which means the plan covers up to a certain percentage of the cost and the patient is responsible for the rest. Many plans cover up to 80% leaving the patient responsible for the remaining 20%. Some cover up to 70% leaving patients responsible for the remaining 30%. It all depends on how the employer set up the boundaries of the health plan.  Another variable that affects coverage amounts is whether the provider is “in network”. Each plan has a list of approved providers it considers “in network”. These are the providers that agree to the plan’s level of reimbursement for services often solidified in an annual contract. If you receive care from a provider that is “out of network,” your plan will require you to pay a greater share of the cost. This is why you have a bill ~ because your health insurance plan is responsible for certain costs and you are responsible for the rest. We know it can be difficult understanding your financial responsibility so we’ll do our best to help you understand.

Why do I have a separate bill for lab tests?

The providers you see at Generations provide one type of service, a medical lab is a separate entity that provides another type of service. Your health plan may cover lab services at a different coverage level, and not all lab tests are covered. We recommend that you contact your health insurance company to determine which lab tests your plan will cover and how much they will cover. This will help prevent surprises when you open the mail and discover you have a separate bill from the lab company.

Do you take my insurance?

We work with many insurance companies. However, not all insurance companies work with all providers. Even within a large health insurance company, there can be a different health plans within the company that only covers care provided by a specific set of providers. Please check with your insurance company to make sure your provider is in network.

Why are preventive services not 100% covered?

Again, this depends on your health plan. Under the Affordable Care Act, marketplace plans are required to cover certain preventive care at 100% without copays or coinsurance, making it free for you.  But Medicare for example has different policies for covering preventive care. Likewise, private health plans cover different preventive care services at different coverage levels.

Whenever you have questions we recommend that you contact your health insurance company to find out the answers. We are happy to assist you as well.

Cary Doctor named NC's Childhood Immunization Champion

Tuesday, 23 January, 2018

Generations Family Practice of Cary is pleased to announce that pediatrician Christine Macomber, MD, is the 2015 recipient of the Centers for Disease Control’s Childhood Immunization Champion Award for the state of North Carolina. The CDC has chosen National Infant Immunization Week, April 18-25, to announce the award winners.

The CDC Childhood Immunization Champion Award is an annual award that recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization. Each year, up to one CDC Immunization Champion from each of the 50 U.S. states, 8 U.S. Territories and Freely Associated States, and the District of Columbia are honored.

“I am honored to be named the CDC Childhood Immunization Champion Award winner for North Carolina and remain committed to educating parents on the importance of vaccination in our community,” Macomber said. “The importance of childhood immunizations cannot be emphasized enough. In spite of many years of progress, we still must work to increase vaccination rates in order to protect children against disease.“

Dedication to Childhood Immunization 

Her dedication to immunization began when she was a medical pediatric resident at University of Massachusetts Medical Health Center. She cared for a child with significant complications from varicella, also known commonly as Chicken Pox. Dr. Macomber felt that the child’s outcome might have been better if she had received the varicella vaccine. This experience inspired her to dedicate her career to helping reduce unnecessary pain and suffering in children by encouraging parents to vaccinate their children in order to protect against serious, preventable diseases.

Dr. Macomber often engages parents in conversations about vaccination by posting and sharing immunization messages on her social media networks. She provides reading materials for parents and has immunization signage displayed throughout her office. She also takes time to talk with parents about the benefits of vaccination and listen to their concerns, so that she can address them.

The Champion Award recognizes individuals who are working at the local level. It honors those who are doing an exemplary job or going above and beyond to promote childhood immunizations in their communities.

Macomber, a mother of four children, joined Generations in 2013 where she sees pediatric patients. She earned her board certification from the American Board of Pediatrics and is a fellow of the American Academy of Pediatrics. Generations Family Practice offers comprehensive primary medical care, from 'cradle to rocker'--from Well-Baby care to Geriatrics, and everything in between. Generations is located at 110 Preston Executive Dr, Suite 100, in Cary.

[Released - CARY, NC – APRIL 22, 2015]

* Read more about this honor at

Early Diagnosis of Autism Improves Outcomes

Tuesday, 23 January, 2018

April is National Autism Awareness Month. The prevalence of autism had risen to 1 in every 68 births in the United States – nearly twice as great as the 2004 rate of 1 in 125 – and almost 1 in 54 boys. Autism is treatable. Children do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. Skills such as taking a first step, smiling for the first time, and waving "bye bye" are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (crawling, walking, etc.). If a child is 'missing' these milestones, parents need to consider evaluation by their pediatrician.

But how does one know if a child is, or is not, meeting developmental milestones? The following is a Developmental Milestones Quiz developed by the CDC to help. If, after taking this quiz, you have concerns about a child in your life, call our office and arrange a time to speak with our pediatrician. We are here to help!


Top Tips for Medicine Safety in Your Home

Tuesday, 23 January, 2018
medicine safety, children, pediatrics

Top Tips for Medicine Safety in Your Home

Moms, do you keep medicine in your purse? Parents, do you have diaper rash cream within arm’s reach of the changing table? Have you ever shared medicine with a friend, like painkillers? Or missed a dose of a medicine so you took two to make up for it?

It’s instances like these that result in 1.34 million calls to poison centers for children each year. Watch the following video and read the below tips to help keep you and your children from being a statistic:

Top Tips for Parents of Little Kids Ages 5 and Under

  • Put all medicine up and away and out of sight, including your own. Make sure that all medicine and vitamins are stored out of reach and out of sight of children. Consider places where kids get into medicine, like in purses, counters and nightstands.
  • Consider products you might not think about as medicine. Most parents store medicine up and away - or at least the products they consider to be medicine. You may not think about products such as diaper rash remedies, vitamins or eye drops as medicine, but they actually are and need to be stored safely.
  • Use the dosing device that comes with the medicine. Proper dosing is important. Kitchen spoons aren't all the same, and a teaspoon or tablespoon used for cooking won't measure the same amount as the dosing device.
  • Write clear instructions for caregivers about your child’s medicine. When other caregivers are giving your child medicine, write clear instructions about what medicine to give, when to give it and how much to give.

Top Tips for Parents of Big Kids Ages 6 to 10

  • Teach your child that medicine should always be given by an adult. It’s important for kids to know that they should not take medicine on their own. Parents and caregivers can help make sure they are taking it correctly.
  • Don’t refer to medicine as candy. While saying medicine is candy may make it easier to get your child to take medicine, it may encourage them to try it on their own.
  • Take the time to read the drug facts or prescription label with your child, even for over-the-counter (OTC) medicine. As your kids get older, it’s important to teach them how to read and understand the label before taking medicine.
  • Model responsible medication behavior. What kids see us doing is a much stronger message than what we tell them to do. Make sure to store medicine out of the reach of children, read drug facts and prescription labels before taking medicine and follow the recommended dose.

Top Tips for Parents of Pre-Teens and Teens 11 and Up

  • Educate pre-teens and teens on how to read an over-the-counter drug facts or prescription label. Take the time to teach your child about each section of a drug facts label and its purpose. For a great resource on this topic, visit:
  • Communicate to pre-teens and teens the importance of only taking medicine that is meant for them. Taking medicine that belongs to someone else or misusing medicines (even OTCs) can cause harm.
  • Teach pre-teens and teens that medicine labels are rules, not guidelines. Be sure they knows that taking more than the recommended dose will not help them get relief any faster, and it could hurt them.
  • Check in with then and talk about medicine they are taking regularly. Even pre-teens and teens who need to take medicine daily may make errors in dose or dosing frequency, so it is important to communicate with them regularly about taking medicine responsibly.

Top Tip for Everyone

  • Save the toll-free Poison Help line number in your home and cell phones: 1-800-222-1222. You can also put the number on your refrigerator or another place in your home where babysitters and caregivers can see it. And remember, the Poison Help line is not just for emergencies, you can call with questions about how to take or give medicine and concerns about other potential dangers, including reactions to plants and mushrooms, bites and stings, chemicals, carbon monoxide, pesticides, and more.


[Courtesy of Safe Kids Worldwide.]

Menopause and your health

Tuesday, 23 January, 2018

According to a recent study published in JAMA Internal Medicine, hot flashes, which afflict up to 80% of middle-aged women, can last much longer than just a few years. In fact, they can last as long as 14 years, with a median length of seven years. Learn more about this study by reading the following NY Times article. To learn more about Menopause and Your health, take a look at our infographic below.