What Will your Visit to the Doctor Cost?

What will be your out-of-pocket cost for your next doctor’s appointment? Unlike most other transactions, learning what a health care procedure will cost before you receive treatment is extremely difficult. Providers charge different prices. Health insurance plans vary. Various aspects of health insurance coverage are difficult to understand. And much of the confusion might be intentional to boost corporate profits. Public discussion of these issues often centers on “transparency of health care costs.”


How Health Insurance Coverage Varies

Most of us are aware that the health insurance landscape has changed. Premiums have increased for people insured by their employers and for those who purchase insurance through the Affordable Care Act (ACA) exchanges. In addition, higher deductibles (the amount that an individual must pay out-of-pocket before insurance payment kicks in) and higher co-insurance (the percentage of health care costs for which an insured person is responsible) amounts have shifted more of the financial burden to individuals. This shift has focused our attention on how much or how little our insurance will pay for particular treatments.

Your insurance carrier can inform you about your deductible amount, your co-payment, your co-insurance rate, and specific details about which treatments are covered.

Insurance companies also negotiate varied rates of payment with different providers—what is called a contracted rate. Sometimes the amount paid by insurance companies to clinical providers could vary by several thousand dollars, ranging from $12,000 to $75,000 for joint replacement surgery, or $1,000 to $6,500 for cataract removal. If your deductible or co-insurance amounts were high, you could be faced with large out-of-pocket expenses, depending on which provider performed the service.

Insurance companies typically do NOT publish their contracted rates for clinical providers.

Because of contracted rates, insurance companies often pay substantially less than the full price that a provider would otherwise charge. This is true especially for providers who are listed as “in-network,” that is, who have negotiated specific rates with insurers. If a patient receives treatment from an “out-of-network” clinical provider, however, the amount charged by the provider could rise to a sum close to what uninsured patients would have to pay.

Insurance companies inform their clients about the differences between in-network and out-of-network payments, but charges assessed by out-of-network clinical providers can still be far above what an insurance company will pay.

Medicare and Medicaid establish fixed rates of reimbursement to clinical providers for specific conditions and treatments. Most providers accept these rates, but a small number of providers have opted out of accepting Medicare or Medicaid rates altogether. Further information can be found at the Kaiser Family Foundation website.

Why Providers Charge Different Prices

Clinical providers often add to the confusion by charging different amounts. Reasons for such differences among providers include the type of practice or institutional setting, the geographic location of the provider which might reflect drastic differences in overhead expenses, including the nature of the clinical staff and medical equipment that must be maintained.

Sometimes, providers’ fees differ because of the professional qualifications of clinical staff who actually conduct a procedure. Differences in overhead expenses are often reflected on your bill as a “facility fee.” Most providers will not itemize the details contained in their “facility fee.” These differences go far to explain why services rendered in a hospital’s emergency department or in their own urgent care centers are so much more expensive than when delivered by an independent urgent care clinic.

Because of such disparity among providers, it is always wise to check with more than one to see what they would charge for the procedure that you require. Some providers might be reluctant to give you such information, or they might claim that they cannot foresee what the final charges would be because they cannot predict whether complications might arise. You should therefore be prepared to make a decision based on an estimate of what the charges might be.

What Transparency Means



Confused? You should be! Understanding the ins and outs of insurance coverage and the differences among providers perplexes even health care experts. But some insurers and clinical providers have begun to provide relevant information in simpler form. And some states have started to require greater transparency in health care costs and even to provide tools to help those who need care and help with paying for it. Here is what such transparency should mean:

  • Insurers and providers should provide accurate, relevant price information, including what is and is not covered by insurance.
    • Some insurance carriers—for example, Aetna and UnitedHealthcare—provide online tools to help their members find estimates for hospital costs and medical procedures.
  • You should be able to obtain information about quality of care and patient experience for different providers.
  • Your clinical provider should include considerations of cost when advising you about undergoing certain procedures or treatments. These considerations should include costs of referrals to other providers and procedures not covered by insurance. After all, crushing debt due to unexpected medical expense can be toxic!
  • Do not presume that higher price means better quality of care. For a list of several resources that you can use to check on quality of care, go to the Commonwealth Fund’s Quality Matters Archive.

Ask Questions

Of course, if you are confronting an emergency, there is no time to ask questions. Otherwise, do not be surprised by your health care bill. Take charge. Ask questions. Assume responsibility for your financial as well as physical well-being.

The Healthcare Financial Management Association (HFMA) has prepared a complete and useful guide in plain language for you to learn what questions to ask and how to ask them: “Understanding Healthcare Prices: A Consumer Guide.” Click here to download the guide free of charge (also available in Spanish).

At Kathy’s Urgent Care, we try to be as transparent as possible about pricing, payment policies, and insurance. For more information, check out our Payment Policies and Insurance page, or call us. We’ll be glad to respond to any questions that you have.

6 Myths about Flu Shots

Many people refuse to get a flu shot because they believe one or more misconceptions floating around on the Internet. Don’t let any of these myths keep you from getting a flu shot!

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1. Flu shots don’t work.
While it is true that flu shots do not keep everyone from getting the flu, effectiveness of the vaccine is rated by the CDC at about 60%. The flu is caused by several different viruses, and it is not possible to produce vaccines for all of them. Further, flu viruses mutate or change often and rapidly, compounding the difficulty. Finally, the vaccine becomes effective 2-3 weeks after the flu shot is administered, and some people catch the flu before then.

One other point to remember is that the primary goal of the flu vaccination program is to prevent an epidemic or pandemic, not to prevent every case of the flu. After all, we do not want to repeat the pandemic of 1918 when approximately 500 million people were affected worldwide resulting in deaths of 20-40 million in one year—the greatest natural disaster in world history. Further, even a modest reduction in flu cases helps to lessen the number of deaths among the elderly, chronically ill, and children. Even if you get the flu, perhaps from a different strain of the virus, you will probably endure less severe symptoms after having the shot.

2. Pregnant women should not get a flu shot.
Some have claimed that flu shots cause miscarriages or other health problems for pregnant women. No scientifically valid study supports that claim. In fact, the flu vaccine can protect both the mother and the fetus—a very important point, since children under 6 months should not receive the vaccine after they are born.

3. I should wait until later in the season to get a flu shot.
Many people put off getting a flu shot because they want the vaccine to last for the entire flu season. Research shows, however, that the vaccine is effective up to a year later which is plenty of coverage for a flu season that lasts from fall until May. No one can predict when outbreaks of the flu will begin. That is why medical authorities recommend getting a flu shot as early as mid-September.

4. I don’t need to get a flu shot every year.
Unlike many other vaccines, the one for influenza is changed every year to counter different or mutated strains of the virus. What worked effectively one year might not work as well the next. Scientists are working on developing synthetic vaccines that could be developed into a universal flu vaccine that would protect against all or most strains and could be administered by means of one dose for life. Until they succeed, however, we will need to get a flu shot every year.

5. People who are allergic to eggs should not get a flu shot.
Although the most widely used flu vaccines are manufactured by a process that uses chicken eggs, the amount of material derived from eggs is miniscule. Therefore, the CDC recommends that the vaccine is generally safe for those who exhibit allergic reactions to eggs. Such persons who are allergic to eggs should consult with their health provider before receiving the vaccine.

In addition, processes, such as cell-based and recombinant technology, that do not use chicken eggs at all have been developed and approved. These forms of the flu vaccine have been approved for use under the name Flublok® and can be administered to adults 18 years of age and older.

6. A flu shot can give you the flu.
No, a flu shot cannot give you the flu. That’s because all forms of the vaccine contain inactive forms of the flu virus.

Because the vaccine is not fully effective for 2-3 weeks, however, some people might get the flu shortly after receiving the shot. That experience probably reinforces this particular myth.

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Bottom line: Get a flu shot this year!

For more information about flu shots, check out my previous post, Get Your Flu Shot Now! If you have questions, call us at Kathy’s Urgent Care.

Athoured by Dr. Tom Brown.

Get Your Flu Shot Now!

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Intro – Get a Flu Shot!

Flu season looms! Get your flu shot before the end of October to protect yourself and others throughout the season that can last until next May. If you don’t have time to read the rest of this blog post, STOP READING! Just go get your flu shot. Kathy’s Urgent Care in Wethersfield and Rocky Hill, CT. No appointment necessary.

Who Should Get a Flu Shot?

According to the Centers for Disease Control and Prevention (CDC), everyone over the age of 6 months should get a flu shot.

·      Pregnant women are especially at risk and should be vaccinated. The flu vaccine also protects their unborn fetus from the flu—an especially important consideration, since children younger than 6 months should not receive a flu shot.

o   The American Congress of Obstetricians and Gynecologists (ACOG) stated in September, “Influenza vaccination is an essential element of prenatal care because pregnant women are at an increased risk of serious illness and mortality due to influenza. In addition, maternal vaccination is the most effective strategy to protect newborns because the vaccine is not approved for use in infants younger than six months.”

·      Children from 6 months to 18 years of age should get a flu shot. Children who receive their first vaccination will require two shots, 28 days apart. The CDC recommends against receiving a nasal spray vaccination.

·      Persons 65 years of age and older usually have weaker immune systems and should get a high-dose shot that protects against 4 strains of flu virus. They should also get a pneumococcal vaccination to protect against serious strains of pneumonia, since the elderly account for 85% of deaths due to flu and complications from pneumonia.

·      Anyone with a compromised immune system is especially at risk for the flu and should be vaccinated.

Note: Persons who are allergic to any component of the vaccine (for example, eggs), who had a severe allergic reaction to the vaccine in the past, who have had Guillain-Barré Syndrome (also called GBS), or who are not feeling well should discuss with their health provider whether they should receive the flu vaccine or what type of vaccine might be appropriate for them.

When Should You Get a Flu Shot?

For the 2017-18 flu season, the answer is simple: NOW! It is impossible to predict just when a flu epidemic will begin, but there will be one and it is likely to be severe. The vaccine takes 2-3 weeks to become effective. Therefore, the CDC recommends getting your flu shot before the end of October.

What Kind of Flu Shot Should You Get?

There are different types of flu vaccines that have been approved by the FDA for general use. To keep things simple, you should be aware of two main alternatives:

·      Most children and adults can get a trivalent shot—one that protects against three major flu viruses.

·      Persons 65 and older should get a high-dose, quadrivalent shot—one that protects against an additional flu virus strain and in a higher dose because of their declining immune system.

For more complete answers to this question, please consult the “Frequently Asked Questions” page on the CDC website.

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What Are the Side Effects of a Flu Shot?

You cannot get the flu from the flu vaccine. Some people, however, might experience mild side effects that include soreness, redness, or swelling at the injection site. About 1-2% of those receiving a flu shot will experience a low-grade fever.

Rarely, more serious side effects result from an allergic reaction to one of the ingredients in the vaccine. Symptoms can include difficulty breathing, swelling around the eyes or lips, hives, racing heart, dizziness and high fever. If you develop any of these symptoms, seek medical attention.

Remember, you cannot get the flu from a flu shot. Because the vaccine takes 2-3 weeks to become effective, however, you can get the flu after you have had a flu shot. Further, since the vaccine is not effective against all strains of the flu, you can still get the flu from a strain against which you are not immunized. In those cases, your experience of the flu will probably be milder.

More about other questions will appear in a later post. If you have concerns about yourself or a family member getting a flu shot, call us at Kathy’s Urgent Care. We’re here to help.

Authored by Dr. Tom Brown

6 Ways to Cope with Fall Seasonal Allergies


Along with colorful autumn leaves, fall brings sneezes and runny eyes to many of us. For some, fall allergies are more bothersome than spring allergies. The primary culprits causing fall allergies are pollen, molds, and dust mites. But don’t just suffer! There are steps you can take to minimize allergic reactions.

What Causes Fall Allergies

Ragweed pollen causes more allergic reactions than anything else during fall months. (These reactions are often called “hay fever” despite their having nothing to do with hay and do not cause a fever.) If you are allergic to pollen during the spring, you have about a 75% chance of also reacting to ragweed. During warm days and cool nights in August through October, wind scatters the pollen nearly everywhere in North America. Pollen levels peak around midday and especially during warm, dry weather. Although rain removes the pollen from the air, dry winds can spread it for hundreds of miles.

Inhaling ragweed pollen can result in allergic rhinitis—a condition that produces runny nose and eyes and causes sneezing. Some symptoms resemble those of a cold. The pollen can also be ingested when certain foods are eaten raw. Bananas, melons, cucumbers, zucchini, beans, celery, and some fruits often carry ragweed pollen. Cooking usually removes the problem, but not always. Orally ingested pollen can result in swollen mouth and throats as well as, rarely, vomiting, diarrhea, or even anaphylactic shock.

Molds are another major trigger of fall allergies. Most of us are aware that molds grow in warm, damp places in our homes. But during the fall, those piles of autumn leaves that kids like to jump in are usually filled with mold spores. The spores can be kicked up by autumn winds or by raking. Even walking through the woods or a park where leaves have fallen can expose you to mold spores. Symptoms resemble those caused by ragweed and can sometimes be severe.

Dust mites present a third fall allergy trigger. They are too small to see without a microscope and are difficult to control. Although they live and are active year-round, turning on our heating systems in the fall forces dust and the residue from the mites into the air. Since dust mites feed on the dead scales of human skin, we encounter them most often in bedding, carpeting, and upholstered furniture. Symptoms, again, resemble those produced by ragweed.

Allergy or Cold?

Many of us have trouble determining whether we’re suffering from a cold or an allergic reaction, especially since some of the symptoms are similar. Remember, though, that allergies are caused by allergens—substances that trigger an autoimmune response in our bodies—while colds are caused by viruses. The following chart can help you distinguish them.

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What You Can Do

To prevent allergic reactions and to treat symptoms, try the following:

1.     Reduce exposure to ragweed and other pollens. If possible, keep windows closed and remain indoors. Use air conditioning to filter the air and change or clean filters monthly. Be especially careful on dry, windy days.

2.     If you are allergic to molds, avoid raking leaves. If you must rake or blow leaves, wear a NIOSH-rated N95mask. Also avoid walking in the woods or other places where leaves have fallen.

3.     Control the presence of dust mites.

a.     Encase your mattress and pillows in allergen-proof covers (available online and in many bedding or department stores).

b.     Wash all bedding weekly in hot (at least 130ºF) water and dry on high heat.

c.     Replace wall-to-wall carpeting with non-fabric flooring.

d.     Remove as much upholstered furniture as possible.

e.     Vacuum with double-layered microfilter bag or HEPA filter installed.

f.      Use damp mop or rag to remove dust (dry rags merely stir up allergens).

4.     Rinsing or irrigating nasal passages can offer temporary relief from nasal congestion and other symptoms. NeilMed™ offers a wide variety of types for children and adults. (Tip: when using nasal washes, be sure to use only distilled water, warmed, to which saline-solution ingredients have been added. Otherwise, the rinse will cause pain.)

5.     To ease symptoms, consider the following medications.

a.     Antihistamines (available in pills, liquids, or nasal sprays; Benadryl™, Zyrtec™, Allegra™) to reduce runny nose, nasal congestion, and sneezing.

b.     Nasal corticosteroids (Flonase™, Nasonex™) for reducing all symptoms and blocking allergic reactions. Best if begun before symptoms emerge. May have side effects.

c.     Leukotriene receptor antagonists (Monteleukast™) useful in treating asthma and blocking effects of allergens.

d.     Decongestants (in spray, pills, or liquids) for relieving nasal stuffiness; can have unwanted side effects for persons with high blood pressure and might cause drowsiness.

6.     In instances of severe or chronic allergic reaction, it might be necessary to receive allergy shots (subcutaneous immunotherapy, or SCIT). This should be handled by a physician or allergist who can conduct appropriate testing to identify the specific allergen that is causing the reaction.

Note: It is wise to consult a health care provider when using any medication.

Remember also that children returning to school in the fall often encounter high levels of allergens. School buildings that have been unused during summer months are usually filled with dust and mites—major allergy triggers. Be sure to monitor your children’s health during these months.

Managing fall allergies can be tricky. At Kathy’s Urgent Care, we can help. We’ll diagnose your situation, offer tips for controlling exposure to allergens, and prescribe the correct medications to help relieve your symptoms. Remember: No appointment is needed! Just walk in, 7 days a week, and we’ll help you feel better.

Authored by Dr. Tom Brown

Don't Eat the Potato Salad


Don’t eat the potato salad . . . unless you know it’s safe! The end of summer, Labor Day outings, final days at the beach—all occasions for cookouts, picnics, and beach parties with family and friends. Unfortunately, they are also occasions for getting a stomach bug from improperly handled or stored food.

To keep yourself and others from getting sick, take a few moments to review what causes “food poisoning” and some food safety tips.

Foodborne Illnesses

The following organisms commonly cause foodborne illness or “food poisoning”:

  • Norovirus. Many persons have never heard of this virus, but it affects over 5 million people per year. It leads to inflamed stomach and intestines and results in stomach pain, nausea, vomiting, and diarrhea. Proper hygiene after using the toilet or changing diapers and safe food handling will prevent most infections.
  • Salmonella. This bacterial infection causes abdominal cramps, diarrhea, and fever, usually within 12-72 hours. Most people recover without medical treatment, but sometimes severe diarrhea requires treatment or hospitalization. If the infection spreads, it can cause death. Very young, elderly, and immune-compromised persons are most at risk for severe infection.
  • Clostridium perfringrens. This bacterium causes about 1 million infections per year. Diarrhea occurs 6-24 hours after infection, but usually without vomiting or fever. Symptoms last about 24 hours, and most people recover without medical treatment. Very young or elderly persons can experience more severe symptoms that require treatment.
  • Campylobacter. This bacterium causes diarrhea (sometimes bloody), abdominal cramping, and fever 2-5 days after exposure. Symptoms last 1-2 weeks. If infection spreads to the bloodstream, usually in immune-compromised persons, it can become life-threatening.
  • Staphylococcal aureus. The staphylococcal bacterium produces toxins that cause vomiting, nausea, abdominal cramping, and diarrhea within 30 minutes to 6 hours of exposure. Since the toxins are resistant to heat and salt, they can survive cooking. Infections typically occur in foods that people handle but do not cook (sliced meat, puddings, pastries, and sandwiches). Contaminated food does not smell or look spoiled.
  • Escherichia coli (E. coli). Most E. coli bacteria are harmless or even beneficial, but some cause diarrhea (sometimes bloody), abdominal cramping, vomiting, urinary tract and other infections. While most infected persons get better in 5-7 days, some strains of E. coli cause a life-threatening condition that requires medical attention. If you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine, go to an urgent care clinic or other health care provider.
  • Listeria monocytogenes. This bacterium causes a serious infection, Listeriosis, that is especially dangerous for pregnant women and persons over 65. Although there are only about 1,600 cases per year, the mortality rate for those infected is about 16%. Foods most at risk for contamination include unpasteurized dairy products (especially soft cheeses), raw sprouts, and melons. Persons at high risk should probably avoid these foods.

Most of the time, foodborne illnesses will not require medical attention. But young children, elderly persons, and anyone whose immune system is compromised can develop more severe infections and symptoms that can become life-threatening.

Basic Food Safety


Clean, Separate, Cook, Chill. This should be the mantra of every person who handles, prepares, and cooks food. Heed these four rules and you will eliminate nearly all foodborne illnesses from your life. It’s really that simple.

Still, a few specific tips will make safe food handling easier and more effective.

Potato Salad, Eggs, and Dairy

While potato salad serves as a primary example, other salads that include mayonnaise, eggs, and dairy products need special attention.

  • Keep prepared salads cold—that means 40ºF or cooler—in the refrigerator or ice chest until they are served.
  • No more than 2 hours (1 hour if surrounding temperature is 90º or higher) after serving, these foods should be chilled again. Remember, many bacteria thrive in warm, moist environments.
  • Even better, place serving dishes or pans for these foods on a bed of ice while they sit out.
  • If these dishes sit out more than 1 or 2 hours (see above), throw the food out! Better safe than sorry!
  • Rinse all produce under running tap water before using or packing it in a cooler.

Chicken, Beef, Pork, and Seafood

Favorites for outside grilling, raw meats require special handling.

  • Use separate cutting boards for animal products only, and wash these surfaces often with warm, soapy water.
  • When handling raw meats, wear disposable, vinyl gloves that you discard before touching other surfaces, utensils, or food.
  • If gloves are not available, wash your hands thoroughly (at least 20 seconds) before and after handling raw meat.
  • Marinate meats safely in the refrigerator. If you want to use some of the marinade as a sauce, reserve a portion ahead of time and separate from raw meat. Never reuse marinade that has been in contact with raw meat.
  • Cook food thoroughly (see chart), and use a meat thermometer to check (you can’t always tell by looking).
  • Keep cooked meats hot while serving. As with cold foods, do not let cooked meats sit out more than 1-2 hours.
  • Never use platters, dishes, or utensils that have touched raw meats to serve food after cooking unless such items have been thoroughly washed. Not heeding this rule is a major cause of cross-contamination and illness.

Cleanliness and Storage

Keeping yourself, dishes, utensils, and preparation surfaces clean, while storing food properly, will prevent most foodborne illness.

  • Wash your hands for at least 20 seconds in warm, soapy water and before, during, and after handling food. Handwashing after handling raw meat, but before touching other food, utensils, or surfaces, is especially important.
  • Similarly, clean food preparation surfaces—countertops, cutting boards, refrigerator shelves—often. Be especially careful to avoid cross-contamination from raw meats on such surfaces.
  • A consensus seems to be building to avoid antibacterial soaps. There is little evidence that they help prevent bacterial infection, and some evidence that they might contribute to antibacterial resistance.
  • Use separate cutting boards and other surfaces to prepare raw meats and keep them separated from surfaces on which fruits and vegetables are prepared.
  • Consider using disposable paper towels for cleaning food preparation surfaces instead of sponges that can harbor nasty bacteria. If you use sponges, keep them as clean as possible and toss them in the trash often.
  • Also consider using disposable vinyl gloves for handling raw meat. Toss them in the trash before touching other utensils, surfaces, or food.
  • Store raw meats in leak-proof containers and separate from vegetables and fruits.
  • Store fruits, vegetables, meats, eggs, and dairy products properly, usually at 40ºF or lower. (Yes, eggs in the U.S. should be refrigerated.)
  • Do not thaw meat on the counter. Meat should be thawed in the refrigerator or, more quickly, in a microwave oven (follow instructions). If left on the counter to thaw, raw meat quickly becomes a site for bacterial growth.

Be safe this Labor Day and on other occasions when you cook out! Your family will thank you for being fussy about food safety. If, despite your best precautions, you or others become ill, monitor the symptoms. If diarrhea is severe and long-lasting or if vomiting prevents ingestion of fluids, seek medical attention.

And remember, we at Kathy’s Urgent Care are here to help. If you live or work near one of our two convenient locations, just walk in. We’re open 7 days and evenings every week.

Authored by Dr. Brown. 

About Those Sports Physicals


If you are a parent of a student who wants to play or try out for school sports, you need to be aware of required health screenings and physical examinations. Most schools require all participants or would-be participants in any form of sports activity to submit the results of a pre-participation physical examination. This must be done every year.

The State of Connecticut is no exception. The Connecticut Interscholastic Athletic Conference (CIAC) requires completion of their Pre-Participation Physical Evaluation form by the student, his or her parent(s)/guardian, and a licensed physician.

The Pre-Participation Physical Evaluation

The physical evaluation consists of four major parts.


The student, with the help of his or her parent(s)/guardian, should complete this section prior to taking the form to a physician. Questions focus on the following general areas:

  • General health history
  • Heart health questions about the student and family
  • Bone and joint questions
  • Specific medical questions

If any question is answered “Yes,” an explanation must be provided on the form or a separate sheet. Circle any question that you cannot answer so that you can discuss it with the physician.

Supplemental History for Athlete with Special Needs

This section provides an opportunity to identify any disabilities, visual or hearing impairment, allergies, use of special equipment, etc. There is also a section that allows identification of any past physical or medical difficulties.

Physical Examination Form

This section is completed only by the examining physician. It addresses the following areas:

  • Questions about mental and physical well being
  • Use of tobacco, alcohol, and drugs
  • Medical examination of vital signs, musculoskeletal condition, and general fitness

The bottom of the form asks the physician to clear the student for all sports without restriction or without restriction but with recommendation for further evaluation or treatment. The physician may also withhold clearance for all sports, some sports, or in order to evaluate further.

The original copy of this form is retained in the physician’s office and can be amended at any time.

Clearance Form

The clearance form summarizes the conclusions of the physician regarding whether the student is cleared for all, some, or no sports activity. There is also a section to identify allergies and other emergency information.

Important Reminder: Submitting a Pre-Participation Physical Evaluation form for sports activity does not fulfill the requirement of submitting a regular Health Assessment Record as required by your school. Be sure to check with your school for specific policies.

Having a Pre-Participation Exam

Many families ask their regular physician or pediatrician to complete this examination. During the crush of back-to-school activities each year, obtaining an appointment in time is often not possible. In that case, or if you do not have a regular health care provider, go to an urgent care center.

When you go for your exam, please observe the following steps:

  • Download, print, and fill out your portion of the Pre-Participation Physical Evaluation form.
  • Reserve an examination time at the clinic if possible.
  • Bring your completed form with you.
  • Bring your student’s health insurance information and ID.

If you live near one of our clinics in Wethersfield or Rocky Hill, CT, come to Kathy’s Urgent Care. We perform many of these examinations every year, and we can help you with any questions that you might have. We also treat minor sports injuries.

Authored by Dr. Tom Brown

Our clinics are open 7 days a week. Just call to reserve a time or walk in at your convenience. Our contact information is available on our website at www.kathysurgentcare.com.

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Back-to-School Physical Exams and Immunizations Are Due!

If you are a parent of pre-school or school-age children, you’re probably in back-to-school mode right now. But do you realize that your kids’ most important exam occurs before they start school? I’m talking about their physical exams and immunizations. Without having the up-to-date records on file with your school district, your kids might be kept from enrolling.

School Health Requirements

As a public health measure, most states require all school children (including day care and pre-school) to submit a record of having had a physical evaluation and up-to-date immunizations. Connecticut, for example, requires all students to submit health and immunization records to their school district or program before they are permitted to enroll. In addition, Connecticut requires additional physical exams and updated immunizations before students begin the 6th or 7th grades and again before the 9th or 10th grades, depending on school district policy.

Connecticut also requires that the physical examination and immunization record be signed by a licensed physician (MD), doctor of osteopathy (DO), Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA).

Public health concerns are very important. Health screenings in Connecticut include:

  • Physical characteristics and vital signs: height, weight, body mass index, pulse, blood pressure
  • Vision evaluation with and without glasses
  • Hearing evaluation
  • Hemoglobin levels and ratio
  • Speech facility
  • Tuberculosis screening
  • Asthma
  • Allergies, including risk of anaphylaxis (e.g., whether Epi Pen is required)
  • Diabetes (Type 1 or 2)
  • Seizures

Immunizations required in Connecticut include:

  • DTP/DTaP (diphtheria, tetanus and acellular pertussis [whooping cough]) OR
  • Tdap (diphtheria, tetanus and acellular pertussis [whooping cough], required for 7th grade entry)
  • IPV/OPV (polio)
  • MMR (measles, mumps and rubella; required K-12th grade)
  • HIB (Haemophilus influenzae type b)
  • Hep A (Hepatitis A; pre-K and K)Hep B (Hepatitis B; required pre-K-12th grade)
  • Varicella (chickenpox; 2 doses required for K and 7th grade)
  • PCV (pneumococcal polysaccharide vaccine; required for pre-K and K)
  • Meningococcal (meningitis; required for 7th grade entry)
  • HPV (human papillomavirus)
  • Flu (influenza; required for pre-K 24-59 months old; given annually)


Exemptions from immunization requirements may be granted for two reasons:

1.     Under some circumstances, a medical exemption for specific vaccines might be indicated. Such an exemption requires submission of the appropriate form that is accompanied by a letter signed by a licensed physician.

2.     An exemption may be granted for religious reasons. To claim such an exemption, the appropriate form must be filed before a student enrolls in a public or non-public school for the first time and before entering 7th grade.

Students who are granted either exemption might be excluded from school (1) until the public health official determines that a disease outbreak danger has ended, (2) until the student has completely recovered from a disease, (3) until the student has been vaccinated, or (4) the student furnishes proof of immunity to the disease.

Meeting the Requirements Easily

After reviewing the requirements, you might worry that you can’t have your child’s physical exam and immunizations completed before school starts. You’re not alone!

Many people find it cumbersome and sometimes impossible to arrange an appointment with their usual physician or pediatrician for this purpose. If you find yourself pressed for time, go to an urgent care center for the required physical exam and vaccinations. When you do, observe the following steps:

  • Download, print, and fill out Part I of the appropriate form, one for each child.
  • Reserve an examination time at the clinic if possible.
  • Bring your health assessment form(s) with you.
  • Collect and bring all immunization records for each child.
  • Bring your child’s health insurance information and ID.

As a precaution, be sure to contact the health office of your child’s school or in the district office to see if they have specific forms for you to use or school-mandated procedures to follow.

If you live near one of our locations in Wethersfield or Rocky Hill, come to Kathy’s Urgent Care. You can call to reserve a time or just walk in. We are open 7 days a week.

For information about how to contact us, visit our website at www.kathysurgentcare.com.

Authored by Dr. Tom Brown

Drink More . . . Water?

Thirsty yet? That’s your body sending you a message. Summer means outdoor fun, construction work, heat, thirst, and . . . dehydration. Most of us are more aware during the summer of the need to maintain body fluids, but we can still get into trouble without noticing. First, a word about the benefits of proper hydration and then some suggestions on how to cope.

Our Bodies and Water

Water comprises approximately 60% of our total body weight (within a range of 45-75%) and is vital for proper functioning of all bodily organs and tissues. Some of the more important benefits include

·      Cushioning our joints and keeping them lubricated

·      Maintaining body temperature within tolerable limits

·      Eliminating waste through urine, bowel movements, and sweat

·      Improving kidney function

·      Preventing constipation

·      Maintaining healthy skin

·      Improving energy level and mental functioning

To obtain these and other benefits, we must maintain a proper balance between total fluid intake from all sources and fluid outflow through urination, sweating, breathing, bowel movements, metabolic processes, and evaporation. If fluid intake does not keep up with outflow to a serious degree, dehydration occurs which can result in mental confusion, muscular weakness, overheating, seizure, coma, and death—depending on severity.

Remember that we acquire water for our bodies from several sources, including fluids that we drink as well as fruits and vegetables that we eat. That means that the common advice for adults to drink eight 8-ounce glasses of water a day need not be rigidly followed. In fact, there is no clear scientific evidence to support such advice.

The trick is to consume a sufficient amount of fluids from all sources to offset the elimination of fluids. Obviously, maintaining that balance and avoiding dehydration depends on several factors: the external temperature of our environment, the intensity and duration of exercise, our general state of health (meaning an absence of fever, diarrhea, urinary tract infection, etc.), and the type of fluids that we consume.

Warning: It is possible to drink too much water under certain conditions. Doing so can lead to severe consequences. Athletes and others who engage in intense, prolonged exercise can create a situation of dangerously low sodium and electrolytes by drinking too much plain water too quickly. Such a deficiency causes a condition called hyponatremia. This condition causes headache, fatigue, nausea, vomiting, frequent urination, mental confusion, and several known cases of death. To prevent hyponatremia, persons who exercise intensely for a long time should drink a beverage such as Gatorade™ or Powerade™ that replaces sodium and electrolytes. Moreover, if too much fluid is consumed too quickly, the body’s cells become overloaded with water—a particularly dangerous situation when neurons in the brain swell where there is no room. (For a good discussion of hyponatremia, see “Strange but True: Drinking Too Much Water Can Kill” in Scientific American.)


What to Drink?


The best answer to that question is water. Under most conditions (see warning about hyponatremia above), water is the most efficient beverage for maintaining hydration without unwanted or unhealthy side effects. Even with water, however, there are some things to bear in mind.


While most municipal water is safe to drink, current water treatment systems are not designed to remove all impurities or contaminants. If your home is supplied by a municipal or regional water system, check the annual quality report for a list of what is or is not removed during the treatment process. As in the case of Flint, Michigan, and other cities, even lead has remained in the water supply at harmful levels. Municipal water treatment sometimes adds a large amount of chlorine, which some people find objectionable.

If you live in a rural or suburban area where you obtain your water from a ground well, you need to be especially careful about making sure that harmful contaminants are not present. Nearby industrial pollution, farm runoff, and shallow water tables can pose significant hazards. Get your well water tested regularly.

For these reasons, many people have turned to filtered or bottled water for drinking and cooking. Most bottled water is safe, but some have estimated that 40% of bottled waters are simply packaged tap water. Further, the FDA regulates bottled water as a food, but it lacks the monitoring capacity of the EPA to check on public water systems. Always check to see if your bottled water is filtered. Many bottled waters also contain artificial sweeteners or other ingredients to enhance taste. If you prefer a flavored water, try adding your own squirt of lemon or lime juice.

Water filtration systems come in many sizes and formats. No single system will remove all contaminants, and all need to be maintained so that contaminants don’t build up in the system. Usually reverse-osmosis filters, when combined with carbon filters, will remove heavy metals (arsenic, lead, mercury), bacterial contaminants, and residue from pesticides most effectively. But prices and effectiveness of different types can vary widely. Check the Environmental Working Group’s buying guide for additional information on water filters.


Although clean, safe water is best for staying hydrated, many of us prefer a little variety in what we drink. So what about the other alternatives?

Fruit Juice.

Always a favorite with kids, fruit juice can be a welcome alternative. Many commercial fruit juices are fortified with extra vitamins and some minerals. But most popular fruit juices—orange, apple, cranberry—contain high concentrations of sugar, either naturally or, in many cases, added. High amounts of sugar in any form are harmful for both children and adults, leading to various chronic conditions such as type-2 diabetes. Therefore, monitor consumption of fruit juices closely for sugar content, and drink them in moderation, not as a routine alternative to water.


By the way, commercial vegetable juices often contain high concentrations of sodium that can also be harmful. Read labels!


Tea and coffee are popular alternatives to water around the world. Most are available in caffeinated and decaffeinated forms. While there is some controversy over whether caffeine is beneficial, most studies show that there are some benefits to moderate consumption of caffeine—say, the amount found in about 1-3 cups of coffee or tea per day. Some people, however, cannot tolerate caffeine, even the minute amounts remaining in decaffeinated coffee or tea. Many herbal teas naturally contain no caffeine and, therefore, offer a pleasant alternative to plain water.


When considering variations on coffee or tea, such as those containing cream or sugar, remember that you are adding calories and sugar to your daily intake. Be careful!


Commercially available smoothies are delicious! Especially on a hot day, they can be very refreshing. But remember that they nearly always come loaded with sugar from both the fruit juices (see above) and the ice cream in them. You’re always better off preparing your own smoothies at home where you can control exactly what goes into them.


Vegetable smoothies made at home are a good alternative, but don’t overdue the sodium or sugar for them.


Americans consume billions of dollars’ worth of soda every year, and it is disastrous for their health. Soda is the largest contributor of sugar to the American diet, and that amount of sugar is creating an epidemic of obesity and related health problems from heart disease to diabetes. We are paying a very steep price in terms of poor health and money for our addiction to sugar.

Artificially sweetened soda does not help. The long-term effects of many artificial sweeteners have not yet been determined. Moreover, it now appears that they alter brain chemistry in a way that causes the body to crave additional intake of calories to match the sensation usually caused by sugar. In other words, artificially sweetened soda causes people to eat more and thereby leads to increased obesity.

Bottom line: if soda is your main beverage of choice, try to cut back or eliminate it altogether. This recommendation is especially important for children’s health as well.


A cold beer on a hot day, a glass of wine with dinner, or a cocktail at the end of the day can be very appealing. For most people and taken in moderation, alcoholic beverages can be a pleasant diversion. Some studies claim that a glass of red wine or a cocktail can carry some health benefits. But alcohol also introduces some genuine risks:

·      Mental or physical impairment, even when consumed in moderation

·      Addiction (alcoholism)

·      Ill effects on specific organs such as the liver

·      Unwanted increase in sugar intake (all alcohol converts to sugar)

·      Mild increase in dehydration due to increased elimination of fluids from the body

Such risks make alcoholic drinks a poor alternative to other beverages, especially in order to maintain hydration.

A Word about Containers

Most people are now aware that they should avoid plastic bottles that contain BPA (bisphenol A). Many countries now ban BPA, and manufacturers increasingly avoid using it. Do not purchase plastic bottles that do not contain a BPA-free label. Other chemicals used in the production of plastics such as PET (polyethylene terephthalate) might also be harmful by imitating the effects of estrogen.

While you should avoid plastics containing these compounds, you must also avoid reusing most plastic bottles. The reason is that reuse increases the likelihood of leaching harmful chemicals into whatever liquid the bottle contains. Rule: use your plastic beverage bottle once and then recycle it.


The safest beverage containers are made of glass or stainless steel. Glass is inert and is safe for nearly any beverage. Stainless steel, especially “food-grade” stainless steel, is also safe. In the case of stainless steel water bottles, however, be sure that any lining is glass, not plastic.


Maintaining proper hydration is vital for your mental and physical well-being. If you are thirsty, pay attention and drink something.

Dehydration, on the other hand, can be debilitating and even dangerous. If you or someone else becomes dehydrated, be sure to provide water for them to drink slowly over a period of time. If you or they have been exercising intensely, do not drink large quantities of plain water. In those instances, drink a beverage that will help restore electrolytes and sodium.

If someone becomes severely dehydrated so that they become confused, have severe headache, develop a fever, or lose consciousness, take them to an urgent care center. Under such conditions, intravenous administration of fluids might be necessary, and they should be carefully monitored. At Kathy’s Urgent Care, we’re ready to help.

Authored by Dr. Tom Brown

Keep Your Kids Safe for a Fun Summer!

We all want our kids to have a fun summer. And most of the time they do without much help from us. Some of your happiest times were probably spent outdoors with your childhood friends. Your children are no different. They love to go to the beach, play at the park, swim in the pool, jump on the trampoline, camp out with relatives, hike in the woods, and so forth. Such activities help them develop physically and emotionally.

But as parents, we need to prevent injuries that can turn a fun summer into a painful time or even a life-altering tragedy. Here are 6 ways to help your kids have an enjoyable summer season.

1.     Prevent Sunburn

These days, you’re probably aware of the hazards of too much sun exposure, especially for infants and children. But it never hurts to be reminded of a few tips to prevent painful sunburn or worse.

  • Keep children out of direct sunlight or cover them completely between 10:00am and 4:00pm when UV rays are strongest. Infants under 6 months of age should avoid all sun exposure.
  • If children play outside during midday, apply a sunscreen with SPF strength of 30 or higher at least 15-30 minutes before sun exposure and have them wear protective clothing (wide-brimmed hats, sun-protective clothing that covers arms and legs, and sunglasses with UV protection).
  • For children playing in water, apply a water-resistant sunscreen every 2-3 hours.
  • If both sunscreen and insect repellant are required, apply the sunscreen first and then apply the insect repellant. Do not use a combination product.


To treat a mild sunburn at home, try applying cool cloths or taking cool showers. Lotions containing aloe vera can help ease pain. Acetaminophen (Tylenol™) can help soothe a headache. It is also important to drink water to prevent or relieve dehydration. Avoid using topical steroids on young children unless directed by a physician.

More extreme sunburns that involve blistering, high fever, severe headache, dehydration, confusion, or nausea require the sort of medical attention that urgent care centers provide.

2.     Police the Playground and the Beach


Playgrounds and beaches provide places for good exercise and lots of fun. They can also be dangerous.

Make sure that your favorite playground has well-maintained equipment. Rusty metal equipment can lead to metal splinters and nasty infections. Untreated wooden equipment can produce splinters and unpleasant scrapes. Loose bolts are accidents waiting to happen. You might also check for poisonous plants such as poison ivy and infestations of bees or other pests.

Beaches are always a favorite with kids, but you should be aware of potential hazards. It goes without saying that you should always watch children in the water. Water depth and wave action can change rapidly. Also watch out for various critters—jellyfish, sea urchins, sting rays, even sharks—that can injure unsuspecting children and adults. Remember that the water and beach are these animals’ primary habitat, not yours. Medical attention might be needed for stings and bites.

A word about trampolines. If you’re thinking of getting one for your home, don’t. Citing nearly 100,000 injuries per year, the American Academy of Pediatrics discourages recreational trampoline use for the home, even when all the safety rules (listed below) are followed. Kids are often injured when bumping into others, trying stunts like somersaulting, falling or jumping off the trampoline, or just landing wrong. Very serious and sometimes life-threatening injuries result, including broken bones, concussions, neck and spinal cord injuries that can lead to paralysis or even death.

If you already have and use a trampoline at home, follow these rules:

  • Allow only one jumper at a time.
  • Do not allow stunts, especially somersaults.
  • Adults who are willing and able to enforce safety rules must supervise at all times.
  • Make sure that safety netting and padding is in place and maintained.
  • Check your homeowner’s insurance policy to make sure that you’re covered for trampoline-related injuries.

3.     Avoid Insect Bites and Stings


Insect bites and stings can interrupt summer fun. Ticks are plentiful this year, and they carry debilitating, sometimes lethal, diseases [insert link to blog post on ticks]. Always check for ticks on anyone who has been outside, and remove them immediately. Using an insect repellant with at least 20% DEET can help.

Insect repellants are usually effective to keep mosquitoes in check. An occasional mosquito bite is seldom cause for concern, but being covered by mosquito bites will ruin any hike or camping trip in short order.

Bee and wasp stings can be dangerous, especially for persons who are allergic to them. For anyone who is allergic and at risk of anaphylactic shock, take the following steps:

  • Call 911.
  • Use an EpiPen™ to inject epinephrine into outer muscle of the thigh, not into hands or feet.
  • Go to an urgent care facility or emergency room immediately after an EpiPen™ injection, even if symptoms subside, since there can be a delayed allergic reaction.

If there are no symptoms of allergic reaction, do the following:

  • Remove the stinger by scraping with a flat edge. Do not pinch or use tweezers since that will inject more poison.
  • Apply ice or cold compress.
  • If stung on an arm or leg, elevate the area.
  • Take acetaminophen (Tylenol™) for pain or an antihistamine (Benadryl™) for itching. Do not use aspirin.
  • Follow up with a visit to an urgent care facility in 2-5 days if necessary.

If you have any questions or concerns after a bee sting, call or visit an urgent care center.

4.     Patch Up Those Cuts and Scrapes

Most minor cuts and scrapes can be treated at home. However, if the wound is deep, dirty, or caused by an animal, a tetanus shot (or booster) might be needed.

Remember the following steps:

  • Wash your hands.
  • If bleeding doesn’t stop, apply pressure with a clean bandage for a few minutes.
  • Clean the wound with clear water. Do not get soap or other cleansers into the wound, but use them as necessary to clean around the wound.
  • If any debris remains in the wound, try removing it with (disinfected) tweezers. If you cannot remove the debris, go to an urgent care facility.
  • Apply an antibiotic cream and cover the wound with a sterile bandage.
  • Change the bandage once a day or if it gets wet.
  • After the wound scabs over, stop applying the bandage.

It’s always a good idea to keep a well-stocked first aid kit handy for these situations.

Deep cuts or wounds that won’t stop bleeding might require stitches. Visit an urgent care facility for that sort of treatment.

5.     Attend to Head Injuries, Sprains, and Fractures

Bumps on the head are common for children and usually do not require medical attention. Nevertheless, if the following symptoms occur, you should go to an urgent care facility:

  • Unconsciousness, confusion, or disorientation.
  • Vomiting.
  • Persistent, severe headache.
  • Persistent irritability.
  • Memory loss.
  • Visual impairment.

If severe head trauma has occurred (immediate loss of consciousness; severe bleeding from head, nose, or ears; weakness in arm or leg; loss of balance, slurred speech, seizures, repeated vomiting, persistent crying, or cessation of breathing), CALL 911. Keep the victim still, lying down, and quiet. Do not move the victim unless absolutely necessary to get the victim out of further harm’s way. To avoid further spinal injury, do not move the neck. If the victim is wearing a helmet, leave it in place.

Sprains and fractures are sometimes difficult to distinguish. If your child merely rolled an ankle, then it might be a mild sprain. In such cases, the child might be able to put weight on the ankle, although sometimes there can be impressive swelling and pain. Rest, ice, and elevation will generally produce a good result in a few days.

P – Protect
R – Rest
I –  Ice
C – Ice
E – Elevation

If, however, there is major swelling, pain, numbness, or if it is extremely difficult for the ankle to bear any weight, a break might have occurred. Broken ankles, wrists, or other bones always require medical attention. Bear in mind that severe sprains can take longer to heal than some fractures.

Because it is difficult to tell a broken bone from a severe sprain, don’t take any chances. Go to your nearest urgent care center to get a professional diagnosis. Most have X-ray equipment on site and are prepared to treat broken bones and sprains.

6.     Keep Allergies in Check

During the summer, the weeds and grasses that developed during the spring continue to spread pollen that causes allergic reactions in children and adults. Sometimes, over-the-counter antihistamines such as Zyrtec™ can control these reactions.

But often, allergic reactions to pollen or molds can be truly debilitating with the potential to ruin a summer of fun. If you or your child suffer from seasonal allergies, ask a health professional to evaluate the situation. They can offer tips and medications that will help you avoid a summer filled with sniffles and runny eyes.

For all of these situations and if you are located near us, call or come to Kathy’s Urgent Care so that we can help you and your children enjoy a fun summer. Remember, we’re here to help you 7 days a week. No appointment needed!

Authored by Dr. Tom Brown

Ticks Can Make You Sick!

Because of the larger number of active ticks throughout the US, tick-borne diseases are on the rise. A warm, moist spring caused adult ticks to become active in April which is much earlier than normal. If you or your family spend time outside in the woods, your lawn, or around bushes and other foliage, you are at risk. More on prevention below, but first some information about ticks and the diseases that they carry.


How Ticks Infect People and Pets

There are several varieties of ticks, and they all carry specific diseases. The blacklegged tick or “deer tick” (pictured here) carries Lyme disease, Powassan virus (POW), and other diseases. It is especially common in New England. Other varieties of ticks can infect people with Rocky Mountain Spotted Fever (RMSF), a serious disease that is sometimes fatal.

Ticks spread various bacteria and viruses by injecting them into humans and animals when feeding. Typically, this happens when an adult tick attaches its head and begins to ingest blood. Since a mild anesthetic is also injected into the bite, people often feel nothing.

How to Prevent Tick Bites

For people, there are three major ways to prevent tick bites and infection.

1.     Wear protective clothing, including long-sleeved shirts and long pants with the legs tucked into socks. Closed footwear is essential. Do not wear shorts and flip-flops into the woods or grass!
2.     Whenever you go outside or into wooded areas, consider using an insect repellent with at least 20% DEET, picaridin, or IR3535 formula. Also treat clothing and gear with a product containing 0.5% permethrin. Permethrin remains effective through several washings. For help in selecting effective products for you and your family, use the Environmental Protection Agency (EPA) tool.
3.     Examine every part of your body as soon as you return indoors. Ticks can attach themselves to any area of your body: under arms, in your hair, between your legs (crotch area), in your belly button, and other nooks and crannies. Ask relatives or friends to help you check areas that you cannot see. Don’t be bashful about this! Also remember to check the bodies of your children thoroughly.

You should also thoroughly check any pet, dog or cat, that has been outside. Check every time they come in. Ticks often burrow into an animal’s fur, making them hard to see. Once a tick gets into your home, it can then transfer to people. Medications are available that prevent ticks from hosting on dogs or cats, and they generally work. But be careful, since some medications that work for dogs are toxic to cats.

Tick Removal

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Remove ticks as soon as you discover them. The best way is to grasp the tick as close to the head as possible with tweezers and lift straight up.

If you need assistance with removing a tick or if your attempt is unsuccessful, come to Kathy’s Urgent Care. We’ll be happy to help you and to answer your questions.

Medical Risks

Lyme Disease: Infection can occur within 24 to 48 hours of a tick’s being attached to your body. Symptoms can appear from 3 to 30 days after a tick bite. Common symptoms include a distinctive rash, weakness of facial muscles, and swollen or painful joints, particularly if fatigue and low-grade fever are also present.

Accurate diagnosis of Lyme disease sometimes requires a blood test. Do not self-diagnose! If you think that you or a family member has been infected, be sure to check with us to have the blood test performed if necessary and so that treatment can begin.

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It is important to begin treatment as soon as a diagnosis can be confirmed. Lyme disease can have very serious and long-term consequences.

Powassan virus (POW): Infection can occur within 15 minutes of a tick’s bite. Early symptoms can appear within 1 week to 1 month. Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures. Unfortunately, many people who are infected exhibit no early symptoms, making detection very difficult. This is why prevention of tick bites is so important.

The POW virus can infect the central nervous system, causing encephalitis or meningitis. There is no known cure and no vaccines or medications to prevent or treat infection. About half of those infected with POW develop permanent neurological problems such as headaches, memory problems, or muscle weakness.


If you think that you or a family member has been bitten by a tick or if you need assistance in removing a tick, come to Kathy’s Urgent Care or other medical facility. Time can be important, and we’re open 7 days a week!

Enjoy your summer, but be careful!

Authored by Dr. Tom Brown

The following links can provide additional information: