Knowledge Is Best Defense Against

Close Encounters with Poison Ivy

You may not notice it at first glance, but its out there, lurking discreetly in your flower beds, creeping up tree trunks, just waiting for a little up-close-and-personal contact with you. Its poison ivy, and if youve ever had it, youre in pretty good company. It is the worlds most common allergen, affecting nearly one-half of Americans, even those who arent allergic to anything else.

What is poison ivy?

In the East, Midwest, and South, poison ivy grows as a climbing vine with three serrated-edge, pointed leaves (leaflets of three, beware of me), but it is not actually the leaves that cause the allergic reaction. The true culprit is a colorless or pale yellow plant oil called urushiol (u-ROO-she-ol), which is released when the plant stem or leaves are cut or crushed. Because it is sticky, urushiol clings to the skin and can be carried on garden tools and pet fur. It can even travel in the smoke of a burning plant. Because urushiol stays active for up to 5 years, dead poison ivy plants and items that were not washed after previously contacting urushiol are potent sources.

Is poison ivy contagious?

There are only three ways to contract poison ivy: touching the sap of this highly toxic plant, touching something that has previously come in contact with urushiol, or being exposed to airborne urushiol particles, as occurs when the plant is burned. Contact with urushiol is the only way to contract poison ivy. It cannot be spread to other areas of the body or to another person by scratching or touching oozing blisters. It is important to note, however, that scratching may introduce bacteria into the affected area, leading to infection.

How do I know if I am allergic?

People are not born with a sensitivity to poison ivy. It generally develops after the first direct contact with urushiol. A first exposure seldom produces any reaction, but a second one may be severe. With repeated exposure, approximately 85% of people who come in contact with the plant oil will eventually become allergic. Sensitivity varies from person to person. Those who reach adulthood without having experienced a reaction have only a 50% chance of developing a sensitivity to poison ivy. Those who are allergic as children or young adults may find their sensitivity to it decreases or even disappears with age. Only about 15% of the population seem to be truly resistant, however, so it is best not to take unnecessary chances.

How can I protect myself?

The best way to protect yourself from an allergic reaction to poison ivy is to avoid contact. If you come into contact with the plant, thoroughly wash the affected area as soon as possible. It is best to shower thoroughly and as soon as possible following exposure to the oil, Dr. Paul Fischer advises.

When practical, use herbicides to kill the plant in your own yard; wear long sleeves, long pants, boots, and gloves when venturing into areas where you know it flourishes; promptly wash any article of clothing or other item that you suspect has come in contact with urushiol; and do not burn any plants that resemble poison ivy.

Skin creams containing bentoquatum offer some topical protection by preventing urushiol from penetrating the skin surface, but avoiding poison ivy remains the best alternative. Immunization is also available, but because of the time required to reduce sensitivity and the potential for uncomfortable side effects, it is not routinely recommended.

What can I do if I get it?

If you find yourself with a poison ivy rash, there is nothing you can do to make it go away, but there are some ways to ease the reaction and the associated discomfort. Cool showers and over-the-counter preparations, such as calamine lotion, may ease the itching. Other ways to relieve itching and dry up the rash include lukewarm baths with oatmeal or baking soda and ice-cold whole-milk compresses (dont use skim milk; it is the high fat content that does the job). If used early enough, antihistamines and steroids in the form of creams, ointments, or pills may diminish the severity of the rash as well as the associated itching.

Source: Poison Ivy Pamphlet Page, American Academy of Dermatology; IntelliHealth Home to Johns Hopkins Health Information: Poison Ivy, John Hopkins University; and Learn More About Poison Ivy, Oak, and Sumac,Dermik Laboratories, Inc.

CPC Physician Profile: Tracy R.
Barefield of CPC South

When Tracy Salenger Barefield first came to Augusta in 1987, it was to work as a dietitian on staff at Humana (Doctors) Hospital Burn Center. When she returned to the Garden City a few years later, it was as a first-year medical student at the Medical College of Georgia. Toward the end of her formal medical education when it was time to consider her next move, she and her husband, Mickey, chose not to move at all. In 1996, they decided to call Augusta home and she joined the staff of the Center for Primary Care as the first female physician in the practice group.

Dr. Barefield completed her undergraduate work at Florida State University in Tallahassee and graduate work at Florida International University in Miami. After working at the Burn Center for only a brief time, she was offered a position as Chief Clinical Dietitian for Marriott Food Services in Carrollton, Georgia. During her 2 years in Carrollton, one of the physicians she worked with recognized her potential and encouraged her to pursue her interest in medicine. Spurred on by his support, she applied to the Medical College of Georgia, was accepted, and returned to Augusta to receive her medical training and launch a career as a family physician.

At the conclusion of her residency, Dr. Barefield was expecting her first child and trying to decide what career move to make. A medical school acquaintance of hers, Dr. Edwin Scott, mentioned that Dr. Paul Fischer had started a new practice and was recruiting physicians. She was intrigued by the prospect of staying in Augusta. She and Mickey agreed that starting a new job, moving to a new place, and having a baby would be too much for their young family to take on all at once. But she kept thinking, Who would recruit a pregnant woman? As it turns out, Dr. Fischer did not consider her impending motherhood a hindrance. In 1996, she became the first female doctor on the staff of the Center for Primary Care. She is now medical director for the South Augusta office.

Of all the specialties she was exposed to as a resident, she was drawn most to family medicine. I loved all the rotations I did, but in family medicine, I saw the full range of people. There was so much variety always something different, she says. Family medicine was the most challenging.

Dr. Barefield believes her interest and background in womens health is a strength she brings to CPC. Throughout medical school and my residency, I was one of the few who enjoyed obstetrics and gynecology, she says. This allowed her to work with many female patients and, combined with her background in nutrition, may have fostered her passion for womens health issues. Being the only woman on staff at their South Augusta office, she believes, has opened the door to many female patients who may not have wanted to see a male doctor. I am proud to be the first woman in this practice, she says.

One factor in Dr. Barefields decision to live and work here was her husbands ties to the community, but it was work not Mickey that brought her here to begin with. They did not even know each other until she was a second-year medical student, when they met by chance. Tracy and her girlfriends had planned to meet sans men for girls night out at the Sheraton Hotels Saints lounge. Tracy wasprompt. Her friends were not. Enter Mickey.

If its true what people say about opposites attracting, that must have been the force that brought them together. She was a city girl, born in New York and raised in Fort Lauderdale. Having grown up on a farm, he was entrenched in the ways of the rural South. Not only of different realms of experience, they were also of different faiths. Coincidence put them at the same place at the same time, and fate took it from there.

He came over and asked me to dance and we hit it off immediately, she recalls. By the time her friends arrived, she was thanking them for being late. Tracy and Mickey have now been married for 7 years and have two sons, James, 4, and Jacob, 2.

Instead of being an obstacle, Tracy and Mickeys differences have enriched their life together as a couple. Thanks to Mickey, she now can drive a tractor and shoot a gun, two activities they enjoy together when visiting the family farm where Mickey grew up. Weve both broadened each others horizons to different areas, she says. Like Aesops town mouse and country mouse, We are from different backgrounds but we mesh so well together.

Of all the new interests Dr. Barefields husband introduced her to, shooting is probably her favorite. We used to set up targets at the farm and we both enjoy trap and skeet shooting, she says. It allows me to get my aggressions out without hurting anyone. She is quick to point out that inanimate objects are the only targets shes interested in hitting. I dont want to shoot anything living unless its going to try to shoot me first, she says.

Her other interests are more on the domestic side. Dr. Barefield loves to sew and says shes a dynamite cook. Her office, which is sprinkled from top to bottom with family pictures, is testament to her passion for photos and family. She also enjoys scrapbooking, which allows her to organize her familys pictorial history in a fun, creative way.

They are both close to their families. Dr. Barefields parents, Ellen and Arthur Salenger, live in Ocala, Florida, and visit as often as once a month. Her sister, Susie, just moved from Ocala to Augusta so she could be closer to the Barefields. Mickeys mother lives in Millen and his grandmother lives in Waynesboro.

When shes not busy being a physician, Dr. Barefield enjoys spending time with Mickey and their two sons. We have lots of fun together doing things as a family, she says. She gives her husband much of the credit for their balanced family life. When she was pregnant with her second son, she and Mickey made an important decision. In what they jointly considered to be the best interest of the children, Mickey decided to leave his job as a plant equipment operator at Plant Vogtle so he could stay home and care for James and Jacob.

Not only has this move been beneficial for their children, it has also allowed Dr. Barefield to devote the time and energy her job demands. It has enabled me to do what I need to do in my work seeing patients, paperwork, doing rounds, she says. How has their decision affected her husband? Besides the obvious perk of being with his sons, the biggest endorsement came from coworkers and friends. Everyone has a great deal of respect for Mickey in this decision, she says. Instead of giving him a hard time, the guys at work were jealous!

Perhaps Dr. Barefields greatest gift to her family, friends, coworkers and patients is her balanced approach to life. It is a philosophy that extends naturally into everything she does at the Center for Primary Care and brings to her practice of medicine a precious balance of professionalism and compassion.

Congratulations to. . .
Dr. Riaz Rassekh and his wife Bahieh on the birth of their second child, a son named Abbas Andrew Rassekh. Born on April 27, 2000 at University Hospital in Augusta, he weighed 6 lbs. 7 oz. and was welcomed home by his older brother, Annis Alexander.

HMO Delays Can Be Frustrating for Patients, Physicians and Staff

If your health insurance provider is a health maintenance organization (HMO) or a point-of-service (POS) provider, you may have already experienced first-hand an increasingly common problem: delays in the approval process for referrals outside your primary care physicians office.

These insurance providers require preapproval for referral, including specialist visits and diagnostic procedures such as x-ray, magnetic resonance imaging (MRI), computerized axial tomography (CAT scan), and sleep studies. Preapproval is required; without it, HMO and POS providers will not pay claims for these services. The responsibility for obtaining approval belongs to both patient and primary care physician.

If obtaining an approval number for a referral were simply a matter of a quick phone call, as some people might think, there would be no problem, but it is more complicated than that. HMOs and POS providers are not always immediately accessible, and once a call is placed to a provider, the approval process is entirely in their hands. According to Rhonda Brown, Clinical Supervisor for the Center for Primary Care, it is almost never a speedy process.

The preapproval requirement has become a stumbling block for everyone involved: patients, physicians, and office personnel. For the patient, there are inconvenient, frustrating, and often unexpected delays, sometimes resulting in missed appointments. For physicians, the approval process impedes appropriate and timely care for patients. For primary care office personnel, it is a logistical nightmare in which they are caught between frustrated patients and a sluggish approval process.

Since 35% of CPCs patients are covered by an HMO or POS provider, we have attempted to minimize delays by assigning one person per office to do nothing but handle approval for referrals, but delays persist. Some of the responsibility belongs to the insurance providers themselves because they are inadequately staffed to handle the influx of calls requesting approval numbers. Busy signals mean repeated attempts to reach the insurance provider and wasted time for patients and staff alike. More importantly, delays can sometimes be a medical liability, especially when a patient requires immediate care.

Some providers have been more responsive than others in addressing the problem with delays. According to Ms. Brown, one HMO has initiated an automatic envoy system aimed at streamlining the process. Another has stopped requiring approval numbers altogether because the review process was time-consuming and financially counterproductive: they were spending $100 million to save only $50 million. If other HMOs and POS providers find the approval process equally costly, dropping the requirement may become a trend in the industry.

Companies that contract with HMOs or POS providers for employee health must share in the responsibility. Once contracts have been negotiated and implemented, companies need to educate employees about their responsibility in obtaining preapproval for referred services. If patients were more aware of the specific requirements of the coverage provided by their employer, they could be more effective in avoiding delays and the process would be more efficient.

Referral delays are likely to continue at least until insurance providers take steps to improve the process, but in the meantime, patients can decrease the likelihood and length of delays by playing an active role in the preapproval process and becoming better informed about their health insurance coverage. Ms. Brown offers the following suggestions:

When required, get a referral from your family physician before obtaining medical services from outside sources (check with your policy or provider to find out which services require referrals). HMOs and POS providers usually will not assign an approval number without an appropriate referral, and without that approval, they will not pay the claim.

Allow a minimum of 3 to 5 days before your referral appointment for the approval process to be completed.

Become well acquainted with your insurance policy so you are knowledgeable about the specific provisions and requirements of your plan (e.g., deductible and co-pay) and what your responsibilities are. It is impossible for your physicians office personnel to know each patients insurance policy thoroughly because there are hundreds of policies and the terms of each vary vastly and change frequently.

Remember that the staff and physicians of the Center for Primary Care are doing everything possible to provide you the best medical care and referrals when needed, and we appreciate your patience and assistance in providing these services.