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Know the Facts: Top Winter Health & Safety Hazards (infographic)

Know the Facts: Top Winter Health & Safety Hazards (infographic)

Know the Facts: Top Winter Health & Safety Hazards


We asked our emergency medicine, same-day care, and walk-in clinic experts about the top health and safety issues they typically see each winter. Armed with the facts, you can take steps to stay healthy and safe this winter.

We hope you don’t suffer from any of these conditions, but we are here for you if you do! Our Emergency departments, Same-Day appointments, and Walk-In Clinic providers can treat these conditions and more. If you have a true medical emergency, call 9-1-1 immediately.

Download/Print the infographic PDF >


To keep yourself and others safe, continue practicing COVID-19 precautions by wearing a mask, social distancing & washing your hands.

Cold Exposure

Hypothermia, or abnormally low body temperature, is a dangerous condition that can occur when a person is exposed to extremely cold temperatures. Symptoms in adults include shivering, exhaustion, confusion, slurred speech, and drowsiness. Seek immediate medical attention if a person’s temperature is below 95° F.¹

Frostbite is an injury to the body that is caused by freezing. It most often affects the nose, ears, cheeks, chin, fingers, or toes. Symptoms in adults include reduced blood flow to hands and feet, numbness, tingling or stinging, aching, and bluish skin. If you notice signs of frostbite, seek medical attention.²

Slippery conditions lead to falls & car accidents

Many injuries related to cold weather happen from falls on ice-covered sidewalks, steps, driveways, and porches. Keep your steps and walkways as free of ice as possible by using rock salt, another chemical de-icing compound or sand.³

Each year, there are approximately 1.2 million vehicle crashes due to adverse weather or on slick pavement.⁵ If you must travel, let someone know your destination and when you expect to arrive. Ask them to notify authorities if you are late. Check and restock the winter emergency supplies in your car before you leave. Always carry extra warm clothing and blankets with you.³

Winter Health Safety Infographic

Space Heater Mishaps

Approximately 21,800 residential fires are caused by space heaters each year, and 300 people die in these fires. An estimated 6,000 persons receive hospital emergency room care for burn injuries associated with contacting hot surfaces of space heaters, mostly in non-fire situations.⁴ Don’t use a space heater within 3 feet of anything that may catch on fire and never cover your space heater.⁴

Cold, Flu & Sickness

Protect yourself & others from feeling under the weather

  • Wash your hands often with soap and water
  • Avoid touching your eyes, nose and mouth
  • Stay away from people who are sick
  • Stay at home if you are sick
  • Avoid close contact with others
  • Practice good cough and sneeze etiquette
  • Disinfect frequently touched surfaces and objects⁶

Winter Sports Injury

According to the U.S. Consumer Product Safety Commission, almost 200,000 people were treated for injuries related to winter sports in 2018.

  • 76,000 injuries from snow skiing
  • 53,000 injuries from snowboarding
  • 48,000 injuries from ice skating
  • 22,000 injuries from sledding

Common winter sports injuries include sprains, strains, dislocations, and fractures. Most winter sports injuries can easily be prevented by wearing protective gear, maintaining good physical condition, staying alert, drinking plenty of water and resting when tired or in pain.⁷

Overexertion while shoveling snow

Shoveling snow is strenuous exercise. People who have a medical conditions such as high blood pressure or heart disease should talk to their healthcare provider before shoveling snow. The combination of cold temperatures and strenuous exercise can trigger a heart attack.¹

Local cardiologist receives international recognition, explains cardiac resynchronization therapy (CRT)

Local cardiologist receives international recognition, explains cardiac resynchronization therapy (CRT)

Andrew Hordes, MDCardiologist Dr. Andrew Hordes is the Heart & Vascular Center’s Certified Cardiac Device Specialist. He was one of the first to perform internal defibrillator procedures at Watauga Medical Center, as well as the first Micra procedure, using the world’s smallest leadless pacemaker.

Dr. Hordes recently renewed his certification for the International Board of Heart Rhythm Examiners (IBHRE). He placed in the top five percent of all scores and was offered an ambassadorship for the IBHRE. Worldwide, the IBHRE has about 50 ambassadors who assist in writing the exam, as well as mentoring others as they prepare to take the test.

Cardiac Resynchronization Therapy (CRT) is a treatment that Dr. Hordes says can make a significant impact on quality of life. He has a wealth of experience and knowledge in pacemakers, internal defibrillators, and CRT.


What’s the difference?


Unless they’ve had a personal experience with heart failure or heart attack, people often don’t know the difference between an internal cardiac defibrillator (ICD) and a pacemaker. Both devices are implanted into a patient’s chest, but they have very different functions.

A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart


An ICD monitors heart rhythm. If it senses dangerous rhythms, it delivers shocks. This treatment is called defibrillation. An ICD can help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA).


Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart’s electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment (source).

Until the early 2000s, ICDs were mainly used for people who had already suffered a heart attack or were in the midst of heart failure. Dr. Hordes served as an investigator on a trial addressing the implications of expanding the use of ICD. The study found that anyone with poor ventricular function could benefit from an ICD – saving and extending lives.

But according to Dr. Hordes, it’s important to understand that with a defibrillator alone, the patient may not “feel” any better. The device will, however, save their life in the event of a sudden heart event.


Heart Pacing History

Heart Chambers 

The innovation:

In the 1950s, physicians began treating heart failure patients with pacemakers, although the first pacemakers were external. On October 8th, 1958 the first internal pacemaker implantation was performed in Sweden (source).

The problem:

These early devices only had one wire pacing the ventricle of the heart. Because the pacemaker was only pacing the ventricle, and not the atrium, some patients suffered from “pacemaker syndrome.” Their atrium and ventricle became out of synch, making the patient very sick.

The innovation:

Enter “dual-chamber pacemakers” in the late 1970s. These devices improved the synchronization of the ventricle and atrium, but there was still a problem.

The problem:

Dr. Hordes explains, “When we’re born, our heart naturally paces itself from left to right. But our pacemakers paced from right to left, throwing off the motion of the wall in the center of the heart – the septum. The heart loses efficiency and quality of life for the patient.  The treatment could actually create a condition called “left bundle branch block.”

To correct the problem with traditional pacemakers, cardiologists asked themselves, “What if we could control the timing between the right and left sides of the heart to more closely match the natural rhythm and create a more efficient contraction?”

And thus, Cardiac Resynchronization Therapy (CRT) was born. Not everyone will respond to this therapy, but when successful, CRT increases survival and quality of life, with 50% reduction in heart failure hospitalizations.


Who is a candidate for CRT?


  1. Patients who have experienced heart attack or suffer from heart failure, have scarring, or a problem with the heart’s electrical system (left bundle branch block).
  2. People with merely a weak heart that doesn’t stem from a heart attack (non-ischemic cardiomyopathy).

“In fact,” says Dr. Hordes, “the second group of patients are the ones who typically get the most benefit from CRT, as left bundle branch block is common with non-ischemic cardiomyopathy.” About 95% of Dr. Hordes’ patients receiving CRT show an improvement in heart function.

Some patients, whom Dr. Hordes calls “super-responders,” experience a significant improvement in heart function and quality of life. These patients feel much better and they live longer.

If you experience fatigue and shortness of breath with exertion – even with medication – contact your cardiologist today to see if CRT may be right for you. In addition to general cardiac needs and interventional cardiology (heart catheterization), you can receive CRT right here in Boone at the Heart & Vascular Center of Watauga Medical Center. Most patients report an improvement in energy levels, ability to exercise, and quality of life.

Heart & Vascular Center

The Heart & Vascular Center

formerly The Cardiology Center
336 Deerfield Road
Boone, NC 28607
Phone: (828) 264-9664
Fax: (828) 264-8144
Visit Website

Men’s Health: 5 topics to discuss with your provider

Men’s Health: 5 topics to discuss with your provider

Men's Health Photo

Some things we love to do and some things we need to do. You may love to play golf or go hiking. You may need to clean out the gutters or schedule your annual physical exam. The gutters need your attention but so does your health. By doing the things that you need to do, we at Appalachian Regional Healthcare System want you to continue to be able to do the things that you love to do.

We want to encouraging men to take time to schedule an appointment with your primary care provider.

Here are 5 important topics that you may want to discuss with your provider.



Ask your provider what age is right for you to begin colonoscopy screenings. This screening test is the most effective way to reduce your risk of colorectal cancer. Stomach pain or unexplained weight loss may be caused by something other than cancer but it is always a good idea to contact your doctor. Your provider may make other recommendations based on your family history, diet and lifestyle choices.



Although never a man’s favorite subject, it is important to speak with your provider about when you should receive a PSA test.  A PSA test is a simple blood test to measure the level of prostate specific antigen in your blood. Levels can be high if you have a prostate infection, an enlarged prostate or even if you are taking certain medications. Your primary care provider is the best person to interpret your PSA test results. Be sure to mention if anyone in your family has a history of prostate cancer. Remember that early detection greatly increases the chance for successful treatments if they are needed.


Blood Pressure/Cholesterol

The two main reasons that people have heart disease or stroke is high blood pressure and cholesterol. The good news is that you can manage both with a healthy diet and regular exercise or medication. While you can’t change your age or your family medical history, you can start the conversation with your provider about managing your blood pressure and cholesterol levels. The Heart & Vascular Center of Watauga Medical Center is dedicated to providing diagnosis and treatment of heart disease…and to putting you back on the road toward healthier living.


Type 2 Diabetes

About 1 in 10 Americans have diabetes, and 90% to 95% of those have type 2 diabetes. You are at risk of developing diabetes if you are overweight, over 45 years of age and have a family history of Type 2 diabetes. A simple blood test is all that is needed to check your blood sugar level. Your provider can discuss the results with you and determine a plan of action. Your diabetes may be able to be controlled with a healthy diet and an active lifestyle or you may be prescribed oral medications or insulin. Type 2 diabetes is a serious condition and can lead to complications such as heart disease, vision loss and kidney disease. So, please don’t wait to contact your provider to address any concerns that you may have.


Shingles Vaccine

An estimated 1 million people in America will develop shingles this year. If you have ever had shingles, then you know the pain and discomfort that this virus can cause. The only way to reduce the risk of developing shingles is to be vaccinated. The CDC recommends adults over the age of 50 receive two doses of the vaccine to protect against the shingles. Check with your primary care provider about receiving your vaccine.


So, strap on those hiking boots and conquer that mountain, enjoy that long drive down the middle of the fairway, and be careful on that ladder while you’re cleaning those gutters. Men, don’t be afraid to contact your provider to have a complete physical check-up or just to ask the questions that have been on your mind.

If you don’t have a primary care provider, Appalachian Regional Healthcare System has a dedicated team in Watauga or Avery County to meet your needs. Call or request an appointment online today.

Infographic: Men's Health

AppFamily Medicine

AppFamily Medicine

148 Hwy 105 Extension, Suite 102
Boone, NC 28607
Phone: (828) 386-2222
Fax: (828) 386-2223
Visit website

Appalachian Regional Internal Medicine Specialists

148 Hwy 105 Extension, Suite 104
Boone, NC 28607
Phone (828) 386-2746
Fax (828) 386-2750
Visit website

Baker Center for Primary Care

Baker Center for Primary Care

436 Hospital Drive, Suite 230
Linville, NC 28646
Phone: (828) 737-7711
Fax: (828) 737-7713
Visit website

Elk River Medical Associates

150 Park Avenue
Banner Elk, NC 28604
Phone: (828) 898-5177
Fax: (828) 898-8306
Visit website

Common Causes and Treatments for Balance Disorders

Common Causes and Treatments for Balance Disorders

Balance Disorders

By Flavio Leite, PT, DPT, physical therapist at The Rehabilitation Center in Linville

Balance…we search for it in our everyday lives. Juggling work, family, and after school activities can figuratively make your head spin. But if you feel that your head is literally spinning then you may want to sit down and take a few moments to look over the causes and treatments of balance disorders.

A balance disorder is a condition that makes you feel unsteady as if you are moving or spinning even though you are standing still or lying down.

Various studies indicate that “dizziness” is among the three most common complaints encountered in the primary care setting, sharing equal time with headaches and lower back pain.  Over the age of 75, it is the number one reason for an office visit and hospital admission.  As the population ages, the total number of complaints regarding balance disorders is likely to increase.


Different people will experience different symptoms


  • Some people may experience frequent falls or loss of balance.
  • Some people may report blurry vision, especially when looking for items at the supermarket. They may also be unable to read signs while driving.
  • Some people may feel dizziness or vertigo when lying down, getting up, looking up/down, or bending over to retrieve objects from the floor.
  • Some people may experience lightheadedness, faintness, or a floating sensation.
  • Other people may experience confusion or disorientation.


The most common causes of a balance disorders


  • Cardiac problems – individuals with cardiovascular disease who have difficulty with blood supply to the brain or to the lower extremities may experience balance issues.
  • Impaired vision – especially at night when there is less light.
  • Inner ear problems or damage to any of the vestibular system apparatus – will affect the way the vestibular system responds to the challenges of the environment you are in.
  • Central nervous system diseases – balance disorders are common in diseases such as multiple sclerosis and Parkinson’s disease.
  • Head injury – even a mild head trauma such as getting hit in the head with a ball while playing sports may cause you to experience episodes of dizziness or balance problems.
  • Peripheral nerve injury – peripheral neuropathy as a result of diabetes or other type of nerve damage in the legs will negatively impact your balance.
  • Muscular weakness – such as lower extremity weakness will increase your risk for falls.
  • Medication – it is very important to check with your pharmacist regarding the side effects of or interaction of medications, since many medications may cause dizziness or lightheadedness.


As you can see, there are many potential causes of a balance disorder – including medical conditions and medications. That is why you should consult with your provider to rule out a more serious medical condition as the cause of your symptoms.  If the cause is a medical condition or medication, your provider may treat the condition or suggest a different medication.  Your provider may also suggest that you see an ENT doctor (physician who specializes in the ear, nose, and throat) or refer you to a physical therapist specializing in treating balance disorders.

If you are referred to a physical therapist here are a few things that you should expect. The physical therapist will perform an initial evaluation starting with an interview and then will ask you about events that may have caused the problem or when you first experienced the symptoms; ask you to describe the symptoms, when they occur, what alleviates or makes them worse, and so forth. Questions will be asked about your medical history to see if it may contribute to your balance problem. You will also be asked about medications you are taking which may contribute to some of the symptoms previously discussed.


How a physical therapist can help


Photo: Physical Therapy Balance TreatmentThe physical therapist will perform:

  • Functional tests to assess your ability to perform functional tasks such as walking on uneven terrain, making turns and moving your head while walking, ascending/descending stairs, looking up and looking down, and bending over to retrieve objects.
  • Positional tests to assess your ability to perform transitional movements such as sitting to lying down, lying down to sitting, rolling to right/left when lying down.
  • Assessment of the systems of balance. The physical therapist will perform a systematic evaluation of the visual system, the somatosensory system, and the vestibular system.
  • Assessment of other systems such as your coordination, strength, flexibility, and sensation – especially in the lower extremities.

Once the physical therapist completes the initial evaluation, he/she will discuss the findings with you.  The physical therapist will talk about your rehabilitation potential; then, will inform you about the rehabilitation program and develop a customized plan of care.

The plan of care will vary according to your needs.  The frequency of treatment may be once or a couple of times a week, depending on your particular condition.  Some exercises are done at the clinic and some are done at home.  The physical therapist works closely with you.  Adhering to the treatment program is the key to getting better, improving your balance, and being able to do more.

If you are suffering with balance issues, contact The Rehabilitation Center to see how physical therapy could help you.

The Rehabilitation Center Boone

232 Boone Heights Drive, Suite A
Boone, NC 28607
Phone (828) 268-9043
Fax (828) 268-9045
Visit website

The Rehabilitation Center Linville

434 Hospital Drive
Linville, NC 28646
Phone (828) 737-7520
Fax (828) 737-7509
Visit website

Dry needling therapy to increase muscle function and reduce pain

Dry needling therapy to increase muscle function and reduce pain

By Michael Moore, PT, DPT, physical therapist at The Rehabilitation Center in Boone

Dry needling doesn’t sound like a fun day at the park but intramuscular stimulation, as it is sometimes called, is a treatment used to target and restore muscle function while reducing muscle pain. During dry needling, a practitioner inserts several filiform needles into your skin. Filiform needles are fine, short, stainless steel needles that don’t inject fluid into the body. That’s why the term “dry” is used.


Photo: Dry NeedlingWhat happens during Dry Needling?


Practitioners place the needles in “trigger points” in your muscle. The points are areas of knotted or hard muscle. The technique may help release the knot and relieve any muscle pain, spams, or stiffness by improving blood flow and diminishing nerve sensitivity. In addition, easing the trigger points may improve flexibility and increase range of motion. That’s why this method is often used to treat sports injuries, muscle pain, and even fibromyalgia pain.


Is it the same as acupuncture?


Dry needling is not acupuncture, a practice based on traditional Chinese medicine and performed by acupuncturists. Traditional Chinese Medicine is based on the use of “meridians,” “pulses,” or “chi” drawn from ancient Chinese medicine and philosophy. Dry needling is a part of modern Western medicine principles, and supported by research accepted by physicians in the United States.


What can Dry Needling treat?


Evidence suggests the use of dry needling in treating many conditions seen by physical therapists such as:

  • chronic neck and back pain
  • cervicogenic headaches
  • knee osteoarthritis
  • carpal tunnel syndrome
  • trigger point pain
  • and more.

Dry needling should not be seen as a replacement for physical therapy. However, it is a very beneficial complement to physical therapy treatment as it can restore muscle function and reduce muscle pain.

If suffering with these conditions, contact The Rehabilitation Center to see if dry needling is right for you.


The Rehabilitation Center Boone

232 Boone Heights Drive, Suite A
Boone, NC 28607
Phone (828) 268-9043
Fax (828) 268-9045
Visit website

The Rehabilitation Center Linville

434 Hospital Drive
Linville, NC 28646
Phone (828) 737-7520
Fax (828) 737-7509
Visit website


American Physical Therapy Association. Description of Dry Needling in Clinical Practice. Published February 2013.

Dunning J., Butts R., Mourad F., Young I., Flannagan S., Perreault T. Dry Needling: A Literature Review with Implications for Clinical Practice Guidelines. Phys. Ther. Rev. 2014;19:252–265. doi: 10.1179/108331913X13844245102034.

Heel pain – it could be plantar fasciitis

Heel pain – it could be plantar fasciitis

Photo: runner with heel pain plantar fasciitis

By Michelle Ziegler, MPT, physical therapist at The Rehabilitation Center in Boone.

As the weather cools and the leaves change into their colorful autumn apparel, it is likely most of us are spending more time on our feet — hiking to enjoy the outdoors and keeping up our exercise routines. To conserve resources, we are unlikely to spend money on new shoes. If your feet are starting to tell the story of the wear and tear you’ve been putting on them, and you’re experiencing pain in the heel, arch or mid foot, plantar fasciitis could be the culprit.


What is Plantar Fasciitis?


foot anatomy imagePlantar fasciitis accounts for 5 to 10% of all running injuries.¹-² Factors which predispose people include low and high arches, weakness of the foot, ankle and hips, diabetes, increased BMI and poor shoe fit.¹ Poor shoe fit could be the result of shoes that are too tight or too big, so that the arch support is in the wrong place or results in the foot shifting in the shoe. It could be the result of a shoe that is worn out and is no longer supporting your arch as it should.

All of these factors may combine to form the symptoms which are characteristic of plantar fasciitis

  • Heel pain is worse in the morning and the first steps after waking up or after sitting for a long time.
  • It is common for the pain to be noticeable when starting a run or hike, then subside midway through the activity, and then return later on in the run/ hike.
  • The pain, which typically entails throbbing, cramping, stabbing type pain, is usually also present when walking upstairs, walking barefoot and on your toes.²


Treating Plantar Fasciitis


The good news is that about 90% of cases can be corrected without surgery. Plantar heel pain is the foot symptom that is most commonly treated in outpatient Physical Therapy centers.¹ Treatment includes a variety of strength training and stretches for the foot, ankle and calf. A physical therapist can help guide you through these strengthening and stretching exercises, as well as provide effective manual treatment and taping which in recent years research has shown to be crucial in the rehabilitation process.

A basic example of some exercises include:

  • plantar fascia stretches
  • calf stretches
  • self-massage by rolling the foot on a golf-ball or foam roller
  • foot-arching exercises
  • leg raises to strengthen the hips

Cryotherapy (icing) frequently throughout the day is also crucial for pain control and recovery.


Get help for heel pain


Checking in with a physical therapist (PT) is necessary to resolve this condition, in order to properly assess your situation and to determine which type of stretches and strengthening are right for your specific condition. A PT can also help you determine the ideal selection of footwear, supplemental arch support and/or heel cup which may help your condition.

Our orthopedic Physical Therapy team at The Rehabilitation Center can provide you with an individualized assessment and exercise program to meet your specific needs to get you back into your routine safely. We have two convenient locations: In Boone next to the Broyhill Wellness Center, and in Linville on the campus of Cannon Memorial Hospital.


The Rehabilitation Center Boone

232 Boone Heights Drive, Suite A
Boone, NC 28607
Phone (828) 268-9043
Fax (828) 268-9045
Visit website

The Rehabilitation Center Linville

434 Hospital Drive
Linville, NC 28646
Phone (828) 737-7520
Fax (828) 737-7509
Visit website

2. Wilder R, O’Connor F, and Magrum E, (2014). Running Medicine. Healthy Learning. pp. 22, 372.