Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Thanks so much for joining us. I'm Joey Wahler. Our guests are nurse practitioner, Jennifer Steyn, and physician assistant, Katie Edgar. Ladies, welcome.

Katie Edgar, MPAS, PA-C: Thank you.

Jennifer Steyn, MSN, APRN, FNP-C: Thank you.

Host: Great to have you aboard. Appreciate the time. First, for you, Jen. As you well know, urgent care has become really more commonly used in recent years. So, why the popularity would you say?

Jennifer Steyn, MSN, APRN, FNP-C: I think there's several reasons. The first is the speed of care, obviously. Lifestyles are busy and not everyone has time to schedule appointments or wait for a doctor's appointment. So, it's a way for our patients to come in and be quickly evaluated and treated. I also think there's been extended wait times in places like the emergency rooms.

So for those patients that may not need emergent services, but urgent services, we have the providers here and treatments available for them and avoid those long wait times. We also hear a lot about people being unable to get into their primary care providers easily. So, I think that we're kind of a gap in between the two. And when people are sick, they're able to come be seen by a provider without the wait.

Host: And in terms of actual services, Katie, what are some of the main benefits of urgent care for patients?

Katie Edgar, MPAS, PA-C: So as far as benefits, we're still providing the same care that you would get at an ER versus primary care. But benefits, as in getting in to be seen. Of course, there's a benefit to that. If you can't wait, like Jen was mentioning, there are urgent matters that need to be addressed and, of course, we are addressing those in a timely manner without having to wait.

Other benefits of utilizing urgent care besides time is financially, of course, you don't want to be spending a ton of money to wait in the ER for something that we can take care of here in the urgent care. We're also pretty good with coordinating care with primary care doctors. So although you're getting into an urgent care, there's not that lack of communication. We're still able to discuss things and follow through with primary care. Especially here with Wood County, we coordinate with the primary cares all the time. We have the same electronic record system. So, everything is able to be seen by primary cares for followup.

Host: So, your primary care doctor is still very much in the picture. Katie, what conditions are you seeing most right now as we tape this during the winter months when obviously certain conditions come to the forefront?

Katie Edgar, MPAS, PA-C: Yeah. So, we're kind of in a weird winter flu season right now, to be honest with you. Typically, we'll go through periods where we see heavy influenza A, maybe periods of heavy COVID, not all at the same time. Right now, we are seeing all of the above. We're seeing COVID, influenza A, influenza B, and a really solid mix of all of those, which is not typical, I would say, of like our flu seasons. But we're also still seeing other viral upper respiratory infections, viral GI bugs, like the stomach flu, some strep ear infection things as well. And you throw in the injuries as well. But it has been an interesting flu season for us, because we're getting hit with all of the more contagious virulent viruses kind of all at once.

Host: And what do you mean in a nutshell by flu A versus B?

Katie Edgar, MPAS, PA-C: So, just two different subtypes of the same virus, it just presents with different symptoms. You start to see patterns of what presents with certain things. Influenza A has the fever, cold symptoms, lasting between like five to six days maybe. Influenza B, again, still a viral process, it is influenza, but lasting longer, sometimes like seven to ten days. Throw in some GI side effects with that too, some diarrhea and things like that.

Host: Gotcha. And Katie, how about people being able to tell the difference between the common cold, the flu, and where's that line where you know that it's time to see a professional like yourselves?

Katie Edgar, MPAS, PA-C: Right. So, it's a great question. So, the common cold, of course, there are like 200 subtype viruses that cause the common cold. But it presents, you know, with a runny nose, sore throat, cough, typically no fever, chills, body aches. Whereas influenza and COVID will have those runny nose, cough symptoms, but also fever, chills, body aches.

The biggest thing, of course, to know if you need a visit, right? So, viral processes in and of themselves, the treatment is just treating the symptoms—symptomatic treatment, conservative treatment management. Whereas things that need a visit for sure are things that require antibiotics. And sometimes you don't know when those things are. That's our job to let you know. But strep, pneumonia, ear infections, those things require antibiotics. But again, you don't always know.

So, what we always say is, of course, we are always more than willing to see you. But things like if you have persistent or new symptoms, we would definitely recommend coming in, or anything that's, I mean, just bothersome. So, an example I always like to talk about is mono. So, infectious mononucleosis is another one that we do see from time to time, especially amongst the college kiddos. Once they get it, they spread it pretty quickly at those parties and things. But mono, although it is a viral process, right? So, it's just symptomatic treatment like other viruses. It can cause complications. It causes a lot of swelling of the tonsils and things that do require, although not antibiotics, further treatment with some steroids and things like that, maybe monitoring. If you're an athlete, your spleen enlarges with mono. So, a big education piece on for three to four weeks, not any sort of intense physical exertion and things like that to prevent complications.

Host: So, Jennifer, how about one thing that you wish patients knew before they come in for these upper respiratory symptoms?

Jennifer Steyn, MSN, APRN, FNP-C: I think one of the most common misconceptions and assumptions that we see is if it's a virus or not, and which medications to take. Ninety percent of the time, the patients we see are going to be viral in nature. And viruses last for a week to 10 days, typically. And in that period of time, the symptom management is really important. And that can be initiated on an outpatient basis. Over-the-counter cough and cold medicines nowadays are extremely effective. So, initiating those to treat your symptoms is safe, as long as you're adhering to any restrictions per your personal health history, and bacterial infections set in after that time when there's a secondary complication or —I don't want to call them a side effect—but a result of that infection, like a bacterial sinus infection that comes after the fact. Bronchitis is not something you catch initially. It's a condition that is a result of the recent infection. So, treating those viral symptoms is really important to prevent that inflammation, and that can definitely be initiated prior to us being seen.

A lot of people have questions about which medicines to take. I feel we spend a lot of time discussing which medications are safe and work the best. And I think that that's a big part of our role, is educating patients about what to do in these situations.

The other thing I would say is the time of testing. We have a lot of patients come in very soon after symptoms that want testing for flu and COVID and strep. Those viral tests within that first 24-hour period aren't always 100% accurate, because the viral load is very low. So although patients may test negative initially, their symptoms may change over that initial three to four-day period. They may develop the fever, the body aches. And retesting, while available, isn't always necessary. It doesn't change the course of treatment. But I think people are sometimes discouraged when they don't get a positive result and a definitive diagnosis.

Host: And Jen, when should someone start to worry about a cough that seems to have been lingering for too long?

Jennifer Steyn, MSN, APRN, FNP-C: We've definitely seen an upswing in the longevity of symptoms and in cough. The first thing is it's normal for a cough to persist for sometimes four to six weeks after a viral infection due to the inflammation of the tissues and the airway, because those viral processes and the physical act of coughing itself causes irritation.

And I also have noticed, as climate changes or we have a lot of BGSU students who move in from other areas, when we have allergens or asthma or secondary complications, those can kind of combine and create the perfect storm for coughs to be really persistent. When they're really bothersome or you have shortness of breath or difficulty breathing is when I would say to worry and to definitely be evaluated. And that those coughs, while they may improve or change, treating that cough is still very important throughout that four to six-week period following the initial illness.

Host: All right. Katie, often, as You know, there's confusion about antibiotics, which were mentioned briefly earlier. So simply put, when do they work and when don't they help?

Katie Edgar, MPAS, PA-C: Right. And I am very big on educating on this as well, because I do think there can be some misconceptions. So, antibiotics are only helpful if you have a bacterial process. Again, most of the things that we see are viral. Again, there's 200 viruses that cause common cold-type symptoms and inappropriately prescribing or taking antibiotics in those settings will simply just cause side effects and will not be helpful. It also leads to antibiotic resistance, meaning in the future, those antibiotics will not work as well, as they could now because of the inappropriate use of antibiotics.

So again, that's the biggest thing is they're only appropriate for bacterial processes, and that is our job to inform you if that's the case. We don't expect anyone to be an expert. That's our job to let you know. And again, we're more than willing to always see you, but antibiotics are only needed for bacterial processes.

Host: Okay. Katie, how about people sometimes thinking what they have is just a virus. What's your take on that?

Katie Edgar, MPAS, PA-C: Yeah. And to kind of add to what Jen had mentioned about early testing sometimes causing false negative results and things like that, when we say, "It's just a virus," it is simply that—it's a virus. If it's influenza A, influenza B, COVID, or some other rhinovirus, any other virus that causes common cold, it is just a virus. And although there are sometimes different treatments geared towards those viruses, the treatment is still the same. And I think sometimes it can be discouraging to patients for them not to know exactly what it is. And again, I'm a woman of science. I love to have answers, black and white answers as well to let you know. And it's good to know in certain subpopulations, if it is, let's say COVID, in case you get complications, it's lasting longer. We can say, "Okay, we had COVID at this point, and not just some other virus." But really, a virus is a virus. We treat symptomatically. And sometimes we're not able to just give you that answer, but the treatment is the same.

Host: Jen, what can people do on their own at home to either recover faster or even prevent spreading respiratory illnesses?

Jennifer Steyn, MSN, APRN, FNP-C: I think that's a really important question, especially given the changes of the, I would say, kind of virulence and fear of viruses since the pandemic. Still number one, first and foremost, is when you're sick, you need to stay away from others. The CDC guidelines have changed. There's no more formal you have to quarantine for five days. They want you to be without a fever for a full 24 hours without the aid of Tylenol or Ibuprofen to control it. And they want your symptoms to be on the upswing. They want you to be getting better. And they don't want you to be developing new symptoms.

Once those guidelines are hit, it's, you know, appropriate to begin resuming activity with still being cognizant of if you don't feel well, it's still a good idea to stay home. These viruses are spread via multiple different means, whether it's touch or droplet or airborne particles that can spread very quickly.

It's also really important with our community here, especially in BG, with the campus right next to us and a lot of the schools, when kids are sick, it is important to keep them home. Kids are not as diligent about sharing their germs as adults are. And we see a lot of spread throughout the school system in both school-aged children and the college kids because of the close proximity and the large groups. So, staying away from those groups when you're sick is also really important.

Also, cleaning your environment. Using disinfectants at home to clean surfaces frequently to protect your other household members, because there are certain viruses that can live on the surface in your home for varying amounts of times depending on the viral process. So, frequent cleaning is always important.

The one thing we always talk about is changing toothbrushes. That's a part of your environment that can also kind of prolong illnesses as well. And then, I would say treating the symptoms. We see a lot of patients who are very apprehensive about starting treatment for their symptoms at home without any guidance. And by the time they get to us, the inflammation and the symptoms have reached a certain point where those over-the-counter medications may not be as effective. So, early treatment of your symptoms and consistent safe treatment of your symptoms can prevent that inflammation from worsening and possibly shorten the duration and severity of the illness itself.

Host: Great advice there. A couple other things. In summary, Katie, what do you most want people joining us to know about urgent care at Wood County Hospital? What are you most proud of?

Katie Edgar, MPAS, PA-C: So as far as our urgent care here at Falcon Health Center, affiliated with Wood County, we of course function as an urgent care. We see you for all of your urgent cough, cold injuries. What we do definitely pride ourselves in our urgent care as being a little bit different than some of the other urgent cares, we are also a student health center. So, ease of convenience of treatment for students while they're on campus is not always there. They don't have their primary care as nearby. They might have ongoing chronic issues that are not necessarily urgent, but do need appropriate treatment and guidance. So, we do function a little bit in between kind of an urgent care to primary care and see more than just the urgent things. And for that reason, we do more of a workup. We will order blood work if needed, and just have that good followup care if needed with primary cares that we have in the building and through Wood Health Company.

Also, we do pride ourselves on informing the community. We are also here for the community and the students, not just the students. So, we help the community of Bowling Green outside areas as much as possible. But yeah, we do pride ourselves on being a bit more than your typical urgent care.

Host: Absolutely. And finally, Jen, for those unfamiliar, is an urgent care appointment needed or can you just walk in? And what hours are you available?

Jennifer Steyn, MSN, APRN, FNP-C: We are definitely a walk-in clinic. There's no appointment needed. Monday through Friday, we are open 8:00 AM to 8:00 PM. On the weekends, Saturday and Sunday, we're open from 9:00 to 5:00. Wait times may vary depending on the season and depending on other factors in the building, but we try to keep wait times as low as possible. So definitely, you can always show up and we'll see as fast as we possibly can.

Host: I'm sure people are relieved to hear that. Folks, we trust you are now more familiar with seasonal illnesses and urgent care. Jennifer, Katie, thanks so much again.

Jennifer Steyn, MSN, APRN, FNP-C: Thank you.

Katie Edgar, MPAS, PA-C: Thank you so much.

Host: Absolutely. And for hours and information, you can also visit falconhealth.org. If you enjoyed this podcast, please do share it on your social channels. Check out the entire podcast library for topics that are of interest to you. Thanks so much again for being part of Health Matters: Insights from WCH Medical Experts.