National Aphasia Awareness Month

June is National Aphasia Awareness Month and Flushing Hospital Medical Center is doing its part to spread the word.

Aphasia is an acquired communication disorder that impairs a person’s ability to process language but does not affect their intelligence. It affects the ability to speak and understand others, causing most people with aphasia to experience difficulty reading and writing.

The most common cause of aphasia is stroke. About 25-40% of stroke survivors are afflicted with aphasia. It can also be a result of a head injury, a brain tumor, or other neurological causes.

Here are the six types of aphasia:

  • Global aphasia- This is the most severe form of aphasia and is applied to patients who can produce few recognizable words and understand little or no spoken language. People with global aphasia can’t read or write. It is often seen immediately after the patient has suffered a stroke and may rapidly improve if the damage to the brain has not been too extensive. However, with greater brain damage, severe and lasting disability may result.
  • Broca’s aphasia or non-fluent aphasia- In this form of aphasia, speech output is severely reduced and is limited mainly to short utterances of less than four words. A person’s vocabulary access is limited and their formation of sounds.
  • Mixed non-fluent aphasia- This form of aphasia applies to people with sparse and effortful speech, which can resemble severe Broca’s aphasia. However, they remain limited in their speech comprehension and do not read or write beyond an elementary level.
  • Wernicke’s aphasia or fluent aphasia- In this form of aphasia, the ability to grasp the meaning of spoken words is impaired. However, the ease of producing connected speech is not much affected. Reading and writing are often severely impaired.
  • Anomic aphasia- This form of aphasia is applied to people left with a persistent inability to supply the words for the things they want to say, particularly significant nouns and verbs.
  • Primary progressive aphasia (PPA)- This is a neurological syndrome in which language capabilities become slowly and progressively impaired. Unlike the other forms of aphasia that result from stroke or brain injury, PPA is caused by Alzheimer’s or frontotemporal lobar degeneration.

Aphasia is diagnosed through physical and neurological exams. An MRI and CT can also be used to identify what is causing the aphasia.

It can also be diagnosed with the help of a speech-language pathologist who can complete a comprehensive language assessment to confirm the presence of aphasia and determine the appropriate course of language treatment.

The assessment helps find out whether the person can:

  • Name common objects
  • Engage in a conversation
  • Understand and use words correctly
  • Answer questions about something read or heard
  • Repeat words and sentences
  • Follow instructions
  • Answer yes and no questions and respond to open-ended questions about common subjects
  • Read and write

Here are some treatments for aphasia:

  1. Speech and language rehabilitation

This therapy aims to improve the ability to communicate and help restore as much language as possible. This is done by teaching the person with aphasia how to make up for lost language skills and find other communication methods.

This therapy:

  • Starts early
  • Often works in groups
  • May include the use of computers
  1. Medications

Certain drugs are being studied to treat aphasia. They may improve blood flow to the brain and enhance its recovery ability or help replace the depleted chemicals in the brain.

  1. Brain stimulation

Transcranial magnetic and direct current stimulation are being studied to help improve the ability to name things.

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop any symptoms.

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Effective Workouts for Busy Schedules

You have a busy schedule and you’re trying to live a healthy lifestyle. But finding the time to get in a workout proves to be a difficult task.

Many exercises can be effective and yield results. But first, here are five tips to get you started as you create a realistic routine that is catered to your busy schedule:

  1. Plan Ahead

Planning allows you to look at your daily schedule and identify ideal times to work out, increasing the likelihood of completing a task by finding a way to fit it in rather than finding an excuse to skip a workout. Plan to succeed by bringing your shoes and workout clothes to go on a walk during your lunch break. Carry your gym bag, including shower supplies in your vehicle.

  1. Schedule It

Once you’ve planned your workout, schedule it. Write your exercise time in your planner, create a calendar entry with an automatic reminder, or reserve your spot in a specific workout class. Consider your workout time as important as a work meeting or dental appointment. Once you’ve allotted the time, avoid using “I don’t have time” as an excuse.

  1. Allot 10 Minutes, Three Times a Day

A common misconception is the more time you spend working out, the more results you will see. Aim for 30 minutes of activity, five days per week. The 30 minutes daily does not need to be consecutive. Consider splitting the time into 10- or 15-minute segments throughout your day. A workout is beneficial, no matter how long or short. Allow yourself 10 minutes to get your heart rate up. Use breaks in your day to go for a walk, or do pushups or jumping jacks, and you’ll benefit from the activity.

  1. Do the Little Things

Small tactics add up to big results. The short activities you do throughout your day will significantly affect your fitness goals. In addition, participating in short activities throughout the day keeps workouts from feeling overwhelming.

Here are some short activities you can try:

  • Take the stairs instead of the elevator.
  • Try parking further away from your destination to get in your steps.
  • Complete 10 pushups when you wake up in the morning.
  • Do jumping jacks, squats, or burpees during commercial breaks while watching TV.
  • Replace a daily distraction, such as scrolling on social media, with an activity like walking around your neighborhood.
  • If you sit at a desk for work, stand up every 20 minutes to do calf raises or stretches. Set an alarm to keep you moving throughout the day.
  1. Let Yourself Experiment

An intense workout routine and eating plan is not something to begin on a whim. This can cause you to quit as quickly as you start. You will be less successful if you decide to exercise and change your nutrition impulsively. Find a workout and nutrition plan you enjoy and can continue long-term. Allow time to experiment with different workout routines and activities. Start slowly and reflect on how you feel. Identify personal fitness goals and realistic nutrition plans.

Here are Five Workouts That Yield Maximum Results:

  • Quick Abs
    • Bicycle crunches
    • Plank
    • Mountain climbers
    • Penguin crunch
  • High-Intensity Interval Training (HIIT)
  • Tabata
  • Going for a walk
  • High-Intensity Circuit Training (HICT)

It is recommended that you consult your doctor before starting a new exercise routine, you can schedule an appointment at Jamaica Hospital Medical Center’s Ambulatory Care Center by calling (718) 206-7001.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Men’s Health Month

Father’s Day isn’t the only celebration for men in the month of June. Men’s Health Month is also observed. Men’s Health Month is an observance to raise awareness of preventable health problems, encourage early detection and treatment of disease, and improve overall well-being among men.

As part of its celebration of Men’s Health Month, Flushing Hospital Medical Center is sharing a few men’s health statistics and facts to consider:

  • Men are more than likely to be uninsured and significantly less likely than women to see a doctor or report symptoms to a healthcare provider.
  • Men, on average, die almost five years earlier than women as the overall mortality rate is 41% higher for men than women as men lead the death rate for cancer, stroke, heart disease, and diabetes.
  • Only 60% of men go to the doctor for a yearly, routine check-up, and 40% won’t see a doctor until something is seriously wrong.
  • According to the Centers for Disease Control and Prevention (CDC), 13.2% of men aged 18 and over are in fair or poor health.
  • Men are more likely to put their health at risk by smoking, drinking alcohol, and making other unhealthy life choices.
  • One in two men are diagnosed with cancer in their lifetime.
  • Prostate cancer is the second leading cause of cancer deaths for men in the United States. A man is 2 to 3 times more likely to get prostate cancer if his father, brother, or son had it. Talk to your doctor about having your PSA and DRE levels checked.
  • Erectile dysfunction affects nearly 30 million men of all ages across the United States. If you are having problems, see a urologist to make sure it’s not an early warning sign of something more serious, like heart disease, high blood pressure or high blood sugar.

Men’s Health Month doesn’t just encourage men to take care of their physical health, but their mental and emotional health as well. Men also lead the death rate for suicide.

Here are a few men’s mental health statistics and facts:

  • 31% of men suffer from depression in their lifetime.
  • 9% of men have daily feelings of depression or anxiety.
  • Only 25% of men talk to a mental health professional.
  • Only 33% take medication for their mental health problems.

Here are some preventative measures that you can take:

  • Choose a primary care provider and go regularly.
  • Get screening tests based on your age and family history.
  • Eat healthy to prevent or manage chronic conditions.
  • Get and stay active.
  • Manage stress and seek a mental health professional if one is needed.

If you are experiencing any medical problems, you can schedule an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center by calling (718) 670-5486. If you are experiencing an emergency, please dial 911 right away.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Debunking 5 Common Health Myths

Many common health myths and misconceptions exist and have been widely accepted as facts. You may have heard of some of these: cracking your knuckles leads to arthritis, cold weather makes you sick, or eating certain foods such as cayenne pepper can burn fat.

Thanks to scientific research, we have explored many of these old wives’ tales to determine if they are indeed myths or facts. Here is the truth provided behind five common health myths:
1. Myth: Cracking your knuckles leads to arthritis.
Truth: Several studies have shown that frequently cracking your knuckles does not increase the risk of arthritis; however, it may lead to reduced grip strength.

2. Myth: Cold weather makes you sick.
Truth: Cold weather in itself does not make you sick. However, research shows that certain germs and viruses may spread more easily because frigid temperatures can make our immune cells less effective.

3. Myth: Eating certain foods such as grapefruit and cayenne pepper can burn fat.
Truth: While some foods can help increase your metabolism or make you feel fuller, which can contribute to weight loss; there aren’t any that can burn excess fat.

4. Myth: You need eight glasses of water per day.
Truth: There is no set number for how much water you should drink daily. Determining how much water you should drink each day depends on several factors including weather or the climate you live in, age, or how much sweat you are producing. The National Council on Aging shares, “You should take one-third of your body weight and drink that number of ounces in fluids daily. For example, if you weigh 150 pounds, aim to drink 50 oz., or a little over 6 cups, of water each day.”

5. Myth: If you pull out a single gray hair from your scalp, more will grow back in its place.
Truth: There is only one hair that grows from each follicle; therefore, plucking a single gray hair will not result in the growth of multiple hairs.

It is important to learn the facts about our health from trusted and reliable medical resources. Receiving accurate information can help us make educated decisions and avoid complications.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

National High Blood Pressure Education Month

A woman getting her blood pressure checked at a doctor's office.High blood pressure, also known as hypertension, is defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg, according to the Centers for Disease Control and Prevention. Hypertension is a main contributing factor for heart disease and stroke, the leading causes of death in the United States. Nearly half of all adults have hypertension, but only about a quarter of these adults have their blood pressure under control.

As your blood flows throughout your body, it pushes against the walls of your arteries; this is what is known as blood pressure. It’s normal for your blood pressure to rise and fall throughout the day, and certain factors, such as anxiety, might cause it to become elevated in specific situations. However, if your blood pressure is chronically high, it can cause damage to your heart.

Certain factors can increase your risk of developing chronic high blood pressure. These include:

  • Diabetes

  • Lifestyle factors, such as obesity, an unhealthy diet, or a lack of physical activity

  • Excessive consumption of alcohol or usage of tobacco

  • A family history of high blood pressure

  • Older age

  • Race (over half of Black adults in the United States have hypertension)

There are steps you can take to manage your blood pressure and decrease your risk of medical complications. To prevent high blood pressure, it is most helpful to:

  • Eat a healthy diet

  • Maintain a healthy weight

  • Engage in regular physical activity

  • Avoid smoking

  • Limit alcohol consumption (no more than two drinks per day for men or one drink per day for women)

  • Get a sufficient amount of sleep each night

To control high blood pressure, you should:

  • Regularly measure your blood pressure

  • Make lifestyle changes to prevent your condition from worsening

  • Get medical care for any underlying conditions that may be contributing to your high blood pressure

Flushing Hospital Medical Center’s expert cardiology specialists can high-quality care for chronic hypertension and any condition that may be causing it to occur. To schedule an appointment with a cardiologist, please call (718) 670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Tips to Prevent Exercise Injuries

A runner holding their leg due to pain from an exercise-related injury.Exercise is generally good for your health; in fact, adults are recommended to get 150 minutes of moderate-intensity physical activity and two days of muscle-strengthening activity each week, according to the Centers for Disease Control and Prevention (CDC). However, it’s also important to keep in mind that there is always a risk of physical injury while exercising. Some of the most common exercise-related injuries include:

  • Injuries to your shoulders, knees, elbows, legs, or ankles
  • Bone fractures
  • Dislocation
  • Sprains
  • Strains
  • Tendinitis
  • Bursitis

Several factors affect your risk of experiencing an injury while exercising. One of these is the exercise itself; certain exercises are more challenging than others and, as a result, may be more likely to cause an injury if you are not able to perform them properly. Another factor is frequency; a moderate amount of exercise is healthy, but working out excessively can put too much stress on your body. You may also be more likely to experience an injury if you have a medical condition or disability that makes an exercise more difficult to perform.

You can off-set these risk factors by taking certain steps to keep yourself safe. When you exercise, you should:

  • Learning the correct form for each exercise you plan to do
  • Warm up before performing an exercise (for example, by performing the exercise at a very light weight)
  • Cool down after performing an exercise (you can repeat your warm-up exercise or do a different, slow-paced activity for this)
  • Using safety equipment (talk to your doctor about what would be most appropriate for the exercises you plan to do)
  • Talking to your doctor about the types of exercises you plan to perform to make sure that they are safe for you
  • Varying your exercises throughout the week, focusing on different muscles each day you work out

It’s also important to recognize when you’re experiencing pain (as opposed to soreness) while working out. Sore muscles are normal, both during and after exercise, and you will need to push yourself to a reasonable extent. However, if you feel pain, stop exercising right away. Additionally, if you feel that you physically cannot finish an exercise, don’t try to force yourself to do so; this can lead to overuse injuries.

If you’ve injured yourself while exercising, you can receive a diagnosis and treatment from a physiatrist at Flushing Hospital Medical Center’s Department of Rehabilitation. To schedule an appointment, please call (718) 670-5515.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

National Poison Prevention Week

Several common household substances that can lead to poison exposure.Each year, more than 2 million poison-related injuries and deaths occur in the United States. In the majority of these cases, the victims are children, and more than 90 percent of these cases occur at home due to exposure to (or ingestion of) common household items that can be toxic. This often occurs due to a lack of proper storage, disposal, or concealment of these items, making it easy for children or other vulnerable members of the household to access them.

To keep your family safe from poisoning, the American Association of Poison Control Centers recommends that you follow these best practices:

  • Display the Poison Help phone number (1-800-222-1222) in a location that is readily accessible or easily noticeable. Remember: this phone line is meant to help in the event of an accidental exposure, but if you or someone else experiences a medical emergency, such as loss of consciousness, severe illness, seizures, or other symptoms, dial 911 right away.
  • Safely store the following substances in cabinets with child-proof locks or in child-resistant containers:
    • Medications
    • Vitamins
    • Tobacco products, especially liquid nicotine
    • Laundry and cleaning supplies
    • Alcohol
    • Pesticides or insect repellants
    • Hand sanitizers
    • Small batteries
  • Read medication labels thoroughly before taking or administering them; if you don’t understand something, call your doctor.
  • Avoid calling medication “candy” to get children to take it.
  • Avoid taking medications in front of young children.
  • Do not use food storage containers to store harmful products such as detergents or pesticides; make sure these products remain in the containers they came in and store them out of the reach of your children.

Make sure to implement a regular routine that reinforces these practices. If you, your child, or someone else in your household experiences a poison-related medical emergency, dial 911 immediately.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

What is Hormonal Acne?

An outbreak of hormonal acne on a woman's cheek.Acne doesn’t necessarily stop after your teenage years; it can affect you far into your adult life. This is what is referred to as hormonal acne (also known as adult acne), which typically occurs in adults between the ages of 20 and 50. It is the most common skin condition in the United States, affecting nearly 80% of Americans at some point during their lifetime. It is most common in women, particularly those who are pregnant or experiencing menopause, but it can affect men, as well.

Hormonal acne occurs due to an excessive amount of sebum, an oily substance that moisturizes and protects your skin. This can cause your pores to become clogged, causing the sebum to interact with bacteria on the skin, which in turn causes acne to form. Your skin’s production of sebum is affected by hormonal changes in your body. Some factors that can affect these hormonal changes include:

  • Stress
  • Sleep
  • Certain hair and skin products
  • Periods
  • Pregnancy
  • Menopause
  • Testosterone treatment
  • Certain medications, such as some steroids
  • Certain pre-existing medical conditions
  • A family history of acne

Not all cases of acne necessarily look the same. It can cause several different types of growths to appear, including:

  • Pimples
  • Whiteheads (small white or yellowish bumps)
  • Blackheads (tiny black bumps or spots)
  • Papules (small, cone-shaped bumps)
  • Pustules (small bumps that contain pus)
  • Cysts (pockets of tissue filled with pus or other fluids)

In some cases, acne may resolve on its own; however, a variety of treatment options are available to reduce its severity, such as steroid injections and topical creams, ointments, and antibiotics. Daily skin cleansing, birth control medication, dietary adjustments, and light therapy can also help.

A dermatologist can help you determine the cause of your acne and find the appropriate course of treatment. To schedule an appointment with one at Flushing Hospital Medical Center’s Ambulatory Care Center, please call (718) 670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

What is Norovirus?

A woman holding her hands to her stomach due to pain from norovirus.Norovirus is a contagious virus that causes gastroenteritis (also known as the stomach flu) to develop. According to the Centers for Disease Control and Prevention (CDC), it is the leading cause of vomiting, diarrhea, and food poisoning in the United States.

Norovirus is most prevalent between the months of November and April. Each year, over 19 million Americans are infected with this virus. Currently, the percentage of positive norovirus test results throughout the United States is over 12%, reaching as high as over 16% in the Northeastern United States.

People with norovirus are most contagious while experiencing symptoms and during the first few days after symptoms subside; however, they can still be contagious over two weeks after they start to feel better. Some specific ways in which norovirus is often transmitted from person to person include:

  • Having direct contact with someone with norovirus, such as by caring for them, sharing food or eating utensils with them, or eating food handled by them
  • Eating food or drinking liquids that are contaminated with norovirus
  • Touching surfaces or objects contaminated with norovirus and then putting your unwashed fingers in your mouth

There are effective steps you can take to protect yourself and others against norovirus. These include:

  • Washing your hands with soap and water for at least 20 seconds after touching surfaces, food, or other people
  • Thoroughly washing fruits and vegetables if you plan to eat them
  • Thoroughly cleaning utensils, plates, bowls, counters, and other frequently-touched surfaces in your home, especially if a sick person has been using them
  • Cooking shellfish to an internal temperature of at least 145° Fahrenheit
  • Washing laundry with detergent and hot water at the maximum available cycle length, then machine drying them at the highest heat setting
  • If you are sick, avoiding preparing food or caring for others for at least 48 hours after your symptoms stop

If you experience vomiting, diarrhea, or other symptoms of norovirus, schedule an appointment with a doctor at Flushing Hospital Medical Center’s Ambulatory Care Center as soon as possible by calling (718) 670-5486.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

Cushing Syndrome

Cortisol blood test used to diagnose Cushing SyndromeCushing syndrome is a hormonal disorder that occurs when the body produces too much cortisol (the stress hormone) over an extended period.  The disorder may also develop as a result of taking medications such as glucocorticoids.

Cortisol, when produced within normal levels helps the body to suppress inflammation, metabolize food into energy, regulate the stress response, control the sleep/wake cycle, and regulate blood pressure and blood glucose.  However, too much cortisol can cause the following symptoms to develop:

  • The formation of a fatty lump between the shoulders
  • Weight gain in the face
  • Weight gain in the trunk
  • Thin arms and legs
  • Pink or purple stretch marks mostly on the abdomen, hips, underarms, and breasts
  • Acne
  • Skin that bruises easily
  • Hirsutism
  • Irregular periods
  • Infections
  • Muscle weakness
  • Erectile dysfunction
  • Reduced fertility in men
  • Slowed or delayed growth in children

Some people are more likely to develop Cushing syndrome than others. A person may have a higher risk if they are taking high-dose corticosteroids over some time, living with adrenal or pituitary tumors, assigned female at birth, or have a family history of certain genetic disorders.

Cushing syndrome can be difficult to diagnose because the symptoms often have other causes. However, a physician such as an endocrinologist can perform a physical exam, review your medical history, and order a series of tests to measure cortisol levels or look for tumors to determine a diagnosis.

It is crucial to receive timely treatment for Cushing syndrome, delayed treatment can lead to the following complications:

  • Diabetes
  • Depression
  • Heart disease
  • Stroke
  • Heart attack
  • Osteoporosis
  • Hypertension

Treatment focuses on lowering cortisol levels in the body. This may be achieved through medications, surgery, radiation therapy, or lowering the dose of glucocorticoids.

To schedule an appointment with an endocrinologist at Flushing Hospital Medical Center, please call 718-670-5486.

 

 

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.