Is Your Child Feeling Sick? When is a Cold Not a Cold?

By Dr. Patricia Avila | Pediatrician

It’s that time of year again! The cooler weather is among us, nights are getting longer, and families are even busier than usual as the holidays approach. It’s also the time of year when children start coming down with symptoms of colds or other respiratory illnesses. While most of these symptoms will turn out to be simple colds and resolve on their own, there are some related illnesses that can be more serious.

The Common Cold: Also Known as an Upper Respiratory Infection

The common cold is caused by several different viruses and is the most common of all the respiratory illnesses. On average, children under the age of two will have three to five colds per year. Children who are in daycare or school-aged children are likely to get sick even more often, because they are exposed to lots of other children on a daily basis. Fortunately, most of these illnesses are just colds and will go away on their own. 

Symptoms of the Common Cold

  • Low fever (101-102 degrees F).
  • Runny nose, nasal congestion, and/or sneezing
  • Sore throat
  • Cough
  • Lack of appetite
  • Fussiness

Symptoms can last up o 14 days but most children feel better within 7-10 days.

When to Worry with the Common Cold

While the majority of children will not need to be see a medical provider for the common cold, you should seek immediate assistance if your child:

  • Is an infant under 3 months old
  • Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
  • Nails or lips turn blue
  • Symptoms last longer than 10-14 days
  • Is dehydrated or not drinking or urinating well
  • Is too sleepy or very fussy and not consolable
  • Has ear pain
  • Has any other symptoms or continues to get worse

Treatment for the Common Cold

  • Antibiotics do not treat the common cold since it is caused by a virus
  • Increased fluids
  • Use of pain/fever medication such as acetaminophen or ibuprofen
  • Nasal saline with suctioning for congestion
  • Honey for cough in a child OLDER than 1 year (NEVER give honey to a child under the age of 1)
  • Use of a humidifier may provide relief

The Flu: Also Called Influenza

The flu is also caused by respiratory viruses called influenza and can present very similar symptoms to the common cold.  However, children with the flu feel much worse and are sicker than with the flu than the common cold.  The flu can have very serious complications including need for hospitalization and sometimes death.   

Symptoms of the Flu

  • Rapid onset of high fever (above 101 degrees F)
  • Chills
  • Headache or other body aches
  • Runny nose, nasal congestion
  • Chest pain and cough
  • Sore throat
  • Poor appetite
  • Feeling tired and weak

Most children will get better after two weeks. Fevers from the flu can last up to seven days. 

When to Worry with the Flu

Flu symptoms can lead to serious complications that require immediate medical treatment. You should seek assistance if your child:

  • Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
  • Nails or lips turn blue
  • Is dehydrated or not drinking or urinating well
  • Is too sleepy or very fussy and not consolable
  • Has ear pain
  • Has any other symptoms or continues to get worse

Young children, infants, and children with high-risk medical conditions who are having flu symptoms should see their pediatrician as soon as possible. High-risk medical conditions may include:

  • Heart defects
  • Chronic lung issues
  • Asthma
  • Weakened immune system
  • Diabetes
  • Cancer

Treatment for the Flu

  • Increased fluids
  • Use of pain/fever medication such as acetaminophen or ibuprofen.
  • Nasal saline with suctioning for congestion.
  • Honey for cough in a child OLDER than 1 year (NEVER given honey to children under the age of 1)
  • Use of humidifier may provide relief

Outside of supportive care, there is an antiviral medication called Tamiflu which may be prescribed if the flu is diagnosed within the first 1-2 days of onset.


Bronchiolitis is another respiratory illness that is common during the winter months.  There are several viruses that can cause this illness, but RSV, also known as Respiratory Syncytial Virus, is the most common.  RSV is an infection that will affect almost all children under the age of 2 at least once. It usually starts as a cold and within 3-5 days of the onset of the illness is followed by lower respiratory symptoms. For some children the illness can be severe, especially in younger infants, preemies, and those with heart or lung defects.   

Symptoms of Bronchiolitis

  • Cold symptoms with fever, runny nose, nasal congestion, and cough
  • Fussiness
  • Poor appetite
  • Wheezing
  • Difficulty breathing

When to Worry with Bronchiolitis

Bronchiolitis symptoms can lead to serious complications that require immediate medical treatment. You should seek assistance if your child:

  • Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
  • Nails or lips turn blue
  • Is dehydrated or not drinking or urinating well.
  • Child is too sleepy or very fussy and not consolable
  • Has ear pain
  • Has any other symptoms or continues to get worse

Treatment for Bronchiolitis

  • Increased fluids
  • Use of pain/fever medication such as acetaminophen or ibuprofen.
  • Nasal saline with suctioning for congestion.
  • Honey for cough in a child OLDER than 1 year (NEVER given honey to children under the age of 1)
  • Use of humidifier may provide relief

For infants who are high risk there is an injection that is given monthly during the winter months called Synagis that can decrease the risk of severe RSV infection. 


Croup is another respiratory illness that is common during the fall and winter months and is usually seen in infants and children under 5. Croup is caused by several different viruses including the flu virus and some cold viruses.  The illness is characterized by swelling of the upper airways including the voice box (larynx) and the windpipe (trachea). Symptoms from croup are usually worse at the beginning of the illness. 

Symptoms of Croup

  • Fever which can be low grade or high
  • Cold symptoms with runny nose and nasal congestion
  • Hoarseness of voice
  • “Barky” or “seal like” cough
  • Noisy breathing called stridor, a high-pitched, turbulent sound when a child inhales or exhales

When to Worry with Croup

The swelling of the airway can sometimes be severe and need immediate medical attention. You should seek assistance if your child:

  • Has trouble breathing – struggles to catch their breath
  • Has noisy breathing that is getting louder and child/infant appears to struggle to breathe
  • Cannot talk because of difficulty breathing
  • Nails or lips turn blue
  • Is drooling and not able to swallow saliva
  • Is dehydrated or not drinking or not urinating well
  • Is too sleepy or very fussy and not consolable

Treatment for Croup

Steroids can decrease the swelling and can be given by mouth, injection, or in a breathing treatment. If given early steroids can help decrease the need for hospitalization and improve breathing.  For severe cases, a breathing treatment with epinephrine may be administered, but this requires careful observation in the emergency department or hospital setting.

Use of cold moist air can help improve mild symptoms as well and can be used at home with a cool mist humidifier.

Tips to Keep Your Child Healthy and Well

  • For all respiratory infections, the best form of prevention is to avoid exposing infants or young children to large crowds or people who are sick.
  • Breastfeeding infants as long as possible (at least 6-12 months) is also an important way to help prevent and fight infections because breastmilk provides antibodies. 
  • Practicing and teaching children good hand hygiene is key.
  • Use soap and water and scrub for at least 20 seconds (sing the ABCs, Baby Shark, or another fun tune).  Another option is the use of an alcohol-based hand sanitizer if hands are not visibly soiled. 
  • Teach children to cover their coughs and sneezes properly by using a tissue or coughing in their arm rather their hands. 
  • Keep children home from daycare or school when they are sick to avoid spreading the illness. 
  • Eating a healthy balanced diet high in fruits and vegetables can help boost the immune system and decrease the chances of getting sick.   

If you have questions about these or other common childhood illnesses, talk to your NOAH provider. If at any time you’re not sure what to do, you can also call our Nurse Triage for immediate advice.

Who Should Get the New Bivalent COVID-19 Booster?

Along with the approval of the new bivalent COVID-19 booster comes new recommendations from the CDC that everyone who is eligible should receive this booster. So who needs which vaccines and when? NOAH’s expert and Pharmacy Director, Eric Scherf weighs in on the most frequently asked questions.

Q. How is this vaccine different from previous vaccines?

A. The new bivalent COVID-19 boosters protect against the original strain of COVID and the omicron variant. Previous vaccines and boosters have only been monovalent, meaning they only offered protection against the original strain of COVID-19.

Q. Which COVID vaccines should patients have before getting this vaccine?

A. To be eligible for the bivalent COVID-19 booster, patients should have completed their primary series vaccine and any boosters at least two months ago.

Q. Which bivalent COVID-19 boosters does NOAH offer?

A. NOAH currently offers Pfizer and Moderna bivalent boosters. Availability varies by clinic so patients having a preference of manufacturer should inquire when scheduling.

Q. What ages are eligible for the bivalent COVID-19 booster?

A. Patients ages 12 and up are eligible for the Pfizer bivalent booster and ages 18 and older are eligible for the Moderna bivalent booster.

Q. Can patients get the bivalent COVID-19 booster at the same time as their flu vaccine?

A. Yes! Patients can schedule to get the flu vaccine and bivalent COVID-19 booster during the same appointment.

Q. Will the bivalent COVID-19 booster make patients sick?

A. If patients experience any side effects, expect them to be minor and brief, as with previous COVID-19 vaccines, the bivalent booster may cause pain, redness and swelling at the injection site; fatigue; headache; muscle pain; joint pain; chills; nausea/vomiting and fever.

Q. How much does the bivalent COVID-19 booster cost?

A. At this time, COVID-19 vaccines and boosters are covered by the federal government. Insurance, if applicable, may be billed for costs associated with administration of the vaccine.

Q. How can I sign-up to get the bivalent COVID-19 booster?

A. Patients who would like to get the booster can request an appointment online or call 480-882-4545 to schedule.

For more details about COVID-19 vaccines and boosters, feel free to ask your NOAH provider or check out the CDC website.

Celebrating Hispanic Heritage

By Lisa Nails and Leslie Pina | NOAH Patient Navigators

National Hispanic Heritage Month is observed from September 15 to October 15 by celebrating the histories, cultures, and contributions of American citizens whose ancestors came from Spain, Mexico, the Caribbean, and Central and South America.

The observation started in 1968 as Hispanic Heritage Week under President Lyndon Johnson and was expanded by President Ronald Reagan in 1988 to cover a 30-day period.

At first it may seem awkward this observation doesn’t follow a traditional calendar month but the dates make perfect sense! September 15 is set as the starting date for the month as it is important for many reasons. It is the independence anniversary for Latin American countries: El Salvador, Guatemala, Costa Rica, Nicaragua, and Honduras. From here onwards, the independence days of Mexico and Chile fall on September 16 and September 18, respectively. Dia de la Raza or Columbus Day also falls within this month on October 12.

NOAH is proud to recognize and celebrate the incredible contributions to medicine brought forth by Hispanic healthcare pioneers. Here’s the story of Carlos Juan Finlay, MD.

Solving the Yellow Fever Mystery

Carlos Juan Finlay
Carlos Juan Finlay, MD (1833-1915)

In a time when yellow fever was ravaging through several nations, one doctor had the answer and was ignored and mocked for his ideas. Dr. Carlos Juan Finlay was a Cuban epidemiologist who is recognized for his research on yellow fever and his discovery of how it is transmitted. Finlay was intrigued in finding the cause of yellow fever ever since he graduated from Jefferson Medical College in Philadelphia, Pennsylvania in 1855.

At this time, it was thought that filthy clothing and filth in the air was the cause of yellow fever. Finlay had a different idea on how yellow fever spread and he began to investigate the relationship between yellow fever epidemics and the increase in mosquito populations. In 1881, Finlay presented his idea that mosquitos are the ones who carry yellow fever from infected patients to healthy patients. Unfortunately, experts ridiculed his idea.

In 1898, during the Spanish-American war the U.S. Army looked to Finlay for help in reducing the number of deaths caused by infectious diseases. During this time more troops were dying from diseases than from combat. By applying the ideas Finlay had about mosquitos-as-vectors and mosquito control, the Army was able to reduce the number of disease outbreaks.

The completion of the Panama Canal had been repeatedly disrupted by disease outbreaks and with Finlay’s discoveries it could finally be completed. After all the ridicule Finlay encountered when he first presented his ideas, his thinking was later referred to by William Gorgas, MD as “the best piece of logical reasoning that can be found in medicine anywhere”.

The Function of Fiber

By Noel Ugarte, MS, RD | Registered Dietitian

Let’s talk about fiber. I’m sure most of us have heard that fiber is good for us – but how? It turns out that fiber can help manage and prevent many diseases.

What is Fiber?

Fiber is plant material that our bodies cannot fully digest. This means that the only food sources of fiber are plants. Vegetables, fruits, whole grains, and beans are all excellent sources of fiber. Fiber is a functional food. This means that as fiber travels through our bodies, it does different helpful jobs. But how does undigested plant material traveling through our body help improve our health?

Type 2 Diabetes

Fiber is technically a type of carbohydrate. The great news is, as stated above, we do not have the digestive tools to break it down into sugar. Instead, our stomachs break down fiber into smaller pieces. This takes a long time for our stomachs to do. Slower digestion time means that blood sugar levels will rise at a slower rate. This is great news for people who are trying to keep blood sugar levels steady. The American Diabetes Association recommends diabetics consume adequate fiber in their diets each day to help manage diabetes.

Whole grain bread, brown rice, beans, whole wheat pasta, oatmeal, popcorn, and potatoes with skins are all examples of high fiber carbohydrates.

Broccoli, carrots, onions, cauliflower, asparagus, green beans, eggplant, cucumbers, and celery are all examples of non-starchy vegetables. These vegetables do not raise blood sugar levels like potatoes and corn do. They are also packed with fiber!

High Cholesterol

Fiber may also help to lower LDL cholesterol (bad cholesterol) levels. Specifically, soluble fiber has been shown to help with this. Soluble fiber is a type of fiber that softens and grows when it comes into contact with liquid. Imagine what happens when you cook rice, oats, or dried beans – they soften and grow in size! As this thick fiber travels through your gut, it grabs some cholesterol that you ate in your meal and stops it from getting absorbed into your blood.

You can get soluble fiber into your diet by eating more lentils, beans, oats, chia seeds, fruits such as apples, oranges, and bananas, and vegetables such as brussels sprouts, carrots, and potatoes.

General Gut Health

Fiber is the main food source for the bacteria in our gut. It may not sound good to have bacteria in your gut, but in fact, these intestinal friends are necessary and help us to stay healthy. As they eat (or, rather, ferment) the fiber, they produce gas. This is why fibrous foods can sometimes cause bloating and gas! It’s important we feed them well in order to keep our gut bacteria diverse and flourishing.

According the the American Cancer Society, fiber has been linked to lowering colorectal cancer risk. It can also help to prevent polyps and diverticulitis flares. This is because the undigested plant material acts as a brush, brushing clean the lining of our intestines as it makes its way through us.

Fiber can also help regulate bowel movements. The different types of fiber – soluble and insoluble – work to change the shape and texture of our stools.  Soluble fiber absorbs water and becomes thick, insoluble fiber travels unchanged throughout the body making stools more bulky in size. These two functions – viscosity and bulking – help our stools to be more regular in schedule and texture.

The great news is that most fibrous foods have a mix of both types of fiber.

Weight Loss

Higher fiber diets have been linked to weight loss. Foods that are naturally high in fiber tend to be higher in vitamins and minerals and lower in calories. Think about the difference between cheese puffs and carrots. You can eat a lot more carrots for 100 calories than cheese puffs for 100 calories. Thus, when meals are higher in fiber, you are more likely to feel fuller for longer while taking in less overall calories.

How Much Fiber Do I Need?

Adult females should get about 25g fiber per day, and males should get about 38g fiber per day (or about 14g fiber per 1,000 calories per day).

If you are looking to increase your fiber intake, consider increasing your fiber intake slowly. Going from a low fiber diet to a normal fiber diet too quickly can cause abdominal pain and bloating. Try increasing intake by 5-10 grams every few days as tolerated and remember to drink plenty of water.

Take a look at some of these higher fiber foods. Which foods can you add into your diet today?

High Fiber Foods (4 grams or more)

FoodServing sizeGrams of fiber
Artichoke1 medium10.3
Beans, baked, plain1/2 cup5.2
Beans, black1/2 cup7.5
Beans, kidney, canned1/2 cup6.9
Beans, lima1/2 cup6.6
Beans, navy1/2 cup9.5
Beans, pinto1/2 cup7.7
Beans, white, canned1/2 cup6.3
Blackberries1/2 cup3.8
Bulgur1/2 cup4.1
Cereal, high fiber, bran1/2 cup4-9
Chickpeas, canned1/2 cup5.3
Lentils1/2 cup7.8
Mixed vegetables, frozen1/2 cup4
Pear1 medium5.1
Peas, green, frozen1/2 cup4.4
Peas, split1/2 cup8.2
Potato, baked with skin1 medium4.4
Potato, sweet, baked with skin1 medium4.8
Quinoa1/2 cup5
Raspberries1/2 cup4
Soybeans1/2 cup5.1
Academy of Nutrition and Dietetics (sources: US Department of Agriculture, Agricultural Resource Service. 2008. USDA National Nutrient Database for Standard Reference, Release 20. Nutrient Data Laboratory Home Page,; accessed November 5, 2008. Nutrition Nutrition Facts and Information,; accessed April 28, 2008. American Dietetic Association, Nutrition Care Manual: Constipation Nutrition Therapy,; accessed June 25, 2008.)

Moderate Fiber Foods (1-3 grams)

foodserving sizegrams of fiber
Banana1 medium3.1
Barley1/2 cup3
Beans, green or yellow1/2 cup2
Beets, canned1/2 cup1.5
Blueberries1/2 cup1.8
Bread, whole or cracked wheat, pumpernickel, rye1 slice2
Broccoli1/2 cup2.5
Brussels Sprouts1/2 cup2
Cabbage1/2 cup1.4
Carrots, frozen1/2 cup2.4
Carrots, raw1/2 cup1.6
Cauliflower1/2 cup2.5
Cereal, bran w/ raisins1/2 cup3.4
Cereal, wheat or oat1/2 cup2 – 4
Cherries, canned or fresh10 cherries1.4
Coconut, shredded1 oz.2.5
Corn, canned or frozen1/2 cup2.1
Cornbread2″x2″ piece1.4
Crackers, whole wheat4 crackers1.7
Cranberries1/2 cup2.6
Dates, dried5 dates3.3
Eggplant1/2 cup1.3
English muffin1 english muffin2
Figs, medium1 fig1.9
Fruit cocktail, canned1/2 cup1.2
Grapefruit1/2 cup1.4
Greens, such as turnips, beets, collards1/2 cup1.6-3.2
Kale, cooked1/2 cup1.3
Kiwi1 medium2.3
Melon1 cup1.4
Muffin, oat bran2 oz.2.7
Nuts, almonds1 oz.3.5
Nuts, pistachios, pecans, walnuts1 oz.2-3
Oat bran1/2 cup2.3
Oatmeal1/2 cup2
Okra1/2 cup2
Orange, 2 1/2″1 orange3.1
Papaya1/2 papaya2.8
Peaches, fresh or canned1 fresh or 1/2 cup canned1.5
Peanuts1 oz.1 oz.
Pears, canned1/2 cup1/2 cup
Peas, green, canned1/2 cup1/2 cup
Pineapple, fresh1/2 cup1.1
Plum, 2″1 plum1
Popcorn, air-popped1 cup1.2
Prune juice1/2 cup1.3
Prunes5 prunes3.5
Pumpkin, canned1/2 cup3.6
Raisins, seedless1/4 cup1.4
Rice, brown or wild1/2 cup1.8
Sauerkraut, canned1/2 cup3.4
Seeds, sunflower or pumpkin kernels1/4 cup1.1
Spaghetti, whole wheat1/2 cup3.2
Spinach, canned1/2 cup2.6
Spinach, frozen1/2 cup3.5
Squash, all varieties1/2 cup2.9
Strawberries1/2 cup1.7
Tangerine1 tangerine1.5
Tomato sauce, spaghetti or marinara1/2 cup3..3
Tomatoes, raw1 medium1.5
Tortilla, corn, 6″1 tortilla1.6
Veggie or soy patty1 patty3.4
Wheat germ2 tbsp.1.7
Academy of Nutrition and Dietetics (sources: US Department of Agriculture, Agricultural Resource Service. 2008. USDA National Nutrient Database for Standard Reference, Release 20. Nutrient Data Laboratory Home Page,; accessed November 5, 2008. Nutrition Nutrition Facts and Information,; accessed April 28, 2008. American Dietetic Association, Nutrition Care Manual: Constipation Nutrition Therapy,; accessed June 25, 2008.)

We’re Here to Help

Learning the ins and outs of a healthy diet can be tricky. Whether you’re just getting started or need a refresher, NOAH nutrition educators are here to guide and support you in living your healthiest life. For more information on nutrition services at NOAH, visit our website, or call 480-882-4545.


Academy of Nutrition and Dietetics

American Cancer Society Guideline for Diet and Physical Activity

Mechanisms of Dietary Fiber – Fiber Facts

Types of Carbohydrates | ADA (

Whole Grains, Refined Grains, and Dietary Fiber | American Heart Association

10 Exercises You Can Do in the Pool

By Alexander Clabourne, RDN | Dietitian

Looking for some exercises that does not involve waking up early in the morning to try and avoid the summer heat? Look no further with these ten pool exercises! Exercising in the pool is a great way to stay cool during the summer, while also improving strength and cardiovascular health. What’s awesome about these exercises is they all can be done with minimal equipment; you just need yourself and the pool, but it can be handy to have some goggles too! Check out the following exercises to learn more!

Remember: Unless using an indoor pool, use plenty of sunscreen to prevent sunburn, even when cloudy outside. Also, drink plenty of water while exercising to stay hydrated. You can still sweat in the pool!

1. Front Crawl

Also known as free style, front crawl is a type of swimming stroke. This is an advanced swimming technique, but once learned, this exercise can take your fitness routine to the next level!  Check out the video tutorial below to learn how to do the front crawl correctly.

2. Breaststroke

Similar to front crawl, breaststroke is another swim stroke that you might find easier to do. What’s unique about this exercise is that it can be easier to swim with your head above the water. Tune into the video below to learn how to do this exercise.

3. Walking

This exercise is great for beginners. It comes with similar health benefits to walking on land, while adding extra resistance and taking stress off your joints. To perform this movement, simply walk back and forth across the shallow end of the pool.    

4. Treading

This exercise involves staying in place, while keeping your head above the water. If you are new to this exercise, start in the shallow end of the pool first before moving to the deep end. There are many ways to do this exercise so do whatever is easiest for you! Check out the video below to learn how!

5. Jumping Jacks

Perform this exercise like you would on land. Don’t worry if you can’t do as many as you can do on land. It’s supposed to be harder!

6. Kicking

For this exercise, hold onto the side of the pool and do a flutter kick to keep yourself afloat and flat across the surface of the pool. You can also do this exercise with a breaststroke kick.

7. Wall Push Offs

This is a fun one! To start, hold on to the side of the pool while placing both feet on the wall so that you are hanging off the edge. Tuck your knees into your chest, and when you are ready, push off and glide on your back. Jog/walk back to the edge and repeat.

8. High Knees

To perform this exercise, alternate between pushing off the bottom of the pool with your foot bringing your knee up as high as you can. You can stay in place or do this exercise across the shallow end of the pool.

9. Dips/Pushups

This exercise is effective for building upper body strength. If you can’t do the dips, pushups in the pool can be an easier alternative. Start in the pool by placing both of your hands on the edge of the pool a little bit wider than shoulder width apart. While at an angle, lower your chest as far as you can and push back up. Watch the video below for step by step instructions.

10. Lateral Arm Raises

This exercise can help strengthen your shoulders. Start with your shoulders below the water with your hands placed at your side. Slowly raise your hands up out to the side until they reach the surface of the water like a cross. Slowly lower your arms back down to your sides to repeat the movement. You can also do this exercise with your arms bent at 90 degrees to make it easier. 

Monkeypox: What You Need to Know

According to recent reports released by the Centers for Disease Control and Prevention (CDC), as of August 1 there have been over 5,100 reported cases of monkeypox in the United States with Arizona accounting for 50 of those cases. Our best defense against monkeypox is to keep it from spreading by understanding symptoms of the virus and how it’s transmitted. Dr. Vanyo-Novak, Family Physician and Medical Director for NOAH answers some of the most common questions.

Q: What is monkeypox?

A: Monkeypox is a virus that can cause fever, body aches, fatigue, swollen lymph nodes, and a rash that typically starts on the face, arms, and legs and spreads toward the trunk. 

Examples of Monkeypox rash:

Monkeypox Example

Though cases are on the rise, this infection is still rare and there is much you can do to protect yourself.

Q: Is monkeypox the same thing as chickenpox?

A: No, monkeypox is caused by a different virus. 

Monkeypox is most similar to Smallpox, a virus that last seen in the U.S. back in 1949. 

Though monkeypox and chickenpox both involve rashes that can itch and be painful, the rash in monkeypox starts as flat red spots that become raised within 1-2 days and then pus filled within 5-7 days.  The rash in monkeypox can involve the palms of the hands and soles of the feet, the rash in chickenpox doesn’t.  Monkeypox also causes swollen lymph glands, something you don’t usually see with chickenpox. 

Q: Who is at risk for monkeypox?

A: Anyone who comes in close contact with other people or animals infected with monkeypox.

Monkeypox can be spread through:

  • direct contact with the rash, scabs, or bodily fluid
  • touching items (clothes, linens) that previously touched the rash or bodily fluids
  • inhaling respiratory secretions during close face-to face contact or during intimate physical contact such as kissing, cuddling, or sex.
  • pregnant women can spread the virus to their fetus through the placenta 

Q: How do I protect myself and my family from monkeypox? 

A: There is a lot you can do to avoid contracting monkeypox, including: 

  • Avoid close, skin-to-skin contact with people who have rashes.  Avoid touching rashes or scabs on other people.
  • Do not kiss, cuddle, or have sex with someone who has suspected or confirmed monkeypox.
  • Do not share utensils or cups with someone who has suspected or confirmed monkeypox.
  • Do not touch bedding, towels, or clothes of someone who has suspected or confirmed monkeypox.
  • Avoid touching your face and clean your hands after touching other people or surfaces.  This can be done with soap and water or with and alcohol-based sanitizer. 
  • If you work in a NOAH Health Center or other patient care environment, make sure to wear appropriate personal protective equipment (PPE) and exercise good hand hygiene.

Q: Is there a vaccine for monkeypox?

A: Yes, there are two vaccines licensed by the Food and Drug Administration (FDA) for preventing monkeypox.  These vaccines are in limited supply and available through the Centers for Disease Control (CDC) and Health Department only.  Unlike most of our vaccines, the monkeypox vaccines can be given after a known exposure to the virus and still be effective.  At this time, the vaccines are mostly being used in high risk individuals who have had close contact with a confirmed case of monkeypox.

Q: What if I suspect I have monkeypox?

A: Please self-isolate until you can seek medical attention for further evaluation.  NOAH has an RN Nurse Triage line available to help assess your symptoms and determine whether a telehealth or in office visit is needed.  Testing for monkeypox can only be completed during an in office visit.  Please make sure to wear a mask and cover all open sores prior to entering any of our NOAH clinics.  This is to help decrease the spread of the virus.

Q: Is there treatment for monkeypox?

A: No, there is no specific treatment for monkeypox.  That being said, because monkeypox is so similar to smallpox and smallpox does have a treatment, TPOXX, this treatment can be approved under what’s called “compassionate use” for patients at extreme risk for complications.  This medication is only available through the CDC.  If a NOAH clinician believes a patient may need treatment for monkeypox they will help coordinate next steps with the CDC.  Though most cases of monkeypox will resolve on their own and not require treatment there are some instances where treatment is indicated (examples include patients with active HIV, intolerable pain from the monkeypox lesions). 

Q: What is NOAH doing to prevent the spread of monkeypox in our clinics?

A: NOAH Health Center teams follow specific guidelines to reduce the risk of exposure to infectious diseases.  Patients with symptoms indicating a potentially contagious condition are roomed upon arrival to the clinic. NOAH staff follow strict protocols for use of Personal Protective Equipment (PPE) and cleaning of the exam rooms and office equipment after each visit.

Q: Where can I learn more about monkeypox?

A: For the most accurate and up-to-date information, please visit the CDC website.

Pool Safety: What you Need to Know

A hot summer afternoon in Arizona often means spending time in the pool with family and friends. This can be a great time to cool off, get active, and enjoy our beautiful weather, but pools can be dangerous. Check out these tips to stay safe next time you dive in.

Monitor Access

  • Install a fence at least four feet tall around the pool, which should ideally surround the pool on all four sides and completely separate it from your home and yard. It should not have any gaps that a small child could slip over, under, or through. The gate should be a self-closing and self-latching without the ability to be be opened or reached by a small child.
  • Add an extra layer of protection with alarms or notifications for your pool, pool gate, doors, and windows that can alert you when someone is in or around the pool.
  • Ensure your pool and property enclosure is compliant with safety requirements per your home’s city or county building code.

Designate a Water Watcher

Never leave children alone, even for a moment, in or near a pool or other body of water including lakes, beaches, and even bathtubs or buckets of water.

When any inexperienced swimmer is around the pool area, make sure there is a designated adult providing continuous supervision. This adult should not be under the influence of drugs or alcohol, should not have any distractions (including cell phones, books, magazines, etc.), and preferably knows how to swim and perform CPR. Ensure your designated Water Watcher is aware they are the only one providing supervision and must hand off the responsibility to another qualified adult if they become distracted or need to leave the pool area. Some households use a lanyard or other item to identify the designated Water Watcher and have a physical item to hand off when transferring responsibility to someone else.

Learn to Swim

Consider parent/toddler swim classes for children over the age of one. These classes help little ones get used to the water and are a good introduction for future swimming lessons. Children ages four and up are typically ready for independent swimming lessons. Talk to your pediatrician about your child’s developmental readiness to take swim lessons. There are a variety of options for swimming lessons for children of all ages, as well as adults, at public pools, private pools, and even your own home. Wherever your child learns to swim, if you have a pool at home or elsewhere that you use regularly, make sure swimmers are familiar with the layout of the pool like changes in water depth and the location of the steps.

Use the Buddy System

Even experienced adult swimmers should never swim alone. Medical and environmental emergencies unrelated to swimming ability can often pop up when they’re least expected. Swimming with a buddy provides an extra layer of safety and it’s more fun too.

Check Your Equipment

  • Keep rescue equipment like a safety hook and life preserver near the pool for easy access in case of emergency.
  • Avoid inflatable swim aids like floaties, as they are not a substitution for proper life-preserving equipment like life jackets.
  • Talk to your pool operator to make sure your pool (and spa if you have one) drains are compliant with the Pool and Spa Safety Act.

Use Caution Around Chemicals

Chemicals like chlorine keep our pools nice and clean but they can have serious affects on your health if used improperly. Always follow the instructions on the chemical packaging for storage and use and make yourself aware of the recommended emergency treatment for various types of accidental exposure or ingestion. It’s also a good idea to program the phone number for Poison Control into your phone (1-800-222-1222).

Avoid Sunburn and Dehydration

It’s easy to get sunburned and dehydrated in the pool because the water keeps you cool. Even if your skin doesn’t feel hot, be sure to apply and reapply sunscreen, protect exposed skin with a t-shirt or wide-brimmed hat, and seek shade between 10 a.m. and 4 p.m. when the sun’s ultraviolet rays are the strongest. Keep a water bottle near the pool and drink up even if you’re not thirsty. There’s a good chance you’re sweating underwater (either from the outdoor temperature or physical exertion) and you need to replenish your fluids to stay hydrated. Make sure everyone in and around the pool is familiar with the signs of heat-related illness and seek first aid or medical treatment when needed.

Do Not Swim During Storms

Afternoon thunder and lightning (or electrical) storms are common during the summer in Arizona and water conducts electricity. In the event of a storm the National Lightning Safety Institute recommends evacuating the pool immediately and seeking shelter inside the house until at least 30 minutes after the last thunder is heard.

Your NOAH provider is a great resource for water safety, heat-related illness, and sun exposure. If you haven’t had a check-up recently or have a specific concern, schedule an appointment, we’d love to see you.

When to Worry About Memory Loss

People forget things all the time; and the older you get, the more it happens. So how do you know when memory loss is something more serious?

Warning Signs

According to the Alzheimer’s Association, there are 10 warning signs to look for:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks
  4. Confusion with time or place
  5. Trouble understanding visual images and special relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

Normal Behavior

Here’s a helpful chart from the Alzheimer’s Association to determine what’s normal and what’s not:

Signs of Alzheimer’s/DementiaTypical Age-Related Changes
Poor judgement and decision markingMaking a bad decision once in a while
Inability to manage a budgetMissing a monthly payment
Losing track of the date or the seasonForgetting which day it is and remembering later
Difficulty having a conversationSometimes forgetting which word to use
Misplacing things and being unable to retrace steps to find themLosing things from time to time

For more tips on identifying the signs of Alzheimer’s and dementia, refer to “Is it Alzheimer’s or Just Signs of Aging” from the Alzheimer’s Association.

Getting Support

If you think your loved one is showing signs of dementia, the Centers for Disease Control and Prevention (CDC) recommends the following steps:

  • Talk with your loved one about your concerns.
  • Identify what activities might be unsafe for your loved one; like driving, managing finances, or remembering to take daily medication.
  • Schedule an appointment for your loved one with a medical provider you trust and attend the appointment with them to share your concerns.
  • Set-up a family meeting to discuss next steps; and ask the hard questions, including advanced medical directives and estate plans.

As with any disease, early detection is key to slowing or stopping the progression of the illness. Unfortunately, there is no cure for Alzheimer’s but there are medications that will slow progression and reduce symptoms of the disease.

How You Can Help

In recognition of Alzheimer’s and Brain Awareness Month, the Alzheimer’s Association holds an annual awareness event on June 21. “The Longest Day” brings people from all over the world together to fight the darkness of Alzheimer’s and raise funds and awareness for the care, support, and research efforts of the Alzheimer’s Association.

Who Should get Tested for HIV?

The only way for someone to know if they are infected with HIV is to get tested. The CDC recommends everyone age 13 to 64 get tested for HIV at least once in their lifetime as part of routine health care. People who participate in high-risk activities should get tested more often.

High-risk activities include:

  • Men having sex with men
  • Having sex with a partner who is HIV positive without using a condom or taking Pre-Exposure Prophylaxis (PrEP)
  • Multiple sexual partners in the last year
  • Having sex with someone who participates in the high-risk activities above or, you don’t know their sexual history
  • Exchanging sex for drugs or money
  • Sharing needles, syringes, or other drug injection equipment

Other risk factors that require testing more often:

  • Previously diagnosed with, or treated for, another sexually transmitted infection, hepatitis, or tuberculosis

It’s recommended that high-risk individuals get tested once a year. Intravenous drug users should get tested every six months. Women who are pregnant and haven’t been tested previously should also talk with their healthcare provider about getting tested for HIV. Infected pregnant women can reduce the risk of passing the virus on to their child to as little as 1% with proper treatment.

How do you test for HIV?

NOAH offers HIV testing as part of routine blood work as well as rapid testing which only requires a simple finger poke and produces results in as little as 30 minutes.

How much does it cost?

HIV testing at NOAH is free but does require an appointment with a medical provider. As preventative care, this appointment is typically covered in full by most insurance carriers.

Maricopa County is an HIV Hot Spot

A federal program launched in 2020 “Ending the HIV Epidemic” identified 50 jurisdictions and seven states accounting for more than half of all new HIV diagnoses in the United States. Maricopa County is on the list of HIV “Hot Spots” with new infection rates per 100K people ranking higher than the state and national average. Allocating additional government funds to geographical areas like Maricopa County improves access to HIV testing, treatment and prevention with the goal to reduce new infections by 75% in five years (2025) and by 90% in ten years (2030).

Now more than ever, people living with HIV can lead long healthy lives with proper treatment. The earlier the virus is detected, the sooner treatment can begin. For more details on HIV treatment and prevention, check out our blog post “What if You Test Positive for HIV?” or schedule an appointment with your NOAH provider.

What if You Test Positive for HIV?

Learning you’ve tested positive for HIV might feel like the end of the world, especially if you weren’t expecting it. It’s normal to feel mad, scared, sad, or even numb at first and you’ll likely experience a wave of these emotions as the reality of your diagnosis begins to set in.

NOAH’s HIV navigation team will contact you immediately if you have a positive HIV diagnosis. Our highly skilled team will help you process and understand your results, help you schedule an initial appointment with an HIV specialty clinic, and connect you with financial assistance if needed.


HIV treatment with prescription medication should begin as soon as possible. The goal of this medicine is to reduce the amount of HIV in your blood, often referred to as your “viral load”. The lower your viral load, the lower your chances are of transmitting the virus to others and/or contracting life-threatening infections or cancers.

Research has shown that patients with HIV can obtain an undetectable viral load in six months or less as long as they continue treatment as prescribed. It’s important to note, every patient is different, and results may vary.

HIV is Not a Death Sentence

Though there is no cure for HIV, taking your medicine can keep you undetectable. According to the CDC, in the early years of the epidemic, HIV positive individuals usually only had one or two years to live. Over the past 40 years, HIV treatment has come a long way and enabled patients to live long, healthy lives. The single most important thing you can do to prolong your life and the lives of others is to get tested.

Resources for Support

It’s a good idea to enlist a few support channels to help you cope with your diagnosis and live your best life with HIV. NOAH offers in-person and virtual individual counseling services and your HIV care provider will likely have referrals or recommendations. There are also hundreds of online resources; try Stop HIV Together and Positive Spin; both backed by the CDC, or Maricopa County’s Positively You.

For more information on HIV testing, read our blog article “Who Should get Tested for HIV?” or schedule an appointment with your NOAH provider.