• Maintain a healthy lifestyle through diet, exercise and keeping up with doctor appointments. Brim says this reduces your risk of a stroke, which can lead to a voice disorder. It can also prevent everyday illness and coughing.
  
  “If someone has had the flu or COVID and they’ve had a consistent cough, it can cause trauma to the vocal cords,” Brim explains. “The vocal cords are closing so rapidly with each cough.”
  
  Using a humidifier and taking lozenges without menthol can help with that pesky cough, Brim adds.
   
• Aim for 40 to 60 ounces of water per day.
  
  “That’s very helpful in maintaining a healthy environment for your vocal cords. It makes sure they’re not getting too strained,” Brim says.
   
• Watch your caffeine. High amounts can strain your vocal cords, Brim says.
  
  “Do you really need that second latte at noon?” she asks with a smirk.
   
• Don’t yell all the time. Obvious, right? But it’s tricky if you use your voice for a living.

“Maybe you have a job like an auctioneer or a teacher trying to yell over a group of students. You have to make your voice louder [for your job],” Brim says.

“Try to focus on more projection. And take vocal rests,” she adds. “Take 10 minutes to let your vocal cords reset. Drink water. Try to decrease the trauma to the vocal cords as much as possible.”

Learn more

Read about all the ways medical professionals help restore voices on the OSF HealthCare website.

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It’s the dead of winter, and you need to run to the mailbox or let your dog out. It’s just a minute, you think. A sweater and sandals will be fine.

Not so fast, says Maddy Draper, APRN, a health care provider at OSF OnCall who sees cold weather injuries often. She says exposure to frigid temperatures can have serious consequences.

Types of cold weather injuries

• Frostnip: Draper says this is a mild form of frostbite where exposure to cold temperatures turns the skin pink or red. Your skin may feel burning or numb.

“The numbness typically goes away with rewarming,” Draper says.

• Frostbite: This is a more severe case of cold exposure. Your skin may be numb and appear yellow, white, gray or black. It may feel waxy and have blisters.
   
• Hypothermia: This is when the body’s temperature drops below 95 degrees.

“There are different stages,” Draper explains. “The first is our natural response of shivering. It gets more severe. The person may get confused and have lethargy, memory loss and slurred speech. It can lead to a coma and death.”

Inside, too?

Yes, there’s a risk for these injuries inside, too, Draper says. Notably, there have been cases of infants getting hypothermia.

“The room may be too cold, and they’re not dressed appropriately,” Draper says. “If they’re in a bassinet or crib with just a onesie and it’s cold, that can lead to hypothermia.”

Signs of infant hypothermia are bright red skin and decreased energy. Sleep experts use a thermal overall grade scale (TOG) to suggest how much clothing a baby should wear to sleep depending on the temperature of the room.

Treatment

Draper says she usually sees cases of frostbite and hypothermia sent to the emergency department. Providers will rewarm you with warm water or blankets and may provide warm liquids to drink, warmed oxygen through a mask and nasal tube or heated fluids through an intravenous line (IV) or other methods. Medication can also help with pain and blood flow.

“The hospital has more imaging resources to see the impact of the tissue damage,” compared to urgent care, Draper says.

For frostnip, you can take steps to warm up at home.

“It’s not as fast as possible. It’s not as hot as possible. It’s just that gradual warming,” Draper says. “Get off your cool or wet clothes immediately. You don’t want to stick your hands or feet into hot, steaming water. Just warm water.”

That’s because hot water can burn your skin. And if your skin is numb, you may not feel the burn before the damage is done. If water is not available, you can place your hands in your armpits. And handle the sensitive skin gently. Don’t rub or massage it. If your feet are affected, get off your feet.

Prevention

Draper says older adults, people who work or do activities outside (like hunters or hikers), unhoused people and people with medical conditions (like peripheral artery disease, diabetes and Raynaud’s disease) are at a higher risk of cold weather injuries. Getting stranded in a vehicle without proper protection is also common in the winter. Drinking alcohol or using drugs may lead to you losing consciousness outside. And smoking impacts blood circulation, putting you at a higher risk, Draper says.

Some ways to beat the cold:

• Dress in layers. You can always take a layer off, but you can’t put one on if you leave it at home. Make a hat, scarf, gloves and winter boots part of your wardrobe. Make sure the clothes aren’t too tight to allow for blood circulation. And look for water-resistant garments when buying clothes.
   
• Have winter weather supplies, like blankets, flares, a first aid kit and food, in your vehicle.
   
• Be well fed and hydrated. Body fat, though unhealthy in excess, helps us stay warm. For drinks, avoid alcohol and caffeinated beverages.
   
• During outdoor activities, take breaks and go with a buddy. Keep a close eye on kids who may not realize how cold they are. Come inside to change from wet to dry clothes. Let others know your plans and when you’ll be back. If you’re not back in time, that’s a sign you may have fallen victim to the cold, and help should be sent.

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• The child’s tongue doesn’t come out of the mouth like it normally would when they stick their tongue out.
   
• Breastfeeding is painful or difficult. Shoemaker notes, though, that you should rule out other causes of painful breastfeeding, such as ineffective latching or the baby wanting to bite. A lactation consultant can help with this. A pediatric provider can also examine the child’s tongue.
   
• When your baby cries and lifts their tongue, the tip of the tongue is pulled downward in the shape of a heart.

The procedure to fix tongue-tie is pretty simple, Shoemaker says. There’s little blood loss, and it can be done in the hospital, at a pediatrician’s office or at a pediatric dentist’s office.

“They just lift the baby’s tongue and, with sterile scissors, snip [the tissue]. Then, immediately breastfeed [or formula feed if that’s what mom has chosen] because the tongue is free at that point,” Shoemaker explains. “Some providers will teach exercises to do with the baby so [the tissue] doesn’t heal back and have to be snipped again later.” Those exercises involve a parent lifting the tongue.

Some cases of tongue-tie may be mild enough that parents opt to do nothing. In some cases, the frenulum will loosen over time. That approach is fine, Shoemaker says. But the decision should be made with the input of the child’s care team, and it should be made sooner than later. That’s because tongue-tie later in life can cause speech and eating issues, Shoemaker says, and she says the procedure to fix the problem can be more complex when the child is older.

“When done in the newborn period, it’s a very simple procedure done while the baby is awake. If parents choose to wait and see how things go, it might have to be a procedure where the baby or child is put to sleep. So it’s a little bit more involved,” Shoemaker says.

Learn more

Read more about how to have a successful pregnancy, birth and first years of your child’s life on the OSF HealthCare website.

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• Dysarthria (pronounced diss-ARR-three-ah): Brim says this common voice disorder could be brought on by a neurological issue, such as the effects of a stroke, Parkinson’s disease or a traumatic brain injury. Muscle issues and medication side effects can also play a role. It all leads to the most common symptom: slurred speech. Brim says to picture trying to talk with a mouth full of marbles. The person’s speech could also be a different volume (too quiet or too loud) and speed (too slow or too fast).
  
  “There’s a restorative approach where we do different types of [vocal] exercises. Try to get that voice to where it sounds better and clearer,” Brim explains. “Then there’s a compensatory approach. For a person with Parkinson’s or amyotrophic lateral sclerosis [ALS] where their voice probably isn’t going to improve in the long run, we might look at an alternative communication device. Or, do we need environmental assistance to help them communicate?”
  
  A communication device could include a voice box to amplify speech or, if someone has lost their voice entirely, a speech generating tablet.
  
  “The [speech generating device] has a bunch of communication presets on it,” such as common phrases conveying hunger or pain, Brim says. “They can have it pre-programmed with their actual voice before they lose it.”

• Dysphonia (pronounced diss-PHONE-ee-ah): This is a general term to describe a voice abnormality, Brim says. Neurological issues and brain injuries are common causes.
  
  “The most common dysphonia people know is spasmodic dysphonia. We really don’t know a specific cause. We assume it’s neurological,” Brim says. “This brings voice tremors. The vocal cords are not abducting or adducting correctly.

“When they’re adducting, the vocal cords are coming together. If you have an adductor-type spasmodic dysphonia, the vocal cords aren’t wanting to go away from each other. They’re wanting to stay together. So there’s a really strained voice. It sounds very harsh, almost like people are trying to force the voice out,” Brim outlines.

“Or you have abductor dysphonia, where the vocal cords are pulling away. The person has a breathy voice because the vocal cords are open all the time. Speech comes out very quiet and whispery. They’re losing all their air in one go,” Brim adds.

Treatment could include voice exercises or Botox injections. Or, if the person has a nodule or polyp on the vocal cords, those can be removed surgically.

“We go over healthy voice habits, such as increasing water intake,” Brim says, describing how she might work with someone after surgery. “Have a humidifier in the house to help increase moisture in the air. Use more of a quiet voice. Try not to yell or project too loudly because that can strain the vocal cords. Try to make your voice sound different but not in a way that causes harm.”

Something else Brim will preach to patients that you might not connect with voice issues: reduce your caffeine intake. Caffeine can increase muscle tension in your vocal cords, she says.

• Vocal cord paralysis: Brim says this is commonly caused by trauma to the throat, such as a car accident or having a breathing tube.
  
  “It’s similar to a bruise or fracture or torn ligament. When there’s trauma to the vocal cord area, there’s damage. And that causes paralysis sometimes,” Brim says. “You can have, most commonly, unilateral vocal cord paralysis, where one doesn’t move. Or you can have bilateral [paralysis] where both aren’t moving.”
  
  Brim says this is often treated with Botox or surgery to get the vocal cords vibrating again. The person would follow up with speech therapy.

There is hope

Brim is up front with her patients: You might not get your voice back to where it was, but you can make improvements. So don’t give up.

“I’d love to wave a magic wand and make your voice great,” Brim suggests with a smile. “But there are other steps we can take so you don’t feel locked in. You don’t feel like no one can understand you and no one can communicate with you.”

Learn more

Read about all the ways medical professionals help restore voices on the OSF HealthCare website.

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We’re talking about sniffing products like paint, markers or nail polish for a temporary high. You might hear it called huffing, chroming or, in the medical community, inhalant abuse.

Health care providers like Justin Rapoff, DO, an emergency medicine physician who sees patients at OSF HealthCare, are again reminding parents about the serious health impacts of this activity and what to do if your child shows symptoms. It’s especially important for kids to steer clear, he says, because their organs are still developing. An interruption to that development could mean trouble. Young people can also be more susceptible to peer pressure, giving in when other kids tell them to try something.

“Inhalant abuse is common because these are things that are easily found in your house," Dr. Rapoff adds. “They’re underneath your kitchen sink and in your garage and bathroom. These are cheap and easy to find for kids.”

The consequences

There are short and long-term effects of inhalant abuse, Dr. Rapoff says. Among the short-term issues is the general haze the activity will put you in. If you have to, for example, drive a vehicle while under the influence, you could crash or face legal consequences. If you’re intoxicated at work or school, your performance will decline.

“You can have cognitive difficulties and even dementia [later in life],” Dr. Rapoff adds of the long-term impacts. “You can have bone marrow suppression and anemia. You can have abnormal coordination.”

Cardiac arrest, when the heart stops beating suddenly, is also possible.

What parents can do

If your child shows signs of intoxication – slurred speech, nausea, confusion and a lack of balance are big ones – call 
9-1-1 and get them to the emergency department.

“Inhalants hit similar receptors to those hit by alcohol. It causes a similar intoxication, which lasts around two to 30 minutes,” Dr. Rapoff says.

That means you should get the child checked out even if they say they feel better. Dr. Rapoff says providers will likely test the person’s blood, urine and heart. There’s no bonafide treatment for inhalant abuse, Dr. Rapoff says. Rather, providers will treat the symptoms. For example, if the child feels nauseous or is vomiting, providers may give an anti-nausea medication.

What about avoiding an unpleasant trip to the hospital in the first place? Dr. Rapoff encourages parents to talk with their kids about the risks of huffing and, generally, any emotional issues they are dealing with. The young ones may be turning to inhalants to cope. In fact, Dr. Rapoff says studies have shown that when young people abuse inhalants, they are more likely to use heroin or even commit suicide later in life.

Parents should also pay attention to kids’ behavior, especially if they make unexplained purchases of things like hairspray or whipped cream canisters. Keep items that could be misused out of reach. Put things like markers and cosmetics out only when it’s time to use them. Keep things like spray paint and gasoline canisters locked up in the garage.

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Telemedicine – seeing a provider by video from home – is a common and useful part of today’s health care landscape. But as Amer Alshekhlee, MD, points out, it’s sometimes not fast. A person will commonly book a virtual appointment days or weeks out.

So how can telemedicine play a critical role when millions of brain cells are at stake in a matter of minutes?

Enter telestroke. It’s a concept in use throughout OSF HealthCare. At OSF HealthCare Saint Anthony’s Health Center in Alton, Illinois, the strategic affiliation between OSF and SSM Health allows telestroke to be seamless. Dr. Alshekhlee, the stroke program director at DePaul Hospital in nearby Bridgeton, Missouri, is one of the doctors who sees people virtually when they come to the OSF Saint Anthony’s Emergency Department with a suspected stroke.

“We see patients quickly. We triage them from hospital to hospital. That provides very quick treatment,” Dr. Alshekhlee says.

“We’ll have a video encounter,” he adds. “We examine the patient. Talk to them and their family. Make a decision on what kind of treatment and where.”

Providers will ask about when symptoms started and their severity. They will likely have the patient demonstrate the BEFAST acronym, a standard way to spot stroke symptoms. Providers will look for problems or abnormalities in balance, eyes, face, arms and speech. The “T” in BEFAST stands for time. In other words, if there is evidence of issues in B through S, it’s “time” to take quick action.

“We have a scale. We score the person, and for example, say ‘these stroke symptoms look very bad’. Then we have to really act on that patient.”

That could mean a transfer to a hospital better equipped to treat stroke. Again, providers will tell you time is of the essence. For example, if you start treatment at the Emergency Department within 4½ hours of the onset of symptoms, you may be able to take Tenecteplase, a blood clot-busting agent that experts say could become the gold standard for stroke care.

On the flip side, for each minute a stroke goes untreated, the brain loses around 2 million cells it cannot recover. Strokes can also have life-altering consequences like vision, walking and swallowing difficulties. They can take years off your life and put you at risk of another stroke.

Learn more about stroke care on the OSF HealthCare website.

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Nearly 800,000 Americans suffer a stroke each year.

Strokes can have life-altering consequences like vision, walking and swallowing difficulties. They also rank in the top five killers of Americans. For each minute a stroke goes untreated, the brain loses around 2 million cells it cannot recover.

“Getting to the hospital quickly – within four and a half hours of your onset of symptoms – is important,” says Leslie Ingold, a registered nurse and stroke coordinator with OSF HealthCare.

A cutting-edge stroke drug rolled out at OSF HealthCare is already turning the tide for people.

Tenecteplase (TNKase ®) can be used in people experiencing a stroke and who meet certain criteria, such as a specific blood pressure, history of brain bleeds, medications taken at home and how quickly they arrived at the emergency department. TNKase is a clot-busting agent that stands to become the gold standard of this type of care, Ingold says.

“It has a lower cost. It’s something providers can mix much, much quicker,” Ingold says. “And it’s given quickly in an IV push over five to 10 seconds, and we’re done.”

TNKase also does a better job than its predecessor at finding and breaking up clots, and there’s a lower risk of bleeding.

“The quicker we can get oxygen flowing back into that brain tissue, the better recovery the person is going to have,” Ingold says.

Why it’s important

The most common type of stroke, an ischemic stroke (also sometimes called an embolic stroke), is when a clot forms and travels to the brain. When watching for one, remember the acronym B.E.F.A.S.T.

• B is for balance: Watch for sudden loss of balance.
• E is for eyes: Check for vision loss or eyes looking askew.
• F is for face: Look for droopiness or an uneven smile.
• A is for arm: Is one arm weak or numb?
• S is for speech: Watch for slurred, slow speech or no speech. Ask the person to repeat a simple sentence.
• T is for time. It’s the conclusion to the checklist. Time to call 9-1-1 if someone has these symptoms, even if they go away.

Another type of stroke, a hemorrhagic stroke, is when a blood vessel breaks and blood seeps into brain tissue. Ingold says hemorrhagic strokes are typically caused by a traumatic injury, like falling and hitting your head. Uncontrolled high blood pressure is also a cause.

For either type, when you arrive at the hospital, a provider will take some pictures of your brain and decide the best treatment option.

Prevention

Up to 80% of strokes are preventable, Ingold says. Prevention goes back to what any doctor will tell you is key for a healthy life: control your blood pressure, cholesterol and diabetes through diet and exercise. Avoid tobacco, alcohol and drugs. If you have an irregular heartbeat, known as atrial fibrillation, see your cardiologist regularly and follow their instructions. And get established with a primary care provider, too.

Ingold says a stroke takes 3.75 years off a person’s life, on average. And if you have a stroke, you have a 25% chance of having another one.

“We always tell people they really need to be on top of their treatment,” Ingold says. “The signs and symptoms of a possible second stroke may not be the same as the first. In fact, they could be completely different. It just depends on what part of the brain the stroke affects.”

Learn more

Read about stroke care on the OSF HealthCare website.

Previous coverage

OSF HealthCare Newsroom stroke stories
OSF HealthCare stroke blogs