Antibiotics: A Balancing Act

A mother brings her 2 year old boy to see their health care provider after the baby has been sick for a day. After examining the baby, the clinician assesses that this is likely a viral illness and recommends rest and fluids. The mother asks if she can have an antibiotic prescription because that had made her feel better when she was sick. The health care provider is initially hesitant….. but ultimately complies and writes an antibiotic prescription. What went wrong?

Unfortunately, antibiotics are not wonder drugs that can cure any ailment. They have specific indications to help the body fight bacterial infections. Viral infections such as the common cold, the flu, and frequent causes of earaches, sore throats, or a wide variety of ailments will not be helped by antibiotics (outside of a potential placebo effect). Worse, improper use of antibiotics can cause real harm.

No medications are without side effects, and antibiotics are no exception. Penicillins and cephalosporins, two of the most common classes of antibiotics used in the outpatient setting, can cause rash or diarrhea. Further, these medications can kill protective bacteria in the gut leaving one susceptible to gut infections by more harmful bacteria. In addition, improper antibiotic use is linked to increasing antibiotic resistance. A real global health concern of the 21st century is that many bacterial infections will not have proper antibiotic treatment due in part to excessive and needless antibiotic use. If we want our antibiotics to be useful for us when we are really sick, we need to be careful not to use them when they will not help.

When your clinician recommends against using antibiotics, they are doing so with careful consideration of a number of factors. They ask not only ‘will this help?’ but ‘how can this harm?’ Balancing the scale between benefits and harms can be a tricky proposition, especially when clinicians and their patients see the potential harms and benefits differently. Health care providers and their patients need to work together to ensure that antibiotics are used appropriately to maximize benefit and minimize the risk of harm to ensure that antibiotics will be effective for many years to come.

By Ross Ehmke, MD, Columbia University 

Dr. Ehmke is the son of Aspire Indiana Health COO Syd Ehmke 


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Healthy Babies start with Healthy Moms

Aspire Indiana Health’s Syd Ehmke Continues her Series on Infant Mortality Prevention 

February, 2017

Greetings and Happy Valentine’s Day!  Like you, I have people in my life that I love and sometimes even give valentines to….. my husband and my kids. Having children was always a big dream of mine. I remember before I even got pregnant, having a regular medical exam and my doctor asking me if I wanted to have children. “Yes I can’t wait!,” I said.  And he said, “Well then you might want to lose some weight.”

I can remember thinking at the time that it was an odd comment. I mean, this was 30 years ago….long before I became a nurse practitioner or knew anything or thought anything about my health and how it was related to my future baby’s health. However, research shows us that he was exactly right!  Did you know that obesity can cause preeclampsia, miscarriage and gestational diabetes when you are pregnant?  And did you know that if you are diabetic and your blood sugars are not well controlled, that your baby can be born with birth defects like Down syndrome?  

And did you also know that smoking can cause low birth weight, preterm labor and preterm delivery….all of which are risk factors for infant death before the age of one? Aspire Indiana Health wants to help decrease the infant mortality rate in Madison County and help Mommy be healthy through weight control, smoking cessation and management of chronic diseases (hypertension, diabetes) even before she becomes pregnant!

So contact the providers at Aspire Indiana Health and find out more about how we can help you have a healthy baby.  Healthy babies love healthy mommies- and that is what this month is all about!

Read more about Aspire Indiana Health’s program to reduce infant mortality in Madison County here.

To good health!


Syd Ehmke, NP

COO, Aspire Indiana Health Inc.

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Personal Experience As a Therapy Tool

My name is Teresa Baker and I have lived with a serious mental illness for as long as I can remember. I know everyone’s experience with mental illness is different, but one thing we do share is that we fight invisible battles every day. That reality follows you through life.  Through every mundane thing, through every hard thing, and through happy times and bad. At first you try to hide it, then you make excuses for it. Ultimately, you have to face the truth of your symptoms and find a way through it.

I have been with Aspire Indiana for about 15 years now. For the first 12 years or so, I worked in group homes. I was drawn to the work. Having a family history of mental illness and living with my own symptoms over the years gave me a unique perspective for the mentally ill. I’ve always been able to find common ground with our consumers and understand their situations a little better than others who did not have personal experience. It was about 3 years ago when I met a Certified Recovery Specialist (CRS). We worked the same shift and we were able to share our personal experiences with mental illness. It was so nice having someone to talk to that knew what it was like to try to live a “normal” life and to fight through symptoms every day. That’s when she told me about becoming a CRS. Not long after that, I enrolled in the class and became a Certified Peer Specialist.

I have always had shared experience with the clients, but my education taught me how to use my lived experience to better serve others. Gone was all that remained in me of the notion that I was the expert who was supposed to tell others how to live. For the first time, the difference between me and them, staff and client, just fell away. I came out of that class a different person. My eyes were opened to all of the wondrous possibilities that a Peer can offer to a fellow person who is suffering with symptoms and trying to go through some of the struggles I lived through. I have a new purpose. My new mission is to walk beside the people who come to us seeking help and safety and to let them know, I know. To brush the tears away and tell them they are not alone anymore. To walk beside them with empathy and support as they discover their own recovery path that will lead them to finding happiness and fulfillment. But most of all, to give them hope. I have come to know that even though my own struggle is ongoing, I can still be a beacon of hope to others who are feeling like they will never be able to reach their goals. I can still be living proof that coping skills and medications work, that bad days aren’t forever, and that their lives and dreams are worth fighting for! I walk beside my clients, I lift them up when they can’t do it themselves, and I inspire hope for the future when they are lost in the darkness.  I share so much with the people I work with, and they see me as someone they can trust to be on their side and to understand their struggles. This work, and these people, have made me a better person. They help me as much as I help them. I have found my purpose in this work and I know it is what I am meant to do. I am proud to be a peer to these wonderful people, and I no longer hide my illness in the shadows.
My name is Teresa Baker, and I battle Major Depression with Anxiety and Panic Disorder.


Teresa Baker 

Certified Recovery Specialist,  Aspire Indiana

Watch this video to learn more about Peer Specialist roles at Aspire Indiana




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Aspire Indiana Health loves Million Hearts

Blogging for health

February, 2017

The heart is an amazing machine. It works like a machine and is consistent like a machine, but yet it is a muscle. But also like a machine, this muscle needs maintenance, prevention and treatments to keep it running in tip top shape!  This muscle is one complicated machine!

Your strong adult heart muscle pumps 2000 gallons of blood a day, beats at least 86,400 times a day, and it is responsible for keeping all of the organs in your body alive. That is a pretty big job for a muscle that is about the size of a fist and weighs only 8 to 10 ounces.

Your heart deserves maintenance, prevention and treatment just like a machine. If you haven’t had your cholesterol checked lately (prevention), now might be a good time to do this, especially if you are a male over 35 years old or a female over 45 years old.  You should also get your blood pressure checked. Do you need to be on medication?  If your blood pressure is consistently over 140 / 90, chances are you need a “treatment” for your heart — otherwise known as a blood pressure medication.

And how do you maintain your heart machine?  Exercising, eating right, and stopping smoking go a long way to help your heart stay healthy and working like the machine that it is.

The Million Hearts Initiative is an organized national effort to decrease heart disease and the chronic health conditions that it causes, such as stroke, congestive heart failure, and heart attack. This initiative focuses on the above mentioned activities: cholesterol testing, BP checking, smoking cessation and exercising.  This is an example of an Evidence Based Practice guideline that Aspire Indiana Health uses as we care for you and your important heart machine.

We look forward to seeing you at one of our four locations, and a heartfelt thank you for reading!
To Good Heart Health,


Syd Ehmke, NP

COO, Aspire Indiana Health


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Preventing Infant Death

Aspire Indiana Health Inc recently received it first ever grant!  And what a better grant than to work with our community partners to help decrease the infant mortality rate in Indiana!  Read all about our plans for this grant from the Indiana State Department of Health here.

Infant mortality is defined as the death of a baby before the age of one. There are many reasons why babies die early, and it is our mission at Aspire Indiana Health to help stop this tragedy from occurring.  

The first reason for infant mortality that we would like to educate our readers about is SIDS or Sudden Infant Death Syndrome. This has also been called “crib” death. There is a lot we do not know about this mysterious phenomenon, but there are a few things that we do know that are important to pass on to you. Whether you are a baby sitter, grandma, mom, dad, brother, cousin or sister, you may, at some time, put a baby to bed and should know some ways to help prevent SIDS. Here are some helpful tips:

1) Always put your baby to sleep on his or her back.

2) Don’t use bumper pads on the crib.

3) No blankets, pillows, or stuffed animals in the crib with your baby.

4) Never let your baby sleep on a soft surface like a pillow, sheepskin, couch or recliner.

5) Never put your baby in your bed with you or anyone else.

5) Sit upright and be awake when feeding baby.  

When you come to see the healthcare providers at Aspire Indiana Health, don’t be surprised if they bring a baby doll into the room and demonstrate putting a baby “back to sleep”.  This is how serious we are about helping to reduce the tragedy of infant death from occurring.

Until next time…. and to good health!


Syd Ehmke, NP

COO, Aspire Indiana Health Inc.

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Mental Health: There’s an App for That


                                                                                                                                            illustration by Oliver Munday 

myStrength Mobile App Extends Treatment 24/7

Mary is a single parent who works hard to support herself and her two children, ages 4 and 7. In addition to her work at a bank, she attends church, visits her parents when she can, and tries to keep herself fit through exercise and diet. She dates on occasion and has friends she tries to see once in awhile.

Mary also experiences episodes of depression and anxiety. For the past two years she has been in recovery from alcohol addiction. It has been difficult to attend her Alcoholics Anonymous meetings and see her therapist on any regular basis, but she does the best she can.  She would like to see her therapist more often, but just can’t find the time.  

According to SAMHSA’s 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB) an estimated 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness. In the past year, 20.2 million adults (8.4%) had a substance use disorder. Of these, 7.9 million people had both a mental disorder and substance use disorder, also known as co-occurring mental and substance use disorders.

Today Mary is feeling particularly tense and worried. She knows she tends to overreact and worry more than she needs to, but once she starts thinking about all of the things going on and what might go wrong she can’t seem to turn it off. She has been doing pretty good, and is proud of her progress and recovery from addiction. Since she stopped drinking and started therapy, her life is no longer in chaos. Still, she struggles with managing her mood and anxiety.

Mary takes out her smartphone and opens her myStrength app. She has already set the app up with shortcuts to helpful videos and tools that have been tailored to her own personal issues and challenges. She quickly pulls up the video she wants on reducing worry. Take a deep breath, focus on the here and now, interrupt the internal chattering, relax. The video helps guide Mary on the steps to take to relax and focus.

She reviews some of the things that she and her therapist have been working on. The app has been set up to remind her of how to manage her feelings and racing thoughts.  It is really helpful to have something to look at and not just try to remember everything talked about in her therapy sessions, especially when her anxiety seems to take over.


According to Monitor On Psychology (November, 2016), there are more than 165,000 health-related apps worldwide, helping users track their diet and exercise, monitor their moods, and even manage chronic diseases. Nearly 30 percent of these apps are dedicated to mental health (Novotney, 2016).

In May of this year Aspire made the web-based myStrength program and the mobile app version available to all of its employees. Clients with substance use disorders (SUD) were also provided access to both the web-based and smartphone versions. All clients at Aspire are able to sign up for myStrength at no charge. 

myStrength provides videos, motivational content, brief articles, and many other tools for working on issues related to depression, anxiety, emotional trauma, and substance abuse. Information on topics ranging from anger management, parenting,  PTSD, and the effects of different drugs is now available at the client’s fingertips.

Some of the tools ask a client to rate feelings, put in thoughts, create action plans, and monitor their successes. In this way, myStrength becomes a very individualized and personal tool.

The information a client shares in myStrength is absolutely confidential. Aspire does not collect any personal information entered into myStrength. While Aspire does track aggregate data on total number of clients using myStrength and on what problem areas seem to interest clients the most, no individual or personal information is tracked or traced to a specific person. This is true for employees as well.

In addition to the personal benefits of using myStrength, Aspire therapists, care coordinators, recovery coaches, and life skill trainers are discovering how myStrength can be a useful tool in “extending” the impact of treatment. While not a direct connection to the therapist (like a chat line or e-mail/messenger service), using myStrength helps keep the client connected to the focus of treatment and provides important motivation for success.

This extension of therapy means that at any time a client can simply log in to get personally tailored information and numerous tools directly related to their therapy goals. It provides coaching, reminders, and a library of information…. all in their pocket.

If a client does not have a smartphone or computer they can use a computer while in a session at Aspire. The clinician can work with the client to identify relevant content and print information to take home.

Aspire is continually looking for ways to enhance treatment and better serve an ever-increasing client population. myStrength is a tool that does both.



About the Author:  Dan Brown is the Lead Clinician of Addiction Services at Aspire Indiana’s Outpatient Services office in Carmel, Indiana. 
Learn more about Aspire Indiana on our website or on Facebook


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How do we face addiction?

Aspire is actively participating in a project with Ball State University entitled, “Facing Addiction”.  The objective of the partnership is to strengthen communities through the stories of people.  What stories would the people who face addiction every day have to tell?  I think they will say that they feel shame and guilt and stuck with their addiction.  I think they will say that there are not enough resources for them and that they are tired of feeling sick and tired.  I think they will say they are terrified and angry and sometimes feel hopeless.  As treatment providers, we hear their stories and their pain. Our clients often  hear the voice of their addiction that tells them that they will never be free of their addiction.  

The truth is that today, there are not enough treatment providers or facilities to take care of all the people who need care.  Incarcerating people who are addicted without treatment doesn’t help them recover. It doesn’t help to shame people about why they started in the first place.  Nobody ever wakes up one day and thinks, “I want to be an addict.”

Addiction does not discriminate and neither should access to recovery.  There remains a very large gap between people who have the ability to access treatment and those who do not. At  Aspire we join others in advocating for people who need treatment versus incarceration and we invest in recovery supports, like medication assisted treatment to help people get back on their feet, get back to work, and support themselves and their families. We come alongside our criminal justice partners to educate and work with them so that there is a mutual understanding about what trauma does to a person’s spirit.  People who are not able to abstain from drugs frequently have a history of trauma, whether that trauma is physical, verbal, sexual or emotional.  We want to help without judging because many treatment providers have traveled on the same  road, albeit years ago, and know that, but “for the grace of our Higher Power” we may not have lived long, useful and happy lives.

My hope for the Facing Addiction project in which we are participating, is that we continue to chip away and finally eliminate the shame and stigma that prevents people from coming to treatment.  I think we are actually making some progress in this battle.  More and more people who have struggled with addiction are coming forward to tell their story and how they came to accept that they needed help.  Few people recover without supportive others who are holding them accountable and helping them understand that they aren’t bad people.  Today, Nov. 3, 2016, my father would have been 100 years old had he lived.  What is important to me is that he died at age 85 as a sober man who enjoyed life, sports, and his grandkids.  People who suffer from an addiction are ill.  As we hear the stories of family members, co-workers, friends, and those who are addicted, we hope to shed more light on recovery, and help our communities understand that addiction is treatable, and treatment works!  

Susie Maier, LCSW, LCAC & Business Development & Marketing Director for Aspire Indiana.


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