Healthy Living - Spring 2014

SPRING 2014

Feel the

BEAT Pound fans march to their own drum

Blowing SMOKE

A new generation lights up in ways old and new

Shot in the

DARK

Produced by

The Anniston Star

Exploring the debate over childhood vaccinations

Spring 2014

Contents • Spring 2014 Health & Wellness 4 Bouncing Back A look at minimally invasive heart surgery at RMC 8 Service with a Smile Sarrell Dental Center sets the standard for serving kids in need 10 Shot in the Dark The vaccination debate continues to divide

Fitness & Nutrition 18 Pound it Out Pound fitness class at Anniston Aquatics and Fitness Center

Editor: Brooke Carbo Writers: Brett Buckner • Eddie Burkhalter Kara Coleman • Madasyn Czebiniak Teri Hasemyer • Patrick McCreless Photographers: Stephen Gross • Trent Penny Bill Wilson Graphics: AnnaMaria Jacob Layout and Design: Patrick Stokesberry

20 Changing Lives Bariatric center at Stringfellow Hospital growing in use

Mind & Body 22 Losing Sleep Why a good night’s sleep is just what the doctor ordered 26 Blowing Smoke Smoking rates drop, but Alabama youth still lighting up Cover photo by Bill Wilson

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HEALTHY LIVING

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HEALTH AND WELLNESS

By Kara Coleman

RMC patients bounce back FASTER with minimally invasive heart surgery Dr. Masumi Yamamuro, cardiothoracic surgeon at Regional Medical Center in Anniston, predicts around 200 heart surgeries will be performed at the hospital by the end of this year.

RMC offers minimally invasive heart surgeries, which require a shorter recovery time than traditional methods of heart surgery.

With traditional surgery, Yamamuro says a patient can expect to stay in the hospital between five and seven days.

Full recovery takes about two months. With minimally invasive surgery, that’s no longer the case.

“The hospital stay is not long, maybe three or four days,” he said. “But the recovery time after that is very short, like maybe a month. If you pass four weeks, you should be feeling really good.”

As the only hospital in its five-county service area to offer heart surgeries, RMC treats arrhythmia, bypass and aortic valve replacement. The hospital has been performing minimally invasive arrhythmia and aortic valve procedures for three years and began doing minimally invasive bypass surgery in March 2013.

Whereas traditional heart operations require a patient’s chest to be opened, the new procedure allows the doctor to work from the left side of the chest, where the heart is located. The left lung does have to be collapsed during operation, leaving only the right lung for breathing, but the patient’s heart is beating the entire time.

“If someone’s going to have the new surgery, they have to have reasonable strength of the lungs,” Yamamuro said. “I have refused people if they’ve been long-time smokers.”

Smoking is just one of the factors responsible for the state having a heart disease rate higher than the national average.

“Alabama is notorious for obesity,” Yamamuro said.

“Smoking is a big issue here, and diabetes.”

Following her heart attack in August 2013, Kim McKenzie of Oxford opted to undergo a minimally invasive bypass at RMC. Photo by Stephen Gross

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smoking or change their habits after surgery often end up returning to him for second or even third operations. Because each surgery leaves a new layer of scar tissue, the procedure becomes more difficult each time.

“The bottom line is prevention is the best treatment,” Yamamuro said. “Better not make it happen. In order to do that, you’re going to have to take care of yourself.”

Cardiothoracic surgeon Dr. Masumi Yamamuro estimates 200 minimally invasive heart surgeries will be performed at RMC this year.

Photo by Stephen Gross

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heart surgery to anyone who had to have one,” McKenzie said. “The scar is only about two inches long. It’s unreal.”

Yamamuro estimates that of the 200 heart surgeries performed at RMC last year, between 130 and 140 have been bypass surgeries. The risk factors for coronary artery disease can be divided into two categories — things that cannot be prevented and things that can. If a person has a family history of heart disease, he is at risk of contracting heart disease himself.

Age is another risk factor. Preventable factors include stress and lack of regular exercise. But a healthy lifestyle greatly reduces a person’s risk of any sort of heart problems.

About nine in 10 of Yamamuro’s patients have diabetes.

“Those people have diabetes, high blood pressure, high cholesterol and they smoke,” he said. “That’s all one package most of the time.”

The issue with diabetes is that abdominal girth is directly proportionate to insulin resistance, Corona explained, “so it just begs cardiac disease.”

No heart surgery is a permanent fix-all, so patients must alter their lifestyle after surgery.

Yamamuro says that patients who fail to stop

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Todd Corona, director of heart and vascular services at RMC, agrees that conditions in this area are prime for heart surgery. “There’s no question about it, diabetes and heart disease go hand in hand.”

Kim McKenzie of Oxford had never heard of minimally invasive heart surgery until she suffered a heart attack last August. Her cardiologist, Dr. Juan Velasquez, introduced her to the procedure and to Yamamuro. McKenzie was originally thinking of having a bypass in Birmingham, but after meeting with Yamamuro, she said, she chose the minimally invasive bypass at RMC instead.

“I was the first patient to come out of this type of surgery not on a ventilator,” said 52-yearold McKenzie. “I had people from all over the hospital coming to see me. Dr. Velasquez said I made history in the medical journals.”

McKenzie had the surgery on a Monday and went home from the hospital that Friday. After being discharged from RMC, she had to go to cardio rehab three days a week. About a month after her procedure, she was able to return to her job as a secretary part time, and was able to work full time three weeks after that.

“I would recommend minimally invasive

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Health and Wellness

Service with a

SMILE

Nationwide attention focuses on Sarrell Dental’s model for serving kids in need

By Eddie Burkhalter

Sitting inside the Anniston office of Sarrell Dental Center, Chairman Jeff Parker described the place as the “Cinderella story of Calhoun County.”

No sign of glass slippers or golden carriages about, but the metamorphosis of the small nonprofit dental chain into a nationally recognized model for providing dental care to underserved poor children is a fairytale-like story.

Sarrell Dental was founded by retired cardiologist Dr. Warren Sarrell with the purpose of providing dental care to lowincome children — those who private practice dentists frequently refuse to treat due to low reimbursements from Medicaid.

Parker, a retired businessman and former executive at several multinational companies, was brought on in 2005, and after eight years of growth, the nonprofit

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HEALTHY LIVING

now employs more than 250 people in 14 clinics statewide.

Sarrell clinics treated more than 150,000 children last year, but Parker is quick to point out that the need is greater still.

“Less than half of the children in the state of Alabama that have Medicaid dental insurance saw a dentist last year,” he said.

A June 2013 study by The Pew Charitable Trust found that in 2011 more than 14 million children enrolled in Medicaid did not receive any dental services.

That’s why they work so hard, Parker said, to make sure those who need it most, and who have the worst access, get dental care.

If Parker was smiling during his interview it was, as he said, because he’s proud: “For one, a local woman is president of this organization.”

Brandi Parris, a Calhoun County native and a Jacksonville State University graduate who started at Sarrell in 2006 after working in marketing for an Atlanta hospital, was

named president of Sarrell on Jan. 1, 2013.

“She has worked tirelessly at community outreach and other areas for us,” Parker said.

“She was the only choice for the job.”

On her travels into the state’s communities for Sarrell’s dental screenings, Parris said she quickly learned just had badly Alabama’s lowest income children need dental care.

“You see the need here,” she said. “I grew up here and I had no idea what the need was. It’s amazing to give back.”

Many dental practitioners talk about the need to treat low-income children, Parris said, but without reaching out to parents who may not know about Sarrell, there’s little chance their children will get the needed care.

“It’s about making the community aware that we’re available. That we’re going to be here for them,” Parris said.

Hiring talented staff and paying them well is one of Sarrell’s keys to success,

Sarrell Dental President Brandi Parris.

Photo by Bill Wilson

Parker said, and the other is putting the patient first.

Another aspect that’s been critical to the organization’s success, both Parris and Parker agree, is something as simple as rethinking traditional business hours — the clinics stay open longer than most practicing dental offices so that working parents can bring their children in without sacrificing precious paydays.

“We stay until the last patient is seen,” Parker said.

“We’re open extended hours. We’re open on Saturdays and we’re providing access. I don’t know how you can see children and close a dental practice at 4 o’clock in the afternoon.”

All the hard work is paying dividends.

Three of the last four years, Sarrell was selected as Alabama Head Start’s Corporation of the Year.

In February, Parker was named an Ashoka fellow, recognized by the Virginia-based nonprofit as one of five of the most creative social entrepreneurs in the nation this year for his work at Sarrell.

Parker was also profiled in December in Health Leader magazine’s HealthLeaders 20, a nationwide list of people who are changing health care for the better.

As the Alabama dental chain began getting more and more national recognition, other businesses and organizations came calling. Last September, Sarrell partnered with the Massachusetts-based nonprofit DentaQuest Care Group, and Parker became CEO of DentaQuest Healthcare Delivery.

Parker was later contacted by Community Dental Care, a 12-office Texas-based nonprofit dental chain that treats HIV-positive patients and homeless adults. Sarrell and DentaQuest recently merged with the Texas dental chain, and Parker was named chairman of Community Dental Care as well.

Sarrell has been featured in Forbes magazine and numerous other trade publications, and there are exciting partnerships on the horizon, Parker said.

The rest of the country is starting to take notice of Sarrell Dental, the once-small nonprofit that began in Calhoun County and that’s also got Parker smiling.

“And that’s very humbling for a large portion of our staff,” he said. “We wake up every day saying ‘You know what? All this hard work — everything has paid off.”’

HEALTHY LIVING

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Health and Wellness

SHOT in the DARK

The debate over childhood vaccination continues to divide

By Brett Buckner The conversations began when Holly was still in the womb, and they continued right up until her pediatrician poked her with the first needle. Looking back almost three years, Holly’s mother, Leslie Renfroe, admits she went a little “nuts” during her pregnancy.

Renfroe, a 37-year-old stay-at-home mom, tried for nearly three years to get pregnant. It got to the point doctors hinted that a miracle might be her final chance to conceive.

“So when that stick turned blue, I pretty much lost my mind,” Refroe said from her home in Talladega. “I obsessed about everything.”

But as the weeks and months passed and tests and ultrasounds all came back normal, she relaxed a bit — until sometime in her third trimester when a Facebook friend posed a question her worried mind had yet to churn up.

“Are you going to vaccinate?” the woman asked, attaching a link to an anti-vaccine website.

At first, Renfroe was confused. Why wouldn’t she vaccinate? But she followed the link and quickly fell into the raging waters of childhood immunization where she nearly drowned amid the conflicting, and often terrifying, information on both sides of the debate.

“Honestly, that was the biggest mistake of my pregnancy,” Renfroe said. “Both sides had a point and both sides seemed a little untrustworthy. I was totally lost and started to feel like my child’s life hung in the balance of whatever decision I made.”

The Centers for Disease Control and Prevention recommends 10 vaccines in 26 doses by the age of 2, with an additional five vaccinations between ages 4 and 6 in an effort to prevent a variety of diseases including polio, measles, mumps, whooping cough and chicken pox. As

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Photo by Bill Wilson

of 2010, more than 10 million vaccines were given to children under the age of 1 each year in the U.S. Yet some parents are opting for alternative vaccine schedules while others refuse to vaccinate their children at all. In a 2009 survey published in the journal Pediatrics, 31 percent of parents said they should have the right to refuse vaccinations for their children. More than 62 percent of the 2,500 parents polled said they believed vaccines protected their children. Overall, 11 percent refused at least one vaccine.

Amy Law and her husband, Chris, a local chiropractor, chose not to vaccinate their 2-year-old daughter.

“It’s just gotten out of control,” said Law, who is 28 and pregnant with her second child.

“There are too many shots. I don’t want to fill my little girl’s body with a bunch of chemicals that she doesn’t really need. Her own body, her own immune system can fight back a lot of these infections.”

But that argument is simply inaccurate according to many in the medical and scientific communities, including local pediatrician Dr. Lewis Doggett.

“Vaccines save lives,” Doggett said. “When I got here in ’90, it was very common for us to see meningitis and those cases very often lead to deafness, mental retardation and even death. Now those cases are rare and it’s all because of vaccinations.”

It’s a debate defined by individual rights versus a community’s greater good. Those who support vaccinations say they are overwhelmingly safe and one of the greatest health advancements of the 20th century because they have protected millions of children against potentially lethal and debilitating diseases.

According to a 2003 report by the Pediatric Academic Societies, childhood vaccinations in the U.S. prevent about 10.5 million cases of infectious disease and 33,000 deaths per year.

Those who oppose vaccinations believe a child’s immune system can defend itself naturally against most infections. So many shots can overwhelm a young child’s body, they argue, and the potential side effects of the vaccines are more dangerous than catching diseases that have largely disappeared. Many also believe that vaccines can cause autism, ADHD and other neurological disorders later in life.

About 30,000 cases of adverse reactions to vaccines have been reported annually to the federal government since 1990, with 13 percent classified as “serious,” meaning they are associated with permanent disability, hospitalization, life-threatening illness or death.

While mild side effects like fever, irritability and a rash at the injection site are not uncommon, the CDC states that the risk of such serious side effects from any of the vaccinations is “minuscule.” For example, with the measles, mumps and rubella vaccine, one child in six might experience a fever, about one in 3,000 might experience a seizure, and less than one in a million will experience a severe allergic reaction that results in deafness or other permanent injury.

Anniston couple Billie Joe Maxcey and her husband initially followed a modified vaccination schedule for their newborn daughter, opting for small doses rather than the multiple injections recommended by their doctor.

“And it worked great, at first,” Maxcey said.

But her daughter began having increased reactions when they went in for her six-month dose of Hib (haemophilus influenza type b) and PCV (pneumococcal conjugate vaccine).

“We went from a few raised bumps on her legs and a slight fever to whelps across her legs and an extreme fever,” Maxcey said. “Plus, there was a complete mood change. It’s like she wasn’t the same child. That’s when we decided enough was enough.”

THREATENED

While the diseases children are being vaccinated against are no longer looming threats, they have not been totally eradicated. Before the polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States. Annual epidemics left victims — mostly children — in braces, crutches, wheelchairs and, in serious cases, iron lungs.

Hib was once the most common cause of bacterial meningitis in the U.S., infecting approximately 20,000 infants and children every year, killing 600 a year and leaving many survivors with deafness, seizures or mental retardation. Since the introduction of conjugate Hib vaccine in December 1987, the incidents of Hib have declined by 98 percent with fewer than 10 fatal cases reported each year.

When people stop being afraid of the dis-

Anniston pediatrician Dr. Lewis Doggett, a strong advocate for vaccination, has seen cases of meningitis drop significantly in the last 25 years due to immunization.

Photo by Trent Penny

ease, they turn that fear to the vaccine.

“When was the last time we had a real outbreak of the measles or the mumps?” Law said. “The worst we really have to deal with is the flu or chickenpox and you’re going to get the chicken pox, whether you vaccinate for it or not. The same goes for the flu. No vaccine is going to protect you 100 percent, so why take the risk?”

Outbreaks do happen, though often in larger cities and within communities that don’t vaccinate.

According to the CDC, measles cases have tripled over the annual average in the past five years. In March of 2013 there were 58 cases tied to a religious group in New York. A mega-

HEALTHY LIVING

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Health and Wellness

church in Texas opposed to vaccination reported 20 cases. In North Carolina, 23 cases were reported among unvaccinated members of a Hare Krishna group. At least 187 cases were reported in 2013, 98 percent of which were unvaccinated. So far this year, there have been at least 71 confirmed cases of measles in the U.S., including a recent outbreak in NYC. A 2009 article published in the New England Journal of Medicine laid the blame at the feet of vaccination opponents.

“Vaccine refusal not only increases individual risk of disease,” the article stated, “but also increases the risk for the whole community.”

Alabama has roughly a 93-plus percent vaccination coverage rate, which places it above the national average. But that doesn’t mean the state is completely immune to vaccine-preventable diseases.

“Whooping cough has become a real issue for us,” said Phyllis Coughran, immunization manager for the Alabama Department of Public Health, whose area includes Calhoun County. “And that could really be true of any of these diseases. You never know when they’re going to pop back up.

That’s why we have to vaccinate.”

OVERWHELMED

While she was pregnant, 20-year-old Shauna Simmons did a lot of research on child development and the benefits of breastfeeding for both mother and child.

“And that’s one of the reasons we didn’t vaccinate, because he gets all of what I have though my breast milk,” she said. “Plus, I just didn’t feel that they were safe or necessary.”

For Simmons, her objection to vaccination is largely pragmatic.

“He’s a child, a baby who hasn’t gotten his feet on the ground,” she said of her 8-month-old son.

“You can’t attack him with all these things without giving his system the chance to build, to get strong. It’s just overwhelming.”

Dr. Matt St. John, a naturopathic doctor and owner of St. John’s Nutrition in Oxford, agrees.

After 30 years of “intensive” research, St. John views what he believes to be a connection between vaccinations and certain brain disorders like ADHD and autism to be one of the “great enigmas.”

As a father of three, he considers the policy of giving numerous vaccinations to individuals, especially children, to be “sheer lunacy,” particularly because they overstimulate the immune

system.

“The problem with our present vaccine policy is that so many vaccines are being given so close together and over such a long period that the brain’s immune system is constantly activated,” St. John said.

According to St. John, the more the body’s immune system is stimulated, the more intense the brain’s reaction. Prolonged activation of the body’s immune system likewise produces prolonged activation of the brain’s immune system.

“This means that the brain will be exposed to large amounts of excitotoxins as well as the immune cytokines over the same period. These destructive chemicals, as well as the free radicals they generate, are diffused throughout the nervous system doing damage — a process called ‘bystander injury,’” he said. “It’s sort of like throwing a bomb in a crowd. Not only will some be killed by the blast, but those far out into the radius of the explosion will be killed by the shrapnel.”

However, the CDC maintains that “no evidence suggests that the recommended childhood vaccines can overload the immune system.”

One rumor that continues to add fuel to the debate over childhood immunizations is that vaccines, namely the MMR, can cause autism.

While whispers of concern have been heard for years, the controversy exploded in February 1998 when British doctor Andrew Wakefield hypothesized that the MMR vaccine led to autism. The

mantel has since been carried by a number of outspoken celebrities, including actor Jim Carey and talk show host and former Playboy Playmate Jenny McCarthy, who has written several books and runs a non-profit organization dedicated to autism research. Both blame the MMR for autism.

These concerns persist despite the fact that Wakefield’s study has been soundly discredited and he was stripped of his medical license. There is no empirical evidence to support the claims that MMR contributes to autism. No less than 12 epidemiological studies have failed to link the MMR vaccine to autism. Six found no link between autism and thimerosal, a preservative containing ethylmercury that has been removed from vaccinations since 2001. And three of the studies concluded that thimerosal caused no neurological damage.

And yet the rumors and fears persist despite all the evidence to the contrary simply because so many people refuse to believe, said local pediatrician Dr. Angela Martin.

“There are some people who refuse to believe that a man walked on the moon,” she said. “We can’t change the way that some people think. But the literature and the research studies overwhelmingly agree that you won’t, for example, get autism from the MMR. I’m a doctor, a pediatrician. And we have taken the oath to do no harm. I would never recommend anything for my patients that would put them in danger.”

Amy Law and her husband Chris, an Oxford chiropractor, have decided not to vaccinate their 2-year-old daughter, Elly, or their second child due in May.

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HEALTHY LIVING

Photo by Stephen Gross

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Health and Wellness 14

‘BULLIED’

There is no federal law that mandates vaccinations. However, all 50 states require vaccinations for students to enter school, the socalled “blue form.” All states permit medical exemptions, which require a doctor’s signature, while 48 states, including Alabama, allow for religious exemption.

If parents don’t want their children vaccinated, either they must plan on homeschooling, like Law and Maxcey, or receive a religious exemption like Simmons. To receive a religious exemption, parents need only go to a department of public health office and explain why their beliefs prevent them from vaccinating their child.

“We’re not here to discuss religious doctrine with people, so we take their word for it,” Coughran said.

That’s exactly what Simmons did.

“Granted, it’s not because of our own beliefs necessarily,” she said with a laugh, “but I wasn’t going to be bullied into getting my child vaccinated just so he could go to daycare. I don’t feel any guilt whatsoever.”

It’s a term tossed around quite a bit among those who oppose vaccination — “bullied” or “pressured.” It comes from friends and family and occasionally strangers who disagree with their choices, but largely it comes from their doctors.

“We were absolutely bullied and made to feel like terrible parents by our doctor because we didn’t want to vaccinate,” Simmons said. “But it was my child and my decision.”

In a national survey of members of the American Academy of Pediatrics, almost 40 percent said they would not provide care to a family that refused all vaccines and 28 percent said they would not provide care to a family that refused some vaccines.

The academy’s Committee on Bioethics discourages this, recommending doctors “share honestly what is and is not known about the risks and benefits of the vaccine in question.”

Martin will refer parents who refuse to vaccinate their children to another pediatrician out of concern for her own health and those of her staff.

“If their child is not vaccinated, it exposes us to those diseases also,” she said. “We could get sick, very sick, because our immunity may have lessened over the years.”

Doggett doesn’t disassociate himself from patients who choose not to vaccinate, hoping he can change their minds over time and perhaps catch the child up on their immunizations at a later date.

“I try to meet them where they are, and it’s still frustrating, but you have to appreciate those fears. Their main goal is not doing harm to their child. I think their fear is real and I try to understand that,” he said. “Plus, I wouldn’t want to punish the child for a decision the parents made.”

As for Leslie Renfroe, she spent those last four months of her pregnancy obsessing over the research, statistics, studies, anecdote and conjecture until she reached the point where she was afraid to open her computer.

“I had more than 50 sites saved just on vaccinations,” she said.

“But I eventually decided to trust my doctor and do what he suggested because it was his job to keep my baby safe.

“As a parent, all you can do is what you think is best for your child and learn to live with those decisions.”

HEALTHY LIVING

Development of the immunization schedule The United States Department of Health and Human Services and the Centers for Disease Control and Prevention offer immunization schedules for children ages 0-6 and 7-18 years, as well as a “catch-up schedule” for ages 4 months-18 years who may have missed recommended vaccinations. All schedules are approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

Some vaccinations have been recommended in the United States since the 1940s, although the official annual schedule endorsed by ACIP, AAP and AAFP did not appear until 1995. A combined vaccine for diphtheria, tetanus and pertussis (whooping cough) was recommended in the 1940s and is still recommended today, while the smallpox vaccine on the schedule in the ’40s is no longer recommended. (Smallpox was declared eradicated in 1980 and eliminated from the United States much earlier.)

The newly developed vaccine for polio was recommended in the 1950s. The specific vaccine used has changed since, but polio vaccine remains on the current schedule. The combined measles, mumps and rubella vaccine was added to the list of recommendations in the 1970s, after vaccines for all three diseases were developed in the 1960s.

The list of recommended vaccines continued to be updated as vaccines were developed for more diseases. The Hib (Haemophilus influenzae type b) vaccine was added to the list in the late 1980s, while a vaccine for hepatitis B was added in the mid-1990s.

In 1995, the ACIP, AAP and AAFP began issuing annual updates to the schedule, which contained detailed information about the recommended vaccines, including specific age- and dosage-related information, as well as information about new vaccines as they were added to the schedule.

Since then, a number of vaccines have been added, including those for chickenpox and hepatitis A, while others have been removed or replaced. (The first rotavirus vaccine added to the schedule was removed because of an association between the vaccine and intussusception, a type of bowel obstruction. It was later replaced with a different rotavirus vaccine that has no association with the condition.)

As of 2010, the recommended schedule for children ages 0-6 years includes the following vaccinations:

Hepatitis B Rotavirus Diphtheria, Tetanus, and Pertussis (combined DTaP vaccine) Hib (Haemophilus influenzae type b) Pneumococcal Polio (inactivated vaccine) Influenza Measles, Mumps and Rubella (combined MMR vaccine) Varicella (chickenpox) Hepatitis A Meningococcal Information provided by The History of Vaccines: A Project of the College of Physicians of Philadelphia. The learn more, visit historyofvaccines.org

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FITNESS & NUTRITION

Alabama’s only

POUND FITNESS CLASS is at the Anniston Aquatics and Fitness Center As people bounce into a studio classroom at the Anniston Aquatics and Fitness Center clutching bottles of water and chatting about their weekend, they each grab an exercise mat and place it on the floor.

But instead of dumbbells, each member of the class picks up a pair of drumsticks.

“Radioactive” by Imagine Dragons starts to play and the class begins.

This is Pound — a cardio workout, as well as a workout for arms, legs and abs in which participants drum along to the beat of each song. The music ranges from the popular to the obscure. Fast-paced songs require participants to drum harder and faster, which builds muscle while strengthening the heart.

For some songs, participants lie or sit on mats and beat their drumsticks on the floor, alternating to the left and right, working muscles in the arms and strengthening the body’s core.

As the class cools off, the songs slow down.

Participants relax and loosen their muscles drumming to the leisurely beat of “Royals” by Lorde.

Stephanie Hobbs has been teaching Pound classes at the center since September, after discovering the program via YouTube.

“A couple of other instructors and I saw a YouTube clip that we just randomly came across,” she said. “One of them took it to our boss, who took it to the city of Anniston, and we got the approval to go ahead and do it.”

Pound was created in Los Angeles by fitness experts and music enthusiasts Cristina

Merry Mayell works out during the Pound fitness class at the Anniston Aquatic Center.

Photo By Stephen Gross

18

HEALTHY LIVING

Peerenboom and Kirsten Potenza, and the program uses special weighted drumsticks called Ripstix. And right now, Anniston plays host to the only Pound class in the state of Alabama.

Hobbs says that many people have reservations about trying Pound because they don’t have a musical background or think they don’t have rhythm, but Pound is a class for everyone, she insists.

“With Pound, it doesn’t matter your age or your fitness level,” she said. “I’ve got men and women ages 7 to 80 that come in here.

They’re in all different fitness levels, and they can come rock it out.”

It was the musical aspect of the class that drew Haleigh Tibbs. The Jacksonville State University senior was not regularly

By Kara Coleman attending any fitness class before she tried Pound.

“Since I’m graduating from JSU this May, I had been wanting to become healthier,” Tibbs said. “Stephanie … said that since I am a trained musician, this class would appeal to me musically. After going to the first class, I was hooked.”

There are modifications for each exercise in the class that cater to different fitness levels, so all class members are working out to the same song in the way that works best for them. Participants may drum on the floor if they are able to bend and do so, but class members who are less limber or unable to bend down to the floor may drum in the air.

According to Hobbs, drumming lowers levels of the stress hormone cortisol, “so you leave here happier, healthier, stress-free,” she said. “And you’ve got a good head-to-toe workout.”

Tibbs enjoys the classes so much she is planning on becoming a certified Pound instructor herself in the near future.

“I never thought that I would want to become a fitness instructor,” she said. “But Pound has made such a difference in my life that I want to teach others so that it could possibly impact someone else’s.”

All group fitness classes, including Pound, are included in an Anniston Aquatics and Fitness Center membership.

Non-members may purchase the Group X Passport for $25, which covers 16 classes to be used at any time.

The current schedule for Pound classes is:

Monday at 8 a.m. and 6:30 p.m., Tuesday at 4:30 p.m., Wednesdays at 8 a.m. and 6:30 p.m., Thursdays at 4:30 and 6:30 p.m., Fridays at 8 a.m. and Saturdays at 8:30 a.m.

For more information, call 256-847-7349 or visit the Anniston PARD Aquatic & Fitness Center Facebook page.

HEALTHY LIVING

19

Fitness & Nutrition

changing

LIVES Stringfellow’s bariatric center growing in use

By Patrick McCreless

Weight-loss surgery did more than help Benny Sheppard lose a few pounds.

It changed his entire outlook on life.

Dr. Cliff Black performs bariatric surgery on a patient in the operating room at Stringfellow Memorial Hospital.

Photos by Trent Penny

20

HEALTHY LIVING

In recent years, the Wedowee resident had struggled with his weight. He was having trouble walking and lifting, and he was always tired — symptoms that adversely affected his job performance as a truck driver.

Then Sheppard had about 80 percent of his stomach removed during weight-loss surgery at the bariatric surgery center of Stringfellow Memorial Hospital. Within a month, he had lost 25 pounds.

And he hasn’t been the same since.

“I feel more like going out and walking and doing things. It’s changed my whole outlook on what I eat,” Sheppard said. “My journey has been amazing.”

Bariatric surgery encompasses several types of weight-loss surgeries, each of which involves shrinking the size of the stomach so that patients require less food to feel full.

Sheppard is one of a growing number of patients to undergo surgery at the nationally accredited center. After the center opened in June 2013, the number of bariatric surgeries performed at the hospital nearly doubled — jumping from 56 surgeries in 2012 to more than 100 last year, according to Stringfellow’s bariatric surgeon, Dr. Cliff Black.

“We’re continually moving up in numbers,” Black said.

That’s growth some hospital physicians expect to continue as obesity continues to plague the state and word spreads about

the state-of-the-art center, which is part of a multi-million dollar expansion of the hospital’s surgery wing.

“Obviously that new-car smell is appealing to everyone,” said center Director Brandon Rogers, adding that it’s the efficient design that makes it easier for personnel to treat more patients. “The center itself makes everyone more cohesive.”

According to Black, the center has also benefitted from its recent accreditation from the American College of Surgeons.

The scientific and educational association of surgeons, which offers several accrediting programs for different surgical fields, awarded the center its level-two accreditation in June. Earning the organization’s leveltwo accreditation means Stringfellow demonstrated it can handle more bariatric cases each year than it could previously.

“When an outside agency like this designates you as a center of excellence, it gives potential patients a yardstick for which to measure,” said Black. And it draws more people from outside the region.

“People are even coming from out of state and it’s been by word of mouth,” Black said.

“That’s what a center for excellence does.”

Debbie Lowe of Gadsden opted to have bariatric surgery at the center last November because of what she had heard about the facility.

“I heard a lot of good things and results,” Lowe said. “I went because I was overweight and heard a lot of success stories.”

Rogers has not been surprised by the growth in the center’s patient load — it meets an expanding need of care for people with obesity, he said. To qualify for bariatric surgery at Stringfellow, patients must be morbidly obese, meaning they are at least 100 pounds over their ideal weight. Also, patients must have already attempted more conventional treatments, such as dieting and exercise.

“Because of the obesity rate in the country and especially in the South, we fit the mold,” Rogers said. “We have the proper skill set and we fit the need.”

According to the Centers for Disease Control and Prevention, obesity is a growing epidemic,

When an outside agency like (American College of Surgeons) designates you as a center of excellence, it gives potential patients a yardstick by which to measure.

— Dr. Cliff Black with more than one-third of American adults being categorized as obese. About 6 percent of adults are morbidly obese.

The situation is even worse in Alabama, which is among the three states with the highest rates of obesity for adults. Obesity can lead to a variety of health problems, from diabetes to high blood pressure and cardiovascular disease.

Like most of Black’s other patients in recent years, Sheppard underwent a type of bariatric surgery known as sleeve gastrectomy, in which the stomach is reduced to about 25 percent of its original size. Black said 95 percent of his patients request the procedure, noting its popularity nationwide has grown in recent

years due to its high success rate with few complications.

Sheppard said he has not had any complications. Instead, the surgery has curbed his appetite and kept him from eating the large portions he once did during meals.

“If this continues to do this for me, it will be a good tool to really control what I eat,” he said.

Lowe, who had the same surgery as Sheppard, also said she has not experienced any complications. In less than two months, she’d lost 30 pounds and is already nearing her goal weight, she said.

“I have more energy and more endurance overall,” said Lowe. “I’ve changed my diet and eating habits ... overall I just feel healthier.”

HEALTHY LIVING

21

MIND & BODY

LOSING SLEEP Despite hindrances, there’s no substitute for a good night’s sleep

By Teri Hasemeyer

JSU sophomore Abby Roberts studies in her bedroom at her off-campus apartment in Jacksonville.

Photo By Stephen Gross

When Chelsea Moody holds her baby first thing in the morning, she sees big blue eyes and short blonde hair. As she rocks and tickles little Alivia, the baby giggles and coos in Moody’s lap.

“It’s the best time of day,” Moody said. “In the mornings, she is so happy.”

Bonding time is almost as refreshing as a full night’s sleep for Moody, who only gets to sleep for short periods of time throughout the night due to her daughter’s condition. Alivia was born with a cleft lip and a heart defect that requires the use of a gastrointestinal bag to hold her formula and continually feed her. For the Anniston couple, this means a routine of cleaning the bag, warming the milk and refilling the bag every four hours, day and night.

At 5 months old, Alivia is beginning to teethe and wants to use her pacifier, but her cleft lip keeps her from being able to hold it in her mouth. Nearly every half hour, Alivia’s cries wake Moody and her husband, who dutifully put the pacifier back in her mouth.

Moody said they use a blanket to gently hold the pacifier in place, but the routine continues.

“I’m so tired,” Moody said. “I have no energy to do what is required of having a household.”

To compensate for the lack of sleep, she tries to nap when Alivia naps, and she drinks a cup and a half of coffee each morning.

“I think it helps me have some energy to

help me take care of my daughter,” she said.

According to Shayne Williamson, a supervisor at the Sleep Center at Northeast Alabama Regional Medical Center, consistently getting enough sleep is one of the most important contributors to maintaining a healthy body, immune system and stress level.

“The purpose of sleep is to rejuvenate the body,” Williamson said. “Generally people need eight hours per night.”

Moody, who has pulmonary atresia, the same heart defect as her daughter, knows her body requires more sleep than it gets.

And she knows that continual lack of sleep affects her physically and keeps her from being productive in other areas of her life, she said.

“When (Alivia’s) dad gets home, I try to hand her off and do housework, but sometimes I am too exhausted,” she said.

While Alivia’s condition is a major contributor to the family’s sleep deprivation, mothers of healthy newborns are certainly not immune.

“I don’t get much sleep,” said Patricia Gortney. The Munford native gets up every two hours during the night to breastfeed her 2-month-old son, Logan. Each time consists of nursing and burping the infant, cleaning him up, changing his diaper and clothes, and getting him back into bed.

“It definitely affects me physically,” she said. “My house is a wreck. Mentally, I’ve always been forgetful, but now I forget a lot of things from being so tired.”

Gortney tries to make up for the toll of Logan’s schedule by resting during the day, she said, recounting a particularly busy night. After getting him to sleep early, Gortney had gone to bed around 8:30 p.m. thinking it would be an easy night. However, the infant had her awake from 11 p.m. to 1 a.m,. then up again at 2 and 4 before her

4-year-old, Lydia, woke her at 6 to get ready for school.

“I took a good nap that day,” Gortney said.

The demands of college life are another common reason for lack of sleep.

The number of hours a college student sleeps each night can depend on anything from homework load to football schedule to frat parties. Jacksonville State University sophomore Abby Roberts says she gets anywhere from five to eight hours of sleep a night. If the 20-year-old misses sleep, she says it’s normally because she’s spending time with friends, so she makes sure to get up for class the next day even if she’s tired.

“Last night I worked pretty late and got home late,” Roberts said. “Then this morning, I slept late and was late to class.”

Roberts does not drink energy drinks or coffee, but admits she will indulge in a soda to help give her a jump-start. But once the sugar high wears off, she is left feeling even more tired, she said.

“The worst thing that could happen from not getting enough sleep would be to become unhealthy or making you stressed and getting behind on school,” Roberts said.

“Not getting enough sleep for a long time would be really bad for your health, affect your brain and studies, I think.”

Williamson, who monitors sleep studies at RMC as a registered polysomnographic technologist, said that symptoms of sleep deprivation can range from feeling tired to severe fatigue, headaches, irritability or moodiness, difficulty concentrating, depression and decreased performance at work or school.

“It can affect your day-to-day activities,” she said. “It can make you sluggish, but it will also affect your immune system because you are not rejuvenating.”

Last night I worked pretty late and got home late, then this morning I slept late and was late to class.

— Abby Roberts, sophomore at JSU

HEALTHY LIVING

23

Mind & Body

RECOGNIZING SLEEP APNEA

It can be tempting to rely on caffeine, but coffee, energy drinks and soda can have many side effects, not least of all the inability to sleep restfully.

“Anyone who uses these products should be aware and pay close attention to how (these drinks) make them feel,” Williamson said. “Too much can keep an individual Sleep apnea, which is characterized by the from getting the proper amount of sleep, along with National Sleep Foundation as snoring and other health issues” — including increased heart rate, interrupted breathing, can disrupt sleep or cause a headaches and insomnia.

And even if a person is getting enough hours of sleep each person to awaken abruptly throughout the night. night, physical factors can affect the quality of that sleep.

According to Shayne Williamson of the RMC The National Sleep Foundation website notes that illnesses Sleep Center, there are three types of sleep apnea. like arthritis cause pain or discomfort that can keep a person awake. And disorders that disrupt breathing, such as asthma “The most common is obstructive,” she said. or chronic obstructive pulmonary disease (COPD), can also “It’s when excessive tissue blocks airways and disrupt sleep. causes snoring. People with this condition may Williamson stresses the importance of rapid eye movement (REM) sleep, which “is when your body is most wake up gasping or choking for air.” relaxed and can rejuvenate,” she explained. “There are In cases of central sleep apnea, the body several things you can do to help get that REM sleep.” stops breathing on its own, forcing the brain She recommends having a routine in place to help the body acclimate to going to sleep at a certain time. to purposefully tell the muscles to breathe, This routine www.facebook.com/peggymillerlacherforjudge should consist of the same activities and be performed atwww.electpeggymillerlacher.comPeggyGradyJanaTydeBamaJetthe same time each night. Include relaxing activities likePaid taking a bath, listening to calm music, or using relaxation exercises to relieve tension.

Williamson also recommends avoiding stress before bedtime, minimizing noise and light, maintaining a comfortable temperature, and avoiding screens, such as smartphones and TVs, in the bedroom.

Sleep is a primary factor in staying healthy, managing stress and performing one’s best.

Yet many people do not set aside time for a restful sleep each night.

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Photos via Associated Press/File

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HEALTHY LIVING

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Get ACTIVE. Stay HEALTHY. Live HAPPY. Williamson said. Symptoms of central sleep apnea include weakness, numbness and difficulty swallowing. The third type is a combination of excessive tissue and the body’s failure to automatically breathe while a person is sleeping.

“If you have these symptoms, see your physician to begin treatment,” Williamson said. “Sleep apnea can be treated with continuous positive airway pressure, or CPAP, oral devices or surgery to remove excessive tissue. It is best to try the CPAP machine first to see if your body actually needs surgery.”

Get advice from local experts in The Star’s health column each Sunday in Life & Arts The Anniston Star

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Mind & Body

Photo via Associated Press/File

BLOWING

SMOKE

While smoking rates drop nationwide, Alabama youth still lighting up

By Madasyn Czebiniak

26

HEALTHY LIVING

In 1957, the surgeon general first pointed to a relationship between cigarettes and lung cancer. In a 2014 report from the surgeon general, the number of cancers linked to smoking and secondhand smoke was 13.

The report also linked smoking to an increased risk of Type 2 diabetes and tuberculosis, erectile dysfunction, ectopic pregnancy, impaired fertility and immune function, rheumatoid arthritis and blindness.

Apparently Alabama hasn’t gotten the memo.

Even though smoking rates have been decreasing, reports from the Centers for Disease Control and Prevention show Alabama still ranks higher than the national average for both cigarette and smokeless tobacco use. In 2011, 24.3 percent of adults in Alabama were smokers — 3.1 percent higher than the national average. The percentage of Alabama’s youth

tobacco THE TOLL OF

smokers, which includes high school students, was 22.9 percent — 4.8 percent higher than the national average.

“It’s really no surprise when you see high rates of adult use, you also see high rates of youth use,” said Brian King, a senior adviser for the Office on Smoking and Health at the CDC. The reason, according to King: Prevalence is mirrored.

“In a lot of Southern states, there are not comprehensive smoke-free laws in public places, so tobacco use is generally seen as a more normative behavior than it is elsewhere in the country,” he said.

According to King and other experts, Alabama lacks three policies known to prevent tobacco use: a statewide ban, higher excise taxes and funding for tobacco prevention programs.

a positive impact on people quitting smoking and trying to quit,” she said.

According to the Campaign for Tobacco Free Kids’ website, 30 states — along with Washington, D.C., Puerto Rico and the U.S. Virgin Islands — have statewide smoke-free laws, as do a growing number of countries including New Zealand, Norway, Panama, Turkey and the United Kingdom.

Alderman had hoped Alabama’s 2014 legislative session would be the one in which a statewide smoking ban would finally be implemented. A bill to ban smoking in Alabama businesses — which included exceptions for bars, private clubs, retail tobacco outlets and electronic cigarettes — was criticized for not going far enough. The bill died in the House Health Committee earlier this month.

CHANGING THE NORM

HIGHER TAXATION EQUALS LESS ASPHYXIATION

Although places in Alabama have issued smoke-free ordinances that ban smoking inside public buildings like businesses, bars and restaurants — including the city of Anniston in 2013 — more need to do so, experts say. “Smoke-free laws definitely help at changing social norms and creating a culture of not using tobacco in public,” said King. “They’re also effective at reducing secondhand smoke exposure as well as promoting cessation.”

Kristie Alderman, a spokeswoman for the American Cancer Society of Alabama, shares King’s sentiments on smoke-free laws.

“I think they definitely have

In the absence of a statewide smoking ban, experts say look to the money — in this case, taxation and funding.

“Increasing the price of tobacco products is the single most effective way to reduce cigarette smoking,” said King Statistics show that states with a high excise tax on tobacco products have extremely low rates of smoking. Only four states have a lower excise tax on tobacco than Alabama. New York has the highest in the nation at $4.35 per pack — Alabama’s is 42 cents per pack.

“The higher the excise tax, the more likely people are going to give it up because it’s just too expensive,” Alderman explained.

NATIONWIDE ADULT SMOKING RATE

18.1%

ALABAMA ADULT SMOKING RATE

23.8%

pe r spec t i v e

A STATE IN

VS.

NATIONWIDE

10.7% 18.1% $8.8B $1.53

ALABAMA

12.1% YOUTH SMOKING RATE 22.9% TOBACCO MARKETING SPENDING $197M CIGARETTE TAX (PER PACK) $0.425 THE COST cl ose to hom e PREGANT SMOKING RATE

PACKS OF CIGARETTES BOUGHT OR SMOKED BY ALABAMA KIDS ANNUALLY

ALABAMA KIDS (UNDER 18) WHO BECOME DAILY SMOKERS ANNUALLY

4,900 15.4M

• Annual health care costs directly caused by smoking: $1.88 billion

Cities where all non-hospitality workplaces are smokefree: 14 1

• Portion covered

by Medicaid: $238 million

22

• Tax burden from smoking-caused government expenditures: $541 per household • Adults who die each year from their own smoking:

7,600

10 3 19 8 7 29 6 38 35 24 2 27 37

30

36 26 9 12 4 33 34 31 13 25 16 32 5 18 21 28

Graphic by AnnaMaria Jacob

17

15

20

23

11

1. Albertville 2. Alexander City 3. Anniston 4. Atmore 5. Bayou La Batre 6. Bessemer 7. Birmingham 8. Center Point 9. Citronelle 10. Clay 11. Cottonwood 12. Creola 13. Daphne 14. Decatur 15. East Brewton 16. Fairhope 17. Flomaton 18. Foley 19. Fultondale

20. Geneva 21. Gulf Shores 22. Jasper 23. Lanett 24. Midfield 25. Mobile 26. Monroeville 27. Opelika 28. Orange Beach 29. Oxford 30. Phenix City 31. Prichard 32. Robertsdale 33. Satsuma 34. Spanish Fort 35. Talladega 36. Troy 37. Tuskegee 38. Vestavia Hills

SOURCE: Center for Domestic Preparedness, Campaign for Tobacco-Free Kids

HEALTHY LIVING

27

Mind & Body Photo via Associated Press/File Statistics also show that states with high levels of tobacco prevention programs have lower rates of smoking.

A study published in the American Journal of Public Health in January 2013 found that states can help reduce youth smoking by implementing statewide bans and well-funded tobacco prevention programs.

“There’s a distinct difference and opinion on the way children look at smoking today than they did six or eight years ago,” Alderman said.

According to reports from the Campaign for Tobacco Free Kids, which were updated in February, Alabama is expected to generate $223.1 million in tobacco revenue in 2014. The CDC’s recommended spending amount for

tobacco prevention control in Alabama in 2014 is $55.9 million. Alabama is expected to spend only 0.5 percent of that.

AVAILABILITY IS KEY Experts say it’s important to emphasize the dangers of smoking to children when they are young, because people who reach their mid-20s without picking up the habit typically never will.

But the cheaper and more available a product is, the more drawn to it kids are. Products such as hookahs, flavored tobacco, electronic cigarettes, flavored cigars and a new spitless tobacco known as “snus” have increased in popularity among youth in the past few years, according to the CDC (see box on page 30).

According to Peter Fisher, vice

E-cigarettes Electronic cigarettes – technically battery-operated nicotine inhalers – are becoming increasingly popular, but the jury is still out on the health risks they may yield.

HEALTHY LIVING

Vaporizer Atomizes the nicotine smoking liquid in the liquid container

Nicotine liquid container

Battery

Inhaler Electronic cigarette One e-cigarette 100 6-24 mg.

E-cigarette with 24 mg of nicotine 0.16 mg/puff Source: E-Cig

28

Electronic components Include control circuits, pneumatic airflow sensor

Light Simulates cigarette glow, indicates when device is ready for use and works as battery indicator

Comparison

Regular cigarette

Equivalent

6-7 cigarettes

Puffs per cigarette Nicotine level Nicotine per puff

15 0.6-2.4 mg.

Cigarette with 1.8 mg of nicotine 0.16 mg/puff © 2013 MCT

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Call today at 256-236-5181 to see Dr. John Nwogu, a cardiac specialist with board certification in Vein and Lymphatic Medicine, Vascular and Endovascular Medicine.

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Mind & Body

KNOW YOUR SMOKE

president of state issues for the Campaign for Tobacco Free Kids, one of the major reasons e-cigarettes have become popular has to do with advertising tactics.

“E-cigarette companies — who now include a couple of the big tobacco companies — are marketing their products with a lot of the same tactics used over the last 50 years to market regular cigarettes to kids,” Fisher said. “You’ve got the celebrity endorsement, lavish magazine ads, auto-racing sponsorships, flavors, all sorts of stuff just like the tobacco companies used to do.”

Even though the risks that come with smoking e-cigarettes are considered lower than those of regular cigarettes, King said a primary concern for youth smokers should be the nicotine contained in the products as “there is a considerable body of scientific literature showing nicotine can have adverse effects on the developing adolescent brain.”

While e-cigarettes have not been regulated by the Food and Drug Administration and there is currently a lot experts don’t know about them, use among middle and high school students more than doubled from 2011 to 2012.

The Oxford Board of Education voted in January to include a ban on e-cigarettes in the school system’s student code of conduct. And when the smoking ban in Anniston went into effect last year, electronic cigarettes were included.

According to King, the growing popularity of e-cigarettes could be attributed to several states not having youth access laws on e-cigarettes.

“It’s possible for a kid to walk into a mall kiosk or a convenience store and legally buy these products for mere pocket change,” he said.

1 Hookah: A device that allows users to smoke vaporized flavored tobacco 2 Electronic cigarettes: A batteryoperated device that simulates the act of smoking with a vaporized solution, which may or may not contain nicotine 3 Flavored cigars: Small cigars flavored with candy, fruit or clove. (Cigarettes with flavoring other than menthol are banned nationwide, while flavored cigars are banned in only four states.)

4 Snus: A powder similar to dipping tobacco that does not require the user to spit out the product

2 1

3

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HEALTHY LIVING

Photo via Associated Press/File

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Over the years, the people of eastern Alabama have come to depend on Stringfellow Memorial Hospital for their health and wellness needs.

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301 East 18th Street | Anniston, Alabama 36207 | 256-235-8900 301 East 18th Street | Anniston, Alabama 36207 | 256-235-8900