Emory Health Digest Autumn 2019 by Emory University

AUTUMN 2019

When the buzzing in my brain meant stroke pg 16

PREGNANCY BEHIND BARS p14 FOOD AS MEDICINE p 24 HIGH TIME FOR TICKS p 32 SLEEPING SICKNESS p 38

travel well

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Pregnant women in prison are often isolated and scared. Their babies will be taken away shortly after birth. This nurse has made it her mission to empower them.

Arrival of the Bees 16 Jerry Grillo planned to write a story about participating in a healthy aging study. Then he had a stroke. What followed was a crash course on his own mortality.

U.S. LIFE EXPECTANCY The U.S. is in the longest period of declining life expectancy since the early 1900s when World War I and a deadly flu pandemic combined to kill nearly 1 million Americans. Suicide rates are up 30% since 1999. Drug overdose deaths also continue to climb in the midst of the deadliest drug overdose epidemic in U.S. history. A baby born in the U.S. in 2017 is expected to live about 78.6 years. 12

Food as Medicine 24 Can you reduce the number of pills you take just by eating more fruits and veggies? You bet. The most effective prescription might be better nutrition.

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MUST SEE TV

The Emory Brain Health Center and Georgia Public Broadcasting (GPB) are partnering on a news magazine, hosted by Emory’s Jaye Watson. Go to emry.link/yfmepisodes.

Emory Health Digest Jonathan Lewin Exec VP for Health Affairs, Exec Director of the Woodruff Health Sciences Center, and President, CEO, and Board Chair of Emory Healthcare Mary Loftus Editor

While about 30,000 cases of Lyme disease are reported to the CDC each year, the actual number is likely many times that.

EMORY HEALTH DIGEST

High Time for Ticks 32 Tick-borne diseases, from Lyme to alpha-gal, are on the rise: What you can do to avoid these tiny blood suckers and their assortment of dangerous pathogens.

Consumed by Sleep 38 An effective treatment for hypersomnia has been elusive, but hope is on the horizon for people who are sleeping their days away.

the well

and more

Social Feed 4 Kudos and tweets from around the Woodruff Health Sciences Center.

Patient POV 43 Spinal surgery patient Stuart Turner details six lessons learned during his medical journey.

The Well 5 Ginger’s genius. Scooter danger. Got (organic) milk? Ebola survivors return. Anemia app. Avoiding measles. Life expectancy declines. Alzheimer’s preparations. Ebola virus disease and vision loss.

Policy Wise 44 Five years ago this August, Emory University Hospital admitted the first patient with Ebola virus disease to be cared for in the U.S. That was only the beginning.

Peta Westmaas Art Director Martha McKenzie Associate Editor Jack Kearse Director of Photography Pam Auchmutey, Sonia Collins, Jerry Grillo, Quinn Eastman, Gary Goettling, Catherine Morrow, Jessica Sales, Stuart Turner, Cassandra Quave Contributing Writers Carol Pinto, Stuart Turner Production Managers Jarrett Epps Advertising Manager Wendy Darling Web Specialist Karon Schindler Exec Director, Editorial, Communications Vince Dollard Associate VP, Communications

Emory University is an equal opportunity/ equal access/affirmative action employer fully committed to achieving a diverse workforce, and complies with all applicable federal and Georgia state laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, or veteran’s status. Inquiries should be directed to the Office of Equity and Inclusion, 201 Dowman Drive, Administration Bldg, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD). 19-EVPHA-EVPHA-0495

travel well

Kendall Lassetter, a recent graduate of the University of Georgia, never saw the tick that bit her. She was diagnosed with Lyme disease after having continuous migraines and other symptoms. “I couldn’t pay attention in class because I was so weak and tired all the time,” she says. “I knew there was something wrong.” Read the full story on page 32

AUTUMN 2019

to our readers

sphere Emory Medicine @EmoryMedicine • 30 July For the 8th year in a row, @usnews ranked Emory University Hospital the No. 1 hospital in Ga & metro Atlanta in its #BestHospitals Guide. @SaintJosephsATL and Emory University Hospital Midtown were also ranked in the top 5 for Ga & Atlanta.

Jonathan Lewin, executive VP for health affairs, executive director of the Woodruff Health Sciences Center, and president, CEO, and board chair of Emory Healthcare.

Emory was named the largest employer in metro Atlanta this July, according to the Atlanta

Business Chronicle, with more than 31,200 full-time Atlanta employees—bumping Delta out of the top spot for the first time in decades. A large number of those (18,000-plus) are Emory Healthcare employees. Our recent growth has included opening new primary care and urgent care locations, closing on a merger with a three-hospital system in our local market, and forging a partnership with Kaiser Permanente in which its patients are referred to Emory specialists and hospitals when the need arises. What does this growth mean for our community, our employees, and our patients? While we are striving to make the most of our resources and opportunities, we remain committed to being a good neighbor, an ethical employer, and a compassionate provider of personalized health care. And, all in all, we’d prefer to keep people out of the hospital by being partners in prevention. This issue of Emory Health Digest, as always, explores ways our people, programs, and research are improving lives, from looking at food as medicine, to helping expectant mothers navigate pregnancy in prison, to raising awareness of tick-borne diseases. Send us an email to let us know how we’re doing, and be well. Jon Lewin evphafeedback@emory.edu

Jon Lewin @JonLewinMD • 1 July So proud of our great @emoryhealthcare doctors—there are no more talented or dedicated physicians anywhere, and we appreciate all that you do for our patients and their families, trainees, and community! @EmoryMedicine Rich Duszak, MD @RichDuszak • 1 July “More than half of the physicians recognized in the annual ‘Top Doctors’ issue of Atlanta magazine are physicians within Emory.” @emoryhealthcare Cover doctor Patrice Harris 98MR, is an adjunct professor at Emory in the Department of Psychiatry and Behavioral Sciences.

Emory Public Health @EmoryRollins • 24 July PrEP is a very powerful tool in the fight against the #HIV epidemic, but Rollins researchers found that “PrEP Deserts” can severely limit #PrEP access for eligible MSM. Read about these high-risk, low-access areas that are prevalent in the South.

eat well

the well Ginger’s Genius

An incredible medicinal root that comes with a kick A spice native to Asia, ginger’s use in cooking or as a condiment dates back at least 4,400 years. It has a distinc-

tive hot, pungent aroma and flavor that is essential to many modern and traditional dishes, such as curry and chutney. Historically, this plant was referred to as “the great cure” and was one of the most essential components of household folk medicines. The wealth and diversity of chemicals present in the rhizomes (rootstalk) of this tasty medicinal and spice plant are responsible for its flavor, aroma, and healing properties. The trade of ginger began with maritime circulation throughout India, China, and Indochina, and by the eighth century, it was commonly traded throughout the Mediterranean region. Ginger was well known in Europe by the 11th century, when Greeks and Romans considered it a favorite spice, second only to black pepper. The spice has been incor-

porated into folklore—you may be familiar with the children’s folktale of the gingerbread man. And Henry the Eighth recommended consumption of ginger as a preventive measure against the Black Plague. An interesting example of its cultural relevance is the traditional red egg and ginger party in China. Newborns are often welcomed with a celebration that includes an announcement package of red-dyed, hard-boiled eggs and ginger root. Ginger can be found fresh or dried. The fleshy rhizome is first washed and peeled, then sliced, grated, or cooked whole. Pickled in sweet vinegar, ginger is a common palate cleanser in Asia, accompanying meals like sushi. Crystalized or preserved ginger is consumed as a confectionary treat and is the key spice ingredient in gingerbread, ginger beer, and ginger ale. The origins of gingerbread may date back to the ancient Greeks, who

Excerpt from the podcast

Foodie Pharmacology with Cassandra Quave, Emory assistant professor and medical ethnobotanist. Quave explores ways we identify, collect, and transform foods and how we determine the role they play in our diets. To listen to episodes, go to soundcloud.com and search for Foodie Pharmacology.

AUTUMN 2019

ANN WATSON

eat well

Cassie Quave, above, is curator of the Emory Herbarium and assistant professor of dermatology and human health. She leads antibiotic drug discovery research and teaches undergraduate courses on medicinal plants, food, and health.

EMORY HEALTH DIGEST

wrapped ginger in bread and ate it after meals as a digestive aid. Dried and powered ginger is also used in various recipes for biscuits, cakes, cookies, puddings, soups, and pickles. I like to keep a couple of fresh ginger roots in my kitchen in case I’m feeling under the weather, have a stomach ache, or just need something warm and comforting on a dreary day. There’s nothing quite as simple and delightful as ginger tea. Just turn the kettle on to boil, wash and peel the outer skin of the ginger root, and grate a tablespoon or two directly into the tea cup. When the water is ready, pour it onto the grated root, perhaps adding a dollop of honey, and you’ve got a delicious brew. Taken internally, ginger is thought to be a neuro-stimulant, improving impulse transmission

and relieving pain. Consumption of ginger prepared with honey is a classic remedy for asthmatic bronchitis, hiccups, coughs, and colds. It is also used for the digestive system to improve appetite and digestion, help with gas pains, and even treat hemorrhoids. Today, ginger is commercially cultivated in at least 34 countries. There are studies showing that ginger has anti-inflammatory properties, potent anti-oxidant compounds, and anti-nausea effects. It may even discourage the growth of cancer cells. Ginger is generally recognized as safe by the FDA; however, pregnant women are discouraged from using it. While we still have much to learn, this fascinating botanical species is a good place to start in the development of some serious health-boosting solutions. EHD

drink well

Scooter Danger Those colorful swarms of motorized scooters at every corner, just waiting to be activated by your cell phone, might seem convenient—but be sure you are safely prepared before jumping on.

As scooter share companies have multiplied, so too have scooter-related injuries and deaths, according to records collected by the National Electronic Injury Surveillance System and compiled by a research team that included Emory orthopedic surgeon Eric Wagner. Head traumas were the No. 1 reason scooter victims required hospitalization, and fractures and dislocations were the most common injuries. “These results highlight the importance of using protective equipment while riding motorized scooters and lay a foundation Wear a for future policies requiring helmet helmet use,” found the study. and slow Injuries mounted between down! 2016 and 2017 when the popularity of motorized scooters took off, and the team found a 77 percent jump in millennials ending up in ERs with scooter injuries. Scooter injuries overall were most common on weekends, but severe injuries, such as collisions with cars, happened most on weekdays. “It’s a new technology, we don’t realize how dangerous it can be,” Wagner says. “Wear a helmet and slow down, being mindful of pedestrians, cars, and stop signs.” EHD

Got (Organic) Milk? In a small study of milk from stores across the United States, researchers found traces of current-use pesticides and antibiotics in conventionally produced milk but not in milk produced using organic methods. They also found

higher growth hormone levels in the conventional versus organic milk samples. While most samples were within limits considered safe by the FDA and EPA, several samples of conventionally produced milk exceeded FDA limits for a few of the antibiotics tested. “Milk is a valuable source of important nutrients that are often underconsumed by U.S. children and adults,” says lead author Jean Welsh, associate professor of pediatrics at Emory School of Medicine. “It’s important that consumers are able to drink milk, as advised in dietary guidelines, without concern. While more research is needed, our results suggest that consuming organically produced milk, when possible, will help minimize any possible impact.” Dana Boyd Barr, professor of environmental health at Rollins School of Public Health, is senior author of the paper and director of a laboratory that studies human exposure to chemicals. In general, say the authors, “sufficient exposure to pesticides may lower birth weight, contribute to delayed motor and neurological development, and increase cancer risk.” The study’s results were published in Public Health Nutrition. EHD

FOOD ALLERGIES: “I think there’s a lot of public misunderstanding of the importance of food allergies—like a little bit is probably OK, or people will just have a tummy ache—it’s not that big a deal,” says Brian Vickery, founding director of the Food Allergy Center at Children’s Healthcare of Atlanta and associate professor of pediatrics at Emory. The reality, he says, is far more serious. Even small exposures can lead not only to symptoms like itching and skin rash or hives, but swelling of the face and throat and difficulty breathing. In the most severe instances, an allergic reaction can be fatal.—U.S. News and World Report AUTUMN 2019

doing well

FIVE YEARS LATER

Ebola Survivors Return Aug. 2, 2014: Emory University Hospitalâ&#x20AC;&#x2122;s Serious Communicable Diseases Unit (SCDU) admits the first of four patients to be treated, successfully, for Ebola virus disease in the U.S. Aug. 2, 2019: Ebola survivor and physician Kent Brantly and fellow missionary and Ebola survivor Nancy Writebol return to Emory for a commemoration of the fifth anniversary of their stay in the SCDU. 8

EMORY HEALTH DIGEST

doing well

LEFT: Physician Kent Brantly, his wife, Amber, and their children tour the SCDU room where he recovered from Ebola in 2014. ABOVE: Missionary and Ebola survivor Nancy Writebol and her husband, David, visit her former room. TOP: Brantly reunites with SCDU medical director Bruce Ribner.

“It’s a lot smaller than it looks in pictures,” said physician Kent Brantly’s young son, after he toured the isolation room where his dad spent weeks recovering from the deadly hemorrhagic fever. Brantly and fellow missionary and Ebola survivor Nancy Writebol took part in a press conference and scientific symposium at Emory, five years to the day after Brantly was admitted to the isolation unit. Speaking to the current outbreak in the Democratic Republic of Congo (DRC), SCDU associ-

ate medical director Colleen Kraft said: “With Ebola still very much a global threat, our infectious disease physicians, nurses, and researchers are using the learnings from 2014 in everyday patient care and are working to find more therapies for challenging infectious diseases.” Brantly and Writebol are returning to Africa (Zambia and Liberia, respectively). As for the other Emory survivors, physician Ian Crozier is working in the DRC and Amber Vinson Markray is a nurse in Texas. EHD AUTUMN 2019

tech well

An app a day

No Bleeding Required Would you rather snap a photo of your fingernails or prick your finger for a blood test?

Researchers have developed a smartphone app that can detect anemia. Instead of a blood test, the app uses photos of a person’s fingernails taken on a smartphone to determine whether the level of hemoglobin in their blood seems low. “This paradigm may replace common blood-based laboratory tests using only an app and patientsourced photos,” says principal investigator Wilbur Lam, a researcher and pediatric hematologist at Emory, Georgia Tech, and Children’s Healthcare of Atlanta. “Our ondemand system would enable anyone with a smartphone to download an app and immediately detect

anemia anywhere and anytime.” Anemia affects 2 billion people worldwide and can lead to fatigue, paleness, and cardiac distress. The app is part of the PhD work of former biomedical engineering graduate student Rob Mannino, who was motivated to conduct the research by his own experience living with betathalassemia, an inherited blood disorder. For now, researchers say, the app should be used for screening, not clinical diagnosis. Melissa Young, assistant professor of global health at Rollins School of Public Health, is focusing on its potential within refugee communities, as anemia affects 40 percent of all refugees. The app could also help patients with chronic anemia manage their disease and be used to screen for anemia in pregnant women or runners/athletes. EHD

Financial Wellness begins here b Investment and Retirement Planning (Your first meeting at no charge or obligation)

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7/10/19 9:56 AM

travel well

Avoiding Measles Here and Abroad If you (or your child) haven’t been vaccinated for measles, health experts strongly recommend getting immunized, especially if you are planning to travel overseas.

Measles is considered one of the most contagious—and preventable— diseases. And yet, despite the availability of a vaccine proven to be safe and effective, about 10 million people worldwide get measles each year. About 110,000 of them die, including many children under 5. “If you’re around someone with measles and are unvaccinated, it’s extremely likely that you will be infected,” says physician Jesse Waggoner at Emory TravelWell Center. The U.S. has experienced a serious increase in measles cases this year. In 2018, the Centers for Disease Control and Prevention reported a total of 372 cases. As of mid-June 2019, there were 1,044 cases, the highest number since 1992. This upward trend is concerning, given that measles was declared eliminated in the U.S. in 2000. Why the spike in cases this year? “We have a large unvaccinated population brought about by the controversy surrounding the safety of vaccines,” Waggoner says. “We’ve seen a large number of outbreaks around the world, and people who are exposed while traveling can bring measles back home. To maintain immunity on a population level, we need vaccination coverage of around 90 percent. There are

pockets well below that threshold.” In April, a young woman in California was confirmed to have measles shortly after attending a late-night movie and exposing everyone in the theater. In June, an Atlanta resident was confirmed to have measles—the seventh case in Georgia this year. Both had recently returned from countries where measles occurred and were unvaccinated against the disease. The MMR vaccine—for measles, mumps, and rubella (German measles)—became part of the childhood immunization regimen in the U.S. in 1963. Before this, 3 million to 4 million people a year got measles in the U.S., with 400 to 500 deaths. Caused by a virus that lives in the nose and throat, measles infects easily. Coughing and sneezing spread the virus, which can remain in the air for two hours. Symptoms include high fever, cough, runny nose, watery eyes, and red itchy spots that spread from head to feet three to five days after symptoms appear. The disease is contagious several days before and after the rash appears. Treatment includes rest, drinking fluids, and using a humidifier. “Most of the U.S. population has forgotten about measles,” says Waggoner. “They don’t know what it was like and how serious it can be.”—Pam Auchmutey

Measles vaccination for international travel*

• A two-dose vaccination

is recommended at least two weeks before departure.

• Adults born in 1957 or

before: No vaccination required because of natural immunity from childhood measles.

• Teens and adults with

no immunity: Get first dose immediately; get second dose 28 days after first dose.

• Children over

12 months: Get first dose immediately; get second dose 28 days after first dose.

• Infants under 12 months: Get an early dose at 6 to 11 months; get another dose at 12 to 15 months and a final dose at 4 to 6 years.

• Women who are preg-

nant or planning to become pregnant: A vaccine is not recommended; avoid travel if possible.

*Source: Centers for Disease Control and Prevention.

To learn more or to make an appointment, call Emory TravelWell Center, Emory University Hospital Midtown, at 404-686-5885.

AUTUMN 2019

aging well

A Distressing Trend

Life expectancy declining in the U.S. For decades, U.S. life expectancy was on the upswing. But now, at an

K.M. Venkat Narayan is the Ruth and O.C. Hubert Professor in Global Health at Rollins School of Public Health and professor of medicine at Emory.

average of 78.6 years (76.1 for men and 81.1 for women), it is heading the other way. “While almost all of the countries of the world are experiencing rapidly increasing life expectancy, the U.S. has experienced a decline for four years in a row,” says researcher K.M. Venkat Narayan. “Furthermore, the gaps in life expectancy between the richest and poorest Americans is about 20 years.” This phenomenon is driven by rising mortality rates during middle age. “Many of the contributing conditions are potentially preventable,” says Narayan. These include opioid and substance

abuse, poor mental health, homicides, suicides, hypertension, metabolic disorders, some cancers, and chronic respiratory diseases. In a recent piece in the Annals of Internal Medicine online, Narayan and colleagues suggest “taking a more integrated and holistic approach to research, whereby we do not study biology in a vacuum, but in the context of socioeconomic and political factors.” EHD

Sharing SPIRIT

Preparing for the long-term realities of Alzheimer’s For millions of Americans and their families, acknowledging what Alzheimer’s disease could mean for their futures is tough. To ease conversa-

tions among these patients, families, and caregivers, Thi Mi-Kyung Song, director of the Center for Nursing Excellence in Palliative Care at Emory, is creating a template for them to follow. With a $3 million grant from the National Institute on Aging, Song will modify a plan that she developed and tested, called SPIRIT, that promotes open, honest discussions among all who are affected by an individual’s mild Alzheimer’s disease— before the dementia progresses to an advanced stage where patients can no longer participate in such discussions meaningfully.

EMORY HEALTH DIGEST

For those with advanced Alzheimer’s, invasive end-of-life care is common, with nearly 41 percent undergoing at least one intensive intervention. This includes things like tube feeding or assisted breathing (e.g., mechanical ventilation), which offer no therapeutic benefits at the end of life. SPIRIT encourages talking through the realities of Alzheimer’s disease during hour-long discussion sessions involving patients and family caregivers, so they can be prepared for future scenarios, helping reduce doubts about end-of-life decisions. “It’s never going to be easy,” says Song. “But talking about it is best.” EHD

seeing well

A Secondary Threat to Ebola Virus Survivors: Vision Loss

PHOTO BY JD KANNAH FOR WHO

Emory ophthalmologist Steven Yeh examines Muhindo, a survivor of the current Ebola outbreak, in the Democratic Republic of Congo.

After successfully treating Ebola virus disease in patients who became ill during the 2014-2016 Ebola outbreak in West Africa, Emory physicians realized that some of the survivors were developing eye diseases after recovering. The Emory

Eye Center has been awarded a $3.2 million grant from the National Eye Institute to further study vision-related issues in Ebola survivors. The team’s research focuses on the prevalence and treatment of uveitis—an inflammatory disease that can lead to vision loss or blindness in up to 40% of affected patients if left untreated. “This will allow our team to evaluate eye disease in Ebola survivors in West Africa, as well as the mechanisms that underlie its development,” says physician Steven Yeh, M. Louise Simpson Associate Professor of Ophthalmology. Investigators from the Emory Eye Center, Emory Vaccine Center, and Rollins School of Public Health will collaborate on the five-year project. Researchers from the U.S. Army Medical Reserve Institute of Infectious Diseases, Tulane University School of Public Health, and Kenema

Government Hospital will collaborate on laboratory diagnostic investigations. Yeh and co-investigator Jessica Shantha, Emory assistant professor of ophthalmology, have worked with Matthew Vandy, of the Lowell and Ruth Gess Eye Hospital in Freetown, and other colleagues in Africa since first traveling to Sierra Leone in 2015. Their work has been expanded to the current ongoing outbreak in Democratic Republic of Congo with ophthalmologist Jean-Claude Mwanza of the University of North Carolina. “Eye care is only one issue among many important issues in Ebola survivors,” Shantha says. “However, prior studies have shown that survivors often develop ocular complications, such as uveitis and cataracts. This will allow us to better understand how to treat them.” Specially designed ophthalmic procedure rooms were used in Sierra Leone to safely test patients before surgery. “Because Ebola virus might remain in a patient’s ocular fluid, we want to ensure that we’re doing everything possible to protect the patient and their health provider,” Yeh says. EHD AUTUMN 2019

Pregnancy BEHIND BARS

Emory nursing professor helps new and expectant mothers in prison by Pam Auchmutey • Illustration by Dan Page

EMORY HEALTH DIGEST

For most women, pregnancy is a happy, busy time of preparation: there are doctor’s visits and

sonograms, baby showers and buying cribs and strollers, and the excitement of giving birth and bringing a newborn home. For pregnant women who are in prison, the prospects are quite different. Research shows that spending time in prison does lead to longer gestation and improved birth weights among pregnant women. But it can affect their psychosocial health, putting them at risk of poor outcomes around the time their babies are born, Emory assistant nursing professor Brenda Baker writes in a recent issue of the Journal of Correctional Health Care. Within 48 hours of giving birth, women return to prison without their infants, further straining their family ties and emotional health. Baker, an experienced labor and delivery and neonatal ICU nurse, helps incarcerated women cope with these challenges. Almost every Friday, she travels to Helms Facility, a 100-bed medical prison in DeKalb County, to provide childbirth and postpartum education. “We typically meet with 10 to 15 moms every week from all over Georgia,” Baker says. “They often have very low health literacy.” Baker volunteers through Motherhood Beyond Bars, a nonprofit that serves incarcerated pregnant and postpartum women in Georgia. Volunteers from Emory ’s schools of theology, public health, medicine, and nursing founded the program in partnership with the Georgia Department of Corrections in 2013. Bethany Kotlar, then a student at Emory’s Rollins School of Public Health, developed the program’s original course materials. Baker, aided by her nursing students, revised the curriculum to include topics such as coping, resiliency, and prevention of sexually transmitted infections. One of her students developed course materials on contraception, based on scientific literature that showed a lack of knowledge about and use of contraception and a high number of unintended pregnancies in the women’s prison population. “There’s so much some of these women don’t

know about their bodies, even if they’ve already had other babies,” Baker says. “Some don’t understand their menstrual cycles or have misconceptions about contraception, birth, and labor.” Pregnancy is even more uncertain for those in recovery from addiction. Some worry about using pain meds during labor. Motherhood Beyond Bars helps them curb their anxiety and prepare for a delivery free of drugs. “These women don’t get to take their family or have a support system for their delivery,” Baker says. “They’re just like other women. They’re afraid of pain and what might happen and wonder if their baby will be safe.” Many have trauma from abuse and living in violent communities. “That influences their experience, their choices, and how they interact with us,” she says. “Nurses recognize that.”

When Baker is teaching, nothing is off limits. “We have a topic for every class, but we often veer off subject,” Baker says. “It can become more of a support group some weeks. We want each participant to be a pregnant woman preparing for the arrival of her child, not just an inmate.” The women cry and laugh together and have baby showers for those who will deliver that month. Book groups and churches help by sponsoring the gatherings and providing gifts. Prison staff often attend. To date, Baker has taught more than 300 women through Motherhood Beyond Bars. “Incarceration is not about bad people who break rules. It is largely about poverty. With poverty comes trauma, drug abuse, foster care, and considerable inequalities in health care. We need to learn more about how to best serve this population.” EHD

PREGNANT IN PRISON* n Of

the 219,000 female prisoners in the U.S., about 25% are pregnant or have a child age 1 or younger.

n In Georgia prisons, 50 to

100 women give birth every year. n In state prisons, 4% of

women are pregnant when admitted; 67% have dependent children. n Within 48 hours of

giving birth, mothers return to prison without their infants. *Source: Motherhood Beyond Bars

STEPHEN NOWLAND

“In health care, we typically don’t do a good job of addressing the needs of the prison population.” —Brenda Baker

AUTUMN 2019

by Martha McKenzie illustrations by Paul Oakley

EMORY HEALTH DIGEST

Arrival of the Bees by Jerry Grillo â&#x20AC;˘ Illustration by Dan Page

This is not the story it was supposed to be, not by a long shot. It was supposed to be about brain research, with an emphasis on the Emory Healthy Aging Study. But then a blood clot unleashed a beehive in my brain. This story begins with the bees. A few minutes before 7 p.m. on August 5, 2018, a day before my son Joeâ&#x20AC;&#x2122;s 17th birthday, I was watching a repeat of Seinfeld with my wife, Jane, and Joe, when the laugh-track faded sharply, giving way to the shrill buzz of what felt like electric bees deep inside my right ear, a sudden sonic swarm, the sound of a brain starving to death. While Jane gave Joe (who is fed through a G-tube) his supper a few feet away, there was a hemoglobin traffic jam clogging one of the arteries that supplies nutritious blood and oxygen to my cerebellum. I was having a cerebellar stroke. The buzz went away after a few seconds, leaving an all-consuming dizziness and nausea in its wake. My personal universe spun in the opposite direction of everything else. So began a vomit marathon and then several days of hell involving: A trip to the hospital emergency room and a stay of several days; a camera down my throat and the discovery that I had a hole in my heart, which may or may not have caused the stroke; the tangible realization that I was old enough to drop dead in a second; oh, and my second MRI in two weeks.

AUTUMN 2019

Jerry Grillo plays guitar as his wife, Jane, and son, Joe, listen in their north Georgia home. “It’s harder to play a B-minor bar chord now,” he says, after his stroke. “But it’s all gotten better with repetition.”

About that first MRI Two weeks earlier I began work on the story this was supposed to be. I paid a visit to Jim Lah, an Emory neurologist and principal investigator for the Emory Healthy Aging Study. The plan was to undergo an MRI procedure so I could write about the study while going through what a typical participant would. My ears were plugged to muffle the intense

EMORY HEALTH DIGEST

racket caused by vibrating metal coils carrying rapid pulses of electricity. As I lay on my back in the snug tube, I stared up at a computer screen with a slide show of calming, bucolic images, glad this was just research. After that, we went over the images of my brain to understand what researchers can learn from high-tech imaging. It was Lah, me, and another journalist, Jaye Watson, who

was working on a GPB television segment that was going to dovetail with my story. Lah pulled the images up on a monitor and said, “Your brain looks brand new, like it’s never been used, right out of the package.” That joke was all I remembered from the interview. I had forgotten everything else from that day until I found the gumption to listen to the recording five months later, in January

he had to go to the emergency room.” On the recording, I was laughing. But it’s not so funny anymore. Turns out, neither Jaye nor I did the stories we were supposed to do. Cerebellar strokes account for about 10 percent of all strokes and they’re not easy to diagnose. Indeed, they are often misdiagnosed as migraines, gastritis, meningitis, even inner ear infections. But if not recognized and quickly treated as the stroke they actually are, they can ruin your life—or end it. I was lucky. Lucky because, even as my brain raged, I had the presence of mind to take an aspirin. Lucky because, like 88 percent of strokes, mine was an ischemic stroke, in which a blockage or clot in an artery to the brain causes reduced blood flow. Aspirin thins the blood and can break up a clot. On the other hand, if this had been a hemorrhagic stroke, the kind where a blood vessel bursts in the brain, the aspirin makes the bleeding worse.

2019, and heard something that gave me chills: Lah is going over images of my brain and says, “I just want to make sure there’s nothing scary here, or unexpected.” Jaye responds lightheartedly, “The story might not happen at all if that were the case,” and then adds an imaginary explanation to an imaginary boss, “We were going to do the story, until he became a patient.” Lah concludes with, “Until

Location, location, location “All things considered and in the grand scheme of things, if you had to choose a stroke, the kind you had would be near the top of the list,” Lah told me in January 2019, the second time we met. “When it comes to damage in the brain, the same three rules apply as the first three rules of real estate. Do you know those? Location, location, location.” The same rule also applies to neurologists, which is why I wound up at the Emory Clinic in

James Lah, associate professor of neurology and principal investigator of the Emory Healthy Aging Study.

Fadi Nahab, associate professor of neurology and pediatrics and medical director of several Emory hospitals’ stroke programs.

Ihab Hajjar, associate professor of medicine and geriatrics, leads Emory’s Brain, Stress, Hypertension, and Aging Research Program.

AUTUMN 2019

Andrew Miller, professor of psychiatry and behavioral science, is director of the behavioral immunology program.

Doug Bremner, professor of psychiatry and radiology and director of the Emory Clinical Neuroscience Research Unit.

the care of Fadi Nahab, medical director for the stroke program at Emory University Hospital and Emory University Hospital Midtown. After looking over my MRI from the night of the stroke, Nahab told me that I’d actually had two strokes. He saw evidence of not only the cerebellar stroke, but an earlier episode closer to the front of my brain. At some point, it seems, I’d had some type of minor stroke, probably while sleeping. I have no memory of it, but learned of something called a

EMORY HEALTH DIGEST

silent stroke, which often has no symptoms but still causes damage to brain tissue. We still don’t know exactly when that first, mysterious stroke happened, but we finally know why the cerebellar stroke happened. We’ll get to that in a moment. The risk factors for stroke are high blood pressure, high cholesterol, heavy smoking, alcohol and drug abuse, and a sedentary lifestyle. I had high blood pressure that I wasn’t treating, but the cholesterol was under control with medicine. Everything else was off the table. I’m not a smoker, not a heavy drinker, and I was in great physical shape—I thought.

Brain-heart connection While I was in the hospital following the episode, doctors found a patent foramen ovale (PFO), a hole between the left and right atria of my heart, that I’d lived with, blissfully unaware, for 57 years. We all have PFOs in utero, but they usually close shortly after birth. For about 25 percent of us, they stay open and, in some circumstances, a PFO will allow a clot to pass through the heart and travel up to the brain. In some cases, the PFO together with another condition, like atrial fibrillation (an irregular heartbeat), can increase the risk of stroke. So, three months post-stroke, in November, an Emory physician implanted a loop recorder in my chest to record my heart rhythms for the next three years, monitoring for atrial

fibrillation, or some other sign that the PFO was responsible. A few months after the device (which is smaller than a thumb drive) was installed, we found it was working just fine. It recorded atrial fibrillation, probably while I was playing basketball. I never felt a thing, but that’s not uncommon with AFib, I was told. Even if the PFO wasn’t responsible, “having a stroke is a warning sign that your brain already sustained some kind of injury from a decrease in blood supply,” according to Ihab Hajjar, associate professor of medicine at Emory. An internist and geriatrician, Hajjar leads Emory’s Brain, Stress, Hypertension, and Aging Research Program (BSHARP), a team of researchers exploring the links between brain health and the cardiovascular system. Hajjar is researching the connection between high blood pressure (hypertension) and cognitive impairment later in life. He’s found that drugs for high blood pressure (such as lisinopril, the drug that I’ve been on since the stroke) have an added benefit. “Evidence has shown that when you treat hypertension, especially in the early stages, you potentially prevent cognitive decline later in life,” Hajjar says. This is positive news for me, since I’ll probably be treating my high blood pressure from now on. With Nahab and Hajjar, I’ve found two biomedical heroes whose work I’m personally interested in. Nahab sees 2,000 patients a year and estimates

that 200 of them have had cerebellar strokes. His research focus is on cryptogenic stroke of an undetermined cause. Thankfully, data collected from the monitor in my chest helped clear up my mystery. I’m back on the basketball court (though at a more cautious pace). But sometimes my imagination takes me down some dark roads. For instance, every time I drive, I make a mental plan of what to do if the bees come back. I try to stay close to the shoulder or the median, due to this irrational fear of crashing while having a stroke and taking out some other poor motorist. I wonder about dying suddenly, or becoming incapacitated. My responsibilities require a fully functioning (and breathing) Jerry. Chief among these are my son, Joe, who is profoundly affected by cerebral palsy. He needs his old Pop, at least for a few more years. The bottom line is, I must be physically and cognitively capable of lifting and caring for my son. Dropping dead or out are not options. I come by my high blood pressure honestly. Fortunately, my physician is

excellent. He’s also glad I’m his patient and was thrilled by the challenge of a mystery like the one my stroke presented. (Of course, I never really shared his enthusiasm.) “Frankly, I get excited when I see patients who are told, ‘We don’t know what caused your stroke,’ ” Nahab says. “I know that they are going to the forefront of evaluation and treat-

ment, and that I will most likely be able to give them peace of mind.”

Looking to the future Nahab collaborates with colleagues in hematology and neurology on his research, which focuses on a blood biomarker that may be an appealing target for identifying how best to treat a cryptogenic stroke. “Studies completed more than a decade ago basically put patients on an

aspirin and wished them good luck,” Nahab says. “But we’ve known for a while that patients who have had a cryptogenic stroke may have issues that necessitate blood thinning medicine that is stronger than aspirin.” Nahab wants to remove “cryptogenic” from the equation, as he did with me. He and colleagues have pinpointed blood biomarkers that identify patients most likely to develop clotting and are conducting clinical trials to determine which patients respond to which treatments. “The goal is to get patients the appropriate treatment before they have a recurrent stroke,” he says. My biomarker numbers didn’t reveal any overwhelming coagulation activity, so I didn’t qualify for a clinical trial. Before the AFib was discovered, I was taking an aspirin every day as part of the post-stroke, new-life regimen. But I’ve since been prescribed an expensive blood thinner called Eliquis. For several months, when the loop monitor wasn’t showing an irregular heartbeat, I hoped for a definitive answer,

Watch Jerry Grillo’s story on GPB’s Your Fantastic Mind, emry.link/yfm-ep10 AUTUMN 2019

wondering if and when another bomb would go off. Now, I sometimes wonder if and when my heart will clock out. But honestly, I’m way too busy to give worry and fear much time and energy. And besides, my recovery has been spectacular. Did I say that I was lucky? Cerebellar strokes, of course, attack the cerebellum, which sits in the back of your skull at the bottom of your brain, where it controls movement and balance. It has symmetrical left and right

EMORY HEALTH DIGEST

sides, each controlling movement for the corresponding side of the body. So while most strokes leave their marks on the opposite side of the body from where they occur in your brain, cerebellar strokes affect the same side. My stroke was on the left side, so my left arm and left leg were affected. But not extremely and not forever. There is some lingering delay in my left-hand—my typing isn’t as fast and accurate as it used to be, and playing guitar is harder

than it was (not that it was ever easy for me, but a B-minor bar chord should not be that difficult to play). It’s all gotten better with repetition.

Brainstorming solutions Hope for patients with brain issues, like me—honestly, like most of us if we live long enough—rests with researchers like the ones I met at Emory while working on this piece. Doug Bremner, a professor of psychiatry and radiology and director of the Emory Clinical

Neuroscience Research Unit, is looking into electrical treatment for post-traumatic stress disorder using noninvasive vagus nerve stimulation, which also may be effective for other disorders, such as severe anxiety. Andrew Miller, professor of psychiatry and behavioral science, is researching the link between brain inflammation and depression. “Our laboratory is particularly interested in the neurotransmitter systems that are affected by inflammation,” Miller says. “We’ve established quite a detailed map, if you will, of how the immune system can influence behavior in the context of inflammation.” Lah, of course, is helming the Emory Healthy Aging Study, which includes several sub-studies: the Healthy Brain Study, the Midlife Depression Study, and the Brain Imaging Project. The Healthy Aging Study was developed to understand and better treat dementia, Alzheimer’s disease, and other age-related disorders. “There is so much we still don’t know about brain diseases like Alzheimer’s,” says neurologist Allan Levey, co-principal investigator of the study and Goizueta Foundation Endowed Chair for Alzheimer’s Disease Research. “So it’s important to get as many people as possible to participate in research studies like this to increase our ability to prevent these diseases in the future.” This relies on v0lunteers like Mary Jenks. “First, I’m obviously aging,” she quips. “I saw a notice about the Emory Healthy Aging

Study and thought, ‘This could be interesting.’ ” Jenks went so far as to volunteer to get a lumbar puncture for research. She took care of her aging mother and knew the cascading difficulties associated with cognitive decline. “I didn’t want to end up the same way,” says Jenks, who worked in special education for many years teaching deaf children in DeKalb County. She now teaches non-English speaking children: “It makes your brain grow.” The Emory Healthy Aging Study (online) has registered 27,929 people, consented 22,136, and completed data collection on 14,989. The Emory Healthy Brain Study (face-to-face, blood, spinal fluid, cognitive testing, etc.) has completed 1,101 visits.

Happy 100th Around the globe, centenarians are expected to number 3.7 million by 2050 (!), and one in five Americans will be 65 or older by 2040. The information gathered from the Emory Healthy Aging studies could bring out the glimmer in our golden years. I’m not sure what my chances are for reaching 100—or even 65. Lah, my chief source for both the story I was supposed to write and the one you’re nearly finished reading, tries to be reassuring. “We can’t tell you what the exact likelihood of a recurrence is for someone in your situation,” he says. “But I can tell you it’s very, very low. The problem is, you know just enough to scare the hell out of you.” EHD

PAYING IT FORWARD What if we could learn something from our aging bodies to help the next generation? This is the intent of Emory’s Healthy Aging Study, the largest clinical research study ever conducted in Atlanta. From people volunteering to participate in the study, researchers can learn vital information about the most common types of age-related diseases: Alzheimer’s, cardiovascular disease, diabetes, and cancer. “It gives us an opportunity to open up a huge group of participants that can be accessed by investigators in any aging-related field— whether it’s brain or heart or mobility health,” says James Lah, principal investigator. To learn more or to join the study, go to: healthyaging. emory.edu, or call the Emory Brain Health Center at 404-727-4877.

Watch Jerry Grillo’s story on GPB’s Your Fantastic Mind, emry.link/yfm-ep10 AUTUMN 2019

Food as Medicine by Martha McKenzie

EMORY HEALTH DIGEST

Swapping pills for produce “Take two asparagus and call me in the morning” After working 18 years in the Secretary of State’s office in Atlanta, Taffie Joseph lost her job in 2012, and with it, her health insurance. She didn’t see a doctor, with the exception of a few emergency visits, for the next four years. Her health deteriorated until constant pain, exhaustion, nausea, and debilitating, frequent menstrual cycles ultimately kept Joseph from coming downstairs in the College Park home she shared with her mother, son, daughter, and granddaughter. “I was so tired I felt like I was going to pass out,” she says. “I hurt just all the time.” Her mother made her an appointment at a Grady Hospital clinic, where she was diagnosed with polycystic ovary syndrome, diabetes, and hypertension. The doctor scheduled surgery for the polycystic ovary syndrome, prescribed Metformin for her diabetes, and started her on three medications for her high blood pressure. She was also referred to a new Food as Medicine program at Grady. For the next several months, Joseph went to a small room within the hospital for a course that taught her how to reduce sugars, salt, and fats in her diet, how to read nutrition labels, and how to plan and prepare

healthy meals within a budget. In addition, she received a weekly “prescription” for fresh fruits and vegetables, which she could redeem at a nearby farmer’s market for free bags of produce. Joseph took everything she learned about healthy food to heart and accomplished the daunting task of changing her diet. She used to spend most of her grocery money on Little Debbie snack cakes, chips, and sodas. She now fills her cart with fresh produce, chicken, and dried beans. The meals she prepares for her family have shifted from fried chicken, hot dogs, and hamburgers to grilled chicken,

“I was seeing patients having to make a choice between paying for medications or paying for food. There’s no way you can heal if you don’t have nutritious food.”—Charles Moore, professor of head and neck surgery at Emory and co-director of the Urban Health Initiative.

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baked fish, and turkey burgers—all with generous helpings of vegetables. And she has traded her beloved sodas for fruit-infused water, which she makes by soaking fresh fruit in a large pitcher of water overnight. “They told us we shouldn’t have more than two sodas a week,” says Joseph. “I was amazed by that. I used to drink three or four sodas a day, at least. But I have not had a soda in over a year, not one.” The changes have done nothing short of giving her back her life. In addition to losing weight and several dress sizes, Joseph has been able to come off one of her blood pressure medicines, and her doctor says she’ll soon be able to go off Metformin. She got a new job, with health insurance, and going up and down stairs is no longer a problem. “Without the Grady program, I could not have made these changes,” says Joseph. “I’m forever grateful to my doctor for sending me to it.” The Grady Food as Medicine program that Joseph took part in is one of two such initiatives supported by the Emory Urban Health Initiative. Treating patients with healthy foods is a growing movement across the country. Several of the leading causes of death in the U.S.—heart disease, diabetes, stroke, even cancer—are lifestyle related, with poor diet playing an oversized role. A recent study published in The Lancet says poor diets result in more worldwide deaths than any other risk factor, including cigarette smoking. The problem is worse for people who are food insecure—those who can’t afford to buy enough food on a regular basis. They turn instead to foods that are high in calories but low in nutrients. “You can get full off of a McDonald’s meal and it tastes good, with all that fat and salt,” says Charles Moore, professor of head and neck surgery at Emory and co-director of the Urban Health Initiative. “It’s cheap, and there’s usually a McDonald’s right around the corner, while the grocery might be farther away.”

Last year, 13 percent of households in the country and 14 percent in Georgia faced food insecurity at least once during the year, according to the United Health Foundation. The food insecurity rate for the Grady population that Moore treats is much higher, hovering between 40 percent and 50 percent. “I was seeing patients having to make a choice between paying for medications or paying for food,” says Moore. “There’s no way you can heal if you don’t have nutritious food.”

BURGERS TO BROCCOLI

To identify patients who might have to choose between meds and meals, Emory primary care physicians at Grady are starting to screen for food insecurity during office visits the same way they routinely screen for high blood pressure and cholesterol. “There is a simple two-question assessment that is quick and accurate,” says Jada Bussey-Jones, Emory professor of medicine, chief of Grady General Medicine and Geriatrics, and co-director of the Urban Health Initiative. “Patients are given two statements—‘We worried whether our food would run out before we got money to buy more,’ and ‘The food that we bought just didn’t last and we didn’t have money to get more.’ If they answer ‘sometimes true’ or ‘often true’ for at least one of these statements, they qualify as food insecure.” Patients who qualify are screened for eligibility for the Supplemental Nutrition Assistance Program, the food stamp program known as SNAP, and are helped to enroll if they are not already on it. They are also signed up for a six-week class by Cooking Matters, a national nonprofit, to learn how to shop and cook healthfully on a budget. Bernard Lewis, who was seeing his doctor for congestive heart failure and hypertension when he was also diagnosed as prediabetic, was referred to one of the first classes. Stacie Schmidt, assistant professor of general medicine and geriatrics, pilot-

“Used to be, my dinner was whatever burger I could get my hands on... I didn’t realize all those burgers were hurting me like they were.”

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ed the first healthy living class out of frustration at the lack of time to talk to her patients. “I wanted to be able to really talk to my patients about dietary approaches to better health,” she says. “The class has expanded and changed over time, but Bernard was in my first pilot group.” For his part, Lewis was skeptical. “I thought this was a fool program,” he says. But he stuck with it and ended up changing his mind. He learned to read food labels, to shop for fruits and vegetables in season, and the benefits of fresh over processed. “Used to be, my dinner was whatever burger I could get my hands on,” says Lewis. “I didn’t realize all those burgers were hurting me like they were. They taught us how to cook vegetables in a way that’s healthy but tastes good. And come to find out, I love them.” Through the class, Lewis became aware of what had been fueling his unhealthy diet. “I had my Oreos at 11:30 p.m. and my Snickers bar at 2:30 a.m. because I was depressed,” he says. “We figured out we were using food to compensate for the hurt and pain that was going on in our lives. That group was really good for us. There was no judgement, just support.” Participants are given a “prescription” for fruits and vegetables they can redeem at participating farmers’ markets. These markets not only fill the prescriptions for free, they double the shoppers’ SNAP benefits, thanks to a partnership with Wholesome Wave Georgia, a local nonprofit. The resulting largess was more than enough for Joseph. “I took my prescriptions to the market at the

College Park train station, and I would have bags and bags of food,” she says. “I got enough fruits and vegetables to more than last the week.”

TARGETING FOOD DESERTS

Moore opened the HEALing Community Center in southwest Atlanta after driving through the area on the way to work and witnessing the poverty. From the beginning, the clinic focused on patients’ food insecurity and poor nutrition. It found a strong partner in Wayfield Foods, a locally owned grocery chain that opens stores in food deserts. Moore writes prescriptions for fruits and vegetables that patients can redeem at a Wayfield store about a mile away. Wayfield employees are trained as “health ambassadors” to help shoppers make healthy decisions, and Cooking Matters runs cooking demonstrations and conducts store tours that come with a 20-minute crash course in nutrition. If a shopper seems to be in need of medical service, Wayfield employees can refer them to the HEALing Community Center where they can get a free or reduced-cost medical consultation. “We’ve essentially built a two-way street of referral processing and support for diet change,” says Amy Webb Girard, associate professor of global health at Rollins School of Public Health and co-director of the Urban Health Initiative. “We’re working with other federally qualified community health care centers and other groceries to expand the program.” AUTUMN 2019

travel well

THE NUTS AND BERRIES OF HEALTHY EATING

Emory’s Food as Medicine initiatives break down how to eat healthy on a limited budget into doable steps. The first commandment is to eat more fruits and vegetables, for good reason. Packed with fiber, vitamins, and minerals, produce can reduce inflammation, even out blood sugar levels, and promote good digestion. Studies have shown that people who eat five or more servings of fruits and vegetables per day have a 20 percent lower risk of heart disease and stroke compared with people who eat less than three servings a day. Other research has shown that following a diet high in fruits and vegetables and low in saturated and total fat can be as effective as medication in lowering blood pressure. And studies have linked diets high in produce with a reduced risk of diabetes as well as a lower incidence of some types of cancer. Moore and colleagues recommend that their patients fill half their plates with fruits and vegetables, preferably those with vibrant colors. “Eat fresh fruits and vegetables first, if you can,” says Moore. “Frozen should be your next choice. If you can’t do either, eat canned, but only after you rinse off all the stuff that comes with it in the can.”

EMORY HEALTH DIGEST

He also suggests eating fruits and vegetables in season. Not only do they tend to taste better, they are more nutritious. Produce starts to lose nutrients when it’s picked, so the longer the travel time to the grocery, the fewer nutrients remain. In-season fruits and vegetables are often cheaper, as well. The next order of business is learning to read food labels. Marcia Rafig, a Cooking Matters instructor and coordinator, recently led Tracy Wingfield and her mother, Meredith Wingfield, on a store tour at Wayfield Foods that included a lesson in this skill. She advised them to look for food options that are low in fat, cholesterol, and sodium and high in fiber, vitamin A, vitamin C, calcium, and iron. Don’t look at the calories without also checking out the serving size. A 230-calorie per serving frozen entree may sound like a weight-friendly option until you notice that it is supposed to serve four. And focus on the first five listed ingredients. “Ingredient labels are like walking down a flight of stairs,” Rafig says. “The top step or first item is the most important, most prevalent ingredient, and it goes down in order to the least. You need to focus on the first five ingredients. When you learn to read labels, that’s the key to the kingdom.”

Marcia Rafig, of Cooking Matters, leads healthy grocery tours and teaches label reading to empower families at risk.

Label reading is particularly important when it comes to grains. Take whole grain versus refined grain. Refined grains are stripped of the bran and germ, leaving only the least nutritious part behind. And those refined grains go by a lot of misleading names—multigrain, 100 percent wheat, stone-ground, bran, cracked wheat, and enriched. (“Why in the world would you call it ‘enriched’ if you’ve taken out the good parts?” asks Meredith Wingfield.) The only way to tell if the product is actually made with whole grains is the ingredient list. The first ingredient must have the word ‘whole,’ be it whole wheat, whole oats, or whole rye. Another tip is paying attention to unit prices, which will usually appear on the shelf-tag along with the retail price. Rafig pulls a box of flavored grits off the shelf and points to the unit price—20 cents an ounce. Then she examines a bag of plain

grits—5 cents per ounce. “That’s a great lesson right there,” says Tracy Wingfield. “That’s going to help my grocery bill.” Looking for sales and buying in bulk can also keep costs down. Joseph has mastered these skills. She now buys a whole chicken instead of boneless, skinless breasts, and dried beans instead of canned, and fruits and vegetables in season. “I’ve been saving $50 to $100 a month off my grocery bill,” she says. “They say preventive medicine is the best medicine,” says Girard. “Well, food is that best preventive medicine. But for lower income populations, there’s a rub. Medicare and Medicaid may cover prescriptions, but they won’t cover food. We’re not going to see significant changes until we come up with ways to overcome the cost barriers. Our Food as Medicine programs are steps in that direction.” EHD AUTUMN 2019

Prescription Nutrition: Med students

end class with a cook-off

The interdisciplinary course From Clinic to Kitchen: An Introduction to Culinary Medicine, was offered as an elective to second-year Emory medical students. At left and below, class members practice what they learned at Few Hall’s teaching kitchen.

When you think of medical school, you probably imagine classrooms, cadavers, and clinics—not spices, sauces, and stovetops. But a new class integrating food science, cooking skills, and medical needs is challenging students to broaden the focus of healing to include nutrition. The Emory Department of Family and Preventive Medicine, with Emory University Student Health Services and Emory Campus Life, introduced the interdisciplinary elective course—From Clinic to Kitchen: An Introduction to Culinary Medicine—to second-year medical students. It teaches nutrition counseling and the skills to purchase, prep, and cook healthy meals. During the pilot, 10 students met weekly at Emory’s Few Hall teaching kitchen.

EMORY HEALTH DIGEST

They were assigned a patient whose medical conditions could be improved by dietary changes. Based on the patient’s disease or condition, eating habits, and socioeconomic status, students researched their nutritional needs, proposed healthy meal options with specific recipes, and provided cost breakdowns. Recipes were compared and critiqued, then the group prepared the meals together. Leading the initiative are family medicine physician Emily Herndon, preventive

medicine physician Javier Valle, student health dietician Carol Kelly, senior director for campus dining Dave Furhman, and Associate Professor of Human Health Jill Welkley. Feedback was positive, Herndon says, with preliminary data showing it “improved students’ confidence in counseling future patients about appropriate diet changes.” “Food and medicine have been intertwined for centuries,” says Kelly. “Hippocrates, the Greek physician who is considered the father of modern medicine, said it best: “Let food be thy medicine and let medicine be thy food.” Medical student Annalise

Littman recounted her firsthand experiences with patients while zesting lemons for a maple-glazed sweet potato recipe. “Medical school teaches you very little about nutrition, even though questions about nutrition come up constantly when I’m in the clinic,” Littman said, adding that the course changed her food habits at home too— instead of using the same old vegetables to make her dinner, she’s becoming more adventurous. This week, the class is cooking a full meal for a case study patient with irritable bowel syndrome (IBS). Most doctors recommend following the low-FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet, which cuts out short-chain carbohydrates found in many common foods that are resistant to digestion. The diet is so restrictive it can feel impossible for patients to follow. Students in the class submitted a low-FODMAP recipe for homework and critique each recipe in class. From across the room, Chef Furhman shouts a verbal pop quiz: “Can we use cornstarch in the low-FODMAP diet?” A few students nod. “Good! Now, does anyone know what an orange supreme is?” he asks. This time, there’s silence in the room. He gathers the students around to demonstrate his technique

for cutting a thin, sweet slice of fruit. In addition to cooking for disease management, the students also learn to cook for patients from different cultures. “One of the patients the students cooked for was a Chinese woman with diabetes who eats rice with every meal,” says Kelly. “It would be unreasonable to ask her to cut out rice from her diet. Instead, she can flip the ratio of rice to vegetables on her plate or substitute with cauliflower rice. This course is all about practical lifestyle changes.” At the end of the semester, the medical students form teams and compete in a cook-off. Just like a TV cooking competition, the students have a limited amount of time to cook, plate, and serve a meal for a fictional patient. Students defend their food choices with scientific research and recommend other lifestyle changes to the patient. For example: the patient with IBS? She wanted a meal that would meet her dietary restrictions but still be appealing to her new “foodie” boyfriend. One creative suggestion: a turkey burger (red meat would be harder for an IBS patient to digest) and a sweet carrot salad. “You learn by doing,” Herndon says. “This class allows medical students to experiment in the kitchen and apply what they have learned.”—Laura Briggs

From Good and Cheap:

Eat Well on $4 a Day Brussels Sprouts Hash and Eggs Serves 2 $2.80 total $1.40 / serving

This is a great light lunch or side dish. The Brussels sprouts get salty and tangy from the olive and lemon, then crispy and caramelized on the bottom. Mix in the little bit of fat from the egg yolk, and wow is this delicious. You’ll need

4 cups Brussels sprouts, finely chopped salt and pepper 1 Tbsp butter 3 cloves garlic, finely chopped 6 olives, finely chopped lemon juice 2 eggs Chop off the ends of the sprouts. Slice them in half, then finely shred each half. Place the shreds in a bowl and sprinkle with salt and pepper. Melt the butter in a non-stick pan on medium-high heat. Swirl it around to coat the pan. Add the Brussels sprout shreds and garlic, then leave it to cook for about 1 minute. Mix it up and toss it around. Add the olives and mix again. Crack the eggs into separate areas of the pan. Sprinkle them with salt and pepper. Pour in 2 tablespoons of water and cover with a lid. Let the eggs steam, undisturbed, for 2 minutes. Once the whites of the eggs are cooked through, turn off the heat and sprinkle everything with lemon juice. For more recipes: cookbooks.leannebrown. com/good-and-cheap.pdf

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High Time for Ticks

Tick-borne diseases are on the rise, from Lyme to alpha-gal. What is the actual danger and how can you avoid these tiny insects that pack a big bite? by Catherine Morrow

EMORY HEALTH DIGEST

It’s as small and inconspicuous as a freckle, and that’s why you don’t notice it for a while. During its nymph stage, a tick is most likely to be undetected and transmit disease. You go

How Big is a Tick?

about your days, running errands, going to work, cleaning house—all without knowledge of your little plus-one that you picked up from the camping trip last week. While you were enjoying the heavily-wooded areas of the mountains, the creature decided to crawl up your pant leg and set up camp, burying its head right underneath your skin. As it feeds on your blood, it might be giving you something in return—perhaps Lyme disease, Rocky Mountain spotted fever, ehrlichia, or alpha-gal allergy. With the warmer months come yard work, hikes, soccer practice, dog walks, and a rising number of tickborne illnesses. Lyme disease is the most common in the U.S., with more than 30,000 cases reported to the Centers for Disease Control and Prevention annually—although experts say the actual number of infections is likely 10 times higher, into the hundreds of thousands. Lyme is most prevalent in New England and the upper Midwest. But cases have been reported all over the U.S.—indeed, around the world. About half the cases occur in people under 21. Boys between 5 and 9 are the most commonly affected group, perhaps because they spend the most time outside. Symptoms include muscle fatigue and weakness, low-grade fever,

headache, memory fog, and in serious cases, damage to the nerves that cause a tingling or numb sensation. Don’t panic though: Just because you have the symptoms doesn’t mean you have a tick-borne illness. Marshall Lyon, an infectious disease doctor at Emory, sees about 100 patients a year with symptoms similar

to Lyme disease, but only a handful test positive for it. “I always ask patients if they have traveled recently,” says Lyon. “If they have been hiking in the northern states, it is much more likely that they have Lyme than, say, a person who lives in Buckhead and their idea of going outside is

Nymph 1.5875mm

Mature tick 3.175mm

Kendall Lasseter, above, a recent UGA graduate, never saw the tick that bit her. She was diagnosed with Lyme disease after having continuous migraines.

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Keep an eye out for... Ticks can be very dangerous because they carry a variety of diseases. The deer tick, sometimes known as the black-legged tick, carries Lyme disease. Ehrlichia and Rocky Mountain spotted fever are transmitted by the lone star tick, which (if female) has a single white spot on its back.

Black-legged tick

Lone star tick

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tired feeling.” walking to their car.” “It seemed like the Lasseter doesn’t Kendall Lasseter, problems just kept know where she a recent college gradpicked up the tick uate from the Univerpiling up. I had ear that gave her Lyme sity of Georgia, is one pain and hearing loss, disease. of Lyon’s patients She had travwho tested positive neurological probeled to London, for Lyme. which is her best Lasseter never lems, and temporary guess as to where saw the tick on her vision loss due to the she got bitten. Ticks and didn’t have the transmitting Lyme telltale bullseye rash migraines. I couldn’t have been found associated with the pay attention in class in parks within the Lyme tick’s bite. city of London, and For Lasseter, it because I was so reported cases are started with mion the rise there as graines about two weak and tired all elsewhere. years ago. “But it the time.” wasn’t episodes,” she —Kendall Lasseter says. “It was continA sampling of uous migraines that tick diseases never went away. Doctors would ask and allergies me, ‘When was your Named for Old last migraine epiLyme, Connecticut, sode?’ And I would where the disease try to tell them it was 24/7.” was first recognized in 1975, Lyme “I had a list of symptoms, and it disease is transmitted by the deer seemed like the problems just kept tick, also called the black-legged piling up. I had ear pain and heartick. ing loss, neurological problems, To call it a deer tick is a bit of a and temporary vision loss due to misnomer, says Lyon. “These ticks the migraines. I couldn’t pay attenusually feed off of the white-footed tion in class because I was so weak mouse, not deer. This mouse is and tired all the time,” she says. “I more common in the northern stopped going to class because I states, which is why Lyme is more couldn’t focus. Some doctors told common there. The mice carry me I was just stressed at school, but Lyme, which is transmitted to the I knew something was wrong.” tick when it bites the mouse and A doctor in south Georgia then can be transmitted to humans diagnosed Lasseter with Lyme disthrough infected ticks.” ease. She was referred to Lyon after With Lyme disease, the sympseeing numerous other doctors. toms are many and varied. People “Dr. Lyon ran some more tests who have been bitten by an into confirm I had Lyme, and then I fected tick often have a “bullseye” was put on antibiotics,” she says. rash, named after the darkening “I’m definitely doing better now, red in the middle of a paler red but I still have neurological probring that expands. (Like Lasseter, lems and just an overall however, some people with Lyme

How to Remove a Tick

Infectious disease physician Marshall Lyon, above, sees patients with Lyme and other tick-borne diseases and recently recorded a video to call attention to tick dangers and prevention. Watch at emry.link/ticksvid1.

were cut off or damaged, the nerve never get this rash.) People with will grow back at about an inch per Lyme will often feel sluggish and month, so it takes a while to heal,” tired, with muscle weakness and says Lyon. “With Lyme disease, fatigue described as “flu-like.” Left there are often two parts to getting untreated, the Lyme spirochete better. There’s the treatment, (spiral-shaped bacteria) can affect where we use antibiotics to kill the the heart, causing irregularities bacteria, and then in rhythm, and can there’s the healing attack the nervous phase, which system, spinal fluid, can take a really and brain, causing long time.” “Lyme meningitis.” Ehrlichia, sciTreatment for “With Lyme disease, entifically known as Lyme disease is a human monocytic round of antibiotics there are often two ehrlichiosis, is more for a few weeks to a common in the month. If the disease parts to getting better. is severe, patients There’s the treatment, southeastern U.S. and is transmitted receive IV antibiotics. where we use antibiot- by the lone star tick In severe cases, (the females have post-treatment Lyme ics to kill the bacteria, a distinctive white disease syndrome, patch on their often including and then there’s backs). Ehrlichia is neurological sympthe healing phase, an acute infection toms, can linger for months to years. “I which can take a really and isn’t likely to cause any long-term tell patients that if long time.” effects. Symptoms they were in an acciof ehrlichia resemdent where nerves —Marshall Lyon

The best way to remove a tick is with good old-fashioned tweezers, says Emory physician Marshall Lyon. “Lift the tick up as close to the head as possible without using too much pressure. You don’t want to squeeze the body off the head. Use gentle traction in a circular motion, and both the body and the head of the tick should release from the skin. “Nail polish, butter, and Vaseline are designed to suffocate the tick and make it release on its own, but these tactics may not work very well. Burning the tick is not a good way to remove it because you will burn the body of the tick and the head will stay inside. It’ll kill the tick, but the tick’s head will get stuck underneath the skin, which would lead to an inflammatory reaction, possibly causing an infection.”

AUTUMN 2019

A Tick’s Best Friend One of the many reasons pets, especially dogs, should be on a regular regimen of flea and tick medication is that they too can become infected and ill from tick-borne disease. Your four-legged friends are susceptible to many of these diseases, including Lyme disease, canine ehrlichiosis, anaplasmosis, babesiosis, and bartonellosis, and Rocky Mountain spotted fever, to name a few. Dogs that have become infected with Lyme disease will act lethargic and may experience loss of appetite, fever, and fatigue. Other tick-borne diseases, like anaplasmosis, may cause your dog to experience vomiting, diarrhea, or seizures. While no method offers 100 percent protection, veterinarians suggest a tick collar or medication for your dog, especially during spring and summer. Be diligent in checking your dogs for ticks when outside.

EMORY HEALTH DIGEST

One way to avoid ticks while enjoying the great outdoors is to tuck your pants in your socks. “It may not be fashionable, but it is practical,” says Emory infectious disease physician Marshall Lyon.

with a few weeks of antibiotics and ble that of an infection: fever and is usually quickly cured if caught chills, headache, and vomiting are early, but can be deadly if not treatthe most common. ed early with the right antibiotic. Ehrlichia is treated with Alpha-gal is transmitted by antibiotics and symptoms can last the lone star tick, which is mostly up to a few weeks. If treatment is found in the southeastern U.S., and delayed, ehrlichia can cause severe can make people who are infected illness, especially in the very old or allergic to red meat. Jennifer Shih, very young, or those with weaka pediatric allergist and immuened immune systems. nologist at Emory and Children’s Rocky Mountain spotted Healthcare of Atlanta, has seen a fever is similar to ehrlichia in that few cases of this rare allergy. it causes a fever and headache, “The allergy and a rash usually itself is not well develops within two understood,” says to four days (the rash Shih. “Alpha-gal is can range from red an allergy to the splotches to pinpoint dots). But Rocky Rocky Mountain spot- carbohydrate ‘galactose-alpha-1,3-galacMountain spotted ted fever is usually tose,’ or alpha-gal fever can be much for short. This is more serious than quickly cured if caught strange in itself beehrlichia if left uncause 90 percent of treated, even causing early, but can be allergies are caused deaths from bactedeadly if not treated by proteins, but rial infection. Rocky this is caused by the Mountain early with the right carbohydrate in the spotted feantibiotic. tick’s gut.” ver is treated

(which contain only “What happens is “What happens is the small amounts of the tick bites a deer tick bites a deer and alpha-gal). and gets infected, “There are no then bites a human,” gets infected, then cases I know of she says. “This is the bites a human. This is where the allergy patient’s exposure to alpha-gal. Then, the patient’s exposure has been cured and the allergic when the patient reaction has just eats red meat, they to alpha-gal. Then, ‘gone away,’ ” says will have an allergic when the patient Shih. “But there’s reaction.” so much we don’t Stranger still, eats red meat, they know yet.” the symptoms of the will have an allergic allergic reaction— vomiting, hives, and Tick avoidance reaction.” occasional anaphyPrecautions to —Jennifer Shih laxis—occur hours avoid tick bites after eating the red include the followmeat. (Most allergic ing: Use EPA-regreactions are almost istered insect instantaneous.) One repellent when in theory is that breakwoods, in undering down a carbohydrate versus a brush, on sports fields, or in your protein may delay reaction time. own yard. Wear long pants and Shih says that people with long sleeves. After being outside, alpha-gal allergy can consume seaalways check for ticks on people food, poultry, and eggs—the allergy and pets. Use a mirror to check specifically is to red meat, includyour back. Shower within two ing beef, pork, lamb, and deer, and hours of coming in from tick-insometimes even milk and butter fested areas. EHD

Lyme disease Relative frequency of symptoms among confirmed cases in the United States, 2008-2017.

Meningitis or encephalitis

Erethema migrans (rash)

Facial palsy 9%

Carditis (heart inflammation) 1%

71%

G. Marshall Lyon, associate professor of medicine and infectious disease specialist at Emory.

Jennifer Shih, assistant professor of medicine and pediatrics at Emory, director of the pediatric allergy clinic at Emory and Children’s Healthcare of Atlanta.

Arthritis 28%

Radiculoneuropathy (nerve damage) 4%

* Source: CDC AUTUMN 2019

A Life Consumed by Sleep by Quinn Eastman

NOTHING HE HAD TRIED HAD WORKED. For Sigurjon Jakobsson, the

overseas trip was a last-ditch effort to seek out a treatment that would help him wake up. He had struggled with sleeping excessively for several years before traveling from Iceland to Atlanta to see a visionary neurologist who might have some answers.

EMORY HEALTH DIGEST

THE NIGHTMARE, 1781, HENRY FUSELI, DETROIT INSTITUTE OF ARTS, BRIDGEMAN IMAGES

In high school, Sigurjon was a young decathlete, competing as part of Iceland’s national sports team. But at the age of 16, an increasing need for sleep began to encroach upon his life. Sigurjon needed several alarm clocks to get out of bed and was frequently late to school or his job at a construction company. He often slept more than 16 hours a day.

When Sigurjon describes his experiences, they sound like depression, although his mood and lack of motivation appear more a consequence of his insatiable desire to sleep than a cause. He quit sports. He dropped out of college, became isolated, and lost touch with close friends.

Sigurjon Jakobsson traveled from Iceland to Atlanta with his parents for treatment for his hypersomnia.

“Your will to do things just kind of dies,” he says. “And then you’re always trying and trying again. It just gets worse. You kind of die inside from being tired all the time.” At the recommendation of a neurologist in Iceland, Sigurjon’s family sought out Emory Brain Health Center’s David Rye, who is known internationally for his research on idiopathic hypersomnia, a poorly understood sleep disorder. Sigurjon’s profile suggested that he might respond to an unconventional medication Rye has experience with: flumazenil. It was not originally developed for use with sleep disorders and is generally given intravenously. It is available in an oral lozenge form, and a cream applied to the skin, through only a few compounding pharma-

cies in the U.S. After evaluating Sigurjon’s medical history and symptoms and giving him a series of tests, Rye concluded that he has idiopathic hypersomnia. “When you listen to him,” Rye says, “he sleeps too much, he has a hard time waking up, he takes long naps, he has ‘sleep drunkenness’ . . . that’s hypersomnia.” For several years, Rye has been calling attention to the neglected status of idiopathic hypersomnia. Hypersomnia means AUTUMN 2019

“too much sleep,” but the word idiopathic can be confounding. It means the cause is not known. Sleep scientists have argued about IH’s origin and mechanisms and whether it’s one, two, or many entities. Rye and his team have an idea for how to redraw the map. “We’re trying to change sleep medicine here,” Rye says. “We want to at least get patients in through the right doorway so that we can direct them more swiftly to an accurate diagnosis and a tailored treatment.” Sleep specialists are trained to recognize conditions that can render someone drowsy, with two of the most common being sleep apnea and narcolepsy. Sleep apnea comes from interruptions in breathing, which interfere with sleep’s restorative nature and put strain on the heart. Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy— partial or total loss of muscle control, often triggered by a strong emotion such

EMORY HEALTH DIGEST

Sigurjon Jakobsson, who has hypersomnia, was tested for alertness by placement of electrodes on his head to monitor his brain waves (an EEG) after being given an experimental drug.

as laughter. One form of narcolepsy occurs when an autoimmune attack eliminates cells in the brain that keep someone awake and alert. But some people with persistent sleepiness don’t fit neatly into either of these categories. Understanding what lies behind their sleepiness could unlock new insights into how the brain works. It could also change the lives of people, such as Sigurjon, who have slipped through the cracks of modern medicine. Rye compares hypersomnia and narcolepsy to “apples and oranges.” He has proposed that in some people with symptoms like Sigurjon’s, the circuits within the brain that promote and maintain sleep are overactive. This idea is supported by the Emory team’s use of flumazenil for hypersomnia and similar disorders. Flumazenil is an antidote against benzodiazepines and related compounds—a class of anti-anxiety and sedative drugs, such as

alprazolam (Xanax), zolpidem (Ambien), diazepam (Valium), and midazolam (Versed). People undergoing an uncomfortable medical procedure, such as a colonoscopy, are often given Versed for “conscious sedation.” If they get too much and have trouble breathing, flumazenil can reverse the sedation. It can also be used to counteract overdoses of benzodiazepines in the ER. In 2007, Rye and his colleagues observed flumazenil’s effects with Anna Sumner Pieschel, an Atlanta attorney whose life was being overtaken by sleep. Due to hypersomnia, Anna had to take a leave from her job and couldn’t drive. She had tried conventional medications, such as the “smart drug” modafinil, together with amphetamines, but found it difficult to tolerate the doses she needed to stay awake and experienced periodic crashes. Rye has compared Anna’s treatment with stimulants to “driving a car with the parking brake on.” He and a colleague, nurse practitioner

and former Emory sleep researcher Kathy Parker, suspected something else was going on. Laboratory tests indicated that Anna’s spinal fluid mimicked the effects of benzodiazepines, even though she wasn’t taking any. Looking for alternatives, Rye and Parker obtained flumazenil from manufacturer Hoffmann-La Roche through a limited “compassionate use” arrangement. They figured out how to deliver it as under-the-tongue lozenges and a skin cream. Flumazenil—in com-

bination with other medications— helped Anna return to work. She eventually became a partner at her firm, got married, and started a family. Nodding toward her energetic preschool-aged son, Anna says: “If you told me six years ago that this would be my life, I wouldn’t have thought it was possible… Today I have everything I never thought I would have.” Likewise, Sigurjon’s family, and some of the doctors he saw in

Iceland, were unsure how to help him. He had already tried other medications that are often used to treat persistent sleepiness: modafinil and methylphenidate (Ritalin). They could physically keep him awake, but he still didn’t feel right. In July 2018, Sigurjon, then 23, came to Atlanta to see Rye and got a chance to let a flumazenil lozenge dissolve under his tongue. As seen in a

David Rye, professor of neurology and director of research for Emory Healthcare’s Program in Sleep Medicine; Andrew Jenkins, associate professor of anesthesiology; and Anna Sumner Pieschel, an Atlanta attorney successfully treated for hypersomnia.

AUTUMN 2019

Georgia Public Broadcasting video filmed for the Emory/GPB series Your Fantastic Mind, both his family and Anna were watching. The effect was not immediate. “This is my last resort,” he said. “If this doesn’t work, I don’t know.” Sigurjon first felt agitation in his legs: “My body is telling me to go move…to go running or go do something.” Within five minutes the drug’s effects began to kick in and he smiled. “It’s like my eyes are being lifted up and yeah—it’s a strange feeling,” he said. “It feels really good…I don’t even remember feeling like this.” The Emory researchers monitored physical changes in his alertness, with an EEG, to rule out the placebo effect. On days he tried flumazenil, he performed tests measuring his reaction

time, which became faster after taking the drug. In addition, after applying a skin cream containing flumazenil, he was able to wake up spontaneously for the first time in years —to his surprise—without the aid of an alarm clock. In January 2019, Sigurjon told Rye he was slowly building stamina to be able to work at his construction job and perhaps return to school. Rye has other patients from European countries who periodically visit Atlanta for check-ups and to maintain their flumazenil prescriptions. Flumazenil is not magic, and its effects on healthy or sleep-deprived people have been inconsistent in previous studies. In a review of 153 Emory Sleep Center patients who didn’t respond well to conventional stimulants, about 60 percent reported that flumazenil helped them become more awake. A smaller number (39 percent) stuck with the drug long term; the effects weakened over time in a few patients. The most common side effects were dizziness and anxiety. Still, the drug offers hope to people with hypersomnia who have had to stop school, leave their jobs, or apply for disability. A recently formed nonprofit, the

Emory sleep specialist Lynn Marie Trotti says the Hypersomnia Foundation’s patient registry, which has 1,400 participants, has been useful in identifying patterns.

Hypersomnia Foundation, is working to raise awareness and promote research. It hosts an annual conference—the first of which was held at Emory. Rye chairs its scientific advisory board and Lynn Marie Trotti, Emory associate professor of neurology and sleep specialist, chairs its medical advisory board. “For some people, hypersomnia really puts their lives on hold, especially if the usual medications don’t work for them,” Trotti says. “We’re seeking a better understanding of the disorder.” EHD

Hypersomnia symptoms zz

eople with hypersomnia crave sleep in the daytime, no matter P how many hours they sleep at night.

ey struggle to wake, despite setting multiple alarms and may Th have difficulty rising from bed (sleep inertia).

They may start the day feeling extremely groggy or “sleep drunk.”

ey can experience brain fog, resulting in reduced focus and Th concentration during waking hours.

*Source: Hypersomnia Foundation

EMORY HEALTH DIGEST

PAT I E N T P O V

Six Lessons from my Surgical Journey As I lay in my Emory hospital bed the night after my second spinal surgery in three months, I was

not thinking about the pain that I had been experiencing for nearly a year and a half. Both surgeries had been successful and my neurological symptoms were gone. My surgical pain was taken care of by medications. Nor did I ponder the road ahead. I was facing eight weeks of rest and then extended physical therapy. I had been through this with my first surgery and knew what to expect. Instead, I was thinking about what I learned along the way.

Lesson 1: I had experienced

days where I could barely walk. I had fallen multiple times. All aspects of my life had been disrupted. When dealing with medical issues, there is often not an immediate, straightforward solution. As my non-surgical spinal specialist, Dr. Di Cui told me, “Degenerative low-back pain is not a disease. It is part of the process of growing old.”

Lesson 2: You must do what your medical provid-

ers tell you. But you also must take an active role, constantly pushing for resolution. Surgery is the method of last resort. You have to try all other options before going that route.

Lesson 3: It is frustrating when you feel that you are kicking the can down the road and not making any progress. I had been depressed, angry, and dejected at points along the way. But there can be unexpected benefits to seeing multiple providers with different perspectives on your condition. For instance, my physical therapist, Lisa Harlan, was the first to detect my spinal issues in the cervical region of my neck. Her insights into my case came about because she was working

with me twice a week, providing hands-on care for several months, and we were constantly discussing my pain. “Sometimes in physical therapy, patients have the perspective that we are going to fix them and that’s incorrect,” Harlan says. “It’s not like a car shop where you can drop your car off to get fixed. There’s work involved from both people, and communication is always key.”

Lesson 4: Don’t be afraid to be selective about your care team. Choose a doctor who matches your needs and comfort level. My surgeon, Daniel Refai, asked me to retell my story from the beginning, although he had seen my X-rays and my MRI. Only then did he make his decision about the path forward for me. Ultimately, Refai performed both of my surgeries with excellent results. I had multiple fusions and implants, but I have been recovering at an excellent rate. Lesson 5: You know your body and your medical

history better than anyone else. That immediately makes you the world expert on your problem and your pain. Refai had questioned the wisdom of my having two surgeries so close together but I knew the extent of my pain, how long I had endured it, and that I had explored all other options. We agreed on a schedule and a recovery plan.

Lesson 6: Your health care is a partnership be-

tween you and your provider. This doesn’t mean you should direct your delivery of care, but that your provider cannot deliver the proper care if you are not expressing your needs. You may not always be right, but you always have the right to be heard. EHD

Stuart Turner is an associate director of production at Emory Communications. AUTUMN 2019

POLICY WISE

The battle against Ebola continues Combating the latest outbreak, and those sure to come in the future, means confronting broader challenges of public health

The current Ebola outbreak in the Democratic Republic of contact with highly infectious pathogens. Our world’s forests are Congo (DRC) is now the second largest in history, behind the being cut down at an astonishing rate. Last year alone, approxidevastating West Africa outbreak of 2014 to 2016 that infected mately 30 million acres of tropical forest were lost. Scientists tell 28,000 and killed more than 11,000. The deadly virus has spread us that as deforestation continues and disease-carrying animals to the city of Goma, a major transit center on the border between are displaced, we are losing our protective barrier against the DRC and Rwanda. This infectious diseases that, news serves as a stark until now, have remained reminder that our battle largely isolated in the against this formidable forests. The question is disease is far from over. not if another special Five years ago this pathogen outbreak will August, Emory University occur. It’s when. Hospital stepped forward Emory’s Serious to accept its first patient Communicable Diseases with Ebola virus disease, Unit is focused on prepaDr. Kent Brantly. In the ration and prevention. midst of the largest outOn Aug. 2, our university break since the disease hosted a conference to was first recognized in assess where we’ve come Physician Kent Brantly, the first person to be treated for Ebola virus 1976, Emory provided in the past five years disease in the U.S., steps out of a specially equipped ambulance on Aug. 2, 2014, heading for Emory’s Serious Communicable Diseases Unit. care to Brantly and three and to look ahead to the additional health care future. Working alongside workers in our Serious courageous partners, we Communicable Diseases Unit—at the time one of just four have made important strides in patient care and safety, includhigh-level biocontainment wards in the United States. ing a new project assessing the feasibility of training health care Fortunately, we now have a powerful new vaccine to help workers to use special, reusable respirators during a respiratory fight Ebola. It will have limited impact, however, if members pathogen pandemic. Emory physicians have even pioneered new of affected communities are reluctant to be immunized. As of research into eye complications related to Ebola that can linger mid-August, the World Health Organization (WHO) reported long after the patient has recovered. 2,888 cases in the latest outbreak, with 1,934 confirmed deaths. To combat this latest Ebola Care of these patients also puts health care workers at heightoutbreak, and to confront the ened risk. broader challenges of public health WHO has declared Ebola a “public health emergency of for tomorrow, we must look toward international concern.” Women and children are especially comprehensive approaches that vulnerable: 56% of the total confirmed and probable cases were are driven by members of affected female, and 29% were children under 18. While Ebola virus communities and supported by disease does not discriminate, the risks borne by women are those who have the knowledge or Claire E. Sterk is increased by sociocultural factors, including serving as primary means to make a lasting differthe 20th president of caregivers to those who are sick or dying. As communities cope ence. Working together, we can Emory University and with the sorrow of loss, many individuals must simultaneously build trust and prepare for what the Charles Howard fear infection by a devastating virus. comes next. Doing so is a matter Candler Professor of As our planet warms and global resources are stretched of global human rights. Our shared Public Health. thin, we can expect that human beings will come into greater future depends on it. EHD

EMORY HEALTH DIGEST

This is my legacy. “Both of my parents died from cancer. More recently, my brother survived kidney cancer. I wanted to do something to honor their strength, and that’s why I made a planned gift to Winship. I would like my bequest to make a difference. The ultimate goal is to fund the research that leads to groundbreaking treatments for cancer. Can you imagine stopping cancer? Wouldn’t that be wonderful?” —Ouida Hayes Lanier 65G

For the past 11 years, Ouida Lanier has volunteered at Winship, where she greets incoming patients and their loved ones. Her bequest will fund cancer research. If you are similarly moved by the mission of Winship, allow Ouida’s planned gift to serve as an example of how you can make a difference.

Have you planned your legacy? Learn how you can make a difference by including Emory in your estate plan. It’s easier than you think. Please call Emory Office of Gift Planning at 404.727.8875. For online resources, go to giftplanning.emory.edu.

Across the State and Around the Corner

Emory Healthcare in Georgia Emory Healthcare is the most comprehensive health system in the state, with locations all over Georgia, including 11 hospitals, 142 outpatient locations in 25 counties, and 19 regional affiliate hospitals in 17 counties. Winship Cancer Network has three locations.

5 4

9 7

8 6

2 1

The Clifton Corridor ... and Beyond 2. Emory Clinic (multiple buildings)

7. Woodruff Health Sciences Center Administration Building

3. Winship Cancer Institute

8. Rollins School of Public Health

4. Emory Rehabilitation Hospital

9. Nell Hodgson Woodruff School of Nursing

5. Yerkes National Primate Research Center

10. Emory University Hospital Midtown

6. Emory School of Medicine (education and research buildings)

11. Executive Park (Emory Healthcare clinics in brain health, orthopaedics, and sports medicine)

1. Emory University Hospital

Emory University Alumni Records Office 1762 Clifton Road Atlanta, Georgia 30322

F I V E Y E A R S L AT E R Ebola survivor and physician Kent Brantly and his two children walk with nurse Sharon Vanairsdale, Serious Communicable Diseases program director, toward the isolation unit where he spent weeks as the first Ebola patient to be cared for in the U.S.

EMORY HEALTH DIGEST