Medical Directory 2019

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Greenwood Commonwealth

Good baby food

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Cassandra Brown, director of maternal child health at Greenwood Leflore Hospital, points to the “Ten Steps to Successful Breastfeeding,” which provides information for facilities providing maternity services and care for newborn infants.

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And the best form of nutrition that provides numerous health benefits for both baby and mother, according to many physicians and health organizations, is breast milk.

Only 1 in 4 infants, however, are still exclusively breastfed, as

recommended, at the age of 6 months, the Centers for Disease Control and Prevention said in a recent report.

“So what that’s saying is only 25% of the population in the United States is receiving the best nutrition that they can for the first six months of life,” said Melynda Noble, a pediatrician at Greenwood Leflore Hospital.

“We’re much lower than that here in Mississippi and definitely in the Delta.”

According to a report by the surgeon general, breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections and pneumonia. Breastfed babies are less likely to develop asthma. Breastfeeding also reduces the risk of sudden infant death syndrome.

“Breast milk has human cells in it, and formula does not,” said Noble. “Those human cells include antibodies. So if you recently had an illness or all of your illnesses that you’ve had throughout your life, whatever immunity you have, you are transferring that immunity to the baby. When that baby is better protected with mom’s immunity, they are less likely to get infections. There are less ear infections. During the first year of life, infection is the most deadly thing parents worry about.”

Also, mothers who breastfeed have a decreased risk of breast and ovarian cancers, high blood pressure and Type 2 diabetes.

“Studies show that mothers who breastfed when they were in their 20s and 30s, when they

STORY AND PHOTOS BY RUTHIE ROBISON

Greenwood Commonwealth

are in their 50s and 60s, they are less likely to have diabetes and ovarian cancer and breast cancer,” Noble said.

Another benefit is “it helps with the bonding of mom and baby,” said Cassandra Brown, director of maternal child health at Greenwood Leflore Hospital Another interesting benefit: Children who are breastfed for six months are less likely to become obese.

“If you are feeding a baby formula out of a bottle, you may give them 10 cc’s, 20 cc’s, 30 cc’s.

‘I’m going to give this baby 10 more cc’s, so maybe he can sleep longer, or it will be longer until the next meal.’ So basically what we are doing is teaching that baby to overeat, even during the first day of life,” said Noble.

“Whereas in breastfeeding, no one is measuring. That baby is just getting what the baby needs, so there’s no overfeeding.”

In years past, before more recent research about breastfeeding and new best practices were started, Noble would have recommended to mothers to feed their babies every three hours.

“We now teach the mothers who are breastfeeding to not go by the clock,” she said. “Don’t say, ‘I have to breastfeed every two hours, three hours, four hours.’

You look at the baby. If the baby looks hungry, if it’s two hours, feed the baby, or if it’s four hours, feed the baby. You don’t want to put the baby on a schedule.”

Noble said for every month a mother breastfeeds, she cuts that child’s chances of being obese by 4%. “If I had a pill and I said, ‘You take this, and your chance of gaining weight is 4% less,’ everybody would be taking that pill,” she said. “We have this for children, and that is really the root. If we’re feeding our children poorly from day one, then how do we not expect them to have all the complications that come with that with time?”

Noble said a new mother’s biggest concern when she is breastfeeding is, “Am I giving my baby enough?”

“When you go to the doctor, one of the things your doctor is going to ask is, ‘How much is

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få=dêÉÉåïççÇ=iÉÑäçêÉ=eçëéáí~äÛë=åÉï=ä~Åí~íáçå=êççã=~êÉI=Ñêçã=äÉÑíI aêK=jÉäóåÇ~=kçÄäÉI=éÉÇá~íêáÅá~åX=hÉêêá=dêçëëã~åI=ÅÜáäÇ=äáÑÉ=ÅççêÇáå~J íçêX=~åÇ=`~ëë~åÇê~=_êçïåI=ÇáêÉÅíçê=çÑ=ã~íÉêå~ä=ÅÜáäÇ=ÜÉ~äíÜK= your baby eating?’ It’s nice to say is only about the size of a mar30 cc’s every three hours. That ble,” she said. “Then when it promakes everyone feel more com- gresses to Day Three, it fortable because we are a num- progresses to the size of a walbers people,” she said. “When nut. You get to Day 10, it’s about you say your baby is ‘taking the size of a large egg. ... So enough,’ it’s not a very confident everybody has a big misconcepanswer. That’s the reason we tion of ‘Oh, I need to feed my baby this much formula,’ but had to get educated.”

Rather than asking a breast- their stomachs do not hold that feeding mother how much is her much.”

Noble said it is recommended baby taking, Noble will ask the mother about how often she is that a mother breastfeed for at least a year, and a baby should putting the baby to breast.

Brown said a Baskin-Robbins be fed only breast milk for the pink spoon size of breast milk first six months of life.

“But most women quit breasthas just as much caloric intake as 30 cc’s of formula. She often feeding before they reach six reassures new mothers who are months,” she said.

With all the health benefits, breastfeeding, “Your baby is getwhy is there not a higher perting enough.”

“That’s one of the fears they centage of mothers breastfeeding exclusively for the first six have,” she said.

Many new mothers are un- months?

“They obviously know it’s imaware of the size of a newborn baby’s stomach and how much it portant; so now we’ve got to can actually hold, said Kerri change the community,” said Grossman, child life coordinator. Noble. “We’ve got to change the “In some of the classes we support to allow mothers to teach, we use props to show that breastfeed for as long as they your baby’s stomach on Day One want to.”

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For some, it might be a lack of education on the benefits of breast milk. Others might feel embarrassed or stigmatized to breastfeed. Some mothers may not choose to breastfeed because they were fed formula, too.

“We’re trying to do our part in educating mothers,” said Brown.

“But once they walk out our doors, you have to have the community’s support. That’s what we’re really starting to embark on now.”

Brown said, however, she is seeing an increase in mothers who are breastfeeding at the hospital. “They didn’t know before what was important or best for the baby, and we didn’t communicate that back in the day,” she said. “We have to teach them why breastfeeding is best and why formula feeding isn’t best.”

One challenge for some breastfeeding mothers is returning to work after maternity leave. “It’s hard for a mom who hasn’t been to work in six weeks to say, ‘I need to pump three times a day. Can I, and where am I going to do that?’ It needs to

jbaf`^i=drfab=OMNVJOMOM be the other way around,” Noble said. “The human resources person needs to say to that mom when they are discussing her maternity leave, ‘When you return back, we will provide a place for you to pump. We support you continuing breastfeeding.’”

For both employers and employees, better infant health means fewer health insurance claims, less employee time off to care for sick children and higher productivity, according to a surgeon general’s report. This also builds employee loyalty.

“There are lots of resources out there for any business owner at just about any business on accommodating a breastfeeding mom,” said Grossman.

During the first week, breastfeeding may be more difficult for some moms than others.

“You don’t know what you are doing. If you are an experienced mom who’s breastfed, it’s probably easier,” Noble said. “But after that first week or so, I think it’s much easier to breastfeed them.”

It’s a learning process, said

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Grossman: “The baby has to learn, and the mom has to learn, and they are learning together.”

The mother, she said, “would still have to be taught how to feed the baby a bottle, and you still have to be taught how to breastfeed.”

Once mother and baby are more established, breastfeeding “is one of the most beautiful things you can ever do,” said Brown.

Noble said she encourages every woman who is pregnant and hesitant about breastfeeding to research the topic.

“Don’t just say, ‘I’m going to give formula because I’m not comfortable with breastfeeding,’” she said. “I think they need to look at the facts and talk to someone who has breastfed or talk to somebody who has some knowledge before they make up their mind. ... If they make that decision to give the baby formula, that is perfectly OK. They are still a great mother regardless of how they feed their baby, but we can definitely say that breastfeeding is better for the baby than formula.” n

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Bottoms up

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the disease, a diet rich in red meat, a fondness for grilling out, and obesity — unfortunately match perfectly with the demographics and lifestyles in the Delta.

The good news is that caught early enough, the pre-cancerous growths can be removed pretty painlessly before they turn into cancer.

The general guidelines for a colonoscopy is to have the first at age 50, unless there are signs of problems before that, such as blood in the stool, abdominal pain, a change in bowel habits or an unexplained weight loss. For African Americans, who have a higher predisposition to the disease, it’s recommended to start the screening at age 45. Most insurance policies, however, still won’t cover the procedure until age 50 because, Goldberg said, 90 percent of the people who are diagnosed with colon cancer are over the age of 50.

One disconcerting development, said Goldberg, is that colon cancer is starting to show up at an increasing rate among people in their 40s, for reasons still not clear.

At a recent medical meeting Goldberg attended, this trend toward an earlier onset of the disease was a major topic of discussion. “That was a big deal.

Do we need to start screening people at 45?”

There are non-invasive screening methods out there — sending your stool off in a box to have its DNA screened (think of the widely advertised Cologuard); testing for hidden blood in the stool; or doing a CT scan of the colon. Goldberg is not a fan of any of those.

“If they’re positive, you still have got to have a colonoscopy,” he said, to confirm the result and remove any polyps (abnormal tissue growths) in the colon and have them tested for cancer.

In the past year, Goldberg has had three to five patients who came to him after receiving a positive Cologuard test, only to find out when scoped that the positive was false.

“So my question is the ones that have had a negative Colo-

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Greenwood Commonwealth

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guard, what do they have in their colon?”

In its own literature, Cologuard acknowledges that it misses 58 percent of high-risk precancers and 8 percent of cancers, and that 13 percent of the time its test produces a false positive.

The occult blood test is even more prone to false positives, Goldberg said. “The test is so sensitive that even a piece of raw meat can turn a positive, or hemorrhoids, or a tiny little nothing.”

Unless you’re into taking chances, the colonoscopy remains the “gold standard” for checking for colon cancer. The challenge for the medical community is getting people over the anxiety of the procedure and its admittedly uncomfortable — but relatively short — preparation at home.

Goldberg said that he is usually successful in talking his patients into having a colonoscopy when it’s medically recommended.

“If people know and understand all the risks, the benefits and the alternatives and truly understand the importance of it, by and large most people get over that, any barrier they have.”

I showed up at the hospital’s endoscopy lab early on a Thursday morning in June to have the procedure. I was put to sleep with general anesthesia at 8:09 and back in recovery at 8:30.

For those 21 minutes or so, I didn’t feel a thing while Goldberg let his tiny scope (about a half-inch in diameter) provide a clear view of the lining of my colon. Made by Olympus, the scope and the rest of the procedural equipment that goes with it are the most up-to-date on the market, he said.

He didn’t find any polyps. If he had, he would have removed them and sent them to a pathologist to be tested for cancer.

After I woke up, I had to be driven home by my wife but could eat solid food immediately afterward. I took it easy the rest of the day (following doctor’s orders) and went to a Greenwood Little Theatre play that night.

The only discomfort I had was when my stomach started to rumble loudly during the second act of the musical. During a colonoscopy, a small amount of air is pumped into the colon, and it eventually wants to work its way out. I was relieved it went in a northernly direction.

I was back at work the next morning, and I’m good for another 10 years. If there had been any adenomas (pre-cancerous polyps), the follow-up would be sooner, three to five years depending on the number of adenomas.

I’m not going to pretend that a colonoscopy is fun, but it’s not as bad as imagined. When you do the cost-benefit analysis, it is foolish not to smile and sign up.n

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Building up the heart

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Harden said patients come in Regardless of what conditions with a variety of medical condihave led patients to cardiac tions. Some have had heart atrehab, when they see the bene- tacks, congestive heart failure or fits of this “medication,” they can angina; some have undergone make lifestyle changes that can angioplasty or post-coronary arhelp prolong their lives, said tery bypass grafting; others are John Cook, director of rehab referred by their primary care services. physicians.

“We’ve had several patients The patients generally live in that I’ve known from 20 years the Greenwood area, although ago, and they’re still coming, and some are referred by doctors in they’re still exercising, and Jackson or Southaven. The genthey’re still not having any heart eral age range is 18 to 75, but problems,” he said. teenagers and people in their 80s have come in for rehab, too. v v v “The goal of cardiovascular rehab is to sort of stave off or to In addition to Roach and Cook, reverse some of the risks that the facility has three other staff have led to this degree of heart members: Dr. Bahati Harden, disease,” Harden said.

“The most inexpensive med- medical director of cardiac Depending on their conditions, ication that you can get is exer- rehab; Sally Walker, a nurse; this can mean educating them

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on the benefits of stopping smoking or managing their diabetes properly in addition to generally staying fit and eating right.

New patients bring their medicine, go through psychological evaluations, and take walks to test their gait and endurance.

Assuming there are no complications from earlier surgery or adverse reactions to the exercise, rehab usually lasts one to three months — typically three sessions a week on Monday, Wednesday and Friday. They might start with 30-minute sessions and work up to doing an hour of exercise by graduation, although some find they can do more.

The sessions also can be tailored to patients’ schedules; some who live farther away might do part of their rehab at the hospital’s facility and part at home.

As their hearts become stronger, they incorporate work with strength-training equipment if they can tolerate it.

The center has treadmills, bikes and equipment for building up strength. Staff can track blood pressure, heart rate and other indicators for 10 patients at a time and monitor their progress with the help of iPads.

The rehab has become popular enough that the exercise area stays at or near capacity most of the time, but some people need to be convinced first.

Roach said the biggest misconception is the level of activity required. People who are not used to exercising often think it will be more intense than it is, she said.

“They think, ‘Oh, you’re going to overwork me. You’re going to work me too hard. And it’s going to be harmful to me. I can’t do that,’” she said. “They are not really sure about what they are able to do. ... When they get in and they realize that we actually start very slow and then we gradually increase it, they go, ‘Oh, this is good. This is easy.’”

Cook said it also can take a while to get accustomed to using a treadmill.

“It’s just an awkward feeling to walk on something that’s moving,” he said. “So I think it takes

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Greenwood Commonwealth

_êÉåÇ~=oÉÉëÉ=ìëÉë=ëçãÉ=çÑ=íÜÉ=ÉèìáéãÉåí=~î~áä~ÄäÉ=íç=Å~êÇá~Å=êÉÜ~Ä é~íáÉåíëK JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ ited several places to talk to cardiologists and look at similar “(For) the most part, programs. At the time, the closest place for Greenwood-area paeverybody seems to tients to go for cardiac rehab was Jackson. enjoy the equipment, “The two of them got together with a cardiologist from Jackson and they kind of get Heart and said, ‘This program needs to be here,’” Roach said. their routine going, “And so Bill hired me to start the program, and together we and they feel like worked and got it going.”

She came on board in May they’ve gotten better 1999, and the center saw its first or stronger by the time patient that September. The operation consisted of her and a part-time exercise specialist they get ready to from the Wellness Center who developed the exercise prescripgraduate. ’’ tions.

Roach said it took a while for John Cook people to become aware of the JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ cardiac rehab option. Only a them a little time to kind of ad- small fraction of patients who just and get used to that. But for need this kind of rehab actually the most part, everybody seems get it, and even some physicians to enjoy the equipment, and they don’t fully understand how it can kind of get their routine going, benefit a patient’s quality of life, and they feel like they’ve gotten she said.

“Once the word got out, everybetter or stronger by the time body was on board,” she said. they get ready to graduate.”

“But it’s always been underutilized — and today it still is.” v v v Patients also can be reluctant Roach has seen the cardiac to make lifestyle changes, alrehab program make great though they tend to be more motivated if they are recovering progress in its 20 years.

She was hired by Dr. Bill from a heart attack or other Gardner, the hospital’s director painful event. But Roach exof cardiopulmonary services. He plains to them clearly how she and Terrell Cobb, who was the and the other staffers can help hospital’s administrator, had vis- them.

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“When I see a new patient, I tell them, ‘I’m a part of the team.

I’m going to help your doctor to take care of you.’ And the doctors really like that,” she said. “Because a doctor sees you for, what, 30 minutes or so in his office?

And then you go out and you may not exhibit symptoms that you would if you were here an hour.”

Nurses typically do intake evaluations on new patients on Tuesdays and Thursdays and then update doctors on how they’re progressing.

Patients also are encouraged to ask questions. “It’s a collaborative effort between the staff and the patient,” Roach said. “I don’t have any ‘blankets.’ Everything is individualized.”

Roach, who has been a nurse for 33 years — and, coincidentally, began that career on the cardiac floor at St. Dominic Hospital in Jackson — has enjoyed seeing patients benefit from cardiac rehab. People tell her they can walk farther and have more endurance and functional capac-

jbaf`^i=drfab=OMNVJOMOM ity even after heart failure. Some diabetics who had been on insulin for 10 years were able to switch to oral medications because of the workouts.

Even after they graduate from the program, Roach passes out cards with her phone number in case they have questions — and she does get calls.

“If a patient just tells me they feel better, then I feel like I’m being of good service,” she said. v v v

Cook has worked for the hospital for 21 years and has worked in rehab for more than 26 overall.

He said the cardiac rehab unit started with “the bare minimum” but has been able to upgrade its equipment periodically, including some newer treadmills and recumbent bikes.

He said he would like to be able to expand and offer more room for exercise. The hospital does accept donations periodically to help with improvements,

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including upgrades to the monitoring equipment within the last couple of years.

Cook said many rehab patients keep coming to the Wellness Center after graduation just because it has become part of their routine and they feel better. “When they come in, they might be a little apprehensive at first, but before they leave out of here, we’re all family,” he said.

Harden said there’s great camaraderie among patients, some of whom have been through other hardships in addition to their medical problems.

“They come in, and they’re really welcomed by the community. And when you see them come back every two to three days, they’re totally changed,” she said. “And I think that’s that non-clinical piece that we think about that can really spark change.”

That change also includes healthier day-to-day habits.

“When they discharge here, what we want them to do is exercise for life,” Roach said. n

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Greenwood Commonwealth

Better brushing t

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For manual brushing, pick one that’s soft, Greenwood dentists say. Soft brushes tend to clean gums and teeth without damage.

If electric, choose one that suits your age, the condition of your gums and teeth, your agility and your pocketbook.

Electrics range in price from $8 to well over $200.

But electric toothbrushes, also known as power toothbrushes, are what dentists choose for themselves and their families and recommend to their patients.

Greenwood’s Dr. Todd Fincher, Dr. Ashley Peyton and Dr. Ward Stuckey are fans of the power brushes, which they say do a great job cleaning both teeth and gums.

Each says manual brushes work well, too, but the electrics encourage people to brush longer.

Stuckey said people are supposed to brush their teeth for two minutes, twice a day, but usually they spend about 20 seconds and often miss spots. Many of the power brushes have timers, and some will walk the user through the process of brushing fronts,

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backs, sides and tops of teeth.

This is useful, he said.

“The whole point to an electric toothbrush is that none of us do as good a job as we should, and it picks up the slack where we are missing,” he said.

Peyton’s comments were similar. Both recommend Philips Sonicare power brushes, which they said are easy to use. Sonicare brushes are oval, and they vibrate from side to side. Another highly recommended brand, Oral-B, has round brushes that rotate back and forth. Both brands also offer brushes with timers, plus pressure sensors that let you know when you are pressing too hard.

“You can get the same results with a manual,” said Peyton.

But, “that’s if you are using a manual brush correctly.”

She named the generally accepted recommendations. Again, buy a soft brush. Then, use it “with bristles positioned at a 45degree angle, aiming the bristles

at the gum line.” This primarly is to remove plaque.

Also, brush twice daily for two minutes.

“It’s just four minutes out of your day,” Peyton said.

On the internet, it’s easy to find studies looking at the efficacy of power brushes versus manuals, and the American Dental Association has a short video addressing the issue.

Even Consumer Reports ran a test. It agreed with one of Peyton’s points, which is that it’s important to pick an electric toothbrush that is easy to use. In 2016, the magazine tested power brushes ranging in price from $15 to $140. The magazine reported, “Some brushes are easier to hold and manipulate than others.”

Peyton said she uses a Sonicare power brush. So do Stuckey, his wife, and their two sons, ages 9 and 12.

“I use one every day. That should say something,” Stuckey

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Greenwood Commonwealth

said. “The Oral-B has the roundshaped head. If you know what you are doing, it does an excellent job.”

Fincher’s not sold on any one brand, although he recommends Oral-B and other less expensive electric brushes.

“They are outstanding,” Fincher said. “You can get one for $50 or $60 that is over the top. The step down in efficiency is not that much, and the cost is so much less.”

He and Stuckey said electric toothbrushes are particularly useful for people who have braces or bridgework, which are hard to keep clean. Stuckey said, “I like them for anyone who has any kind of dental work ... crowns, braces, anything but perfect teeth.”

Both have seen a change in the oral health of patients who use electric brushes.

Fincher said, “Every trip, there is less and less plaque. It’s good for my patients.”

And Stuckey, speaking particularly about patients who use

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“The whole point to an electric toothbrush is that none of us do as good a job as we should, and it picks up the slack where we are missing. ’’ Dr. Ward Stuckey

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Sonicare brushes, said, “We see big changes in bleeding and plaque when they come in for regular cleaning.”

Children are a little different because parents brush their kids’ teeth when they are very small.

“They don’t yet have the coordination to get all of the plaque off their teeth,” said Dr. Anna Jennings Nix, a Greenwood na-

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tive who practices pediatric dentistry in Jackson.

Dr. Nix said, “It’s really hard to brush kids’ teeth.”

Baby teeth and gums need to be wiped after each feeding, and after teeth emerge, brushed twice a day.

Sometimes it takes two adults sitting in chairs facing one another, with one adult holding the infant and the other using the brush.

“I do recommend a soft toothbrush, and change it every three months,” Dr. Nix said. She also recommends infant dental wipes with xylitol, a plant-based sugar substitute that is believed to promote better dental health, perhaps aiding in cavity prevention.

She noted that some research suggests that bacteria inside the mouth of an adult with a cavity can be transferred to a child via a nuzzle or kiss.

Nix, who is familiar with the pros and cons of electric and manual toothbrushes, said, “If a toothbrush costs $2 or $200, you have to use it for it to work.” n

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Greenwood Commonwealth

A village of support

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the clinical services coordinator of the program. He’s been with Life Help in Greenwood since his internship there about 15 years ago, when he was earning his master’s degree in mental health counseling at Delta State University. Organized and unflappable, Grantham seems to have a firm grip on reality as it applies to PACT: Although it won’t solve all problems in the mental health system, the program has achieved an admirable success rate for its patient population.

“The program is designed to provide wraparound facilitation for clients who have been in and out of the system,” Grantham said.

“As they move back out into their communidê~åíÜ~ã ties, we try to engage them to keep them from returning (to the hospital).”

The team also has access to two 16-bed crisis centers, in Cleveland and Grenada, known as acute stabilization units, which can provide a place for clients who might need a brief stay in a facility to get back on

course but not full hospitalization.

The clients in PACT currently number roughly 65 in the three counties served by the team — Leflore, Grenada and Holmes — though the capacity is 80, Grantham said.

The PACT team, dedicated to serving these clients, comprises up to 10 professionals: nTeam leader nMaster-level therapists (two) nRegistered nurses (two) nNurse practitioner nPeer support specialists (two) nEmployment/education specialist nAdministrative assistant “The vast majority of treatment is in the patient’s home,” Grantham said. Team members check on their patients where they live about three times a week. Checking that often makes it more likely that problems will be noticed early, so interventions can help the client avoid another hospital admission.

Do they need medications?

Are they taking their medications as instructed? Do they need therapy? Do they need help managing their money? Do they

need groceries? Do they need to enroll in GED classes or to be linked to other agencies that can help? Do they need something as basic as a place to live?

“We meet them where they are,” Grantham said, firmly. “We do our best to provide whatever support is needed.”

Meeting at 9 a.m. every day, the team members plan their day, discuss their patients and bring up any problems they’re sorting out.

One team member said, “Sometimes doughnuts are involved in these meetings,” but it’s clear to even a casual observer that it’s not doughnuts that motivate these enthusiastic, committed individuals.

“If you believe in your mission — to help people — you feel supported,” Grantham said. “Two heads are better than one. We believe in consulting.”

The wide-ranging experience of the team members contributes to the power of the team’s synergy.

While the professionals, such as the therapists and nurses, have the clinical skills and proficiency, the peer support specialists provide a unique patient perspective.

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“Each of our peer support specialists either has a diagnosis of psychosis or has had a close family member with one,” Grantham explained.

Hearing “I’ve been there” from a team member often helps PACT clients feel more comfortable opening up about their own illnesses and their day-today challenges.

“Clients are almost always glad to see us when we visit,” Grantham said. “They believe the PACT team is a benefit to them and their families.”

Most of the therapy happens at the clients’ homes, but the team plans other opportunities for the clients to socialize. Isolation can be problematic for people who may already feel different from everybody else. Grantham was serious when he described the program as “wraparound.” Not every client-provider contact is clinical in nature. Some are actually fun.

“We may take a group of clients to Grenada for a movie and dinner,” Grantham said. “We’ve gone to carnivals. We’ve gone bowling. We go out to eat. We have a birthday party once a month in honor of the clients who have birthdays in the month.”

And every week the PACT team has a gettogether where the clients can just hang out and listen to music, play games, talk and eat. Everyone is welcome and encouraged to join in these weekly events, Grantham explained, but no one is required to attend.

Many of the events

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the PACT team hosts, including the morning team meetings, take place in a compact building at the corner of Mississippi 7 and Browning Road near the main Life Help office.

Formerly a fast-food restaurant, the space is a great fit for PACT’s needs. It includes a bright, easily adaptable open-concept center area with a kitchenette, offices, cubicles and restrooms around the perimeter.

One feature of the former occupant remains a conversation piece that usually earns a chuckle: the office of the PACT team leader, India A. Mitchell, preserves the drive-thru window.

Grantham acknowledges it takes an enormous effort to keep the PACT team functioning at such a necessarily high level, with so many plates spinning in the air.

The level of organization required just to ensure each of the current 65 clients in three counties receives a visit from three team members every week is staggering. Add in all the opportunities for socialization and the other services the team members provide their clients — plus the stacks of documentation required by the state — and the mind boggles.

But the payoff is huge: The reduction in hospital re-admissions for the PACT team’s clients is a whopping 90%.

An element of the PACT team that was started about five years ago, Grantham said, is known as Navigate; its

providers are PACT team members. Navigate is designed to be the wraparound facilitation for the younger crowd, starting around age 15.

Life Help Region VI has helped schoolbased therapists and counselors at the public schools in its counties learn how to identify students whom they can refer directly to the PACT team for early intervention.

And Grantham wants everyone to know about one other service Life Help provides its communities — the Mobile Crisis Response Team, or MCReT. Available 24/7/365, the MCReT, which is completely separate from the PACT team, receives referrals from emergency rooms, law enforcement, clergy,

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Greenwood Commonwealth

families — anyone who is concerned about an individual who is experiencing or is about to experience his or her first psychological crisis.

Again, the emphasis is on early intervention, the common theme in these intervention programs. The sooner a problem is identified and treatment can begin, the more likely the client can avoid becoming caught up in the never-ending hospital admission and readmission cycle.

A phone call to the 24-hour Crisis Hotline (866) 453-6216 as soon as the crisis is noticed can, quite literally, be the difference between a life spent cycling in and out of mental institutions and a well-balanced life of mental health and independence. n

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Greenwood Commonwealth

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The keto diet option t

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Adherence to a diet often depends on an individual’s food preferences and lifestyle.

By now, you’ve probably heard of the ketogenic diet — or, as it’s commonly called, keto. This diet is known for allowing indulgences such as bacon, full-fat cheese and butter but heavily restricts sugary treats, grains, starchy vegetables and most fruits. Although this may seem like the newest weight-loss fad, the ketogenic diet is actually an almost century-old diet created by a Mayo Clinic doctor as nutritional therapy for children with epilepsy.

“It’s a diet that’s actually been in the medical literature since the ’30s, but at that time it was used to treat medicine-resistant childhood seizures,” said Dr. John F. Lucas III, a surgeon at Greenwood Leflore Hospital. “It was very effective for children when medications didn’t work.”

Lucas has been a follower of the ketogenic diet for a little more than a year now.

“I had been trying to lose some weight for a while and not successfully. So I was reading about different diets, and this sounded interesting,” he said. “I tried it, and, for me, it’s been very successful. I’ve lost about 25 pounds.”

Many who currently adhere to

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“It’s been around for a long time, but it hasn’t been rigorously studied long term, and I think that’s its shortcoming,” Lucas said. “There’s some good studies on six-month, one-year and now two-year outcomes, but there are not any studies on 10year or longer outcomes in individuals who’ve been strict on the keto diet.”

The diet is different from most weight-loss plans on the market.

Rather than counting calories or points, the keto diet is all about tracking macronutrients — fats, carbohydrates and protein. This is a high-fat, moderate-protein, very low-carb diet.

“The diet is supposed to get about 80 to 85% of your energy from fat and 10 to 15% from protein and then only about 5% from carbohydrates,” said Lucas.

By sticking with these macronutrient ratios, one can achieve nutritional ketosis,

which is a metabolic state of the body.

The ketogenic diet is the only diet defined by the presence of a biomarker — ketones, which can be tested in the blood, urine or breath. This is what sets keto apart from other low-carb or Atkins-style meal plans.

The goal of keto is to change the dieter’s metabolic state — from using carbs or their simple sugar subgroup, glucose, as the body’s main energy source to using fatty acids and ketones as the body’s main source of energy.

While the dieter is consuming more fat, he or she is also burning more fat.

“The main part of the keto diet is that your body can run off of either carbohydrates or fat for about 85% of your body’s energy needs,” said Lucas. “It’s only your red blood cells and your liver that need glucose to run, and the breakdown of fat can actually provide enough glucose for those to do well.”

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Moderate protein intake is recommended because overconsuming the macronutrient can start a process called gluconeogenesis, which is when the liver converts protein into glucose.

Transitioning from being a carb-burner to a fat-burner does take some time.

“When an individual switches over from a high-carbohydrate diet to a low-carbohydrate and high-fat diet, it takes a while for the body’s metabolic mechanism to make that switch,” said Lucas. “There’s a couple of weeks where some individuals may not feel well.”

This is called the keto flu, which usually occurs because of low levels of electrolytes — sodium, potassium and magnesium.

Supplementing electrolytes “reduces (keto flu) for sure and may eliminate it for some people, but having enough sodium, magnesium and potassium is important,” said Lucas. “I personally get more leg cramps than I used to, and I do take some extra sodium, and that helps it. That’s probably the only downside that I’ve seen, as far as side effects.”

On keto, weight loss can occur quickly at first. But it’s not necessarily fat loss.

In the beginning, Lucas said, the dieters deplete or exhaust their reservoir of glycogen, the substance through which the body stores carbohydrates.

This causes a loss of water weight, since “each gram of glycogen requires three grams of water while it’s being stored.

“That’s why, in the beginning when you’re getting rid of the extra glycogen, there’s rapid weight loss,” said Lucas. “Then it plateaus.”

After adhering to keto for about four to six weeks, a dieter becomes what is called “fat adapted,” which is when many say they begin to see and feel the benefits of a ketogenic lifestyle.

“Once you’ve converted over, it’s an easy thing to stay on,” said Lucas. “Your body has about 4,000 calories of stored glycogen, which is how your body stores carbohydrates. It

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Greenwood Commonwealth

Dr. John F. Lucas III, a surgeon at Greenwood Leflore Hospital, has been following a ketogenic diet for a little more than a year. After unsuccessful attempts at dropping a few pounds, Lucas began researching diets and found scientific literature on the keto diet. Since being on keto, he’s lost 25 pounds. Lucas continues a ketogenic lifestyle for the diet’s insulin-stabilizing benefits, such as reduced hunger and no longer feeling the “afternoon slump.”

has about 40,000 calories — even for a lean individual — of fat. So if you have your body used to metabolizing fat, you can just go on and on. You don’t have to recharge. Whereas if you’re running off of carbohydrates, you get low and then you have to recharge.”

Not only is fat more satiating to eat, but also a keto diet can aid in stabilizing insulin levels, which causes a dieter to feel less hungry. Many who are fat adapted can go hours without eating — or even feeling hungry.

“Whenever you eat carbohydrates, it stimulates the pancreas to make insulin, and insulin is required to get the glucose into the cell. When you have excess carbohydrates, (insulin) is a fat-storing hormone,” said Lucas. “So when you eat a lot of carbs and it’s more than you need for energy, it all gets stored as fat.”

Some scientific studies now conclude that dietary fat is not the culprit of the obesity epidemic, but rather an overconsumption of sugar and carbs.

The carbohydrate-insulin model of obesity theory states that diets high in carbohydrates are fattening due to their propensity to elevate insulin secretion.

“Because of elevated insulin levels, hunger and appetite in-

crease and metabolism is suppressed, thereby promoting the positive energy balance (a caloric surplus) associated with the development of obesity,” the theory says.

“There’s a good analogy that I like to tell folks when we’re talking about it,” said Lucas. “How do you fatten hogs or cattle? You feed them grain, soybeans, corn — particularly corn, which is a high carbohydrate content. You don’t feed them fat. A common misperception is that the fat that you eat gets stored as fat.

Some of it can, but it mostly is used for energy metabolism.”

Lucas said a ketogenic diet could be helpful for those with Type 2 diabetes.

“Type 2 diabetes is a disease where you’re not making enough insulin for the amount of carbohydrates that you’re taking in,” he said. “Instead, you’re adding more medicine that causes the pancreas to produce more insulin or adding exogenous insulin,” which is manufactured. “Since your body can safely run off of fat for its major energy source, if you limit your carbohydrates in a Type 2 diabetic, the insulin they have is plenty for their body’s needs.”

Some health organizations are now recognizing a low-carb diet as beneficial.

Greenwood Commonwealth

The new American Diabetic Association’s nutrition guidelines now include low-carb and very low-carb diets. According to the association’s 2019 Census Report, “low-carbohydrate eating patterns, especially very low-carbohydrate eating patterns, have been shown to reduce” blood sugar levels and the need for medications to lower them.

There are, however, many critics of the ketogenic diet in the health industry.

Some health experts claim that the diet can cause adverse side effects, such as low blood pressure, kidney stones and even an increased risk of heart disease.

There are other nutritionists and diet experts who say that a high-fat, low-carb diet can be used as a tool to lose weight for people who can adhere to its restrictive way of eating. It would not be ideal, however, for those who cannot stick with the diet for the long term.

Some also say that keto dieters are successful at losing weight not because of the carbohydrate-

jbaf`^i=drfab=OMNVJOMOM insulin model of obesity theory, but rather because they are creating a caloric deficit.

For Lucas, he enjoys the food he eats and also likes not feeling the “afternoon slump.”

“A lot of times, I don’t have breakfast or lunch, and I’m not hungry till I get home,” he said.

Lucas may snack on nuts or cheese throughout the day. He typically eats lots of vegetables, such as collard greens, kale, spinach, cabbage, cauliflower, broccoli and asparagus; a variety of meats and fish; rich sauces; and some fruit, such as strawberries, blueberries, blackberries and raspberries, but only in moderation.

“I think for not just the ketogenic diet but for diets that are being promoted these days, they talk about whole foods — to eat less processed foods and more fresh vegetables, and particularly the leafy green vegetables,” said Lucas. “Getting away from the packaged stuff and getting to the whole produce part.”

Keto is not for everyone, and anyone who is interested in

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starting the diet should talk with a doctor first.

“I think there are some individuals who metabolize fat differently, where they may have bad increases in their cholesterol and other lipids,” said Lucas. “That’s why you need to do it in conjunction with your physician, so that can be checked regularly to see if you’re in that small group.”

Additionally, although a ketogenic diet may be ideal for someone who has a metabolic disease, it may not be an optimal diet for someone who is already lean.

Lucas has come to a realization since he began researching the ketogenic diet.

“We as a society have way too much carbohydrate intake compared to what we need,” he said.

“I think for some people, though, this is deleterious and is contributing to the diabetic epidemic. I think a high-carb, high-fat diet is the worst of both worlds, and that’s what a lot of us are eating these days. You can either choose one or the other — a low-carb, high-fat diet or a lowfat, high-carb diet.” n

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Greenwood Commonwealth

Dialysis that’s convenient

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However, unlike other patients with chronic kidney disease and end-stage renal disease who receive dialysis treatment

at a clinic thrice weekly, Hullaby receives the treatment in the comfort of his own home.

“I hook up and go to bed,” he said. “I don’t have any problem.”

A healthy pair of kidneys will remove excess water, waste products and toxins from the body. However, when a person’s kidneys function at less than 15%, dialysis treatment is required, said Suzanne Watkins.

A Fresenius Kidney Care home therapies manager, she covers the Delta and central Mississippi.

There are two types of dialysis — hemodialysis and peritoneal dialysis.

Hullaby undergoes peritoneal dialysis, also known as PD. With PD, a catheter is inserted into the lower abdomen to allow

cleaning fluid to be pumped into the body. The fluid stays in the body for a prescribed amount of time, Watkins said.

PD can be administered either in 30-minute bursts four to five times a day or once a day continuously for about nine hours, Watkins said. Hullaby uses the latter option, beginning PD right before he goes to bed.

Patients who come into Fresenius in person receive hemodialysis treatment, Watkins said. In hemodialysis, blood is taken out of the body and is cleaned through a machine, which acts as an artificial kidney. Hemodialysis is administered three times a week for four hours each session.

Hemodialysis can also be administered at home.

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Greenwood Commonwealth

Because of the frequency and time commitment, coming into a clinic for dialysis can interfere with a patient’s other responsibilities.

Watkins said not many jobs can accommodate someone who needs to take time off for regular dialysis treatment at a clinic.

When a patient learns he or she has kidney failure, Watkins said, a kidney care advocate from Fresenius will explain the different types of dialysis treatment, including PD treatment at home.

Hullaby said he was scared at first to try administering PD to himself. He had, however, nine days of training from Fresenius staffers, and he now says he made the right choice.

“I love it now,” he said, adding that he has “more time for myself.”

This means that he can visit his mother in Shreveport, Louisiana, something that would be very hard to do if he received hemodialysis treatment at a clinic. If he had opted for clinic visits, he could still visit his mother, but first he would have to check for kidney care clinics nearby to her and schedule appointments.

With home PD, Hullaby said, “I pack my machine and go.”

Hullaby’s dialysis machine, called a cycler, transfers data back to Fresenius so its staff can monitor Hullaby’s treatments and vitals. In addition, Hullaby still comes by to the clinic twice a month for blood work.

“They’re very good,”

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Hullaby said of the Fresenius staff. “They take care of you so well.”

Despite the freedom and flexibility of home dialysis, the number of Fresenius patients who opt for it is low.

Of the approximately 600 patients treated by the Greenwood clinic, some of whom come from as far away as Cleveland, only 78 get dialysis at home, Watkins said.

She attributes this to people who are scared, nervous and not familiar with it. “They don’t know how good it is,” Hullaby chimed in.

Watkins goes into the community to educate dialysis patients about the freedom of home dialysis treatment — and she’s not the only one to advocate the practice.

In July, President Donald Trump issued an executive order advancing kidney health.

The order’s goals include increasing home dialysis care among patients with end-stage renal disease.

Kidney disease is a big problem in Missis-

sippi, Watkins said. For every million people in the state, 2,194 people have kidney disease, according to Watkins.

Given the state’s high rates of obesity, diabetes and high blood pressure, it’s likely the

need for dialysis within the population will go up.

Should that happen, dialysis patients may find that their lives will be less interrupted if they opt for home dialysis. n

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^cqbo=elrop

^cqbo=elrop=`ifkf`= 1601 Strong Ave. Greenwood, MS 38930 662.451.7565 _be^sflo^i eb^iqe

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c^jfiv=abkq^i= ^ppl`f^qbp Perry M. Whites, DMD Adam W. Hodges, DMD 702 Hwy 82 West, Suite A Greenwood, MS 38930 662.453.5536

of`e=efiiI=aja=C pq^`bv=tfkcloaI=aja 613 Lexington St. Carrollton, MS 38917 662.237.4646 pqr`hbv=c^jfiv abkqfpqovI=mii` Victor Ward Stuckey, DMD 912 Medallion Drive Greenwood, MS 38930 662.453.5143

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ibufkdqlk= mofj^ov=`^ob=`ifkf`= Sarah "Niki" Walker, FNPC 110 Tchula St. Lexington, MS 39095 662.834.1855 j^dklif^= jbaf`^i=`ifkf`= Dee Jones, FNP-BC 1413 Strong Ave. Greenwood, MS 38930 662.459.1207

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prjkbo=`ifkf` Barbara Criswell, CFNP 100 North Court Sumner, MS 38957 662.375.9989

prkciltbo=`ifkf`= Heidi Compton, MSN, FNP, BC, APRN Elizabeth “Liz” Evans, MSN, AGPCNP-BC, APRN Angela Gibson, MSN, CNP, FNP-BC Brooks Rizzo, MSN, CNP, FNP-BC, APRN Dean Seeley, MSN, CNP, FNP-BC Shannon Myers, MD Brent Roberts, MD James Edward Warrington Jr., DO 840 North Oak Ave. Ruleville, MS 38771 662.756.4024 d^pqolbkqbolildv

dobbktlla= d^pqolbkqbolildv `bkqbo= Richard A. Goldberg, DO Kate Evans, FNPC 1401 River Road Greenwood, MS 38930 662.455.8058 efsL^fap=

j^dklif^=jbaf`^i `ifkf`= Dee Jones, FNP-BC 1413 Strong Ave. Greenwood, MS 38930 662.459.1207

elpmfq^ifpqpL mbaf^qof`=elpmfq^ifpq

dobbktlla=ibcilob= elpmfq^i 1401 River Road Greenwood, MS 38930 662.459.7009 or 877.212.1454 fkqbok^i=jbaf`fkb

ebkov=ci^rqq=goKI=jaI=m^ 408 West Market St. Greenwood, MS 38930 662.453.0722 Fax 662.453.5284

Greenwood Commonwealth

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hbkkbqe=iK=efkbpI=ja 408 West Market St. Greenwood, MS 38930 662.455.1442

jf`e^bi=_liboI=ja 201 Walthall St. Greenwood, MS 38930 662.453.5331 jbaf`^i=pm^

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dobbktlla= kbrolildv=`ifkf`= Ravi Pande, MD 1317 River Road Greenwood, MS 38930 662.459.2520

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dobbktlla= l_Ldvk=^ppl`f^qbp= Nneka Okeh, MD Kimberly Sanford, MD Terry McMillin, MD Tracey Mullins, CFNP 203 9th St. Greenwood, MS 38930 662.459.1367

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Greenwood Commonwealth

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Administrators at the Greenwood Orthopedic Clinic say it’s one of the top five procedures performed by its surgeons, Dr. Asa Bennett and Dr. Jay Culpepper.

Tears of the rotator cuff of the shoulder are potentially painful and disabling. Treatments vary widely depending upon the severity of symptoms and signs, Bennett said. A person with a rotator cuff tear can have a sudden or gradual onset of shoulder pain with or without weakness.

Although tears can occur as a result of a traumatic injury, many occur gradually, and no specific injury can be recalled.

“We see it in athletes a lot of times, but this type of problem can occur with a lot of overhead motions in others and can progress to the point that it is present with normal activities or wake the patient during sleep,” said Bennett. “Repetitive stress is another culprit. Tennis players, swimmers and baseball pitchers are at risk for repetitive stress injuries of the shoulder, as are carpenters and painters.

“You can injure your rotator cuff through wear and tear or poor movement patterns over time. Slouching and chronically pushing your head forward are two movement patterns that put your rotator cuffs at risk. As

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you get older, the rotator cuff can be irritated or pinched by calcium deposits in your shoulder area or bone spurs due to arthritis.”

The pain associated with rotator cuff tears is usually located at the front and side of the shoulder or upper arm.

What is the rotator cuff?

It’s “a combination of muscles and tendons that link your upper arm bone, the humerus, to your shoulder blades,” Bennett said. “The rotator cuff also holds your upper arm bone in place in your shoulder socket.

The four muscles of the rotator cuff are the supraspinatus, the infraspinatus, the teres minor and the subscapularis. Each muscle is connected to the arm bone by a tendon. Rotator cuff repair is the surgery used to repair a tear in one of these tendons.”

In rotator cuff surgery, the tendons are sewn back to the humerus. The other major reason patients have pain after the

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surgery is stiffness in that shoulder.

The type of repair performed depends on several factors, including the surgeon’s experience and familiarity with a procedure, the size of the tear, the patient’s anatomy and the quality of the tendon tissue and bone.

The three techniques most commonly used for rotator cuff repair include traditional open repair, arthroscopic repair and mini-open repair.

A traditional open surgical incision, several centimeters long, is often required if the tear is large or complex. Open repair was the first technique used for torn rotator cuffs. Over the years, new technology and improved surgeon experience have led to less invasive procedures, such as an all-arthroscopic repair. In that, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Symptoms of a rotator cuff injury include: shoulder weakness; not wanting to move the shoulder; shoulder pain, especially when you lift, pull and reach behind your back or overhead; and decreased range of motion in the shoulder joint.

People with these kinds of problems can also go to Ruleville to the North Sunflower Medical Center, which has partnered since 2016 with the Mississippi Sports Medicine and Orthopedic Center to provide the Delta with quality orthopedic care.

The arrangement provides for some of the Jackson-based surgeons to travel to Ruleville on a weekly basis. n

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