Medical Guide 2016 by Greenwood Commonwealth

A Lifetime of Care

LIFE IS A BEAUTIFUL JOURNEY From the months of preparation for your arrival to the moment you enter this world, Greenwood Leflore Hospital is here to provide you and your family with a lifetime of quality care.

A Lifetime of Care 1401 River Road • Greenwood, MS • 662-459-7000 • www.glh.org

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Greenwood Commonwealth

Diabetes plagues Delta M

ississippi ranks second in the nation in diabetes among its populace, with Leflore County and most of the Delta at the top of the list within the state.

Why so much diabetes in the Delta? Dr. Joseph Assini, a podiatrist at the Greenwood Leflore Foot Clinic, says the state has a confluence of risk factors. “The most important thing you have to know is that in the Delta, it’s the epicenter for diabetes in the country,” Assini said. “We have a combination of high genetic predisposition, an obesity crisis, diet problems, sedentary lifestyle and comorbidities of hypertension and kidney disease all at work here among a large segment of the population.” But a diagnosis of diabetes is not necessarily a precursor of the foreboding end-stage conditions most often associated with the endocrine disorder — blindness, kidney failure and circulatory problems leading to loss of limbs. “If you catch it early, there’s no reason to end up with the bad stuff,” Assini said. Diabetes is a metabolic disease that affects the body’s ability to produce

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dropped to zero among Hospital are related to dithose in the study. abetes. “Governor Phil Bryant In Ruleville, North has said that this will ultiSunflower Medical Cenmately save us lots and ter has been participating lots of money,” Perkins in telehealth monitoring, said. “But what we really an experimental selfcare about are the people management program in here. We live in a pretty close cooperation with sick part of the country. I the University of Missisdon’t have data yet, but I sippi Medical Center, have personally observed General Electric and the weight loss changes, Mississippi Governor’s changes in energy level Office. and people making betThat program, a human research study, gç~åáÉ=mÉêâáåëI=ÅÜáÉÑ=Åçãéäá~åÅÉ=çÑÑáÅÉê=~í=kçêíÜ=pìåJ ter eating choices.” Perkins points to the will end on Sept. 30, said ÑäçïÉê=jÉÇáÅ~ä=`ÉåíÉêI=ïçêâë=ïáíÜ=é~íáÉåíë=~åÇ=íÜÉ=éìÄäáÅ çå=Çá~ÄÉíÉë=çìíêÉ~ÅÜ=~åÇ=Å~êÉK window of her office that North Sunflower Chief looks out on the front Compliance Officer the hospital, uploading informalawn of the hospital with a circling Joanie Perkins — and the results tion from home to primary care walking track for employees, citibeing quantified now are strikphysicians, dietitians, pharmacists, zens of Ruleville and patients. ingly hopeful. “I see patients regularly using “The thought for telehealth was nurses and even, from time to time, endocrinologists who spethe walking track for the physical that if we have constant contact cialize in the disease. exercise component of self-manwith patients, we’d get better rePerkins said the most striking agement,” she said. “Constant sults,” Perkins said. measure she has seen of the telecommunication is what this is all Some 200 patients chosen for health approach’s success is the about, and it’s a team approach the study were provided with GE hospital’s readmission rate for diawith the patient being the key tablets and maintained daily conbetes complications, which player on the team.” tact with a management team at

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Greenwood Commonwealth

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You can live with diabetes so long as you know you have it. If you don’t know you have it, then you’re not going to be able to manage the disease in ways that work. So first and foremost, if you are experiencing symptoms or have a combination of significant risk factors, get your blood checked to see if you have the disease. Risk factors include: n Genetic predisposition: a family medical history of diabetes. n Race: Hispanic and African-American people have a higher predisposition toward developing diabetes. n Age: More people develop diabetes as they grow older. n Obesity: People with a high body mass index are more likely to develop diabetes.

Greenwood Commonwealth

qfmp=clo=ifsfkd=tfqe=af^_bqbp n Physical inactivity: People with sedentary lifestyles are more likely to develop the disease. Symptoms of diabetes might include: n Frequent urination n Extreme thirstiness n Feeling very hungry even though you are eating plenty n Blurriness of vision n Extreme fatigue n Cuts and bruises that are slow to heal n Weight loss even though you are eating more n Tingling, pain or numbness in the hands and feet Bottom line: Pay attention and get a diagnosis if you don’t have one. If you have been diagnosed with diabetes, start managing your life appropriately. n People with diabetes

Perkins said she and her team have learned that this model of managing chronic disease works because it is self-motivated from within, not dictated from the outside. “We discovered it’s important to assess someone’s readiness to change before they enter a program like this one,” she said. “They have to drive this car.” Community outreach is another important part of North Sunflower’s approach, especially to younger and younger audiences, students in Mississippi schools who need to learn the risk factors and how to make healthier lifestyle choices. “We know we’ve got to start getting to them earlier,” she said. “What we see here in Mississippi are kids who start out malnourished; then at pre-adolescence there’s a flip to obesity that puts them more at risk to develop diabetes, especially if they are geneti-

should have their eyes checked annually. n They should have their feet checked twice a year. n They should have a hemoglobin blood test, HBA1C, every three months to check sugar and medicine levels. On a daily basis, basic lifestyle changes can help manage diabetes. Specifically, eat healthier and exercise more to live better with diabetes. n Eat more fresh foods and fewer processed fast foods. If you can’t cook, learn to cook. The fast food you’re eating is loaded with sodium, sugar and fat, things you need to eat less of. Learn to cook so that you can control intake of sugar, salt and fats. n Exercise regularly. Twenty to 30 minutes a day of walking is ideal. You don’t need fancy

gym equipment to get your muscles working and your blood circulating. Walking consistently is the best thing you can do to help manage your diabetes. nSeek help. In Greenwood, the Greenwood Leflore Hospital Diabetes Education Center offers classes in self-management, support groups and community outreach. Call 459-1438 for more details. If you’re experiencing diabetes-related problems with your feet, call the Greenwood Leflore Foot Center at 453-9004. If you’re pregnant and have risk factors for diabetes, get checked. You may have gestational diabetes with no symptoms, and may be at risk of developing diabetes later in life. Kathryn Eastburn

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cally predisposed.” Assini said that in his practice and at the Diabetes Education Center at GLH, prevention and outreach are key.“People really need to take responsibility for their own health,” he said. “And it starts with education. “If you know you have a genetic predisposition, get checked. If you

start feeling extremely thirsty and you’re urinating a lot, you need to get tested,” he said. Vision changes and fatigue are other warning signs. “Realize that we’re in the epicenter here in the Delta,” Assini said, “and know that you can live with diabetes so long as you know you have it. Be proactive rather than reactive.” n

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Early obesity poses risks

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child doesn’t become obese overnight, and taking the weight off is also a slow process — but with the right amount of commitment, it can be done, local experts say.

Obesity poses many long-term risks, including increased chance of diabetes, high blood pressure or cholesterol, kidney failure, early stroke or heart attack and certain kinds of cancer. It also makes it harder for sufferers of asthma of eczema — which are widespread

in the Delta — to control their conditions. Dr. Billy Boldon, who practices at the Greenwood Children’s Clinic and has been a pediatrician in Greenwood since 1994, says he is seeing weight-related health problems increasingly early in pa-

tients’ lives, including Type 2 diabetes in children as young as 10. “Those things that we used to think of as being a 40-, 50-year-old (person’s) complication of obesity, we’re now seeing at 10 and 12,” he said. Early obesity can affect the growth plates, or areas at the ends of bones that produce new bone tissue. “If you get obese early in life, it makes you grow quicker than the other kids. You start to secrete more growth hormone,” Boldon said. “So you become the big kid in your class when you’re in third grade, but you close your growth plates early.” That means someone who ge-

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“It can affect the whole child — physically, emotionally, socially — if they get really overweight.”

netically should grow to be 6 feet tall might end up only 5 feet 8 inches — but at the same weight. The good news, Boldon said, is that “if you can get ahold of that child before he’s through growing, then he can grow into that weight. But he has to stop continuing to gain weight.” Even children who develop Type 2 diabetes have hope if they can lose weight, he said: “Almost all children who are Type 2 diabetic, if you can get them back to their ideal body weight, they will no longer have to be on high blood pressure or diabetes medicine.” Obesity can affect daily life in other ways, too. Obese children often are teased, which may lead them to withdraw from others and not participate in healthy activities that could help get them in better shape, Boldon said. They also could develop self-esteem issues or have problems in school that could affect their college options. “It can affect the whole child —

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physically, emotionally, socially — if they get really overweight,” he said. Also, if they develop knee problems from carrying extra weight, they could end up on disability later and become even less active, he said. Dr. Brent Roberts, a general practice family physician at North Sunflower Medical Center in Ruleville, said many of his patients who are overweight also oçÄÉêíë develop chronic arthritis, including some moderate cases involving people in their late 20s or early 30s. They might need joint replacement in their late 30s or early 40s, and that has longterm effects, he said. “Joint replacements last maybe about 10 years,” he said, “so if we’re getting them that early in life, you’re looking at six or seven

joint replacements over the course of your lifetime and the complications of surgery.” A number of factors contribute to obesity, including genetics and socioeconomic considerations. “We know if you have one parent that’s obese, you have an increased risk,” Boldon said. “If you have two parents that are obese, you have an 80 percent chance of being obese the minute you’re born.” Also, blacks and Hispanics are more prone to diabetes and high blood pressure, so if someone in one of those groups is obese, the question is not whether the patient will develop those conditions but when, he said. Still, those risk factors can be overcome, Roberts said. Many people with overweight parents think there’s nothing they can do about becoming overweight themselves, but they can combat that with physical activity and better food choices, he said. “Even in an event where we do

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have some pretty word about fitness, bad genetics, it’s but awareness `efiaella=l_bpfqv=mobsbkqflk definitely somemust start in the n eÉ~äíÜó=äáÑÉëíóäÉ=Ü~ÄáíëI=áåÅäìÇáåÖ=ÜÉ~äíÜó=É~íáåÖ=~åÇ=éÜóëJ thing that can be home. áÅ~ä=~ÅíáîáíóI=Å~å=äçïÉê=íÜÉ=êáëâ=çÑ=ÄÉÅçãáåÖ=çÄÉëÉ=~åÇ=ÇÉJ turned around The wellness îÉäçéáåÖ=êÉä~íÉÇ=ÇáëÉ~ëÉëK with guidance and center doesn’t n qÜÉ=ÇáÉí~êó=~åÇ=éÜóëáÅ~ä=~Åíáîáíó=ÄÉÜ~îáçêë=çÑ=ÅÜáäÇêÉå=~åÇ perseverance,” he allow children ~ÇçäÉëÅÉåíë=~êÉ=áåÑäìÉåÅÉÇ=Äó=ã~åó=ëÉÅíçêë=çÑ=ëçÅáÉíóI=áåJ said. under 13, but ÅäìÇáåÖ=Ñ~ãáäáÉëI=ÅçããìåáíáÉëI=ëÅÜççäëI=ÅÜáäÇ=Å~êÉ=ëÉííáåÖëI Roberts said Ryals said some ãÉÇáÅ~ä=Å~êÉ=éêçîáÇÉêëI=Ñ~áíÜJÄ~ëÉÇ=áåëíáíìíáçåëI=ÖçîÉêåãÉåí obesity is such an parents do ask him ~ÖÉåÅáÉëI=íÜÉ=ãÉÇá~I=íÜÉ=ÑççÇ=~åÇ=ÄÉîÉê~ÖÉ=áåÇìëíêáÉë=~åÇ epidemic in the to work with their íÜÉ=ÉåíÉêí~áåãÉåí=áåÇìëíêóK Delta that many children individun pÅÜççäë=éä~ó=~=é~êíáÅìä~êäó=ÅêáíáÅ~ä=êçäÉ=Äó=Éëí~ÄäáëÜáåÖ=~ see others who are ally. They might ë~ÑÉ=~åÇ=ëìééçêíáîÉ=ÉåîáêçåãÉåí=ïáíÜ=éçäáÅáÉë=~åÇ=éê~ÅíáÅÉë obese and conget nervous if they íÜ~í=ëìééçêí=ÜÉ~äíÜó=ÄÉÜ~îáçêëK=pÅÜççäë=~äëç=éêçîáÇÉ=çééçêJ sider those have heard their íìåáíáÉë=Ñçê=ëíìÇÉåíë=íç=äÉ~êå=~Äçìí=~åÇ=éê~ÅíáÅÉ=ÜÉ~äíÜó=É~íJ weights normal. children diagnosed áåÖ=~åÇ=éÜóëáÅ~ä=~Åíáîáíó=ÄÉÜ~îáçêëK “It’s become as “pre-diabetic,” such a common he said. pçìêÅÉW=`ÉåíÉêë=Ñçê=aáëÉ~ëÉ=`çåíêçä=~åÇ=mêÉîÉåíáçå sight that it’s no Ryals, who has longer something seen several 12“At childhood age, correcting that raises flags for people, alyear-olds over 200 pounds, said, obesity is a much easier task than though it should,” he said. “If you can intervene early and doing it as we get older,” he said. Boldon said financial considerahave the kids “And if it’s not addressed as we tions can affect the food choices get back into are young, then the lifestyle, the that make people obese. physical activity, food choices, all of those things Fresh produce has a short shelf whether that’s kind of become ingrained in our life and costs more than some less sports or just psyche.” healthy snack choices. Healthy working out or Roberts said he advises those drinks cost more than “sugar doing somewith weight problems to start any water” punches that might cost thing recrekind of exercise they can think of, only a dollar a gallon, he said. ational at home, oó~äë and it doesn’t have to be “overly “Unfortunately, it’s much less you can start exerting.” expensive to buy unhealthy food them back on a “One mile is 100 calories any than it is healthy food,” he said, better path and start to see some way you slice it,” whether a peradding that preparing the healthy of those issues reverse.” son runs that distance in eight food takes more time. He said he, like any health speminutes or walks it over a longer Many children also have four or cialist, advises them to set shortperiod, he said. five meals a day, counting afterterm and long-term goals and then Still, it must be done in combinoon snacks. Those who follow formulates a plan. nation with better eating, and it’s that path and don’t exercise gain “It’s a journey,” he said. “It important to set goals. an average of about 25 pounds a doesn’t happen in three weeks. It “A lot of times it’s difficult for year beginning at the age of 5 or 6, doesn’t happen always in a year.” Boldon said. Parents can head this people to make sweeping changes, Ryals said an obese youth will so I’ll often encourage them to take typically be put on a regimen with off — and improve their own one thing and make a change, one health along the way — by develexercise at least three days a week oping better eating habits and set- thing at time,” Roberts said. “So if before working up to five or more. they’re bad about sodas, then our ting examples. The sessions might be 30 to 60 first goal is to cut back on the sodas “The whole immediate family minutes a day with moderate inand use things that are less and the extended family have to tensity or 20 to 30 minutes with processed and don’t have as much buy into trying to help the child more vigorous activity. sugar. When we get to a stopping get over that,” he said. In any case, that kind of activity point with that, we can move on to Even small choices make a difdoes more good than video games. another target.” ference over time. Boldon said Boldon said if a child reduces his or There also are phone apps to ketchup, mayonnaise and other her computer or video game help people count calories and set condiments are “sneaky” calorie “screen time” to an hour a day and goals. sources — and fruit juice, which just spends more time taking walks, Noah Ryals, director of the Bea- it will make a difference. may seem healthy, has nearly as con Wellness Center at North many calories as a candy bar if In fact, he said he might tell a Sunflower, said there are more consumed by the glass. mother, “Even if it’s walking government and community proRoberts said it’s crucial to get around the house aggravating you, grams available now to spread the they’re walking.” n into good habits early.

Greenwood Commonwealth

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Make time for fitness

ou know physical fitness is important for your health and well-being, but setting aside enough time to exercise can be tough for those with hectic schedules.

John Cook recommends five days a week but realizes some people will struggle to work out three times a week. “People seem to be busier than ever, but getting the proper amount of exercise is very important to maintain a healthy lifestyle. That’s why we help people cram it in whenever they can,” said Cook, the outpatient rehab director at the Greenwood Leflore Hospital Well-

ness Center. “If you are short on time, you can walk or jog in the mornings for 20 or so minutes and then hit the strength training in the afternoon after work or once you get the kids settled.” The U.S. Department of Health and Human Services recommends a minimum amount of 150 minutes of moderate aerobic activity along with two strengthtraining sessions weekly. That

may sound like a lot, but if you work out at a moderate pace, it's about 30 minutes, five times a week. Cook said the biggest thing is to be flexible and make fitness a way of life. And all physical activity — not just formal exercise programs — adds up. The GLH Wellness Center opens at 5:30 a.m. on weekdays and doesn’t close until 9 p.m. Cook said there is no reason even the busiest person can’t find time to stop in for a workout. The center offers state-of-the-art exercise equipment for every fitness level, plus an outdoor track and “endless swim” pool access. “Everybody’s schedule is different,” Cook said. “We have an early morning group that gets here

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before they start their day, and then the biggest crowd is from about 4 to 7 as people are getting off work.” Cook said the Wellness Center’s staff can assist with individual workout plans to meet a busy schedule. “We feel like we provide a very important service for our community. Society is more proactive than ever on physical fitness, especially insurance companies, on keeping you out of the hospital. We can help with that,” Cook said. Those in surrounding counties also have some great options for fitness training, especially those in Tallahatchie County. The James C. Kennedy Wellness Center opened last December at Tallahatchie General Hospital in Charleston. The 20,000-square-foot building houses exercise equipment and recreation space as well as health education and disease prevention programs and employee wellness programs for local businesses. Dr. Catherine Woodyard, Tallahatchie General’s wellness executive director, said the center is much more than a gym. “Only 10 percent of our offerings are that of a traditional gym, while 90 percent of our efforts are focused on outreach, programming, events and community engagement.” The Tallahatchie General well-

ness center also houses outpatient physical and operational therapy. Cook said one of the most cited reasons to skip a workout goes something like this: “I am just too busy at work today. I can’t make it.” Make time, he says. Take some work home with you, or find time during lunch to hit the gym quickly or just take a brisk walk. The advice of several local trainers is to make a schedule, stick to it and remind yourself that working out is a worthy priority. Becoming an early-morning exerciser is one of the best ways to meet a demanding schedule, according to Greenwood personal trainer Terri Kimmel. She added there are simple steps you can take to reset your sleep schedule and wake up earlier to make sure you have time for the gym. “We all get the same 24 hours in every day. If you realize how important maintaining an active lifestyle really is, you will find the time. You can split your workouts into two, or even three, daily segments if time is a problem,” Kimmel said. Greenwood personal trainer Hal Haney suggests a few more tips to squeeze exercise into a busy day: n Exercise as part of a hobby. Become part of a team. Walk while playing golf. Play football or soccer with the kids. n Enlist family, friends, coworkers and even the family pet

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for a walk. It helps when you have company. n Take family bike rides before or after dinner. n Just because you're watching television doesn't mean you can't do push-ups, crunches or squats, too. Clear up some space between the couch and the TV so you don't miss anything while breaking a sweat. All trainers have different ideas on how to tackle the time crunch, but all agree on one thing: Make the time for exercise. n

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Tips for surgery patients

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s nurse manager for pre-admissions at Greenwood Leflore Hospital, Karen Watts’ responsibilities include making sure that patients coming in for surgery are properly prepared for the best surgical experience.

Here are the key pointers Watts likes to make with patients regarding their surgery: n Patients need to see their primary care physician first and then schedule a pre-op visit at the hos-

pital. “The pre-op visit is key to having a successful surgical experience,” Watts said. During that visit, patients will have blood drawn and will be

asked questions that will inform anesthesiologists of anything they might need to know. For example, that could include pre-existing breathing difficulties, problems with airways, nausea or vomiting. The point is to have all the information needed to keep the patient safe and comfortable. n This pre-op visit is also important to deal up front with any anxiety patients might be experiencing around surgery. Anesthesia specialists will meet with patients then and also on the morning of their surgery to talk about anxiety and how to treat it if needed. “People are generally pretty honest about their concerns,” said Watts. Patients are encouraged to say how they are feeling, even if

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Questions you may have before operation D r. John Speca is an orthopedic surgeon at the University of Mississippi Medical Center at Grenada and a longtime physician for the U.S. Men’s Ski Team. Speca says these are the questions he’s asked most often by patients facing surgery and the answers he gives them: nW=tÜ~í=Çç=óçì ãÉ~å=f=åÉÉÇ=~å=çéÉê~J íáçå\ A: Unfortunately, you have a problem that won’t heal on its own. nW=vçìÛêÉ=âáÇÇáåÖI êáÖÜí\ A: Sorry, but this time I’m serious. nW=aç=óçì=Ü~îÉ=~ éáää=çê=ëçãÉ=íóéÉ=çÑ ãÉÇáÅ~íáçå=f=Å~å=í~âÉ áåëíÉ~Ç\ A: Your problem has progressed beyond the point where medications alone will do any good. nW=tÜ~í=ïáää=Ü~ééÉå áÑ=f=ÇçåÛí=Ü~îÉ=íÜÉ=ëìêJ ÖÉêó\ A: You will have further deterioration, and what may have been a simple operation will become more difficult to do.

lêíÜçéÉÇáÅ=ëìêÖÉçå=aêK=gçÜå=péÉÅ~=çÑ=råáîÉêëáíó=çÑ=jáëëáëëáééá=jÉÇáÅ~ä=`ÉåíÉê=~í dêÉå~Ç~=ë~óë=ëçãÉ=ëìêÖÉêáÉë=Å~å=ÄÉ=éçëíéçåÉÇ=Äìí=çíÜÉêë=Å~ååçí=ïáíÜçìí=êáëâáåÖ=ÉîÉå ïçêëÉ=éêçÄäÉãëK

nW=`~åÛí=f=ï~áí=ìåíáä ~ÑíÉê=ãó=î~Å~íáçåI ~ÑíÉê=~åçíÜÉê=ëìêÖÉêóI ìåíáä=f=ÄìáäÇ=ìé=ÉåçìÖÜ ëáÅâ=äÉ~îÉ=íç=ÄÉ=çÑÑI==çê ìåíáä=f=~ã=ÉäáÖáÄäÉ=Ñçê áåëìê~åÅÉ\ A: For elective surgery, the answer is yes — let us know when you’re ready. For urgent surgery, the answer is no, the surgery needs to be done immediately for the best results to you. And if you need very urgent or emergency surgery, a delay could mean you end up with severe complications, could lose

they are embarrassed by it. n During the pre-op visit, all patients, whether or not they are smokers, are given smoking cessation information. “It’s important to reiterate to them that smoking can increase post-operative infections and can make it harder for the body to heal,” Watts said. n Patients will talk to a pre-op nurse about what medications they’re taking and will be instructed which medications to take and which to stop prior to surgery.

a limb or even die. nW=táää=f=ÖÉí=~åÉëJ íÜÉëá~\ A: I find it easier when patients have anesthesia so that I don’t have to chase them around the room. nW=eçï=ãìÅÜ=ïáää=áí Åçëí\ A: It depends on your insurance and the agreement they have with the hospital for payment. This differs from company to company. nW=tÜÉå=ïáää=ãó ëìêÖÉêó=í~âÉ=éä~ÅÉ\ A: It depends on when it’s approved by your in-

n At the pre-op visit, patients will be told what to expect when they arrive at the hospital on the day of surgery — where to go, what to bring, what to leave at home, what will happen after surgery and an estimated timeline for the day of surgery. n Once the surgery is over, beyond the recovery room, patients will receive more instructions. “Depending on the nature of the surgery, they will talk to different specialists around the hospital for

surance. You will need to see your primary care provider first to evaluate your medical health for anesthesia and your surgical risks. nW=aç=f=êÉ~ääó=åÉÉÇ íç=èìáí=ëãçâáåÖ=ÄÉÑçêÉ ëìêÖÉêó\=eçï=ã~åó ÅáÖ~êÉííÉë=Å~å=f=ëãçâÉ ~åÇ=ëíáää=Ü~îÉ=ëìêÖÉêó\ A: You should not smoke any cigarettes. Cigarette smoking affects the healing of tissue. Delayed healing may lead to complications, including infections or failure of the surgery. n

some post-op teaching,” Watts said. Patients will also be given sheets to take with them, reiterating all post-op instructions. n Watts said nurses will give patients a special soap to prevent post-op infections and will be told how to use it properly. n While patients are in the hospital for surgery, they are offered the opportunity to have a flu or pneumococcal vaccination or to set one up for later. The hospital’s pre-op department can be reached at 459-2744.n

LIFE IS A GREAT ADVENTURE Growing up means allowing your imagination to run wild and constantly being on the move towards the next great experience. Life is full of bumps in the road. Greenwood Leflore Hospital is always here to get you back on track and keep you moving torward a happy and healthy future.

A Lifetime of Care

1401 River Road • Greenwood, MS • 662-459-7000 • www.glh.org

LIFE IS FULL OF NEW BEGINNINGS Leaving the nest and joining the real world can be overwhelming. Milestones and achievements mark the journey. Parents and children can find comfort in knowing that Greenwood Leflore Hospital will always be here to take care of them.

A Lifetime of Care 1401 River Road • Greenwood, MS • 662-459-7000 • www.glh.org

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Greenwood Commonwealth

How to identify, prevent breast cancer

Dr. Kimberly N. Sanford, an obstetrician and gynecologist at Greenwood OB/GYN Associates, educates her patients about how to be “breast aware.” This can help women notice symptoms, such as lumps, pain or changes in size that may be of concern.

r. Kimberly N. Sanford says that a common misconception most women have about breast cancer is that every lump is cancer. That’s not so, she said.

“Especially if you are cyclic and having regular periods or pregnant,” said Sanford, an obstetrician and gynecologist at Greenwood OB/GYN Associates. “The breasts are glands. They make fluid, so they are going to make cysts just like ovaries. It’s sort of a natural, normal phenome-

non. The breasts are actually doing their job, making fluid and then retracting. The breasts react to your cycle.” Usually when a noncancerous lump is found, it is during the two weeks that follow ovulation, which Sanford said is not a good time to do a self-exam.

“If you are checking your breasts during those two weeks after you ovulate, you’re making a huge mistake,” she said. “You should only check your breasts on day three to five of your period, when there is the least amount of hormone activity in your breasts, and you are least likely to feel a lump that is going to freak you out and just be due to hormonal changes.” Sanford said that another common misconception women have is that breast density is a major cancer risk factor. “There’s a higher risk, but it’s a really small number,” she said. Women who have heteroge-

STORY BY RUTHIE ROBISON n PHOTOS BY RUTHIE ROBISON AND THE ASSOCIATED PRESS

Greenwood Commonwealth

neously dense breast tissue have a higher risk by 1.2 percent. Women who have extremely dense tissue have a higher risk by 2.1 percent. Therefore, breast density is not a major cancer risk factor. The Centers for Disease Control and Prevention recommends for women to become “breast aware,” which means being familiar with how your breasts look and feel. This can help women notice symptoms, such as lumps, pain or changes in size that may be of concern. “So what the CDC said is to become familiar with the architecture of your breast,” Sanford said. “If you see something in the mirror that looks weird, such as dimpling, skin texture that looks like an orange, or peau d'orange, or puckering. The skin is going to look kind of pinned up if there is a mass there. Those are major changes, and you want to bring that to a physician.” Sometimes women see minimal changes, which often can be caused by hormones. Rather than reacting in extremes — ignoring a lump or getting emotional for fear of a minimal change being cancer — Sanford suggests to track the change. “So if you find a lump there that wasn’t there before, what I usually explain to women, especially to those who are menstruating, making their own hormones or even utilizing hormones with birth control, is to make a note of where that change is on the breast,” she said. “Don’t panic, because a lot of times it is most likely hormonederived, especially if it’s painful.” Sanford said to make a mental note of the lump as if it is on a clock — 12, three, six or nine. “Wait 30 days. Then check for it again,” she said. “Usually it’s gone. If it’s still there, make an appointment with a doctor.” For women under 40 years old, normally what follows during an appointment with a physician is an ultrasound. Women over 40 will mostly get a mammogram first, and then an ultrasound or MRI could follow. Women who have a primary member in their family — a mother

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n `~åÅÉê=áë=~=ÇáëÉ~ëÉ=áå ïÜáÅÜ=ÅÉääë=áå=íÜÉ=ÄçÇó Öêçï=çìí=çÑ=ÅçåíêçäK=tÜÉå Å~åÅÉê=ëí~êíë=áå=íÜÉ=ÄêÉ~ëíI=áí áë=Å~ääÉÇ=ÄêÉ~ëí=Å~åÅÉêK=bñJ ÅÉéí=Ñçê=ëâáå=Å~åÅÉêI=ÄêÉ~ëí Å~åÅÉê=áë=íÜÉ=ãçëí=Åçããçå Å~åÅÉê=áå=^ãÉêáÅ~å=ïçãÉåK n _êÉ~ëí=Å~åÅÉê=ëÅêÉÉåáåÖ ãÉ~åë=ÅÜÉÅâáåÖ=~=ïçã~åÛë ÄêÉ~ëíë=Ñçê=Å~åÅÉê=ÄÉÑçêÉ ëÜÉ=Ü~ë=~åó=ëóãéíçãëK=^ ã~ããçÖê~ã=áë=~å=uJê~ó éáÅíìêÉ=çÑ=íÜÉ=ÄêÉ~ëíK=j~ãJ ãçÖê~ãë=~êÉ=íÜÉ=ÄÉëí=ï~ó íç=ÑáåÇ=ÄêÉ~ëí=Å~åÅÉê=É~êäóI ïÜÉå=áí=áë=É~ëáÉê=íç=íêÉ~í=~åÇ ÄÉÑçêÉ=áí=áë=ÄáÖ=ÉåçìÖÜ=íç ÑÉÉä=çê=Å~ìëÉ=ëóãéíçãëK n jçëí=ïçãÉå=ïÜç=~êÉ=RM íç=TQ=óÉ~êë=çäÇ=ëÜçìäÇ=Ü~îÉ ~=ëÅêÉÉåáåÖ=ã~ããçÖê~ã ÉîÉêó=íïç=óÉ~êëK=fÑ=óçì=~êÉ QM=íç=QV=óÉ~êë=çäÇ=çê=íÜáåâ óçì=ã~ó=Ü~îÉ=~=ÜáÖÜÉê=êáëâ çÑ=ÄêÉ~ëí=Å~åÅÉêI=~ëâ=óçìê ÇçÅíçê=ïÜÉå=íç=Ü~îÉ=~ ëÅêÉÉåáåÖ=ã~ããçÖê~ãK or a sister — who has been diagnosed with breast cancer have the most risk of getting that same cancer. “If they were diagnosed before the age of 40, or even before the age of 50, you count backward 10 years, and that’s when you should start getting mammograms in terms of screening,” said Sanford. Normally, Sanford said, women have a 12 percent rate of getting breast cancer. That rate, however, becomes drastically higher for women with a genetic predisposition or those with genetic abnormalities. “Everybody assumes that all breast cancer is genetically inclined, and it’s not,” said Sanford. “There are two major types of genetic abnormalities that lead to breast cancer, and that’s BRCA1 and BRCA2. These genes are actually genes that we all have, but they are abnormal in patients who get breast cancer.”

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About one in every 500 women in the United States has a mutation in either her BRCA1 or BRCA2 genes (BReast CAncer genes 1 and 2). If either your mother or your father has a BRCA1 or BRCA2 gene mutation, you have a 50 percent chance of having the same gene mutation. “These genes are called tumor suppressor genes,” said Sanford. “When you have cellular growth, these genes keep abnormal cells in check. They’re the guys that inspect and do the cleanup. If you have those genes and they have defects, they don’t clean up so well, and they don’t inspect so well. That allows mistakes to happen and can lead to cancer.” The risk of getting breast cancer for women who have BRCA1 goes from 12 percent — the normal rate — to 55 to 65 percent. Those who have BRCA2 have a 45 percent chance of getting breast cancer. The BRCA1 and BRCA2 gene abnormalities also cause an increase in getting ovarian cancer. Normally, a woman has a 1 to 3 percent chance of getting ovarian cancer. That risk goes up to 39 percent for BRCA1 and 11 to 17 percent for BRCA2. “This is why celebrities like Angelina Jolie get their breasts removed or get their ovaries taken out,” said Sanford. In 2013, Jolie, an American actress, announced that she had undergone a double mastectomy and also planned to have her ovaries removed after learning that she carried the BRCA1 gene mutation. Jolie wrote an op-ed in The New York Times about her decision. “My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was,” Jolie said. “My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman. Only a frac-

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Greenwood Commonwealth

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pçãÉ=ï~êåáåÖ=ëáÖåë=çÑ ÄêÉ~ëí=Å~åÅÉê=~êÉW n kÉï=äìãé=áå=íÜÉ=ÄêÉ~ëí çê=ìåÇÉê~êã=E~êãéáíFK n qÜáÅâÉåáåÖ=çê=ëïÉääáåÖ=çÑ é~êí=çÑ=íÜÉ=ÄêÉ~ëíK n fêêáí~íáçå=çê=ÇáãéäáåÖ=çÑ ÄêÉ~ëí=ëâáåK n oÉÇåÉëë=çê=Ñä~âó=ëâáå=áå íÜÉ=åáééäÉ=~êÉ~=çê=íÜÉ=ÄêÉ~ëíK n mìääáåÖ=áå=çÑ=íÜÉ=åáééäÉ=çê é~áå=áå=íÜÉ=åáééäÉ=~êÉ~K n káééäÉ=ÇáëÅÜ~êÖÉ=çíÜÉê íÜ~å=ÄêÉ~ëí=ãáäâI=áåÅäìÇáåÖ ÄäççÇK n ^åó=ÅÜ~åÖÉ=áå=íÜÉ=ëáòÉ=çê íÜÉ=ëÜ~éÉ=çÑ=íÜÉ=ÄêÉ~ëíK n m~áå=áå=íÜÉ=ÄêÉ~ëíK= líÜÉê=ÅçåÇáíáçåë=Å~å=Å~ìëÉ íÜÉëÉ=ëóãéíçãëK=fÑ=óçì Ü~îÉ=~åó=ëáÖåë=íÜ~í=ïçêêó óçìI=Å~ää=óçìê=ÇçÅíçêK tion of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.” Getting a mastectomy or an oophorectomy — removing the ovaries — is a drastic way to prevent cancer. Although some women who have a genetic mutation and a high risk of breast or ovarian cancer may decide surgery is the way to go, Sanford said the average women should not have her breasts or ovaries removed as a way of cancer prevention. “For the general population, you don’t need to take off your breasts for 12 percent or take out your ovaries for 1 to 3 percent,” she said. That has not always been Sanford’s stance on oophorectomies. “From a gynecological standpoint, when I perform a hysterec-

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tomy on a woman 45 years old who is finished having children, what I used to say is just take it all out, because if you don’t have ovaries you can’t have ovarian cancer,” she said. New medical studies, however, have changed her professional opinion. “That’s not necessary,” she said. “If you don’t have a risk beyond 1 to 3 percent for ovarian cancer and you’re 45 years old, you may be finished having children but you’re still using those ovaries. What we found through certain studies is when you keep your ovaries and let your hor-

mones decrease in a natural pattern, it reduces your risk of cardiac disease, lipid disease and osteoporosis. I’m doing a disservice by taking your ovaries out early. We didn’t know that before, but now we do.” Sanford said that she does encourage women who can to get the BRCA gene test, which uses a blood sample, so they can know their risks for developing cancer. “If your mom or sister has been diagnosed with breast cancer at any age, it is ideal,” she said. “If they test positive, or even if they test negative, everybody should be checked.”

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Sanford said that, with the help technological advances, doctors have now isolated 21 to 25 genes with genetic abnormalities that could cause cancers, including breast cancer. “That’s the future wave, I think, is gene testing,” she said. “Preventing cancer has improved, because now we can look at genes, gene therapy, DNA markers and tumor markers. We can look at mutations on the surface of these genes and sort of predict women with this gene are at risk by this percentage. We’re finding out more and more every day.” Sanford said that one of the best technological improvements in the detection of breast cancer is the digital mammogram. “What makes it better than the traditional mammogram is that now I can put it on a computer,” said Sanford. “On a computer, I can make it bigger, I can enhance it, I can really make that image better so I can view those parts within a very dense, fatty type of tissue

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that’s compressed. I can enhance those images and maybe make a better decision.” Although deaths from breast cancer have declined over time, it remains the second-leading cause of cancer death among women overall. Sanford recommends that women self-exam about four times a year. Those with family members who have breast cancer should selfexam monthly. She also said that if you feel you may have signs or symptoms of

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breast cancer, talk to a physician rather than using Google. “When we were going through medical school, you take pathology class and you think you have every disease you study,” she said. “It really is just a grouping of symptoms, and at any given time you’re going to have some of these symptoms.” Detecting if something is wrong “is looking at the whole picture mixed with screenings and diagnostics and putting it all together,” Sanford said. She also said that women who are worried about their health should write down a concise list of their concerns to talk to their physician about and be aware of their own bodies. “Your job is to be an expert on what you are doing every day,” Sanford said. “What I try to provide the patient is to educate her on the basics. You need to know what normal is, because if you know what normal looks like, then you don’t wig out so much when there is a variation.”n

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Hygiene key vs. cold, flu

ith the return of fall weather comes the annual battle with colds and flu — and just washing your hands can make a big difference.

“That’s probably the most important thing to prevent a cold,” said Dr. Keith Rushing of Winona Family Practice, which is owned by Tyler Holmes Memorial Hospital. “Hand washing, hand washing, hand washing. That’s your No. 1 line of defense; it really is,” said Allison Harris, Greenwood Leflore Hospital’s director of quality, whose job includes infection prevention. Rushing said normal hand sanitizers are no replacement for simple soap and water. “If you have a cold, try not to

spread it. Sneeze into your elbow rather than your hand. Drink plenty of fluids and rest,” he said. Harris said if coughing gets to be persistent, she suggests wearing a mask to prevent the spread of germs to other people. She also advises anyone suffering from a cold to refrain from touching the eyes, nose or mouth. Keeping one’s distance from others suffering with colds is also important since a single sneeze contains numerous atomized droplets, which could be infectious. “You need to stay 3 to 5 feet away from a person sneezing,” she

said. The common cold isn’t just one virus, Rushing said. “On average, there are about 200-odd viruses hanging around. You might encounter 50 in a lifetime, particularly when you are young,” he said. The very young and the elderly often have trouble with colds, Harris said. The young haven’t developed their immune systems, and the elderly often suffer from weakened immune systems. Taking Vitamin C may help in warding off a cold because it can boost a person’s immune system. Then again, Rushing said, “it doesn’t work for everybody.” Harris said in addition to Vitamin C and E, probiotics are often helpful. Rushing said over-the-counter decongestants, such as Robitussin or Mucinex, can help clear the lungs of mucus, and a salt-water spray can be used to keep nasal

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passages clear. Stronger medications are not usually necessary unless there is a bacterial infection, and that would have to be determined by a physician, he said. Rushing said a cold typically goes away on its own within 10 days. Regarding the flu, he recommends that people get shots. “We used to limit them to those 65 and older. Now, they are recommended for almost everyone older than 6 months,” he said. In the past, Rushing said, the potency of flu shots did make people sick, and that still causes people to be reluctant to get them today. The flu season generally runs from September through April. Rushing said he’s already seen some flu cases coming into his clinic. The Centers for Disease Control and Prevention recommends getting a flu shot annually for optimal protection starting at the end of October. The agency recommends the shot for those suffering from chronic health conditions. In addition, it helps protect women during and after pregnancy and also protects the developing baby. By getting vaccinated, you reduce the risk of spreading flu to babies, young children and older people. Getting a flu shot is fairly easy, Rushing said. They can be administered at doctors’ offices and at many pharmacies. Intranasal sprays, which were recommended for children last

year, are being discouraged this year. The CDC is advising that only injectable vaccines be used for children, Harris said. The CDC recommends that everyone 6 months old and older get a flu shot, except in certain cases. Those exceptions include a severe allergic reaction from any previous vaccine or from any vaccine component, including egg proteins, Harris said. “Some people, depending on the severity of their egg allergy, are still able to take the vaccine,” she said. Rushing said symptoms of an allergic reaction might include a mild rash at the injection site. He and Harris urged anyone with concerns to talk with a physician before getting vaccinated. The CDC says that allergic reactions to flu shots are typically mild and can include a low-grade fever and body aches beginning one to two days after the shot is administered. The agency also says that people might get flu symptoms even after getting the shot. This might be caused by other respiratory viruses, such as rhinoviruses, which are associated with the common cold. Other possible explanations include exposure to flu viruses prior to getting the flu shot or variations in how well the vaccine works in certain people. The flu vaccine is available now, and Harris said the hospital has plenty of it. The hospital orders its supply a year in advance based upon the previous year’s flu season.

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Physician burnout growing problem

he cost of operating Dr. Luke Lampton’s family medical clinic in Magnolia has doubled since 1999, he said, but his passion for medicine has paid an even higher price.

“Even after hiring a nurse practitioner,” Lampton said, “we’re spending less time with patients and more on a bureaucratic system of measures that has nothing to do with saving people’s lives.” As chair of the Mississippi State Board of Health and editor of the Journal of the Mississippi State Medical Association, Lampton mingles with enough physicians to know that many are overwhelmed by a system in which the joy of practicing medicine is slowly dripping away. “Physicians have a sense of powerlessness,” Lampton said. “People in suits are getting in the way of patient care, and they’re doing it to save money.” Physicians aren’t the only professionals who endure work-related frustrations and bureaucratic burdens — but to the nation’s doctors, the hurdles are now high enough to foster a level of burnout and stress so pervasive it has been labeled a “health-care crisis.”

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pìáÅáÇÉ=ï~íÅÜ More than 54 percent of physicians in the U.S. reported at least one sign of burnout in a 2014 study released this year by the American Medical Association and the Mayo Clinic. Even more telling, that percentage has jumped, from 45 percent, since a similar study was conducted three years earlier. Over that period, nearly a dozen specialties registered a bump in burnout of more than 10 percentage points, including family medicine, up by 11.7 points to 63 percent. “There are a lot of specialists who are burned out, and we are very burned out,” Lampton said of family medicine physicians. The upsurge was greatest for urologists, 22.4 percentage points (from 41.2 to 63.6), and dermatologists, 24.7 (from 31.8 to 56.5). For

all physicians, the rate is even higher than that for the general U.S. working population, the study says. Physicians in mid-career are most likely to encounter burnout. “The burnout issue exists not only for physicians and residents but for non-physician providers as well,” said Dr. LouAnn Woodward, the University of Mississippi Medical Center’s vice chancellor for health affairs and dean of the School of Medicine. “Increasing pressures for high quality and efficiency put a squeeze on the provider’s time with the patient, which is what usually attracts someone to health care in the first place.” “Stunning” is the word Dr. Jeffrey P. Gold used to describe statistics on stress, burnout, depression and suicide among

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physicians and other health-care professionals in an essay published in the April issue of Reporter, the flagship news publication of the Association of American Medical Colleges. Every day at least one physician dies by suicide, reports the American Foundation for Suicide Prevention. Doctors are more than twice as likely to die by suicide, compared to the general population. For medical students, rates of depression exceed the general population’s by 15 to 30 percentage points. “We have generations of physicians in practice who were never trained in career resiliency and who are being asked to do things now that they never had to do before,” said Dr. Alan Jones, professor and chair of the Department of Emergency Medicine. “For the next generation, we need to build medical school curriculum around resilience.” As for residents, each program at UMMC affords them an education on wellness and impairment, as required by the Accreditation Council for Graduate Medical Education. How that education is presented depends on the individual programs. “But burnout is a relatively new problem in medicine,” Jones said. “I don’t believe we realized the impact all these changes in health care would have on us.” As Gold, the chancellor of the University of Nebraska Medical Center, wrote in the AAMC Reporter, it all amounts to “the greatest health-care crisis American physicians and other health professionals face today.” And, when physicians suffer, their patients suffer, said Lampton. “We’re like the canaries in the coal mine. For our patients’ safety, there needs to be a revolution in medicine.” fãÄ~ä~åÅáåÖ=~Åí The revolution is about time, which Lampton says is devoured by the mandates of electronic health records, at the expense of a physician’s personal touch.

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“Physicians should demand that patient care be the center of their practice,” he said, “instead of jumping through administrative hoops.” Digital record-keeping is designed to, among other things, give providers more complete information about their patients and to deliver it faster. This year, the Mississippi Division of Medicaid began exchanging patient information in real time with Epic, the electronic records system adopted in 2012 by the state’s largest provider of Medicaid care to patients: UMMC. “Our new medical records system is one of the best things the Medical Center has done,” said Dr. Kimberly Crowder, chair of the Department of Ophthalmology, “but it adds to the stress. You have `êçïÇÉê to see the same number of patients, but there’s more accountability.” Lampton is less sanguine about EHR. “Computer systems on airplanes help a pilot be a better pilot and protect passengers,” he said. “Computers for physicians in our clinics and hospitals are built for billing. “The potential of computers is massive. In another decade they may help us take care of patients, but right now they’re still in their awkward teenage years, and they’re putting up barriers that paper never did.” The adoption of EHRs isn’t the

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only burnout combustible. The riddle of work/life “balance” may hark back to Hippocrates. Today, there is a pushback to try to equalize the scales, said Dr. Charles O’Mara, professor of surgery and associate vice chancellor for lÛj~ê~ clinical affairs. “The lack of an ability to commit to family or hobbies can contribute to burnout. Those outside relationships are extremely important to anybody. Younger physicians in particular understand that life means more than spending 90 hours at the hospital. “They have expectations of a lifestyle balance that older physicians did not have.” But it’s not necessarily a “balance,” said Dr. Molly Clark, associate professor and fellowship director in the Department of Family Medicine, a licensed psychologist and `ä~êâ mother of two school-age children. “I did choose a specialty and a role that allow for a lot of autonomy. But, with two kids, having balance depends on a joint effort between me and my husband. “Wherever you work, there will be difficulties and stressors. If it’s something you can’t change, then you have to learn to cope with it or leave that system. If you can change it, then work toward changing it. But, as for work-life balance, I don’t think it’s possible to have it all at any given time at work and in your personal life. This goes for women and men.” For men and women, the stressors are similar, said Crowder, the mother of three young children. “But during residency, females with families may feel even more guilt about time away from them. You hardly ever control your own hours.

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“I’ve told my residents that ophthalmologists tend to be happy people,” Crowder said. “We get to have relationships with our patients, and I believe that contributes to our well-being. The core of why I became a physician is still there: making things better for someone. “That continuity with your patients is what you envision when you’re thinking about becoming a physician.” Continuity is absent for the No. 1 burned-out specialty: emergency medicine. “It always tops the list,” said Jones, who has led UMMC’s Emergency Department since 2013. “Emergency medicine is physically and emotionally taxing. You’re dealing sometimes with difficult patients; intoxicated patients. Children who are injured or killed. “That’s different from oncologists, for instance, who get to know their patients over time. But, in the end, you can have the same problem, which is a patient’s death.”

aáëíêÉëë=íÉëí Beyond a vexing technology and work/life imbalance, accelerators of burnout and stress include government regulations, loss of autonomy and declines in physician reimbursement. “All of us have stress,” said Dr. Patrick Smith, UMMC professor of family medicine, chief faculty affairs officer and a clinical psychologist. The question is: Is it low-level stress or distress? To understand why stress is most distressing for modern-day physicians, Smith said, “Go to the money.” First of all, it costs more than ever to train a doctor. “People are coming out of medical school with the equivalent of a mortgage — without a house to show for it,” Smith said. Once in practice, they face a species of stress not encountered in the wilds of many other professions. “When a physician looks into a patient’s eyes and sees the fear,

jbaf`^i=drfab=OMNSJOMNT knowing they’re expected to provide answers, that is difficult, that is a heavy responsibility, and this happens every day,” Clark said. “We see very ill people all the time. In health care, not everyone experiences death and serious illness as much as we do.” Those traditional, age-old pressures have been compounded of late by the onus of reeling in costs, Smith said. “Health-care expenditures in this country will represent close to 21 percent of the gross domestic product by 2021, so they become a target.” At academic medical centers like UMMC, Smith said, where about 40 percent of the patients are uninsured or underinsured, cutting costs is a tall order. It becomes taller in Mississippi when you consider Medicaid, he said. “Medicaid was not expanded here, under the Affordable Care Act (ACA or Obamacare). So we’re providing a lot of unreimbursed care.” Physicians have to see more patients to make up for a decline in revenue, but have less time for each one — all while being pressganged to improve health outcomes. Or else, their compensation falls. Then, there’s Medicare revenue, sapped by cuts under the ACA. Finally, many physicians find they cannot afford to be independent any longer, Smith said, “so they become employees of a health system. “All these changes are contributing to burnout.” `çêåÄêÉ~Ç=~åÇ=íÉ~ How disgruntled are UMMC’s physicians? No burnout survey, as such, exists, but there is the Comprehensive Faculty Development Needs Assessment conducted from April to December in 2015. Tackling burnout did register as a need, if not a top priority, said Vickie Skinner, project manager for faculty affairs. “But I believe strongly that if we deal with the four issues faculty identified as top

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priorities, we will also address burnout and work/life balance,” she said. Those priorities: NK=jÉåíçêëÜáé, “which can help identify potential burnout early, and manage it,” Skinner said. OK=mêçãçíáçåLíÉåìêÉ, meaning evenhanded opportunities for advancement, with clearly stated guidelines. PK=`çää~Äçê~íáçå, that is, more of it across departments and schools. QK=oÉëÉ~êÅÜ=~åÇ=ëÅÜçä~êäó ëìééçêí, particularly more protected time to engage in these activities, a requirement for faculty promotions. In the January issue of the JMSMA, Dr. Daniel Edney, MSMA president, announced that Mississippi has been selected to serve as a pilot project state for the AMA’s new STEPS Forward program, aimed at helping physicians combat stress and “reignite professional fulfillment in their work.” Lampton, for one, is taking his own steps to do that. Like many other physicians, Lampton says that spending time with patients is where he finds joy in the practice of medicine. “I still believe medicine is the most important profession on the planet,” he said. “Physicians save lives every day. So it’s not only important to save our profession, but also to elevate it. “We have to find a way to restore that passion for taking care of patients, to remember why we became doctors in the first place.” For him, the answer lies in “reinventing” his practice. He has taken on nursing home and hospice care, which involves home visits. “It’s talking to people about their lives,” Lampton said. “It’s sitting down with them at the kitchen table, being served a glass of sweet tea with cornbread and field peas in a skillet on the stove. It’s having time to let them know I care about them. It’s listening to their hearts. These are the things that restore me.”n

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Using YouTube to fight HIV

r. Leandro Mena considers himself a shy person. He doesn’t do Facebook, and he barely tweets.

But his international reputation as an expert in the field of sexually transmitted infections has placed him in a sweeping social media spotlight. He's one of three “smart and sexy docs” answering questions on an array of topics in #AskTheHIVDoc, a YouTube-based series of short-form, question-andanswer videos in English and Spanish produced through the initiative Greater Than AIDS. Mena, a native of the Dominican Republic and associate professor of infectious diseases at the University of Mississippi Medical Center, and HIV/AIDS experts Dr. David Malebranche and Dr. Demetre Daskalakis give frank and information-packed answers to questions about sexually transmitted diseases — questions that many men who have sex with men (MSM) might never feel comfortable asking their own providers. “We do it in a straightforward, simple way,” said Mena, who joined the duo of Malebranche and Daskalakis in December 2015 and can be seen in the second season of #AskTheHIVDoc that debuted June 1 on YouTube. That's 23 English videos and an additional 11 narrated by Mena in Spanish. The nonprofit Kaiser Family Foundation created the

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branded campaign Greater Than AIDS; #AskTheHIVDoc is a part of that brand. “We just fell in love with him,” said Tina Hoff, the Kaiser Family Foundation's senior vice president and director of health communications and media partnerships. “He's not only incredibly knowledgeable and skilled as a clinician, but he's a warm person who feels so deeply passionate about what he's doing. He connects with his patients. He's everything we were looking for.” The trio takes on topics that include “Can I Get HIV if My Partner is Undetectable?” “Herbal Treatments?” “Can I Still Have Sex?” and “How Can I Find Help?” At the beginning of the season two videos, a smiling Mena tells viewers: “We're going to give you what you need.” The tone of the videos is some-

times playful and always engaging, but the underlying messages are tough in a society that's experiencing an HIV/AIDS epidemic. In the United States, Mena says, one out of every two black MSM will become HIV positive in their lifetime. Among Latino men, the figure is one out of four. And a recent Emory University study shows four of 10 MSM in Jackson have HIV, the highest rate in the nation. “That right there tells you that there's a need for this information,” said Harry Hawkins, field organizer for the Jackson office of the Human Rights Campaign, a civil rights organization dedicated to achieving LGBT equality. “There's an urgency to act and do something to change what might seem inevitable for a significant portion of the population,” Mena said.

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Using social media as the platform for the videos “gets the message across in a very effective way for the times we live in,” Hawkins said. “A lot of people who are infected are between the ages of 15 and 24.” The first season of #AskTheHIVDoc received 731,141 views on YouTube and another 405,302 on other social and digital platforms, Kaiser Family Foundation statistics show. The #AskTheHIVDoc messages empower not just MSM, but the caregivers whose lack of expertise in HIV and AIDS treatment leaves them struggling to answer their patients' questions and manage their overall health. “We're in a health-care system where many clinicians don't regularly ask their patients about their sexual behavior,” Mena said. “They're uncomfortable about having a conversation about sex and uncomfortable about discussing behaviors to decrease their risk.” But at the same time, Mena said, clinicians such as himself are trying to improve access to health care, especially to those most vulnerable to sexually transmitted infections.

The videos encourage discussions that can never be too basic — for example, the difference between AIDS and HIV or how people can become infected when they have sex. “We talk about how often you should be tested for HIV and what tests gay or bisexual men should have when they go to the doctor and when they should start treatment,” Mena said. “We talk about how safe certain practices are. “In clinic, I start by talking very frankly with my patients and breaking things down into the language that makes them comfortable. If you do that, you have a better chance to address their health needs,” Mena said. The three doctors also talk about PrEP, short for pre-exposure prophylaxis, a medication that works to keep the HIV virus from establishing a permanent infection. A pill that's taken once daily, PrEP targets those with an ongoing, substantial risk of HIV infection and, when taken consistently, can reduce risk of HIV in people who are at high risk by 92 percent, the Centers for Disease Control and Prevention says. “I've talked to folks in my job

Greenwood Commonwealth

and outside of my job that have been to doctors in this area who just don't know anything about PrEP,” Hawkins said. “There's a need for education when you have a patient coming to you who says, ‘I'm a sexually active gay male, and I want to get on this to protect myself.’” Brandon Brazzle of Jackson, one of Mena's patients, agrees. “People think you have HIV rather than these drugs trying to prevent it,” said Brazzle, 27, who is taking Truvada, the brand name of the drug that gained federal approval in the United States. “I had to explain to my family members that I wasn't HIV positive.” He regularly talks to friends about PrEP because it can help them with their sexual health. “It's kind of hard sometimes to take it up with your doctor, because they might not be used to seeing that kind of patient,” Brazzle said. The first #AskTheHIVDoc videos featured just Malebranche, an internal medicine physician with Georgia-based Wellstar Health Systems who also cares for inmates at the DeKalb County Adult Detention System in Mari-

Greenwood Commonwealth

etta, a suburb of Atlanta; and Daskalakis. But Daskalakis, assistant commissioner of the Bureau of HIV Prevention and Control at the New York Department of Health and Mental Hygiene, approached Mena about joining the team last fall when the two served as co-presenters at the U.S. Conference on AIDS. “It was a no-brainer,” said Malebranche, who has specialty training in HIV, AIDS and health needs of the LGBT community. “The additional bonus is him being from the Dominican Republic. He can not only do this in English but in Spanish so that we can reach a whole different audience.” Mena said yes to #AskTheHIVDoc but not without hesitation. “I'm kind of a shy person, but this is something important to reaching many people who might not otherwise have access to this information in a format that people can understand,” he said. “If people are educated, they will make better-informed decisions and in

jbaf`^i=drfab=OMNSJOMNT turn will have better health outcomes.” “We really like each other, and it's not super subtle,” Daskalakis said. “Although we come from different perspectives, we all come to the same conclusion — to give medical information related to HIV and sexual health in a way that's digestible, fun and brief. Leandro gets it, and his comfort level on #AskTheHIVDoc is great.” How education on MSM sexual health is delivered greatly needs improvement, said Dr. Thomas Dobbs, state epidemiologist with the Mississippi Department of Health. That agency runs the Crossroads Central Clinic in Jackson, which offers HIV testing, counseling and medical referral services. Mena serves as medical director at Crossroads, the only publicly funded clinic of its kind in the state. “There's been a lot of effort to get the word out,” Dobbs said. But one of the challenges, he said, is that many doctors see treatment

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of HIV patients as a specialty field. “It really needs to be addressed as part of core health. There's a role for every doctor in the state in HIV care. Everyone should be able to provide testing and have an awareness of the options in care.” That includes PrEP, Dobbs said. “It's probably not making a big impact right now,” he said of the drug. “Not enough people are on PrEP, but it holds a lot of promise. It's an underutilized opportunity.” Brazzle is a former Crossroads patient. “It was like my second home,” he said. “I feel comfortable in that environment, and they won't think my questions are silly or stupid.” “The fact of the matter is, with HIV and patients' adherence to their medications, it's very personal,” Malebranche said. “You have to scrap the old notions of being stoic and not giving patients your cellphone number. All of us embody that spirit. Dr. Mena's patients absolutely love him.” n

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Greenwood Commonwealth

The renal cost of smoking

he list of smoking-associated conditions continues to grow, according to University of Mississippi Medical Center researchers.

The study, published recently in the Journal of the American Heart Association, found that African-Americans who currently smoke cigarettes had an 83 percent higher incidence of rapid renal function (RRF) decline than never-smokers. “Cardiovascular and kidney diseases are closely linked, but few people are aware of the impact of smoking on kidney function,” said Dr. Michael Hall, assistant professor of medicine, cardiologist and lead study author. The study is among the first to examine the relationship between smoking and kidney dysfunction in African-Americans. Hall and cole~ää leagues followed 3,648 members of the Jackson Heart Study, the largest prospective cohort study of African-American cardiovascular health. They estimated glomerular filtration rate (GFR) at two visits several years apart. Glomeruli are the small blood vessel bundles that filter blood through the kidneys. “The function of the kidney is to clean the blood,” said Dr. Luis Juncos, professor of medicine, nephrologist and study co-author. “If the kidneys don't have enough filtration, the blood can-

not be adequately cleaned.” People with RRF decline had a 30 percent or greater decrease in GFR between the visits. This puts a person at risk for chronic kidney disease (CKD) and endstage renal disease (ESRD). People who smoked at least 20 cigarettes daily, a standard pack, had RRF decline 97 percent more often than never-smokers. Those who smoked less than a pack daily experienced RRF decline 75 percent more often than neversmokers. “There does seem to be a dosedependent effect, meaning patients who smoke more are at higher risk for having worsening kidney injury over time,” Hall said. African-Americans have four times the risk of ESRD than whites, attributed to higher rates of high blood pressure and diabetes. However, people of all races are susceptible to smoking's health risks. “It's important for those who have risk factors for kidney disease to realize that smoking is a significant risk factor and could ultimately end up leading to dialysis,” Hall said. “Once you have kidney disease, it exacerbates the risk of cardiovascular diseases.” Hall and colleagues also measured C-reactive protein, a marker for systemic inflammation. They found that current smokers had 38 percent more of the protein in their blood than never-smokers.

This could point to the way smoking affects the kidneys, but the study did not establish a cause-and-effect relationship. “There are numerous ongoing studies, including our own, that examine potential mechanisms by which smoking and nicotine cause renal injury, as well as whether it is reversible and how to best treat gìåÅçë it,” Juncos said. The study also pointed to the benefits of quitting. Past smokers had a similar risk of RRF decline to never-smokers when adjusted for age, sex and weight. This means it may be possible for past smokers to recover kidney function, Hall says. Although the study did not account for the length of time since quitting, future studies will. The American Heart Association says that a former smoker's excess risk of coronary heart disease decreases 50 percent one year after quitting. Their risk of developing several kinds of cancers decreases 50 percent five years after quitting. After 15 years, past smokers and never-smokers have the same risk of coronary heart disease. The study's findings can also inform tobacco policy and regulation. “Understanding how tobacco is adversely associated with rapid renal function decline in AfricanAmerican users has implications for product warnings and campaigns directed towards at-risk individuals,” said Dr. Thomas Payne, director of the UMMC ACT Center for Tobacco Treatment, Education and Research and study co-author. n

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