Medical Directory 2014 by Herald-Citizen

A2 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

M MEEDDIICCAALL D DIIRREECCTTOORRYY LIST OF ADVERTISERS BY SERVICE Aesthetic Services OF PHYSICIANS ON STAFF Fitness AT COOKEVILLE REGIONAL MEDICAL Nephrology CENTER • Dr. Laura Connelly ......................................21 • Lady Godiva Day Spa .................................31

• Little Gym......................................................30 • YMCA............................................................37

Allergy Clinics • Allergy, Asthma & Sinus Center ................43

Funeral Homes • Anderson-Upper Cumberland Funeral Home................................................45 AssistedLivingFacilities • Crestlawn Funeral Home.............................14 • Cedar Hills Senior Living Community. . . . . . .39 • Hooper, Huddleston & Horner Funeral • Heritage Pointe Senior Living......................34 Home..............................................................17 Audioprosthology / Hearing • Tennessee Hearing Instrument Specialists....9 • Upper Cumberland Ear, Nose & Throat.....48

Hospice • Caris Healthcare..............................................9 • Life House Residential..................................26

Chiropracitc • Back To Health..............................................39

Hospitals • Cookeville Regional Medical Center......24-25 • Cumberland Medical Center.................10, 36 • Jamestown Regional Medical Center..........46 • Cumberland River Hospital.........................18 • High Point Health..........................................30

Dentistry / Oral Surgery • Hayes Family Dentistry................................15 • Wheeler Orthodontics...................................41 • Cookeville Regional Dental..........................23 Dermatology • Highlands Dermatology & Surgical Assoc. .31 Drug Abuse Prevention • Power Of Putnam..........................................37 Elder / Home Health Care • Home Instead Senior Care.............................8 • Quality Home Health...................................27 • Health Access Plus.........................................11 • Careall Home Care.......................................23 • Cumberland River Homecare......................35 • Suncrest Home Health..................................47 Eye Care/O ptometry/O phthalmology • Eye Centers Of Tennessee.............................22 • Huddleston & Shepherd Family Vision. . . . . .13 • John Martin Epley, Jr. M.D.........................28 • Middle Tennessee Eye Associates.................46 • Center Of Vision............................................45 Family Practice • Innovative Family Care...............................34 • Joyce Health Care.........................................33 • Joseph Tokaruk.............................................32

Insurance • Health Benefit Solutions...............................26 • State Farm.....................................................12 • Mackie Financial...........................................37 • Nationwide.....................................................11 Medical Clinics • Satellite Med..................................................11 • Minor-Med Walk In Clinic...........................42 • Cookeville Medical Clinic.............................17 • Cumberland Center For Healthcare...........18 • Tier 1...............................................................20 • Cookeville Family Medicine.........................27 • Baxter Medical..............................................42 • Hometown Family Care................................47 Mental Health Services • Family Care Counseling...............................12 • Volunteer Behavioral Health........................43 • Personal Growth & Learning......................28 • Barbara Johnson, Office Of Counseling.......8 • Jamestown Regional Medical Center......9, 47 • Ten Broeck.....................................................39 Natural / Alternative Health Care • Pinnacle Health Care....................................42

• Dr. Mendirattta Sharma...............................40 OB-GYN • Highlands OB-GYN......................................45 Orthopedics • Tier 1.................................... ............................3 • Tennessee Spine & Joint...............................41 Pain Management • Comprehensive Pain Specialists................... 44 Pathology • Community Pathology.................................46 Pediatrics • Kids Kare.......................................................13 Pharmacy • Andy’s Pharmacy..........................................38 • Algood Drugs.................................................32 • Monterey Drugs.............................................35 Podiatrist • Family Foot Center.......................................26 Prosthetics / Orthotics • Tennessee Limb & Brace..............................15 Real Estate • Susan Johnson - First Realty........................21 Rehab/P hysical Therapy • Bethesda Health Care Center......................19 • NHC Health Care.........................................29 Skilled Nursing Facilities (Nursing Homes) • Overton County Nursing.............................33 • Signature Health Care Community.............16 • Life Care Center Of Crossville....................38 Surgical Centers • Middle Tennessee Surgical Specialists...........5 • Jamestown Regional Medical Center............9 • Cookeville Plastic Surgery............................40

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A3

The

TOP TIER in Orthopedic Care

John M. Turnbull, M.D.

Gregory J. Roberts, M.D.

James D. McKinney, M.D.

or more than three decades, Tier 1 Orthopedics (formerly Upper Cumberland Orthopedic Surgery) has specialized in

the care of our patients’ musculoskeletal systems — bones, joints, ligaments, muscles, nerves and related structures of arms, legs, IHJR HUK WLS]PZ 6\Y VY[OVWLKPJ Z\YNLVUZ HYL IVHYK JLY[PÄLK each having mature judgment, successful experience and high X\HSPÄJH[PVUZ ( JVTTP[TLU[ [V SLHKPUN LKNL VY[OVWLKPJ JHYL OHZ led to our being the primary provider of orthopedic services to Cookeville Regional Medical Center, which has received numerous

Philip Elizondo, M.D.

Carl M. Hollmann, M.D.

J. Keith Nichols, M.D.

#1 in Tennessee for Overall Orthopedic Services, 2012 - 2013 #1 in Tennessee for Joint Replacement, 2013 (TVUN [OL ;VW PU [OL 5H[PVU MVY 6]LYHSS 6Y[OVWLKPJ :LY]PJLZ (TVUN [OL ;VW PU [OL 5H[PVU MVY :WPUL :\YNLY` (TVUN [OL ;VW PU [OL 5H[PVU MVY 1VPU[ 9LWSHJLTLU[ Orthopedic Surgery Excellence (^HYK Joint Replacement Excellence (^HYK :WPUL :\YNLY` ,_JLSSLUJL (^HYK

orthopedic Healthgrades® awards, including . . .

Tier 1 Institute offers a comprehensive range of services PU H IYHUK UL^ JVU]LUPLU[ MHJPSP[` )LJH\ZL ^OLU P[ JVTLZ [V [VW SL]LS JHYL ^L NP]L V\Y WH[PLU[Z ÄYZ[ WSHJL

105 S. Willow Avenue, Suite 100

Cookeville, TN 38501

(931) 526-9518

Fax: (931) 372-0087

T1Institute.com

A4 —HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

M OR RY Y MEEDDIICCAALL D DIIRREECCTTO OF PHYSICIANS ON STAFF AT COOKEVILLE REGIONAL MEDICAL CENTER Allergy & Asthma

• LEWIS WILSON, JR., M.D.

Facial Plastic & Reconstructive Surgery

228 West Fourth Street, Suite 301, Cookeville, TN OF PHYSICIANS ON STAFF AT COOKEVILLE REGIONAL• DALE MEDICAL CENTER • ALBERT HENSEL, MD GUILLORY, M.D. 38501, 783-4269 220 N Oak St., Cookeville, TN 38501 – 520-1010 Anesthesiology • BLAKE BUTLER, M.D. 100 West Fourth Street, Suite 310, Cookeville, TN 38501, 528-7877 • ROBERT H. LANDRY, M.D. 100 West Fourth Street, Suite 310, Cookeville, TN 38501, 528-7877 • RODERICK LOVETT, M.D. 100 West Fourth Street, Suite 310, Cookeville, TN 38501, 528-7877 • STEPHENSISKO,M.D. 100 West Fourth Street, Suite 310, Cookeville, TN 38501, 528-7877 • GEORGE A. STARKWEATHER, M.D. 100 West Fourth Street, Suite 310, Cookeville, TN 38501, 528-7877

39 East First Street, Cookeville, TN 38501, 520-7520

E-N-T (Ear, Nose, Throat) •SCOTT H. KEITH, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 • MARK KRISKOVICH, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 •THOMAS L. LAWRENCE, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 • FREDERICK S. BRONN RAYNE, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 •GRANT ROHMAN, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 Emergency Medicine

Cardiology • MARIANO BATTAGLIA, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • STACY BREWINGTON, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • R. ALEX CASE, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • BRIAN DOCKERY, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • TIMOTHY FOURNET, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • THOMASLITTLE,M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405, 1-888-391-0048 • SCOTT REISING, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405, 1-888-391-0048 • GARY REYNOLDS, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • JOSHUA SPENCER, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405 1-888-391-0048 • MARK WATHEN, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405, 1-888-391-0048 Bariatric (Weight Loss) Surgery • CHARLES T. HUDDLESTON, M.D. 203 N. Cedar Avenue, Cookeville, TN 38501, 528-1992 Cardiology-arrhythmias/electrophysiology • MARK WATHEN, M.D. 228 West Fourth Street, Suite 200, Cookeville, TN 38501 372-0405, 1-888-391-0048

•MICHAEL DEBOER, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •WILLIAM GAILMARD, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •KEITH HILL, M.D. Cookeville Regional Medical Center, E.R., 528-2541

• MARK KRISKOVICH, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 • THOMAS L. LAWRENCE, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 • FREDERICK S. BRONN RAYNE, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 • GRANT ROHMAN, M.D. 100 West Fourth Street, Suite 200, Cookeville, TN 38501, 528-1575 Family Practice • MATTHEW BOLTON, M.D. 1120 Sam’s Street, Cookeville, TN 38501, 528-7312 • ERNEST BUCHANAN, M.D. 1101 Neal Street, Cookeville, TN 38501, 528-7797 • JAMES CATES, M.D. 1120 Sam’s Street, Cookeville, TN 38501, 528-7312 • HAROLD CHERTOK, D.O. 445 North Cedar Avenue, Cookeville, TN 38501, 5285787

•JAMES MULLEN, M.D. Cookeville Regional Medical Center, E.R., 528-2541

• GAMAL ESKANDER, M.D. 1150 Perimeter Park Dr., Cookeville, TN 38501, 5204900

•ROBERT PAASCHE, M.D. Cookeville Regional Medical Center, E.R., 528-2541

• JULIAN FIELDS, M.D. 866 East 10th St., Cookeville, TN 38501, 526-2155

•BRIAN SAMUEL, M.D. Cookeville Regional Medical Center, E.R., 528-2541

• STEVEN G. FLATT, M.D. 1101 Neal Street, Cookeville, TN 38501, 528-7797

•JOHN SHIELDS, M.D. Cookeville Regional Medical Center, E.R., 528-2541

• CHET GENTRY, M.D. 3300 Williams Enterprise Dr., Cookeville, TN 38501, 528-9222

•SHERIF SHOUKRY, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •SULLIVAN SMITH, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •WILLIAM SMITH, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •DANNY E. STRANGE, M.D. Cookeville Regional Medical Center, E.R., 528-2541 •DRUMMOND VOGAN, M.D. Cookeville Regional Medical Center, E.R., 528-2541 Cardiovascular Thoracic Anesthesiology • BRUCE JOHNSON, M.D. Cookeville Regional Medical Center 528-2541 • STEVE CLEMONS, M.D. Cookeville Regional Medical Center 528-2541 •JAN HERHOLDT M.D. Cookeville Regional Medical Center 528-2541

• JANE ANN GOTCHER, M.D. 1101 Neal Street, Cookeville, TN 38501, 528-7797 • AMY HIX, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 7835848 • THOMAS JENKINS, M.D. 445 North Cedar Avenue, Cookeville, TN 38501, 5285787 • PUSHPENDRA KUMAR (P.K.) JAIN, M.D. 225 North Willow Avenue, Cookeville, TN 38501, 5288899 • KENNY LYNN, M.D. 210 North Cedar Avenue, Cookeville, TN 38501, 5287418 • CRYSTAL MARTIN, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 7835848 • CEDRIC PALMER, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 7835848

Endocrinology

• CAROLYN ROSS, M.D. 120 Walnut Commons Lane, Cookeville, TN 38501, 5282557

Cardio - Thoracic Surgery • G. TODD CHAPMAN, M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269

• ROHINI KASTURI, M.D. CRMC Diabetes Center, 127 N. Oak, Cookeville, TN 38501 783-2648

• PAM SANDERS, M.D. 3300 Williams Enterprise Dr., Cookeville, TN 38501, 528-9222

• TIMOTHY POWELL, M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269

• JOSEPH TOKARUK, M.D. 109 West Sixth Street, Cookeville, TN 38501, 372-1885

• PARDEEP K. SHARMA, M.D. 221 North Oak, Cookeville, TN 38501, 646-0880 • C. GRAY SMITH, M.D. 400 Crawford Avenue, Monterey, TN 38574, 839-2224

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A5

A6 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

M OR RY Y MEEDDIICCAALL D DIIRREECCTTO OF PHYSICIANS ON STAFF AT COOKEVILLE REGIONAL MEDICAL CENTER • JAMES STAGGS, D.O. 753-B Humble Drive, Cookeville, TN 38501, 520-1800

•JACK CAREY, M.D.

• BRIAN WAGGONER, M.D.

• HUNTER STENZEL, D.O. 128 North Whitney Avenue, Cookeville, TN 38501, 783-5848

•TATIANA CHESNUT, M.D. Cookeville Regional Medical Center, 528-2541

Medical Oncology

• KIM TABOR, D.O. 753-B Humble Drive, Cookeville, TN 38501, 526-4600

•APRYL HALL, M.D. PEDIATRICS Cookeville Regional Medical Center, 528-2541

Gastroenterology

•XIANGKE HUANG, M.D. Cookeville Regional Medical Center, 528-2541

345 West Broad St., Cookeville, TN 38501, 528-2300 Cookeville Regional Medical Center, 528-2541 OF PHYSICIANS ON STAFF AT COOKEVILLE REGIONAL MEDICAL CENTER

• MAAN ABARI, M.D. 438 North Whitney Avenue, Cookeville, TN 38501, 783-2616 • PHILLIP BERTRAM, M.D. 438 North Whitney Avenue, Cookeville, TN 38501, 783-2616 • JOYCE BREMER, M.D. 438 North Whitney Avenue, Cookeville, TN 38501, 783-2616

• WARIT JITHPRATUCK, M.D. Cookeville Regional Medical Center, 528-2541 •RON JOHNSON, M.D. Cookeville Regional Medical Center, 528-2541 •KIM LANGLEY, M.D. PEDIATRICS Cookeville Regional Medical Center, 528-2541

• PAUL JACQUIN, M.D. CRMC Cancer Center, 1 Medical Center Boulevard, Cookeville, TN 38501 783-2497 • HEMAMALINI KARPURAPU, M.D. CRMC Cancer Center, 1 Medical Center Boulevard, Cookeville, TN 38501 783-2497 • VENUMADHAV KOTLA, M.D. CRMC Cancer Center, 1 Medical Center Boulevard, Cookeville, TN 38501 783-2497

•GUILLERMO MANTILLA, M.D. Cookeville Regional Medical Center, 528-2541

• ALGIS SIDRYS, M.D. CRMC Cancer Center, 1 Medical Center Boulevard, Cookeville, TN 38501 783-2497

• MICHAEL ZELIG, M.D. 438 North Whitney Avenue, Cookeville, TN 38501, 783-2616

•DALIA MILLER, M.D. (neurohospitalist) Cookeville Regional Medical Center, 528-2541

Nephrology

General Surgery

•FRANK PERRY, M.D. Cookeville Regional Medical Center, 528-2541

• LEE RAY CROWE, M.D. CRMC Professional Office Building, Suite 201, Cookeville, TN 38501, 783-5848

• LORRIE HENSON, M.D. 137 West Second Street, Suite 103, Cookeville, TN 38501 520-4887

• SCOTT A. COPELAND, M.D. 203 North Cedar Avenue, Suite A, Cookeville, TN 38501, 528-1992 • BRIAN GERNDT, M.D. 203 North Cedar Avenue, Suite A, Cookeville, TN 38501, 528-1992 • CHARLES T. HUDDLESTON, M.D. 203 North Cedar Avenue, Suite A, Cookeville, TN 38501, 528-1992 • GEORGE L. IVEY, III, M.D. 340 North Cedar Avenue, Cookeville, TN 38501, 528-6496 • JEFFREY McCARTER, M.D. 203 North Cedar Avenue, Suite A, Cookeville, TN 38501, 528-1992

•FELICIA SCALES, D.O, Cookeville Regional Medical Center, 528-2541 •REBEKAH SPROUSE, M.D. Cookeville Regional Medical Center, 528-2541 •AYUK TABI, M.D. Cookeville Regional Medical Center, 528-2541 •LORI THOMAS, M.D. Cookeville Regional Medical Center, 528-2541 •JAY TURKEWITZ, M.D. (neurohospitalist) Cookeville Regional Medical Center, 528-2541 Infectious Diseases

• JEFF MOORE, M.D. 203 North Cedar Avenue, Suite A, Cookeville, TN 38501, 528-1992

•MARK PIERCE, M.D. CRMC Professional Office Building, Suite 202, Cookeville, TN 38501 783-5848

• KENNA WILLIAMS, M.D. 1120 Sam’s St., Suite A, Cookeville, TN 38501, 528-7312

Internal Medicine

Geriatrics

•ROY ANDERSON, M.D. 201 West Fifth Street, Cookeville, TN 38501, 526-1688

• KATHERINE BERTRAM, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 783-5848 • PARDEEP K. SHARMA, M.D. 146 South Willow Avenue, Cookeville, Tn 38501, 646-0880

•REXFORD AGBENOHEVI, M.D. 315 North Washington Ave., Suite 109, Cookeville, TN 38501 372-8668

Hematology

•DAWN BARLOW, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 783-5848

• PAUL JACQUIN, M.D. CRMC Cancer Center, 1 Medical Center Blvd., Cookeville, TN 38501 783-2497

•KATHERINE BERTRAM, M.D. 128 North Whitney Avenue, Cookeville, TN 38501, 783-5848

• HEMAMALINIKARPURAPU,M.D. CRMC Cancer Center, 1 Medical Center Blvd., Cookeville, TN 38501 783-2497 • VENUMADHAV KOTLA, M.D. CRMC Cancer Center, 1 Medical Center Blvd., Cookeville, TN 38501 783-2497 Hospice&PalliativeCare • ChetGentry,M.D. 3300 Williams Enterprise Dr., Cookeville, TN 38501, 528-9222 Hospitalists • PIERCE ALEXANDER, M.D. Cookeville Regional Medical Center, 528-2541

• FREEDOM IKEDIONWU, M.D. CRMC Professional Office Building, Suite 201, Cookeville, TN 38501, 783-5848 • ANJU MENDIRATTA, M.D. 221 North Oak Avenue, Cookeville, TN 38501, 646-0880 Neurology • DANIEL DONOVAN, M.D. 105 North Cherry St., Cookeville, TN 38501, 528-5811 • RANDY GAW, M.D. CRMC Professional Office Building, Suite 201, Cookeville, TN 38501 783-5848 • THUY T. NGO, M.D. 315 N. Washington Ave., Suite 201, Cookeville, TN 38501, 528-5633 Neurosurgery • JOSEPH JESTUS, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 372-7716 • LEONARDO R. RODRIGUEZ-CRUZ, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 372-7716 Obstetrics/Gynecology • MICHAEL P. CASAL, M.D. 1080 Neal Street, Suite 200, Cookeville, TN 38501, 520-1529, (931) 823-9970

•CHRISTOPHER DILL, M.D. 1120 Sam’s St, Cookeville, TN 38501, 528-7312

• MICHAEL COLE, M.D. 317 North Hickory Avenue, Cookeville, TN 38501 528-7527 or 1 (800) 897-1898

•DOUG DYCUS, M.D. 3698 Grundy Quarles Hwy., Gainesboro, TN 38562, 268-3224

• LAURETTA CONNELLY, M.D. 109 West Sixth Street, Cookeville, TN 38501, 528-6945

•TIM FLYNN, M.D. 201 West Fifth Street, Cookeville, TN 38501, 526-1688 •ABHAY KEMKAR, M.D. 441 Sewell Road, Sparta, TN 38583, 931-837-9048 •ANJU MENDIRATTA, M.D. 221 North Oak Avenue, Cookeville, TN 38501, 646-0880 • JOSEPH TOKARUK, M.D. 109 West Sixth Street, Cookeville, TN 38501, 372-1885 •AUDREY TOLBERT, M.D. 345 West Broad St., Cookeville, TN 38501, 528-2300

• BERT GEER, M.D. 100 W. 3rd Street, Cookeville, TN 38501, 528-9047 • PAIGE GERNT, M. D. 317 North Hickory Avenue, Cookeville, TN 38501 528-7527 or 1-800-897-1898 • CHRISTINE PHAM, M.D. 317 North Hickory Avenue, Cookeville, TN 38501 528-7527 or 1 (800) 897-1898 • MICHAEL S. PIPPIN, M.D. 317 North Hickory Avenue, Cookeville, TN 38501 528-7527 or 1 (800) 897-1898

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A7

M OR RY Y MEEDDIICCAALL D DIIRREECCTTO OF OF PHYSICIANS PHYSICIANS ON ON STAFF STAFF AT AT COOKEVILLE COOKEVILLE REGIONAL REGIONAL MEDICAL MEDICAL CENTER CENTER • JOSERIVERO,M.D. 406 North Whitney, Suite 4, Cookeville, TN 38501, 400-0231 • HARRY STUBER, M.D. (Gynecology Only) 503 North Cedar Avenue, Cookeville, TN 38501, 372-1746 Oral&MaxillofacialSurgery • ROBERT E. BROOKSBANK, D.D.S 33 West Third Street, Cookeville, TN 38501, 528-6252 • TERRELL JONES, D.M.D. 920 South Willow Avenue, Cookeville, TN 38501, 525-6059 Orthopedics • PHILIP ELIZONDO, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 526-9518 • CARL M. HOLLMANN, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 526-9518 • JAMES D. McKINNEY, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 526-9518 • GREGORY ROBERTS, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 526-9518 • JONSIMPSON,M.D. 118 Brown Avenue, Suite 103, Crossville, TN 38555, 931-484-8861 • JOHN TURNBULL, M.D. 105 South Willow Avenue, Cookeville, TN 38501, 526-9518

• CHRISTOPHER CLIMACO, M.D. 758 South Willow Avenue Cookeville, TN 38501, 526-6173 • LLOYD D. FRANKLIN, M.D. 150 North Willow Avenue, Cookeville, TN 38501, 528-1485 • CHET GENTRY, M.D. 3300 Williams Enterprise Dr., Cookeville, TN 38501, 528-9222 • APRYL HALL, M.D. Cookeville Regional Medical Center, 528-2541 • CARRIE LOGHRY, M.D. 150 North Willow Avenue, Cookeville, TN 38501, 528-1485 • CEDRIC PALMER, M.D. 128 N. Whitney Avenue, Cookeville, TN 38501, 783-5848 • MARIA TERESA S. RAMOS, M.D. 758 South Willow Avenue, Cookeville, TN 38501, 526-6173 • LESLIE TREECE, M.D. 150 North Willow Avenue, Cookeville, TN 38501, 528-1485 • NEIL TREECE, M.D. 150 North Willow Avenue, Cookeville, TN 38501, 528-1485 Pediatric Cardiology • CHRISTOPHER CLIMACO, M.D. 758 South Willow Avenue, Cookeville, TN 38501, 526-6173

• JOSUE MONTANEZ, M.D. CRMC Imaging Department,, 783-2686 Rheumatology • SANGEETHA PABOLU, M.D. CRMC Professional Office Building, Suite 201, Cookeville, TN 38501 783-5848 Sleep Medicine • DAVID HENSON, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 783-2143

Plastic Surgery

• G. TODD CHAPMAN, M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269

• DALE GUILLORY, M.D. 39 East First Street, Cookeville, TN 38501, 520-7520

• TIM J. COLLINS, M.D. 115 Peachtree Avenue, Cookeville, TN 38501, 528-2836

Pulmonology/Critical Care

• SAMUEL GLASGOW, M.D. 115 Peachtree Avenue, Cookeville, TN 38501, 528-2836

• BERNADETTE HEE, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 783-2143

• TIMOTHY POWELL, M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269 • LEWIS WILSON, JR., M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269 Urology • QUINTON CANCEL, M.D. 320 North Oak Avenue, Cookeville, TN 38501, 528-5547 • TIMOTHY R. COLLINS, M.D. 254 West Seventh Street, Cookeville, TN 38501, 520-6270

• DAVID J. HENSON, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 520-1696

• LEE S. MOORE, M.D. 320 North Oak Avenue, Cookeville, TN 38501, 528-5547

• HIMA KONA, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 783-2143

• G. TODD CHAPMAN, M.D. 228 West Fourth Street, Suite 301, Cookeville, TN 38501, 783-4269

• NDUBUISI OKAFOR, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 783-2143

• JASONNOLAN,M.D. 115 N. Peachtree Avenue, Cookeville, TN 38501, 528-2836

• VIJAY RUPANAQUDI, M.D. CRMC Professional Office Building, Suite 102, Cookeville, TN 38501 783-2143

Pediatrics

Radiation Oncology

• JAMES BATSON, M.D. 150 North Willow Avenue, Cookeville, TN 38501, 528-1485

• ALGIS SIDRYS, M.D. CRMC Cancer Center 1 Medical Center Boulevard, Cookeville, TN 38501, 783-2497

• SATYA CHAKRABARTY, M.D. 435 North Cedar Avenue, Cookeville, TN 38501, 526-6100

• SPENCER MADELL, M.D. CRMC Imaging Department, 783-2686

Thoracic Surgery

• CYNTHIA RECTOR, M.D. - TEN BROECK TENNESSEE, CRMC, 1 Medical Center Blvd., Cookeville, TN 38501, 783-2570

• WALTER DICKSON MOSS, III, M.D. 115 Peachtree Avenue, Cookeville, TN 38501, 528-2836

• JASON HARDIN, M.D. CRMC Imaging Departmen, 783-2686

• THOMAS GANNON, D.O. 427 N. Willow Avenue, Suite 4, Cookeville, TN 38501, 854-9393

• DON ASBERRY, M.D. 115 Peachtree Avenue, Cookeville, TN 38501, 528-2836

• MEIKLEJOHNMcKENZIE,D.O. 115 Peachtree Avenue, Cookeville, TN 38501, 528-2836

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A8 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Tomotherapy less invasive cancer treatment By LaUra mILITaNa

treatment.” Clay County’s Ray Norris can attest to the benefits of the tomotherapy machine. “I have been through cancer a couple of times before and this, by far, is the easiest treatment,” he said. He was diagnosed with prostate cancer in late 2008 and went through tomotherapy treatments for eight weeks. “It was done on my schedule,” he said. “I

HERALD-CITIZEN Staff

COOKEVILLE — Less side effects and more effective treatment. That’s what Dr. Jonas Sidrys, oncologist with Cookeville Regional Medical Center’s Cancer Center, says about the latest cancer treatment available at CRMC. “It’s like a CAT scan machine on steroids,” he explained of the tomotherapy system, which has been used at CRMC for the last five years. “I was immediately impressed with the decrease of side effects and the results that came from treatment,” Sidrys said. It’s a new type of radiation therapy that employs a technique called IMRT (intensity-modulated radiation therapy) and delivers thousands of beamlets of strength that converge on the target to control the dosage. It is best used to treat prostate cancer (intact prostates or on prostate bed), head and neck cancers (namely tonsil and throat cancers to protect the salivary glands), pancreatic cancers and certain brain cancers. “It depends on the location of the tumor that determines the treatment,” Sidrys ex-

had no side effects either.” In 1998, he was diagnosed and treated for skin cancer and 10 years later, was diagnosed and treated for colon cancer. “I went through 11 months of chemotherapy,” he recalled. “When the prostate cancer occurred, I knew I had enough surgery. I read about radiation treatment and decided See TomoTherapy, page 9

Barbar a J. Johns on Licens e d Clinical S o cial Worker a tomotherapy device.

plained. Each session takes around five minutes, five days a week for around seven weeks of treatment. CRMC is one of two hospitals in the state to have a tomotherapy machine. The other is in Knoxville. “I had one patient drive 4,875 miles for tomotherapy treatment,” Sidrys said. “It is ultraprecise and determines on the patient’s position each time for optimal

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MEDICAL DIRECTORY

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Laura Militana | Herald-Citizen

Dr. Jonas Sidrys, oncologist with Cookeville Regional Medical Center’s Cancer Center, is pictured with Ray Norris, tomotherapy patient.

TOMOTHERAPY: Less invasive cancer treatments

treatments. “It’s been a great experience,” Norris said. to go this route.” “I’ve also become very competent in eduSidrys reported that Norris’ PSA levels cating my sons about prostate cancer and the have steadily dropped since the tomotherapy different treatments that are available.” From Page 8

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A-10 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Immunizations key to immunity-building By LAURA MILItANA HERALD-CITIZEN Staff

COOKEVILLE — Just a century ago, babies and children were dying from smallpox, polio and pertussis, among many other diseases rarely heard about today. “We’ve come a long way,” Dr. Apryl Hall, pediatric hospitalist at Cookeville Regional Medical Center, said. “This is the number one key public health issue and the number one issue the U.S. has won over the years.” According to the Centers for Disease Control, cases of polio and diphtheria in the U.S. are becoming more and more rare, thanks to the vaccine. “We’ve come a long way in a very short period of time,” Dr. Hall said. There are numerous benefits to getting the vaccines, she said. “It protects the young children who may be around those children who are not vaccinated,” she explained. “Herd immunity is waning due to the fact that there are more unvaccinated children.” She also noted that people are coming in See ShotS, Page 11

this is a schedule of immunizations recommended for children from birth through six years old recommended by the Centers for Disease Control and the American Academy of Pediatrics.

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-11

MEDICAL DIRECTORY

SHOTS: Winning a medical battle with disease VKDB is that it occurs in perfectly healthy babies and it happens spontaneously. Bleeding can present in many ways, ranging from mild to fatal. Skin bruising, bleeding into mucosal tissues (mouth, nose, throat, intestine, uterus, urethra), bleeding at the umbilical stump or circumcision site, and bleeding into the brain can all happen. “Vaccines are available to anyone at any

From Page 10 from other countries and may not have the immunities necessary to fight these diseases off. “(Other countries) don’t have the vaccines that we do,” she noted. “The U.S. is leading the way in this field.” It’s also important for expectant mothers to get vaccines. One important vaccine that children get right off is the Hepatitis B shot. “It’s very contagious and very bad,” Dr. Hall explained. “It can lead to liver failure, chronic liver infection and even liver cancer.” She also noted that children can go blind from contracting the measles. “If an pregnant mother contracts rubella, there can be numerous birth defects with the baby,” she said. Some parents might have concerns that their child would have an allergic reaction to vaccines. “That’s very rare,” Dr. Hall explained. “The benefits outweigh the risks.” If your child does get sick from any vaccine, it’s simply a method of the body building up antigens to fight the disease or virus. Another concern might be that the child might develop a disorder, such as autism. “That’s been completely debunked,” Dr. Hall said. “It’s no longer a concern in the medical community.” Every vaccine has hundreds of antigens. “The vaccines are very safe and has been studied extensively,” she said. Another very important shot, but not necessarily a vaccine, administered at birth is the Vitamin K shot. Vitamin K’s primary role is in blood clotting. Newborns are deficient in Vitamin K. It does not transfer across the placenta and the immature liver cannot store it. It also is not sufficient in breast milk. Last year, the Tennesseean reported that a

doctor’s office or pharmacy,” Dr. Hall said. “There’s zero excuse to not getting them. With the immunizations, the baby becomes an immunity-building machine and, therefore, affects everyone around them.” For more information about vaccines, their ingredients and a timeline as to when a vaccine should be administered, visit www.cdc.gov/vaccines/default.htm.

Laura Militana | Herald-Citizen

Angie Houston, RN in the Cookeville Regional Medical Center’s nursery, prepares to administer a Hepatitis B vaccine to a newborn.

few babies were re-admitted to Vanderbilt with significant bleeds because the parents rejected the Vitamin K shot. Without supplementation, newborns are at risk for a potentially devastating condition known as Vitamin K-deficient bleeding (VKDB). VKDB is a better designation because life-threatening bleeds can occur as late as 3 months of age, particularly in breastfed babies who did not receive an intramuscular dose of vitamin K on the first day of life. Most bleeding occurs during the first week, however.

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A-12 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY Closing the gap: Mental health services and the Latino community COOKEVILLE — Are fewer Latinos benefiting from mental health services? According to Familycare Counseling Services in Cookeville, that may be the case. Between 2007 and 2013, FCCS, which provides psychotherapy through clinician Annette Gallardo LPC, became aware that few referrals came from the Latino community. Gallardo pointed out that for many Latino patients, the first contact with mental health services is through a non-bilingual psychotherapist who is trying to diagnose using an interpreter. “Psychotherapy through an interpreter is possible but not ideal due to several issues,” Gallardo said. “For example, issues including language and culture differences between the therapist and patient and issues of therapy in a triadic situation involving group dynamics.” To explore this further and identify possible barriers preventing these individuals from getting effective treatment for mental health issues in the primary care settings, Gallardo, who is a bilingual clinician, conducted a twoyear survey and collected feedback from FCCS’s Latino patients. She established a general overview of this community and existing issues: Referrals

Appropriate referrals to mental health services are the biggest barriers, according to Gallardo. “Latino patients stated that it took them between eight months and a year to find out about FCCS,” she said. “Most stated they had no idea Cookeville had a community mental health facility providing bilingual services.” Disconnectedness “A strong sense of community within this culture is highlighted by significant feelings of disconnectedness, which are due to communication difficulty and a lack of written material translated in to Spanish language,” Gallardo said. Trust and support Initially, there is difficulty establishing oneto-one rapport, trust and the ability to provide support, according to Gallardo. Stigma “Lack of acceptance and stigma regarding mental health is significant among the Latino community,” Gallardo concluded. What is the role of FCCS in the community as a bilingual and bicultural mental health facility? To facilitate a “healthy mutual adjustment process” between medical providers and mental health services. “As soon as patients are referred to us, we

take care of their mental health issues,” Gallardo said. “We are able to understand their cultural identity. Assessments and evaluations are administered in their own native language that allows the patient to provide important information about their emotional state.” Bilingual family sessions help to integrate the family, and for younger children, play therapy in their own language provides a supporting and validating environment for

addressing any necessary issues, Gallardo added. “As with all medical and mental health providers, it is our responsibility to let our Latino community know there is help for them — help that is provided in their native language, so they can start to benefit from the very first day of therapy.” FCCS is located at 1437 N. Washington Ave., Cookeville. To learn more, call 931372-9915 or visit www.familycare-cs.com.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-13

MEDICAL DIRECTORY

CRMC adds neurohospitalist By LAUrA MILItANA HERALD-CITIZEN Staff

COOKEVILLE — Dr. Jay Turkewitz has been a busy guy since he joined the physicians at Cookeville Regional Medical Center about six months ago. As the hospital’s second neurohospitalist, he is bringing a new level of care to the region. “This is a field which really developed in the 1990s,” he explained. “We’re responsible for a different branch of neurology in that we deal with aspects of neurology that lead people into a facility, from strokes, seizures, meningitis, severe incapacitating headaches, sometimes Multiple Sclerosis — these are things that require hospitalization, and a neurohospitalist focuses on the acute care and stabilization of serious neurologic problems and determines the best method to stabilize the patient and to move them when appropriate to a setting of lesser intensity, whether that’s home or a rehabilitation facility, depending on the patient.” He was born in New York, went to medical school in Boston, trained in New York and spent many years in New Orleans at Charity Hospital until Hurricane Katrina hit. “Social circumstances brought me here to this wonderful facility,” he said. “The community is very for-

tunate to have the excellence demonstrated in the skill of the physicians and the staff as a whole here.” Dr. Turkewitz joins Dr. Dalia Miller, who was the single neurohospitalist for a long time. While at Charity Hospital, Dr. Turkewitz focused on the in-patient population and oversaw the majority of inpatient coverage. turkewitz “It was really teaching, but supervising the care of patients in the hospital,” he said. “Our greatest interaction we have on a daily basis is with the emergency room physicians and having a wonderful ER staff to work with is something that every neurohospitalist looks at in making a decision as to where they want to be working. The ability to have not only skilled and expert people, but experienced people who have ties to the community, (is essential). Things are so collegial here.” Neurology happened to be his first fourth-year elective. “The thing that attracted me to it was the fact that See Stroke, Page 18

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A-14 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Mayor now limp-free thanks to knee replacement By aMy DaVIS HERALD-CITIZEN Staff

MONTEREY — He sports a small scar on his left knee – a reminder of the titanium parts underneath. And the pain that once plagued him. “It just wore me out to walk,” said Monterey Mayor Richard Godsey, thinking back to just over two months ago when even a stroll across the lawn proved to be a tedious task. “It was just bone on bone,” he recalled. Which wasn’t much good for getting around. “It was just real sore,” he said. “It didn’t hurt sitting; it didn’t hurt sleeping. But it did hurt when I was standing on it, walking or working.” And when he had to walk, it was with a limp – even though Godsey said he’s never suffered any hard licks or accidents to damage his knees. But he had spent many a day on the racquetball court, which he believes contributed to problems with both of his knees, especially his left.

Monterey Mayor richard Godsey, left, who has been out of work and recovering from total knee replacement surgery since late November, enjoys a visit with physical therapist Larry Burks at Putnam Physical Therapy Services. Ty Kernea | Herald-Citizen

See Mayor, Page 15

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-15

MEDICAL DIRECTORY

MAYOR: Monterey mayor now stands on his own From Page 14 “I’m dominant left and played racquetball for years, and you pivot on that knee, which wears it out quicker,” he said. To help deal with the pain, Godsey had tried such things as cortisone shots and “rooster” shots, but eventually none of it helped. Finally, after around three years of pain, doctors convinced Godsey to undergo total knee replacement surgery. “They told me that was the only thing that would help me,” he said. Which wasn’t good news for him. “I dreaded it,” he said. “But, of course, there wasn’t any other option.” Godsey’s journey began Nov. 22 at Centennial Medical Center in Nashville. It was there that titanium and polyethylene plastic parts were added to just the right places to make for an easy glide between bones that previously had no cushioning between them. “Everything in between was gone,” Godsey recalled. “On x-ray, you couldn’t even see daylight between either one.” Godsey’s physical therapist, Larry Burks, who he now sees three days a week, explained the process further:

Ty Kernea | Herald-Citizen

Encouraging Monterey Mayor Richard Godsey, center, in his recovery from total knee replacement surgery are Putnam Physical Therapy Services staff members, from left, physical therapists Matthew and Rachel Grubb, and, after Godsey, Lindsey Kirby, PT tech; and Larry Burks, PT.

“Basically, they go in and lay back the kneecap,” he said. “They smooth the undersurface off and put a plastic piece on there so it will glide smoothly over the prosthesis.” After the surgery, Godsey spent a couple of weeks at NHC Healthcare in Cookeville for daily physical and occupational therapy to

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help with some medical complications due to his diabetes. “My blood sugar went crazy,” Godsey said. “They said that was normal and helped me regulate it. I didn’t have to go; I chose to go.” After that, he went on home to Monterey to continue his therapy regiments there

while also seeing his physical therapist in Cookeville. “One of the most important things with total knee replacement patients early on is to get their motion – trying to get the knee to bend and straighten out,” Burks said. “You want to make sure it’s straight and that it bends to about 120 to 130 degrees. “Also, the quadriceps muscle often is weak after surgery, and you want to put a lot of emphasis on strengthening it or whatever muscles might be weak, whether at the hip or the knee or the ankle.” Swelling is also typical and can be helped with a lot of icing and elevation. Burks added, “Doctors usually recommend they walk about five minutes every hour or two during the day – frequent short walks.” Godsey has been following doctors’ orders and feels good with the results so far, even though he’s been told it typically takes nine months to a year before the knee begins to feel “normal” again. “It’s great!” he said. “It doesn’t bother me at all to stand on it or walk.” Which means soon he’ll be able to get back to managing his town. “I’m anxious to get back,” he said. “They need me!”

A-16 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

CRMC, Vanderbilt making strides in partnership By LAURA MILITANA HERALD-CITIZEN Staff

COOKEVILLE — It’s been more than a year now since the partnership between Vanderbilt University Medical Center and Cookeville Regional Medical Center was finalized. And a lot has happened in that time, Paul Korth, chief executive officer of Cookeville Regional Medical Center, said. “Probably the newest event is the fact that we’ve changed insurance parties to join with Aetna through Vanderbilt’s network,” Korth said. “That went pretty smoothly, from what I understand.” This is part of the Vanderbilt Health Affiliated Network, the largest provider-organized network of doctors, regional health systems and other health care providers in Tennessee and seven surrounding states. Network providers actively collaborate to provide patients with high-quality, efficiently coordinated and cost-effective health care services. This network began organizing in 2010 with the announcement of a local clinically integrated network that then included

Ty Kernea | Herald-Citizen

The 100 W. 4th Street building is where Vanderbilt will be operating a pediatric clinic, with hopes of opening in February. Williamson Medical Center, Maury Regional countable Care Organization,” Korth exMedical Center and NorthCrest Medical plained. “It’s all about saving healthcare dolCenter. lars.” “This is all part of an integrated health netThe long-term objective is to be able to work that has the same elements as an Ac- offer a product through Aetna’s brokers to

companies in the community to give them a new choice in health insurance. “It’s a cost-sharing savings program,” he said. On the clinical side, patient referrals are much easier. “We transfer fewer than two percent of patients overall, but the majority are from the emergency department and are psychiatric cases,” he said. Also with this partnership, cancer research will be tied in through the medical university. “There’s a great cancer center here with great physicians,” he said. One big piece of news is the fact that Vanderbilt will be renting space to open an outpatient pediatric clinic for cardiology, general surgery and urology. “Hopefully, the clinic will begin in early February,” he said. “It’s a necessary and needed service.” It’s also a service for those who want a choice in their child’s care. “It’s hard to travel to Nashville for treatment,” he said. “There’s a lot more to come with this partnership. We’re all looking forward to it.”

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-17

MEDICAL DIRECTORY E-cigarettes cause concern among health professionals By LAURA MILITANA HERALD-CITIZEN Staff

COOKEVILLE — It’s the new rage — electronic cigarettes. But what exactly is in the vapor that is emitted from the cigarette-like packaging? “According to the Centers for Disease Control, we don’t know what’s in them,” Colleen Schabacker, director of the respiratory therapy unit at Cookeville Regional Medical Center, said. “You’re still inhaling a vapor.” The major concern is the fact that the Food and Drug Administration does not regulate what goes into the vials. “It’s also been found that the usage of e-cigarettes has doubled in middle schoolers,” Kyle Allmond, PharmD, said. “This may become a gateway drug into smoking.” According to the e-cigarette documentation, different levels

of nicotine can be inserted into the vials, which heat up and allows the user to fell like they are smoking, but actually emitting a water vapor. “It’s the nicotine that’s the addicting element, but the tar is what is damaging,” Schabacker explained. “Sure, there’s no second hand smoke with an e-cig, but since it’s not regulated, we don’t know what’s in it.” Some reports have found carcinogens in the vapor, but with so many types of e-cigarettes on the market, it’s hard to break it down. “There’s also the concern that since they are operated by battery that the battery could overheat or spark, causing injury,” Allmond noted. CRMC policy states that employees, patients and patient families cannot smoke e-cigarettes on the hospital campus, something that was put into effect last year.

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This is one of the many electronic cigarettes on the market. Ty Kernea | Herald-Citizen

A-18 â&#x20AC;&#x201D; HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. â&#x20AC;&#x201D; www.herald-citizen.com â&#x20AC;&#x201D; Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Benefits to carrying baby to at least 39 weeks Local OBs are encouraging women to wait until at least 39 weeks in the pregnancy to deliver the baby, as long as the mother and baby are healthy.

By LAURA MILITANA HERALD-CITIZEN Staff

COOKEVILLE â&#x20AC;&#x201D; The new initiative to encourage women to carry babies to at least 39 weeks is having an impact, according to local OB/GYN Jose Rivero of Highlands OB/GYN. â&#x20AC;&#x153;The number of women who have had premature deliveries has dropped,â&#x20AC;? he said. â&#x20AC;&#x153;It was a real problem.â&#x20AC;?

Amy Davis | Herald-Citizen

Itâ&#x20AC;&#x2122;s a challenge to convince women to do this as well. But the majority have taken the advice pretty well, he said. At 39 weeks, the pregnancy is considered full-term and the baby pretty much developed. â&#x20AC;&#x153;Those deliveries before 39 weeks mainly experienced underdeveloped lungs,â&#x20AC;? he said. But there are medical issues that some women experience, forcing them to deliver early. Some of those

include hypertensive disorders and diabetes. â&#x20AC;&#x153;Diabetes poses a risk to the child in utero,â&#x20AC;? Rivero said. â&#x20AC;&#x153;We try to encourage them to deliver as close to 39 weeks as possible.â&#x20AC;? He also mentioned there might be placental issues, which are fairly rare. â&#x20AC;&#x153;Everything is finalized with the creation of the baby within the last five weeks, so thatâ&#x20AC;&#x2122;s why this is so pertinent to wait at least until 39 weeks,â&#x20AC;? he said.

STROKE: Working to improve stroke response times From Page 13

itâ&#x20AC;&#x2122;s a speciality that you have to know something about all aspects of internal medicine,â&#x20AC;? he said. â&#x20AC;&#x153;There are neurological complications of everything from inflammatory bowel disease to cardiac tumors so you have to know about many aspects of medicine. This became more of a puzzle to me.â&#x20AC;? This is world class neurology, Dr. Sullivan Smith, emergency department director, said. â&#x20AC;&#x153;I see him as much as I see the cardiologists,â&#x20AC;? he said. â&#x20AC;&#x153;They (both Miller and Turkewitz) hang out with us a lot.â&#x20AC;? With the addition of Dr. Turkewitz, the hospital is now in the process of being certified as a stroke center under joint commission. â&#x20AC;&#x153;There are almost 800,000 strokes in the U.S. on an annual basis and that number is probably low,â&#x20AC;? he said. â&#x20AC;&#x153;How quickly people are treated saves brain. Time is brain because brain cells die regularly with every minute that passes. To open a clot up to get that blood flowing again saves brain tissue. But we canâ&#x20AC;&#x2122;t do that without a cohesive, working relationship with the emergency

department, with the nursing staff and the physicians and EMS folks.â&#x20AC;? Strokes are one of the top five causes of disabilities. â&#x20AC;&#x153;Not only are we saving lives, we are often saving disabilities,â&#x20AC;? Jamie Deneau, clinical nurse specialist and stroke coordinator, said. â&#x20AC;&#x153;If we donâ&#x20AC;&#x2122;t get people here in time to give them the clotbusters, we might keep them alive, but their quality of life or their level of disability might be so much higher...â&#x20AC;? Accreditation work began about two to three months ago, with the goal of getting it done by the summer. â&#x20AC;&#x153;People are getting better care here, closer to home,â&#x20AC;? Dr. Smith said. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s more comfortable for the patient and families.â&#x20AC;? The accreditation process just shows a high level of commitment from physicians. With that in mind, itâ&#x20AC;&#x2122;s now all about getting the word out and educating the public on strokes. â&#x20AC;&#x153;We use the FAST terminology,â&#x20AC;? Dr. Turkewitz said. Face â&#x20AC;&#x201D; ask the person to smile. Is one side drooping? Arm â&#x20AC;&#x201D; ask the person to raise both arms.

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Does one arm drift downward? Speech â&#x20AC;&#x201D; ask the person to repeat a simple phrase. Is their speech slurred or strange? Time â&#x20AC;&#x201D; if any of these symptoms appear, call 911 immediately. Like with the Code 37 heart attack protocol, Code 51 is initiated upon the time EMS arrives on the scene and evaluates the pa-

tient. â&#x20AC;&#x153;They look at the patient and then call the ER where Code 51 is initiated,â&#x20AC;? Dr. Smith explained. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s essential that clotbusting drugs be administered within three hours of symptoms.â&#x20AC;? â&#x20AC;&#x153;The faster you get treatment, the better the outcome,â&#x20AC;? Deneau said.

Cumberland Center for Healthcare Innovation (CCHI) is an Accountable Care Organization (ACO) driven to improve healthcare in the Upper Cumberland which includes 37 primary care physicians who maintain private primary care practices. CCHI greatly values the contribution that all healthcare resources provide in improving the healthcare economy. We at CCHI will take a shared approached to working with the physician, the patient, home health agencies, skilled nursing facilities, and hospitals. CCHI wants to empower the healthcare community and patients in the Upper Cumberland and surrounding communities to do more to ensure that patients receive the highest quality of care at the right time and at the right place.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-19

MEDICAL DIRECTORY

Residential hospice takes stress out of caregiving By MeGAN TRoTTeR HERALD-CITIZEN Staff

COOKEVILLE — When a loved one is facing the end of their life because of the natural progression of aging or because of a terminal illness, families can be stressed trying to provide the necessary day-to-day care while also trying to ensure the last days are filled with as much happiness as possible. The recently-opened non-profit foundation Life House residential hospice makes it possible for a loved one’s last months to be as easy on everyone as possible. “The beauty of it is, the families can be here. We take care of the day-to-day stuff,” Connie Mitchell, executive director, said. “We take care of cleaning them, feeding them, we take care of medical needs, changing the bed pans — all that stuff that nobody wants to do. So we’re kind of in the background. You’re living here. This is your home. You can have your pets visit, you can have your grandchildren visit, you can go bake cookies if you feel good enough. It’s like you’re home. ... Your family is going to be able to give you all the love and attention

that they want to without having to do all the stuff that tires them out and stresses both the patient and the family.” The facility can house up to 10 patients at a time, offering them 24/7 medical care, support services, counseling and spiritual services. The staff is composed of registered nurses and CNAs who are all ready to give the patient whatever he or she needs. “If they wake up at 2 in the morning and want tomato soup, we’ll fix them tomato soup, or we will go to McDonalds and get them a shake or whatever (they want),” Caryolyn Copeland, nurse administrator, said. Mitchell added, “We’re not a hospital; we’re not a nursing home. We’re your home. You become a part of our family.” Their services are not only for families physically or emotionally unable to cope with a loved one’s terminal illness, but also for those don’t want to leave their families with sad memories of their death in their home. Life House also offers temporary rooms for the symptom management of those with home hospice care. See HoSpice, page 20 one of the resident rooms at Lifehouse Hospice.

Ty Kernea | Herald-Citizen

A-20 —HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY HOSPICE: Residential service helps relieve stress of caregiving From Page 19 “If a patient is at home, maybe with home hospice, who is having a symptom they can’t control — maybe pain, nausea, vomiting, seizures, something like that — they can come here,” Andrea Goss, administrator, said. “We can get them better, get them feeling better. They don’t have to stay here. We can get them feeling better so they can go home, so instead of going back … into the hospital or going somewhere to get those treatments, they can come here. That’s a big thing with hospice patients. They have these symptoms, but they don’t ever want to go back into the hospital, so they suffer at home. They don’t have to anymore.” They can stay at Life House for several days until their symptoms Ty Kernea | Herald-Citizen are under control, and then return From left, Connie Mitchell, executive director at Life House hospice; Andrea Goss, admin- home. Staff also provides respite istrator; and Nancy Echard, volunteer coordinator and director of the Foundation look care for families who need of a break through some paperwork at the nurse’s station. from caregiving, or who need to be

Shift

AGING into REVERSE

out of town temporarily. The goal is to relieve stress on the whole family and make sure that their loved one has as much control as possible over their end-of-life circumstances. “We want to provide services that put the patient and the family in the position of being able to choose what environment is going to be home for them,” Copeland said. “… Part of what we do here is help people and not let symptom management or anything stand in the way of them being in control and being able to die where they want to die.” Life House is currently looking for volunteers for tasks such as greeting guests and directing them to where they need to go, doing paperwork, yard work and house work, making clothes, shopping, running errands, visiting or reading with the patients, or helping them to put together scrapbooks. For more information about volunteering or becoming a resident, call 931-881-6417 or 931-854-9084.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-21

MEDICAL DIRECTORY Address the trauma underneath to help prevent relapse By AMY DAVIS HERALD-CITIZEN Staff

COOKEVILLE — The good news? She got her feelings back. And the bad news? Same thing. Because some feelings are too painful — best not felt at all. Which was why they were numbed in the first place. At least, that’s what a friend of Tammy Holmes, residential director of New Leaf at Plateau Mental Health Center in Cookeville, said while going through recovery from substance abuse. “When they become clean, they’re finally feeling things maybe they’ve not felt in years,” Holmes said. All it had taken was some pills or alcohol to bury it deep. Make life more bearable. Or so it had seemed... until addiction set in, opening up a whole new world of troubles. “It becomes the number one thing in their lives,” Richard Gillespie, a licensed marriage and family therapist at the center, said. And it’s something both he and Holmes see on a daily basis in their efforts to help people break the addiction cycle. Which isn’t a simple thing — even after clients have completed a 28-day detox and residential treatment. “Treatment is not over at that point,” Holmes said. “It’s really just the beginning — especially if there’s been trauma or abuse. They’re going to need long-term counseling or possibly medication.” And trauma was something Gillespie and Holmes stressed as a reason one may turn to substance abuse in the first place. “A lot of individuals, especially women but men also, report of having been sexually or physically abused in terms of previous relationships,” Gillespie said. “There are other things, too, of course, but that’s connected to the reason they drank and/or used drugs. It was a way to escape or self-medicate because of the feelings with that — depression, self-blame, anger and so on.” He and Holmes also pointed out that trauma is something that needs to be addressed along with the addition. “We really focus on trauma,” Holmes

Amy Davis | Herald-Citizen

Tammy Holmes, residential director of the New Leaf program at Plateau Mental Health Center in Cookeville, talks with counselor Richard Gillespie about helping people overcome addiction by also addressing the trauma in their lives that may have contributed to it.

said. “We are a co-occurring facility, which means we are able to treat every area — the mental health, the depression and the addiction.” Otherwise — if the trauma is not addressed — relapse is likely. “If it’s not treated and it was part of why someone self-medicated or used, the underlying cause increases the possibility of relapse,” Gillespie said. “That’s why we treat the co-occurring disorder.” Holmes agreed, also pointing out that those in recovery need to keep at it long after initial treatment. After all, it’s taken the person years to get to the point of needing help to get sober. “We try to help them and their families realize it’s going to take time and long-term treatment,” Holmes said. “We work on a relapse prevention plan. They work through the first three steps of the 12-step program, and then we refer them to individual counseling, Narcotics Anonymous and Alcoholics Anonymous meetings, halfway houses — whatever their

needs are, we try to get them hooked up within the community.”

To learn more about recovery options, call New Leaf at 931-432-4123.

A-22 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-23

MEDICAL DIRECTORY

Cord blood banking may be worth the investment

hen I found out I was pregnant, I signed up for all these email newsletters and the like. Sometimes the information contained in those was very helpful. (I started getting formula in the mail right before my third trimester. Sheesh.) Others...not so much (Birth experience horror stories? No thank you! Considering this is my first child-bearing experience, I’m already a little terrified as it is.) One subject that kept coming up was cord blood banking. I didn’t think too much of it until my husband’s uncle, who is a gynecologist in Florida (he used to do obstetrics, but retired from that field a while back) mentioned it during a recent visit. So I started doing research into it. And from the looks of it, it may be worth the investment. When a baby is born, there are blood platelets left over in the umbilical cord and placenta. These are typically discarded as medical waste. But research has found that cord blood

contains stem cells (much like the ones found in bone marrow) that have the ability to replicate or develop into additional cells which can be used to treat life-threatening diseases. Cord blood banking is the process in which Laura cord blood is colMilitana lected, processed, frozen, and cryogenically stored. When the baby is born, the physician will take the blood and place it into a special transportation carrier to be sent to the bank to be processed and stored. Cord blood transplantation is the process where the stored cord blood is thawed and subsequently infused in patients. It can last years in state-of-the-art facilities — and the possibilities for cures of life-threatening diseases are ongoing.

Cord blood transplants have been successful in the treatment of more than 70 life-threatening diseases including leukemia, lymphoma and sickle cell anemia. Other diseases include NonHodgkin’s Lymphoma, Hodgkin’s Disease, Neuroblastoma, and much more. There are two types of cord blood banking: public donation or private. Private cord blood banking is stored for a fee for the exclusive use of the child or family who provided the cord blood. The public donation is put into a database for patients needing transplants. There is no charge for this type of donation. I had a cousin who died from leukemia when she was 13. It can strike anyone — with few symptoms and no warning. I’ve heard of young children coming down with cancer or leukemia, forcing parents to take them to Nashville or Knoxville for treatment. Fortunately, I’ve been healthy my entire life, but these things do happen — and can hit without warning.

The private cord blood banking is pricey (the enrollment fee for one particular company I’m looking at is $1,870 for processing and testing, $150 for shipping and an annual storage fee of $125). But if you think about it, if the cells are needed and can help in treating my child’s life-threatening disease(s), this would be so much cheaper than traveling to a research hospital and going through all the testing and treatment, racking up hospital bill after hospital bill, not to mention the trauma that my child would endure. To me, it’s better to have these cells available (which do stay viable for many years) and not need them than to need them and not have them available. More than likely, my daughter won’t need it, but it’s a nice security blanket. And the research continues. Many more diseases can possibly be treated down the road, as technology and research improves and expands. Laura Militana is a reporter and the business editor for the Herald-Citizen.

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A-24 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

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A-26— HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Investment in people: TTU nursing By JAIME STANFORD Special to the HERALD-CITIZEN

COOKEVILLE — Every semester, hundreds of students apply for entry into upper division nursing at Tennessee Technological University in Cookeville with about 60 students gaining admission. The incoming 2014 class is the largest admitted since the beginning of the nursing program in 1980, which gained full accreditation by the National League for Nursing Accrediting Commission in 2004 and has secured it through 2019. The program has been refined and improved upon since its inception with the most current change extending it from a four-semester to a five-semester program. “The new five-sePiras mester program more evenly distributes coursework,” said Susan Piras, assistant professor and coordinator of junior-one clinical experience. “This change ensures that students are more prepared to enter clinical.” Bumbalough After spending two years fulfilling general education requirements, students admitted into the upper division program begin their junior year with a semester of fundamentals, assessment, and pharmacology. This groundwork then leads the students into more focused coursework while begining clinical hours at Cookeville Regional Medical Center. “You can tell coming into this position

that they [CRMC] have a vested interest in our students” said Piras, of her experience coordinating clinical hours with CRMC. “The groundwork has been laid.” From the initial experience at the local hospital and nursing homes, students extend their clinical experience to Vanderbilt, Erlanger, and UT Knoxville during the final three semesters in upper division nursing. “We are heavily vested in student success,” said Piras. “I will see about five students lined up outside faculty offices’ waiting for counseling, and when I interviewed it was strongly implied that extra drive to advise students was part of the job.” Graduates of the TTU nursing program attest to the rigorous demands of the experience. Joyce Bumbalough, graduate since December 2010 and current registered nurse at CRMC intensive care unit, commented on the intensity Verble of the program. “It was hard but the instructors were always there,” said Bumbalough. “They were not just my teachers, they were my mentors. I really felt like my teachers cared about me and my success in the program.” Bumbalough, 25, who is also a single mother to her 2-year-old son, is currently earning her master’s in nursing through the Regents Online Degree Program at Tennessee Technological University to become a nurse practitioner. “I see why the instructors are so hard on students because they are responsible for the lives of the patients that their students are caring for,” said Bumbalough. “I thought I knew what I was doing as a stu-

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dent but I don’t have the knowledge that I do now.” Lindsey Verble, 2007 graduate of TTU nursing program and registered nurse at CRMC, spoke of her experiences postgraduation. “I love my job,” said Verble. “But it is not easy and it wasn’t easy getting to this position. I had never studied a day in my life until I got into the nursing program. It is

not the normal college experience.” Verble, also a single mother of her 4-yearold son, further elaborated on the perspective she gained after graduating. “You have to put yourself in someone else’s shoes and be compassionate,” said Verble. “Growing up, I was sheltered. This profession has introduced me to various other ways of livSee NURSING, Page 27

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-27

MEDICAL DIRECTORY

NURSING: Education an investment in people

From Page 26 ways of living. Everyone deserves the same treatment regardless of their lifestyles.” Verble said that the learning never stops. “Every day I see something new. School sets you up to be able to keep learning because you will never know it all.” Invested learning is a theme coursing through students and professors alike of the TTU nursing program. Piras reiterated that many of the instructors are also students, earning their doctorate degrees and are therefore sympathetic to the struggles of their students. She also emphasized that many professors come from backgrounds with hands-on nursing experience as well as extensive education in the art of teaching. But, when asked what trait best serves students in the nursing program, Piras quickly answered with firm conviction. “Investment in people. I can’t teach someone to care.” Advice to applicants The admittance program is highly selective. Several factors are taken into consideration as to who is chosen for the program. Therefore, if applicants do not gain entry upon the first attempt, reapply. “There are many avenues to becoming a nurse,” said Piras. Students may also look into community colleges and become licensed practical nurses so that they can use the bridge program to become registered nurses. “Keep the focus on nursing,” said Piras. “Don’t give up.” Success in the program “Frame that letter of acceptance,” said Piras, “and let that keep you motivated for

the hard work ahead of you.” Other suggestions from graduates are to form study groups, and approach professors for help before falling too far behind, pay attention in class, and participate in courses that teach test-taking strategies. Bumbalough emphasized the importance of studying daily. “It really does make a difference to study something every day, even if it is for just a few minutes. Also, find out what the passion of that particular professor is and learn from them.” Future of the profession “I don’t think that the foundation and fundamental skills that nurses possess can ever be replaced by technology because technology cannot make a human connection,” stated Piras. Both Bumbalough and Verble expressed their passion for and loyalty to the profession of nursing. “I’ve always been a helper of people,” said Bumbalough. “And nursing allows me to do that. When you really work hard on a patient who is down for the count—after they wake up a day or two following admittance and live through the situation… It really is rewarding,” said Bumbalough. “You know you took part in it.” Verble simplified how she sees her basic role as a nurse. “If you’re going to do something, do it. Be honest, and don’t sugar coat it. Always give hope when you can. Inform. And, above all, be your patient’s advocate,” Verble matterof-factly said with a resolute nod. “You may be the only person who is advocating for them.” For more information about the TTU nursing program, visit www.tntech.edu/nursing/home or call 372-3203.

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A-28 — HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Campaign offers assistance in the Marketplace By AMY DAVIS HERALD-CITIZEN Staff

COOKEVILLE — Relax, take a deep breath, and just log on. That’s the advice Barbara Myers, program coordinator with the Tennessee Health Care Campaign for the Upper Cumberland, has for those who may be hesitant to explore the new Health Insurance Marketplace at www.healthcare.gov. “It’s really a pretty easy process now that the website is working!” she said. THCC, which began in 1989, is the state’s premier nonprofit consumer health care advocacy group and a leader in the health care justice movement, according to its website at www.thcc2.org. Its Cookeville office has been open since October, which was when open enrollment in the Marketplace began. Since that time, volunteers have been reaching out to the 14-county Upper Cumberland region to get the word out and offer assistance to those wishing to sign up. “The THCC was around long before the Affordable Care Act,” said Nancy Himell, THCC’s local chairperson. “This provided us an opportunity to fill the void and offer accurate information on what the actual benefits for people signing up for Marketplace coverage are because there definitely has been a lack of good information on what’s available. “We’re trying to build awareness that there really are good plans that are going to be extremely helpful for the uninsured, the underinsured and even the insured – people like myself who have been penalized for preexisting conditions who now can get a higher quality product for lower premiums.” Not only do THCC volunteers help people enroll at their Cookeville office, they go out in groups to do presentations wherever they can. They’re also looking for

Amy Davis | Herald-Citizen

“When people (sign up) without providing any information, they get the basic premium without the tax credits and subsidies, and that can create a negative impression,” he said. Himell stressed that THCC for the Upper Cumberland exists to help provide information and resources. “We are not certified application counselors, but we have had training to help assist people in applying, and we’ve been doing a fair amount of that,” she said. Myers added, “We really hope the Upper Cumberland becomes a healthier place because there are so many people who need healthcare and don’t get it until they’re really sick.” Through the Marketplace, applicants can compare options and find out if they can get lower costs on monthly premiums or get free or low-cost coverage, the coalition’s literature states. To learn more, call the local THCC at 931-528-8422 or visit the office at 14 S. Madison Ave. The Marketplace call center may be reached at 1-800-318-2596.

Nancy Himell, left, chair of the local Tennessee Healthcare Coalition, left, talks with volunteer Ed Milner and program coordinator Barbara Myers about insurance options available through the Marketplace on www.healthcare.gov. To learn more, call 528-8422 or stop by the office at 14 S. Madison St. in Cookeville. more volunteers to join them in the effort. Myers was hired in December to coordinate the program, and she hit the ground running as the deadline for early enrollment for January coverage came and went by quickly. Now she’s helping Including, but not limited to: combat people get signed up by the next deadexperiences, childhood sexual or other abuse, line, Feb. 15, for coverage that begins victims of crime, domestic violence, motor March 1. vehicle and other accidents, witnessing a Himell added, “Cookeville Regional death of crime, adults abused as children, Medical Center actually gave us $50,000 neglect and any other situation in which to help cover the expenses of building awareness for the Affordable Care Act, the person did not get their needs met so we’re very grateful to have their supand felt powerless. port.” Volunteer Ed Milner pointed out that tax All of our staff are trained in EMDR credits and subsidies are available de(Eye Movement Desensitization and pending on family size and income.

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A-30 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

LRH part of four-hospital partnership By AMY DAVIS HERALD-CITIZEN Staff

LIVINGSTON — It’s been three months since Livingston Regional Hospital joined forces with HighPoint Health System. And LRH’s interim CEO, Ron Tyrer, is glad to be part of the progress and foresees plenty of advantages — including the sharing of resources with its three sister hospitals. “It’s been working out well,” Tyrer said. “Communications are great. We’re in contact with one another quite often.” LRH become part of a comprehensive health system along with Sumner Regional Medical Center in Gallatin, Trousdale Medical Center in Hartsville and Riverview Regional Medical Center in Carthage in October. “The three other hospitals have been together for some time, and we were added,” said Tyrer, who is also a new addition to LRH, having been on board

Ron Tyrer, Livingston Regional Hospital interim CEO, talks with certified nursing assistant Natasha Swingley, center, and registered nurse Jessica waters while making his rounds through the hospital. Amy Davis | Herald-Citizen

See LRH, Page 31

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-31

MEDICAL DIRECTORY

LRH: Four-hospital partnership begins From Page 30 since late November following the resignation of former CEO Mike Meadows. “We are all owned by LifePoint Hospitals, but it’s a new market just for our four hospitals where we can work together on various things and share staff if we need to.” Tyrer said HighPoint Health System CEO Susan Peach, who is based in Gallatin, has been “very involved” in LRH’s transition. Other changes are taking place as well, beginning with a facelift for around 40 patient rooms. “We’ve been approved for a nice renovation, and that’s going to begin shortly,” Tyrer said. Tyrer said the renovations were among some of the points that stood out in a recent “deep dive” conducted by a LifePoint strategic resource group. “They met with community leaders, board members, medical staff and so forth, and the purpose was to gather opinions on our strengths, opportunities

and weaknesses as a hospital,” Tyrer said. “We used that in our strategic planning process to determine what to look at moving forward with our mission.” The deep dive also revealed a need to extend the hospital’s service area northward and be more involved in the community, particularly with medical fairs. In the meantime, LRH will be working with its sister hospitals on some joint educational activities for employees. A little further down the road, the small, 114-hospital will benefit from shared physicians and services. “We’re looking at that opportunity,” he said. “There are some specialities — such as urology and ENT (ear, nose and throat) — we could use here.” Tyrer, who retired in Frankfort, Ky., in 1997, has enjoyed his time as interim CEO but said a new leader will soon take the reins, most likely in March. “We’re in the midst of soliciting resumes and interest,” he said. He also touched on the big job that awaits that leader.

“Rural hospitals are having a challenging time with all of the healthcare reform and so forth,” he said. “It requires a lot of focus to make sure you’re meeting community needs while at the same time paying the bills and making sure you have enough money to have good equipment and qualified staff. “It seems like it’s more challenging

each year as far as reimbursement goes. It impacts urban hospitals, too, but I think it hits rural hospitals harder.” But if LRH’s recent joint commission accreditation survey is any indication, the hospital looks to be headed in the right direction. “We’ve got a good staff, which was reflective in the findings,” Tyrer said.

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A-32 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Women: Catch problems early with regular screenings To help detect health problems in the early stages, women should consider a varity of screenings. Screenings are tests that look for diseases before you have symptoms, examples being blood pressure checks and mammograms. You can get some screenings, such as blood pressure readings, in your doctor’s office. Others, such as mammograms, need special equipment, so you may need to go to a different office. After a screening test, ask when you will see the results and who to talk to about them. Breast cancer Ask your health care team whether a mammogram is right for you based on your age, family history, overall health and personal concerns. cervical cancer Have a Pap smear every one to three years if you are 21 to 65 years old and have been sexually active. If you are older than 65 and recent Pap smears were normal, you do not need a Pap smear. If you have had a hysterectomy for a reason other than cancer, you do not need a Pap smear. chlamydia, Other Sexually Transmitted Diseases

Sexually transmitted diseases can make it hard to get pregnant, may affect your baby, and can cause other health problems. Have a screening test for Chlamydia if you are 24 or younger and sexually active. If you are older than 24, talk to your health care team about being screened for Chlamydia. Ask your doctor or nurse whether you should be screened for other sexually transmitted diseases. colorectal cancer Have a screening test for colorectal cancer starting at age 50. If you have a family history of colorectal cancer, you may need to be screened earlier. Several different tests can detect this cancer. Your health care team can help you decide which is best for you. Depression Your emotional health is as important as your physical health. Talk to your health care team about being screened for depression, especially if during the last two weeks: • You have felt down, sad or hopeless. • You have felt little interest or pleasure in doing things. Diabetes Get screened for diabetes if your blood pressure is higher than 135/80 or if you take

medication for high blood pressure. Diabetes (high blood sugar) can cause problems with your heart, brain, eyes, feet, kidneys, nerves, and other body parts. High Blood Pressure Starting at age 18, have your blood pressure checked at least every two years. High blood pressure is 140/90 or higher. High blood pressure can cause stroke, heart attack, kidney and eye problems, and heart failure. High cholesterol Starting at age 20, have your cholesterol checked regularly if: • You use tobacco. • You are obese. • You have diabetes or high blood pressure. • You have a personal history of heart disease or blocked arteries. • A man in your family had a heart attack before age 50 or a woman, before age 60. HiV Talk with your health care team about HIV screening if any of these apply to you: • You have had unprotected sex with multiple partners. • You have injected drugs. • You exchange sex for money or drugs or

have sex partners who do. • You have or had a sex partner who is HIV-infected, bisexual, or injects drugs. • You are being treated for a sexually transmitted disease. • You had a blood transfusion between 1978 and 1985. • You have any other concerns. Osteoporosis Have a screening test at age 65 to make sure your bones are strong. If you are younger than 65, talk to your health care team about whether you should be tested. Overweight and Obesity The best way to learn if you are overweight or obese is to find your body mass index (BMI). You can find your BMI by entering your height and weight into a BMI calculator, such as the one available at www.nhlbisupport.com/bmi/. A BMI between 18.5 and 25 indicates a normal weight. Persons with a BMI of 30 or higher may be obese. If you are obese, talk to your doctor or nurse about seeking intensive counseling and help with changing your behaviors to See ScreeningS, Page 33

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-33

MEDICAL DIRECTORY SCREENINGS: Women should have these screenings From Page 32 lose weight. Overweight and obesity can lead to diabetes and cardiovascular disease. It’s Your Body You know your body better than anyone else. Always tell your doctor or nurse about any changes in your health, including your vision and hearing. Ask them about being checked for any condition you are concerned about, not just the ones here. If you are wondering about diseases such as glaucoma or skin cancer, for example, ask about them.

Take Preventive Medicines If You need Them Aspirin If you are 55 or older, ask your health care team if you should take aspirin to prevent strokes. Breast Cancer Drugs If your mother, sister, or daughter has had breast cancer, talk to your doctor about whether you should take medicines to prevent breast cancer. • estrogen for Menopause (Hormone Replacement Therapy) Do not use estrogen to prevent heart disease or other diseases. If you need relief from symptoms of menopause, talk with

your health care team. Immunizations • Get a flu shot every year. • If you are 65 or older, get a pneumonia shot. Depending on health problems, you may need a pneumonia shot at a younger age or need shots to prevent diseases like whooping cough or shingles. Talk with your health care team about whether you need vaccinations. You can also find which ones you need by going to www2.cdc.gov/nip/adultimmsched/. Take Steps to Good Health • Be physically active and make healthy

food choices. Learn how at www.healthfinder.gov/prevention. • Get to a healthy weight and stay there. Balance the calories you take in from food and drink with the calories you burn off by your activities. • Be tobacco free. For tips on how to quit, go to www.smokefree.gov. To talk to someone about how to quit, call the National Quitline: 1-800QUITNOW (784-8669). • If you drink alcohol, have no more than one drink per day. A standard drink is one 12-ounce bottle of beer or wine cooler, one five-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.

Men: Screenings can lead to healthier life Screenings are tests that look for diseases before you have symptoms, and men have plenty to be aware of. Blood pressure checks and tests for high cholesterol are examples. You can get some screenings, such as blood pressure readings, in your doctor’s office. Others, such as colonoscopy, a test for colorectal cancer, need special equipment, so you may need to go to a different office. After a screening test, ask when you will see the results and who you should talk to about them. Abdominal Aortic Aneurysm If you are between the ages of 65 and 75 and have ever been a smoker, talk to your doctor or nurse about being screened for abdominal aortic aneurysm (AAA). AAA is a bulging in your abdominal aorta, the largest artery in your body. An AAA may burst, which can cause dangerous bleeding and death. Colorectal Cancer Have a screening test for colorectal can-

cer starting at age 50. If you have a family history of colorectal cancer, you may need to be screened earlier. Several different tests can detect this cancer. Your doctor can help you decide which is best for you. Depression Your emotional health is as important as your physical health. Talk to your doctor or nurse about being screened for depression especially if during the last two weeks: • You have felt down, sad, or hopeless. • You have felt little interest or pleasure in doing things. Diabetes Get screened for diabetes if your blood pressure is higher than 135/80 or if you take medication for high blood pressure. Diabetes (high blood sugar) can cause problems with your heart, brain, eyes, feet, kidneys, nerves and other body parts. High Blood Pressure Starting at age 18, have your blood pres-

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sure checked at least every two years. High blood pressure is 140/90 or higher. High blood pressure can cause strokes, heart attacks, kidney and eye problems and heart failure. High Cholesterol If you are 35 or older, have your choles-

terol checked. Have your cholesterol checked starting at age 20 if: • You use tobacco. • You are obese. • You have diabetes or high blood presSee Men, Page 34

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A-34 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

MEN: Health screenings can lead to better health From Page 33 sure. • You have a personal history of heart disease or blocked arteries. • A man in your family had a heart attack before age 50 or a woman, before age 60. HIV Talk with your health care team about HIV screening if any of these apply to you: • You have had unprotected sex with multiple partners. • You have sex with men. • You use or have used injection drugs. • You exchange sex for money or drugs or have sex partners who do. • You have or had a sex partner who is HIV-infected or injects drugs. • You are being treated for a sexually transmitted disease. • You had a blood transfusion between 1978 and 1985. • You have any other concerns. Syphilis Ask your doctor or nurse whether you should be screened for syphilis. Overweight and Obesity

The best way to learn if you are overweight or obese is to find your body mass index (BMI). You can find your BMI by entering your height and weight into a BMI calculator, such as the one available at www.nhlbisupport.com/bmi/. A BMI between 18.5 and 25 indicates a normal weight. Persons with a BMI of 30 or higher may be obese. If you are obese, talk to your doctor or nurse about seeking intensive counseling and getting help with changing your behaviors to lose weight. Overweight and obesity can lead to diabetes and cardiovascular disease. It’s Your Body You know your body better than anyone else. Always tell your doctor or nurse about any changes in your health, including your vision and hearing. Ask them about being checked for any condition you are concerned about, not just the ones here. If you are wondering about diseases such as prostate cancer or skin cancer, for example, ask about them.

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Take Preventive Medicines If You Need Them Aspirin If you are 45 or older, ask your doctor if you should take aspirin to prevent heart disease. Immunizations • Get a flu shot every year. • If you are 65 or older, get a pneumonia shot. • Depending on health problems, you may need a pneumonia shot at a younger age or need shots to prevent diseases like whooping cough or shingles. Talk with your doctor or nurse about whether you need vaccinations. You can also find which ones you need by going t o : http://www.cdc.gov/vaccines/recs/schedules/default.htm. Take Steps to Good Health • Be physically active and make healthy food choices. Learn how at www.healthfinder.gov/prevention. • Get to a healthy weight and stay there. Balance the calories you take in from food and drink with the calories you burn off by your activities.

• Be tobacco free. For tips on how to quit, go to www.smokefree.gov. To talk to someone about how to quit, call the National Quitline: 1-800-QUITNOW (7848669). • If you drink alcohol, have no more than two drinks per day if you are 65 or younger. If you are older than 65, have no more than one drink a day. A standard drink is one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-35

MEDICAL DIRECTORY

Urging pregnant smokers to give up habit By AMY DAViS HERALD-CITIZEN Staff

UPPER CUMBERLAND — He’d be the first to pick one back up. Light it up, inhale the smoke. That is, if no health risks were involved. Instead, Randy Todd plans to stay away from the product he calls “a killer.” “Tobacco use is a love-hate relationship,” he said. “You love it when you’re using it, but you get to where you hate it because you know the harm it’s doing to you and the ones around you.” He and fellow ex-smoker Julie Gibson hope others will feel the same way. That’s why they’ve joined forces to form the new Upper Cumberland Anti-Tobacco Coalition. “The purpose is to decrease the use of tobacco in the Upper Cumberland,” Todd said. Particularly among youths. “It may be too late for most of us older smokers, but if we can get youth and parents more aware, hopefully we can head this thing off before it gets any worse,” Todd said. The coalition’s three main focus areas all have to do with young people, including second-hand smoke and how it relates to children as well as youth education about tobacco’s harmful effects. But first, they’re hoping to appeal to pregnant women who smoke with their first project — “Baby and Me Tobacco Free” — which they plan to kick off in February. Todd and Gibson said 20 percent of pregnant women in Tennessee are smokers. “She’s at high risk of having her baby born too early and with an abnormally low birth weight,” Gibson said of a woman who smokes while pregnant. “She also increases her infant’s risk of death from SIDS.” Gibson said the coalition will be offering educational classes this year for pregnant

Ty Kernea | Herald-Citizen

Encouraging pregnant women to take part in “Baby and Me tobacco Free” — a project of the newly formed upper Cumberland Anti-tobacco Coalition — are, from left, Randy todd, uCAtC; Angie Richards, Power of Putnam antitobacco committee for youth; Julie Gibson, uCAtC; Lisa Bumbalough, Putnam County Health Department; and mom-to-be Danielle Fay.

women who desire to stop smoking. The goal is to have at least 25. And, as an incentive, those moms who participate will receive diaper vouchers if they test nicotine free afterward. Anyone interested can call Gibson at 931261-6352 or Lisa Bumbalough at the Putnam County Health Department at 528-2531. Gibson and Todd are hoping for plenty of interest — especially since 25 percent of Tennessee’s high school students and nearly 10 percent of middle schoolers use cigarettes, according to 2007 statistics in “The Burden of Tobacco in Tennessee,” which may be viewed online at hit.state.tn.us. In Putnam County, 47 percent of 10th and 12th graders surveyed by the Power of Putnam Anti-Drug Coalition in 2012 said they have at least one best friend who has smoked cigarettes. The survey also revealed that 38 percent of those students have smoked cigarettes,

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while 7 percent smoke regularly. Twentyfour percent have used smokeless tobacco, and 8 percent use it regularly. “The American Cancer Society tells us that one out of three of kids using tobacco

will die from tobacco,” Todd said. “So, when I think about that, it tells me that there’s a killer that’s being turned loose amongst our youth.” Gibson added, “And it doesn’t affect their sobriety like marijuana, drugs or alcohol does, so it’s more justifiable, I think.” They also want to warn parents that tobacco companies are targeting youths with “clever” advertising. “We adults don’t see it, but these kids see it,” Todd said. “For example, if you walk into a convenience store, you’ll see all of these tobacco displays. You’ve got fruitflavored cigars as well as dips and snuffs that are chocolate and cheery-flavored, and they’re all down low where the kids can see them.” According to the American Lung Association, smoking is the leading cause of cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach and cervix as well as acute myeloid leukemia. It’s also a leading cause of heart disease, stroke and aneurisms and strongly linked to infertility.

See quit, Page 36

A-36 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

PCHD caters to uninsured, underinsured, underserved PUTNAM COUNTY — The Putnam County Health Department provides several key screenings and offers treatment of acute problems and management of some chronic medical conditions. The PCHD Primary Care Clinic targets those who are uninsured, underinsured and underserved. The clinic features an in-house pharmacy with limited formulary for established patients. No controlled substances are prescribed. Health care management includes examination, diagnostics, treatment, referral and coordinated assistance. Fees are based on a sliding scale that is dependent on things like household size and income. There is a minimum fee of $5 per visit. • Breast and cervical cancer screening program: Reaches and serves lower income, uninsured, underinsured women for these basic preventative health screening exams. Mammograms are only available for women 50-64 years old unless meeting certain requirements. • Children’s special services and case management services for families: Provides comprehensive medical care for children with

physical disabilities from birth to 21 years of age. • Communicable disease treatment: Provides treatment and testing for all reportable diseases including sexually transmitted diseases, STDs, HIV and TB. • Dental services: Includes sealants, cleaning, fluoride treatments, fillings, minor extractions, repairs and referrals for procedures requiring general anesthesia. Available by appointment only for uninsured and TennCare children up to age 21. • Early Periodic Screening, Diagnosis and Treatment (EPSDT): Checkups and health care services for children from birth until age 21 to detect and treat health problems. EPSDT checkups are free for all children who have TennCare. • Family planning: Women’s and men’s health exam and birth control program. • HUGS (Help Us Grow Successfully): Home-based intervention services for pregnant and postpartum women, children birth through the age of 5 and their primary caregivers. • Women, infant, and children (WIC): A special supplemental nutrition program designed to provided supplemental food to lowincome pregnancy, postpartum and

breastfeeding women, infants and children until the age of five. It is based on income guidelines. Non-medical services include the following: • Certify and issue death certificates for anyone deceased within the last three years. • General environmental services: Inspect and issue permits for restaurants, camps, swimming pools, temporary food permits, issue rabies tags to veterinarian offices, investigate reported animal bites and any suspicious animal activity, inspect county school grounds/buildings, including cafeterias, child

care facilities, tattoo and piercing establishments. • Issue transit and cremation permits. • Vital records: Issuance of birth certificates for anyone born in 1949 or after. • Voter registration: Provides voter registration forms for anyone eligible to vote in Tennessee. Putnam County Health Department is located at 701 County Services Dr. in Cookeville. Hours are Monday through Friday from 7:30 a.m. to 4:30 p.m. Call (931) 528-2531 for an appointment.

QUIT: Helping pregnant women quit smoking From Page 35 “Tobacco use is the single most preventable cause of disease and death in the United States,” according to “The Burden of Tobacco in Tennessee,” which also pointed out that tobacco-related deaths number approximately 438,000 per year. The Upper Cumberland Anti-Tobacco Coalition, which is now working toward 501(c)3 status and forming a board of direc-

tors, is getting a boost in its mission through tobacco settlement funds. Putnam County will be getting $57,000 per year for next three years to be used toward prevention, Todd and Gibson said. The coalition will be working in a variety of ways to encourage tobacco users to give up the habit, one of the next projects being “Kick Butts Day” on March 19, which challenges people to stop smoking for at least a day.

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-37

MEDICAL DIRECTORY New guidelines say annual pap tests unnecessary METRO — Women may sigh in relief because they won’t have to make the yearly trek to the gynecologist or family practitioner for a Pap test any longer. New information from medical groups states that by having pap smears in combination with a human papillomavirus (HPV) test, many women can safely spread out testing by five years. Recently, advice on having cervical cancer screenings has varied from medical expert to medical expert. Many advise women to get screened every one to three years. Now the U.S. Preventative Services Task Force, which published a new set of guidelines in the Annals of Internal Medicine, state that by undergoing both a Pap smear and an HPV test together, which has been dubbed “co-testing,” women ages 30 to 65 who have had negative results can wait another five years before the next test. The American Cancer Society is another organization issuing these revised guidelines. Experts advise that this is the first time that co-testing has been suggested and widely pushed, although some doctors have been doing cotesting on their own for years. The change was based on information that showed more frequent testing for cervical cancer did not dramatically lower the numbers of those at risk. Although the tests are safe, fertility risks abound if further testing and procedures are done as the result of a positive Pap test, which can sometimes be inaccurate. Researchers have also found that many cases of cervical cancer are linked to HPV. Because cellular changes triggered from HPV are slow-moving, it is not vital to have annual testing. It is possible to find and treat the cancer before it becomes dangerous, even if 10

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We focus our work in three key areas, because nurturing the potential of kids, helping people live healthier, and supporting our neighbors are fundamental to strengthening communities.

Women may be able to wait longer between Pap tests. years have passed, says George Sawaya, M.D., professor in the University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences. Although the guidelines are in place, many women may continue to have annual Pap smears, particularly because they are used to them and don’t want to risk their health. Those who do not rely on their gynecologists as their primary care providers may be more apt to wait longer intervals between testing. Women who are uncertain about waiting longer than a year between Pap tests can discuss their concerns with their gynecologists or family doctors. Together they can weigh the pros and cons of adopting a new schedule for cervical cancer screenings.

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A-38 —HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Easy ways to enjoy a flu-free winter

METRO — Spending significant time in close proximity to others indoors can make people more susceptible to the flu. As a result, winter, when people typically spend more time indoors than outdoors, is often dominated by the sniffling and sneezing synonymous with the flu. But men and women can take steps to protect themselves from the flu this season. Get a flu shot Some people prefer to avoid getting a flu shot because they want to build up their natural immunities or they believe the shots can make them sick. But most flu shots contain an inactive virus that will not make you sick, and will only trigger your body’s immune system response to a foreign invader. It can take a couple of weeks for full immunity to develop, so it’s possible to still get sick even after a flu shot has been administered. Also, a flu shot does not guarantee recipients won’t get the flu. People can still get the flu after receiving a flu shot, as it may be another strain of the virus. But flu shots are largely effective. Quit smoking Smoking cigarettes and cigars can affect the immune system and also compromise the body in a number of different ways. Smoking can disable mechanisms in your breathing passageways that serve as natural repellants to the flu. These include the hairs on the lungs that brush away contaminants. Smoking also can create holes in the lining of lower air passages, and such holes can make people more susceptible to illness, including the flu. Smokers who get the flu typically find that the flu further complicates their ability to breathe. Avoid sick people When those around you are sick, it is best to keep your distance, especially

Quitting smoking and getting plenty of rest and good food are some ways to help avoid the flu.

when those people have the flu. The Centers for Disease Control and Prevention state that people with the flu can spread it to others up to six feet away. Flu viruses are spread mainly by droplets of bodily fluids expelled during coughing, sneezing and even talking. This is why doctors recommend that anyone who has the flu stay home from work or school until they are fully recovered. Be especially cautious when pregnant According to Dr. Cameron Wolfe, an infectious disease specialist at Duke University Medical Center, women who are pregnant are at a higher risk of complications and even death from influenza. Doctors don’t fully understand why, but

many feel that because the flu can compromise a woman’s ability to breathe well, this makes it difficult for oxygen to be passed on to the fetus. Pregnant women should speak with their obstetricians about the safety of the flu shot. Get plenty of rest and good food Adequate sleep and a healthy diet can bolster your immune system. It’s important to stay hydrated, eat fruits and vegetables rich in vitamin C and prioritize getting a good night’s sleep each night. Beware of homeopathic remedies Always check with a doctor before adding any natural remedies to your flufighting repertoire. While some supplements like elderberry syrup, zinc and oscillococcinum can mitigate symptoms of the flu, there’s no solid evidence that these items offer any preventative value. Homeopathic remedies also can interfere with medications or may be dangerous to a developing fetus, so do not take these substances without first checking with a doctor.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014— A-39

MEDICAL DIRECTORY

Get the facts on stomach bugs to feel better fast METRO — Few things can prove more painful or inconvenient than stomach bugs. Digestive tract illnesses can cause persons to spend many hours of the day running to restrooms while confining others to the house for extended periods of time. Though often temporary, stomach bugs can last several days to more than a week and they may lead to more dire situations if not properly treated. Causes Stomach bugs are known as gastroenteritis, a condition characterized by an inflamed and irritated stomach and intestines. The Mayo Clinic says people are most likely to contract gastroenteritis after eating contaminated foods or drinking contaminated water. Sharing items, like utensils, with someone who is infected is another way to contract gastroenteritis. Viral gastroenteritis is caused by a virus that enters the body. However, bacteria and parasites also are responsible for stomach bug outbreaks. Viruses that trigger gastroenteritis include adenoviruses, rotaviruses, calciviruses, astroviruses, and noroviruses. Bacteria that can cause gastroenteritis include E. coli,

salmonella, campylobacter, and shingella. Symptoms Stomach bugs often strike suddenly. Sufferers may experience queasiness or nausea and a loss of appetite. Pain or bloating in the stomach also may occur. Vomiting and diarrhea often cause many people to suspect something is wrong, and some stomach conditions are also accompanied by fever, achiness and lethargy. Treatment Many people opt for a wait-and-see approach when struck with stomach bugs. Gastroenteritis often heals on its own. Some refer to it as a “24-hour-bug” and find that once the stomach has been purged clean, the offender no longer wreaks havoc on the body. But stomach bugs can be more persistent as well. Sufferers should visit a doctor if vomiting or diarrhea last more than a few days. Doctors may take a stool sample to determine what’s behind the bug. In the event of a bacterial infection, an antibiotic may be needed to clear up the infection. Visiting a doctor when stomach problems persist is also beneficial because he or she may be able to rule out certain conditions, such as colitis, ulcers or

Crohn’s disease. Helpful hints When a stomach bug strikes, it is best to refrain from eating, especially when vomiting regularly. Stick to clear broths and liquids, which are easy on the digestive system, while the stomach is irritated. Once vomiting has subsided, sufferers should opt for a bland diet. When plagued by diarrhea, the BRAT diet is adviseable.

This acronym stands for Bananas, Rice, Applesauce, and Toast. These foods can help bind a person and are relatively easy to digest. Because a stomach bug often leads to dehydration, drink plenty of fluids. To restore salt and electrolyte balances, sports drinks are adviseable for adults, while a beverage like Pedialyte is best for children and the elderly.

A-40 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Can diet soda cause weight gain? METRO — For decades, people have turned to diet soft drinks as a healthier alternative to regular soft drinks. However, consuming diet soda on a regular basis may have some serious health ramifications, including weight gain. It may seem counterintuitive to suggest that diet sodas may be causing people to gain weight, particularly because these sodas are commonly consumed by people who are trying to lose weight. However, artificial sweeteners found in some diet sodas may increase a person’s risk of obesity. It’s not entirely what you are eating that can cause weight gain but what the body thinks it is eating (or drinking) that plays a role. There are two factors at play with regard to the artificial sweetener conundrum. First, The University of Texas Health Science Center in San Antonio has researched the potential link beDiet soda may seem a healthier op- tween obesity and artificial sweeteners. tion than sugary drinks, but it may Researchers have found that something cause weight gain and contribute to in the chemical structure of these obesity. sweeteners alters the way the brain

processes the neurotransmitter serotonin. In addition to helping with sleep, mood and other functions in the body, serotonin helps tell the body when it is full. When natural foods and sugars are consumed, serotonin signals to the brain to turn off your body’s appetite. However, artificial sweeteners may prolong the release of serotonin, and your appetite remains in full force long after it should have abated. Another component of artificial sweeteners, particularly aspartame, is that these chemicals can trick the body into thinking it has, in fact, consumed sugar. That triggers the pancreas to produce the insulin needed to regulate bloodglucose levels. It also causes the body to store the glucose as fat. This can lead to low blood sugar, which may cause you to eat a sugary treat in response. Having diet soda or eating a sugarless item once in a while won’t create any long-term effects. But repeatedly relying on artificial sweeteners could affect appetite and change

blood sugar levels for good. These aren’t the only consequences to diet soda and other beverages. Drinking diet soda regularly may affect cardiovascular health. According to the American Heart Association, research presented at the American Stroke Association’s International Stroke Conference found people who drink diet soda every day have a 61 percent higher risk of vascular events than those who reported no soda consumption. Regular soda isn’t a better alternative. It can contribute to weight gain and cardiovascular issues as well as an increased risk for diabetes. A 2011 review published in the journal Circulation stated that a positive association has been shown between sugar-sweetened soft drink consumption and weight gain in both children and adults. Nutritionists and doctors have advised that instead of adding artificial sweeteners to water and other beverages, flavor them with lemon or lime juice. Instead of drinking diet soda, opt for unsweetened tea or plain water.

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Anju Mendiratta, M.D. trained at East Carolina University and Temple University, and currently is practicing nephrology at Cookeville, TN. She is currently a medical director of Sparta Davita Dialysis Center. She is board certified in nephrology and internal medicine. Her interest remains in dialysis – especially home dialysis (peritoniel dialysis and home hemodialysis). She takes care of patients with chronic kidney disease, hypertension, edema, electrolyte imbalance, and proteinuria. She is excited to see new referrals in her new office.

Pardeep Sharma, M.D. is a Diabetologist who did his extensive training at Diabetes Clinical Research Center (DCRC) at East Carolina University. He is board certified in geriatric and family practice. He is currently practicing in Cookeville, TN. He is very good in managing complicated diabetic patients and has a proven track record of success. He is a member of American Diabetes Association. He is accepting most insurance and is excited to serve patients in his new location.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-41

MEDICAL DIRECTORY

Exercise benefits the brain, too METRO CREATIVE — Regular exercise can benefit the body in many ways, helping men and women maintain healthier weights and lower their risks for developing potentially deadly diseases. Though many people are quick to associate exercise with its physical benefits, those hours spent on the treadmill also can boost brain power. According to Dr. Barry Gordon, professor of neurology and cognitive science at Johns Hopkins Medical Institutions and coauthor of “Intelligent Memory: Improve the Memory That Makes You Smarter,” exercise has a direct impact on the brain. That’s because exercise works directly on brain tissue, improving the connections between nerve cells, creating new synapses, growing new neurons and blood vessels, and improving cell energy efficiency. So while many people may begin an exercise regimen with a goal of trimming their waistlines or toning their bodies, they might be happy to know that those physical benefits are accompanied by several cognitive benefits as well. As the American Psychological Association acknowledges, the connection between exercise and mental health is hard to ignore, and the APA notes that the following are just a few of the mental benefits men and women might reap from regular exercise. Improved mood Many people feel great after exercising, especially if that exercise comes at the end of a particularly stressful day. However, those extra laps on the track or those hours spent on the treadmill don’t just pay shortterm dividends. In a controlled trial overseen by Duke University researcher and clinical psychologist James Blumenthal, sedentary adults with major depressive disorder were assigned into one of four groups: supervised exercise, home-based exercise, antidepressant therapy, or a placebo pill. Those in the

ued to exercise had lower depression scores than those participants who were less active. Blumenthal’s study was not the only one to conclude that exercise can have a positive impact on mood. In a review of 11 studies that examined the effects of exercise on mental health, Boston University professor of psychology Michael Otto and his colleagues found that exercise could be a powerful tool when treating clinical depression, and even recommended clinicians include exercise as part of their treatment plans for depressed patients. Antidote to anxiety Some researchers, Otto included, have begun to examine the effects of exercise on treating and possibly preventing anxiety. The body’s nervous system responds quickly when people feel frightened or threatened, often causing the body’s heart rate to increase and sweating and dizziness to occur. Those people who are especially sensitive to anxiety respond to these feelings with fear, and that makes them more likely to develop panic disorders.

Regular exercise benefits the human body in numerous ways, not the least of which is its impact on the brain.

exercise and antidepressant groups had higher rates of remission than those in the placebo group, and Blumenthal concluded that exercise was generally comparable to antidepressants for men and women with major depressive disorder. In addition, in following up with patients a year later, Blumenthal found that those who contin-

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But Otto and fellow researcher Jasper Smits of the Anxiety Research and Treatment Program at Southern Methodist University studied the effects that regular workouts might have on people prone to anxiety. Since exercise produces many of the same physical reactions, such as sweating and an elevated heart rate, the body produces when responding to fear or threats, Otto and Smits wanted to determine if exercise might help people prone to anxiety become less likely to panic when experiencing fear or threats. In studying 60 participants withheightened sensitivity to anxiety, Otto and Smits found that the subjects who participated in a two-week exercise program exhibited marked improvements in anxiety sensitivity compared to those participants who did not take part in the exercise program. They concluded that this improvement was a result of the exercise group participants learning to associate the symptoms common to both fear and exercise, such as sweating and an elevated heart rate, with something positive (exercise) instead of something negative (anxiety).

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A-42 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY

Choose snacks that pack an energy punch METRO — Many adults find themselves feeling drowsy in the hours after they eat lunch. A heavy lunch, a staid office atmosphere or a combination of the two can make professionals feel sleepy as the workday winds down. Though some might opt for a second cup of coffee, the immediate energy boost provided by caffeine quickly wears off, leaving men and women feeling even more tired as a result. Oftentimes, the right mid-afternoon snack can provide the energy boosts adults need to stay productive throughout the workday. The following are a handful of healthy snacks that tend to provide a lot of energy. Greek yogurt Greek yogurt has become increasingly popular in recent years, as more and more people are opting for this snack that’s rich in calcium, protein, phosphorous, and zinc. Traditional yogurt tends to provide a quick energy boost, as it is generally easy to digest, before that boost quickly fades. Greek

yogurt is thicker than traditional yogurt, so it does not digest so easily, producing more sustained energy levels as a result. However, Greek yogurt is also loaded with protein, helping men and women feel fuller longer. Whole grains Whole grain snacks are loaded with energizing ingredients, including fiber, iron, magnesium, and protein. Whole wheat snacks are also loaded with B vitamins, which help people fight fatigue and stabilize blood sugar levels. Edamame Many people may know edamame from recipes, but few might know edamame can be an energy-boosting snack as well. Edamame are boiled soybeans that are rich in protein, iron, omega-3 fatty acids, and fiber. Each of these things helps the body sustain energy levels. In addition, edamame is also packed with a trace mineral known as molybdenum that helps cells function properly while enhancing alertness and im-

Can children benefit from weight training? METRO — A review published in a 2010 issue of the medical journal Pediatrics found that children benefited from weight training. In the review, researchers from the Institute of Training Science and Sports Informatics in Cologne, Germany, analyzed studies that focused on children and weightlifting. The review looked at studies going as far back as 60 years, finding that children and adolescents who lifted weights grew stronger. Those who participated in strength training twice per week gained more strength than those who participated just once per week. These findings contradict a longstanding belief that children do not actually get

stronger. But while children and adolescents may be getting stronger, researchers found that they do not add as much bulk or obvious muscle mass as adults. Instead, researchers feel the strength changes in children and adolescents stem more from neurological changes that make their nervous systems and muscles interact more efficiently. Though parents have long worried that strength training will stunt their children’s growth, researchers now feel that properly supervised strength training will not stunt growth or lead to growth-plate injuries and will perhaps even reduce their risk of injury as opposed to increasing that risk.

proving concentration. Almonds Almonds are loaded with ingredients that increase energy levels, including vitamin E, phosphorous, vitamin B2, and magnesium, which serves numerous beneficial functions, including aiding in the production of energy and relieving stress and anxiety. Because they are rich in protein and fiber,

almonds take longer for the body to digest, which means energy levels will stay up for longer periods of time than they would for those snacks that are easily digested. Almonds also contain healthy fats that curb appetite, making it less likely that men and women who snack on almonds will overeat and find themselves fighting the fatigue that’s often a byproduct of overeating.

HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-43

MEDICAL DIRECTORY Benefit from the nutritive power of apples METRO — Who hasn’t heard the old adage, “An apple a day keeps the doctor away”? It may seem unlikely that one fruit could be so effective at maintaining good health, but apples really are a super food. Apples are a member of the Rose family and are related to pears, peaches, apricots and plums. Though considered a fall fruit, apples can be enjoyed year-round thanks to commercial food production and importing. Apart from being sweet, sometimes sour and refreshingly crisp, apples pack a number of nutritional benefits. Research has shown that apples can help to reduce a person’s risk of heart disease and help those with diabetes. In addition, apples can help fight cancer and prevent dental problems. According to new information from longrunning studies published in the British Medical Journal, eating at least two servings a week of whole fruit, particularly apples, blueberries or grapes, reduces a person’s risk for type 2 diabetes by around 23 percent.

Apples are high in many antioxidants and, as a result, this makes them especially valuable at fighting illness. For example, the disease-fighting compounds in antioxidants have been shown to reduce the risk of certain cancers by neutralizing free radicals. Apples also are very high in fiber. Fiber is needed to help a person feel full and can also regulate digestive function. Fiber also can help reduce cholesterol by preventing the buildup of cholesterol-causing plaques in the blood vessels, improving cardiovascular function and possibly reducing risk of a stroke as a result. In addition to working their magic inside of the body, apples can have a noticeable impact on physical appearance as well. Apples are sometimes referred to as “nature’s toothbrushes” because they can brighten and clean the teeth. The crisp, abrasive texture stimulates the gums and removes debris from the teeth. What’s more, the natural mild acidity of apples helps to stimulate saliva production that can rinse away germs that lead to plaque.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-45

MEDICAL DIRECTORY

Clean produce properly to avoid contaminants METRO — The demand for fresh produce has increased in recent years as more people are turning to fresh fruits and vegetables for their nutritional value. That increase in demand has forced many suppliers to import more produce from other countries, which could be putting consumers’ health at risk. Although the United States and Canada may have stringent standards for produce, many other countries do not. Less stringent regulations overseas can result in irrigation water carrying sewage, pollutants and parasites to crops, and herbicides and pesticides may be used in abundance in foreign countries where such usage is subject to little, if any, oversight. Fewer regulations means some farms pay more attention to profit than to the purity and safety of crops. The Pure Food Growers of America states that the average American consumes more than 10 pounds of insecticides and herbicides every year from produce. Many of these substances are proven carcinogens. Thoroughly washing and soaking fresh produce is the key to removing potential hazards from foods. Organic fruits and vegetables may be less risky, but even organic foods are susceptible to contamination because of potentially unsafe handling practices. All produce should be washed before eaten. Before cleaning produce, stock up on a few supplies. You will need a large plastic bowl, some apple cider vinegar or baking soda and a produce brush. Add enough cool water to cover the produce you will be washing. Add either three tablespoons per gallon of water of the vinegar to the bowl or sprinkle about three tablespoons of the baking soda into the water. It’s best not to mix both the vinegar and the baking soda, or you may end up with a foaming, overflowing concoction thanks to the chemical reaction that occurs when vinegar mixes with baking

soda. Add the vegetables or fruit to the treated water and allow it to soak for around 10 minutes. Use a vegetable brush to thoroughly scrub the produce. Some foods, like celery and lettuce, have dirt or bugs trapped in their ribs and folds. Soaking and scrubbing can dislodge any bugs. Instead of washing the entire head at once, wash lettuce leaves as they are used to retain the vitamins and minerals. After rinsing the produce, allow to dry before eating. A salad spinner can help dry lettuce and cabbage leaves so they are not soggy. It is best to wash produce right before using it rather than washing it in advance. Moisture encourages bacterial growth and hasten spoiling. Even foods that have a rind, such as melons, should be washed prior to eating to avoid contamination from the rind to the flesh inside. The Dirty Dozen Certain foods are dirtier than others in terms of the pesticides they contain. However, foods that were grown without pesticides may still be contaminated by animal feces and bacteria from the soil and irrigation. That being said, here are the 12 foods that are most likely to contain the highest amounts of pesticide residue, according to The Environmental Working Group. 1. Apples 2. Celery 3. Cherry tomatoes 4. Cucumbers 5. Grapes 6. Hot peppers 7. Nectarines 8. Peaches 9. Potatoes 10. Spinach 11. Strawberries 12. Sweet bell peppers

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A-46 —HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

MEDICAL DIRECTORY Shed more pounds with metabolism-boosting basics METRO — Men and women looking to shed a few pounds and keep those pounds off often look for ways to boost their metabolisms. Some may not know just what metabolism means, and though it is a complicated combination of processes, metabolism is perhaps best explained as the sum of those processes, each of which is instituted to convert food into energy. So it’s no surprise that so many people, especially men and women whose metabolisms have begun to slow down, want to boost their metabolism and turn that food into energy more quickly. Though metabolism is a collection of complicated processes, boosting metabolism can be rather easy. The following are a handful of ways to do so, which can help men and women reach their fitness goals. Eat right... and often Many adults have been turned on to the concept of grazing, an approach to diet wherein adherents eat small portions of food every two to three hours instead of the more traditional three square meals per day. But grazing is only effective when men and women eat the right foods. Each small meal should still have nutritional value just as if it were a large meal. When eating smaller meals, include healthy sources of protein and fiber. Vegetables tend to be especially beneficial because they are high in fiber, a nondigestible carbohydrate that is hard for the body to break down. As the body works hard to break down fiber, it’s burning energy and boosting its metabolism along the way. Fish is another potentially beneficial food for those looking to boost their metabolisms, as studies have shown that the omega-3 fatty acids found in fish oils increase the levels of fat-burning enzymes in the body while decreasing the body’s level of fat-storage enzymes.

Eating more often benefits the body because doing so stimulates metabolism, reassuring the body that food will be coming on a regular basis. When meals are skipped or there are long intervals between meals, the body reacts as if it might run out of food and begins to store fat. Add some lean muscle Lean muscle can boost metabolism, so a workout dominated by cardiovascular exercise won’t have as positive an impact on metabolism as one that includes a combination of weight training and aerobic exercise. When muscles are worked hard, the body needs to work hard to recover and rebuild those muscles, burning more calories and boosting metabolism as a result. Don’t believe everything you read or hear Suggestions abound as to ways to significantly improve metabolism. Unfortunately, many of these suggestions boost metabolism but not enough to help people lose weight, which is the ultimate goal of many people looking to boost their metabolisms. For example, green tea has its proponents who feel it can have a significant impact on metabolism thanks to EGCG, a compound found in the tea that has been proven to elevate metabolism. However, the impact of EGCG on boosting metabolism is negligible, and therefore won’t make much of an impact on a person’s weight. The same can be said about capsaicin, an active component found in chili peppers that some feel boosts metabolism enough to promote weight loss. Don’t get too comfortable Modern technology may be a reason why waist sizes are getting bigger. Heating and cooling systems may be must-have items, but when the body is too comfortable, it burns less energy to stay warm in the winter or comfortably cool in the summer.

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HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014 — A-47

MEDICAL DIRECTORY

Find time for fitness

METRO — Finding time to exercise is no small feat for many men and women. Obligations at home and at the office can make it hard to fit in a workout, a familiar quandary for men and women with multiple commitments. Though it’s not always easy to fit in a workout when juggling multiple responsibilities, men and women must consider the responsibility they have with regard to maintaining their physical and mental health. The United States Department of Health and Human Services advises that healthy adults get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, and that such activity should be spread out over the course of the week. In addition, the DHHS also advises that healthy adults include strength training exercises in their workout regimens at least twice a week. Such a workout schedule can improve both physical and mental health, making it easier for men and women to handle their hectic schedules. While such recommendations may seem manageable, many men and women still feel as if there’s just not enough time in the day for them to incorporate a daily exercise regimen. The following are a few ways to find time for fitness: Take a walking lunch Many professionals have heard of a “working lunch,” but those strapped for time to exercise might want to take a walking lunch instead. Rather than sitting at your desk or in your favorite booth at a nearby restaurant on your lunch hour each day, consider squeezing in some time to walk during those 30-60 minutes you normally spend eating or catching up on office gossip with coworkers. Invite a few coworkers along, walking to and from your favorite restaurant or finding a nearby park and going for a quick walk. This is an easy way to squeeze in the recommended 30

minutes of moderate aerobic activity each day, and you will no doubt feel more energized after lunch than if you had simply eaten without exercising. Exercise in the morning Research has shown that men and women who exercise in the mornings exercise on a more consistent basis than those who exercise later in the day, including after leaving the office at the end of the workday. When exercising in the early morning hours, men and women are less likely to encounter scheduling conflicts, as coworkers, colleagues and even the kids will likely still be asleep. That means fewer interrupted or missed workouts. Prepare meals ahead of time If working out in the morning simply won’t work out for you, then consider planning meals in advance so you can free up time between the office and dinner each night. For example, slow cookers and crockpots make it possible to start making dinner in the early morning and require little or no effort once you arrive home in the evening. Plan to cook a few meals each week in a slow cooker, which will free up time for you to workout when you would otherwise be preparing dinner. Work while you workout Smartphones and tablets have made it easier than ever to get work done while you’re away from work. This includes getting some work done while you’re getting in your weekly recommended aerobic activity on the treadmill, elliptical machine or exercise bike. Thanks to smartphones and tablets, you can now read and answer emails and work on some projects while you sweat away those extra pounds. Get off the couch Many men and women prefer to unwind on the couch as they catch up on their favorite television shows and movies. But such unwinding should not come at the expense of working out.

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Reflections Life is constantly being renewed. We all experience it as we grow and change with age. Some older adults may need the specialized help provided by the staff at Reflections to successfully adapt to the challenges of aging.

Reflections is located inside Jamestown Regional Medical Center atop the beautiful Cumberland Plateau. The unit provides:

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H o m e t o w n Family Hometown F a m i l y Care Care ““Where W h e r e we w e care c a r e for f o r you y o u aand n d yyour o u r ffamily” amily”

New Patients, Walk-Ins and Same Day Appointments Welcome! • T-DOT Physicals • Sports Physicals • Medical Supervised Weight Loss Accepting most insurances including Medicare.

Monday-Friday 8-5 • Saturday 8-12 • Sunday 11-4 675 B Cookeville Wanda Keagle, FNP S. Jefferson Ave. 931-854-0050

A-48 — HERALD-CITIZEN/REGIONAL BUYERS GUIDE, Cookeville, Tenn. — www.herald-citizen.com — Wednesday, Janaury 29, 2014

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Our team of Ear, Nose and Throat doctors, nurses, and hearing professionals strive every day to provide you with the best and most complete Ear, Nose and Throat care in Middle Tennessee. All Ear, Nose and Throat problems, such as hearing loss, sinus issues, facial skin lesions, thyroid and parathyroid disease, and facial plastic surgery are among the services we provide to you. We also offer diagnostic testing, including CT scans, in our office for your convenience and efficient diagnosis.

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