Inside Medicine Magazine 2019 Spring by Inside Medicine

Inside Medicine | Spring Issue 2019

and function of the Attune total knee improve the daily life of my patients vs total knee implants I have used in the past. My patients gain early post-op flexion, greater overall range of motion and stability. Many patients insist they â&#x20AC;?forgetâ&#x20AC;? they even have a total knee implanted. -Jack Moore, MD

Inside Medicine | Spring Issue 2019

From here, Anywhere.

Patients implanted with the ATTUNE® Knee have reported improvements in the following outcomes: stability, function, range of motion, and reduced pain.1 The ATTUNE Knee can help you get back to your life and pursuing your passions sooner vs. other knee brands.2,3 1. Hamilton WG, Brenkel, I, Clatworthy M,, Dwyer K, Gibbon A, Kantor S, Lesko J, Himden, S. Early Outcomes with a New primary TKA system vs. contemporary TKA: interim results of two worldwide, multi-center prospective studies. American Academy of Orthopaedic Surgeons (AAOS), San Diego, California. March 14-18, 2017; Poster #106. Other implants tested: SIGMA Knee (DePuy), NexGen® (Zimmer), Triathlon® (Stryker). 2. Etter K, Lerner J, Kalsekar I, de Moor C, Yoo A, Swank M. Comparative Analysis of Hospital Length of Stay and Discharge Status of Two Contemporary Primary Total Knee Systems. J Knee Surg. 2017. 1(212): 1-10. DOI https://doi.org/10.1055/s-0037-1604442. 3. Clatworthy, M. (2015). An Early Outcome Study of the ATTUNE® Knee System vs. the SIGMA® CR150 Knee System. DePuy Synthes Companies White Paper. DSUS/JRC/0814/0418. In an IRB approved early outcomes study, physiotherapists collected data on 40 patients implanted with ATTUNE® Knees and 40 patients with SIGMA® CR150 knees. The results demonstrated that patients implanted with the ATTUNE Knee had statistically significant improvements in some early outcomes, other outcomes demonstrated a trend favoring the ATTUNE Knee, and some outcomes were equivalent.

Inside Medicine | Spring Issue 2019

features &

CONTENTS

Sharing with Purpose

Inside Medicine | Spring Issue 2019

FEATURES Talking about Hormones

CONTENT

Expectations & Brain Power

questions and answers

The Ageless Prescription

Get Your Butt In Gear

For Better or Worse

how genetics can affect our relationships

CO N T R I B U T O R S

Kimberly Waldrop, MA Rachel Sullivan, MFTA Donald Aulds, MD Nikki Rohling

Brett Davenport, MD LaChara Fletcher Kaki Morrow

colon cancer awareness

ISSUE 13

Traci McCormick, MD

how to change negative thinking

actions for a longer, fuller life

The Power of People

VOL 3

Jill Windham

Jackie Makowski Kari Kingsley, MSN, CRNP Heather Morse, MS, ATC, OTC

benefits of joining professional organizations

Neil Lamb, PhD Nick Thomas Anne C. Jewell

Join our mission to establish and grow an alliance among our community and healthcare providers. Together, we can change the way healthcare information has been and will be distributed for years to come.

To reach our readers, whether through editorial contribution or advertising, please contact Kelly Reese at kellyreese. im@gmail.com or 256.652.8089

Making a Difference

Larry Parker, MD S A LE S & M A R K E T IN G

Kelly Reese, Founder Lisa Layton, VP Sales/Marketing Leza Perez CH I E F E D I T O R I A L WRITER

Kimberly Waldrop, MA G R A P H I C D E S I GN

Leigha Parker Karen Gauthier P U B LI S H E R S

The information and opinions contained in this publication constitute general medical information only and should not be construed as medical advice. Before making important medical decisions, readers should consult with a physician or trained medical provider of their choice and have their needs and concerns assessed in a clinical setting appropriate for their problem.

Inside Medicine | Spring Issue 2019

Blake Bentley, President w w w . i n s i d e m e d i c i n e m a g a z i n e.com

} FROM THE EDITOR

grow with Inside Medicine

I can just feel spring in the air. It is such a refreshing time of year! We can all relate to everything spring brings….the sun is setting later in the day, kids are playing outside and enjoying spring sports, people are traveling for school breaks, the grass is getting greener, the buds are blooming and the allergies are coming out. At the same time, it is Easter, and we are reminded of our Savior’s love at this time of year. John 3:16, For God so loved the world that he gave his ONLY Son that whosoever believes in HIM will have everlasting life. We just cannot fathom the depths of that verse, even though we can all recite it from memory. In this spring season, let us remember the sacrifice of our Savior. Because of HIM, we can all live eternally! Our hope and prayer with this publication is to always reflect God’s love. We work hard to try and give you stories that are uplifting, informative, and even sometimes spiritual. In this edition of Inside Medicine, we hope you find something you can use or share with others. Read along in this issue to find out about chronic pain, hormones, ovarian reserve, and the lymphatic system’s role in your health. You will be surprised at how much you may learn. Also in this issue, you will find an editorial about love and trust by Jill Windham and a reminder about how your brain and thoughts effect how you feel as told by Rachel Sullivan. From an editorial about being addicted to nasal spray to an interview with a surgeon, there is a wide range of content in this issue. As always, we hope you enjoy our magazine and will share it with others. If you ever have any questions or concerns, ideas for stories, or want to be a contributor, please let us know!

Kimberly Waldrop

Inside Medicine | Spring Issue 2019

} COVER FEATURE

Expectations & Brain Power by, Rachel Sullivan, MFTA

An expectation, as defined by dictionary.com, is “a strong belief that something will happen or be the case in the future.”

Inside Medicine | Spring Issue 2019

I would wager that you have been expectant at some point in your life. Expected a good test score. Expected a certain response from a friend. Expected a specific outcome from a medical test. You have also likely felt disappointment when those expectations were not fulfilled. Expectations are an interesting thing. They can certainly benefit us in our journey of life, helping us along as we set goals and aspirations for ourselves. However, expectations are not always positive, and that tends to be where this subject gets tricky. When we have had multiple negative experiences in our life, especially surrounding the same circumstance or person, our expectations can begin to be primarily negative. Although this typically takes a long period of time, and many encounters with disappointing outcomes, it can happen relatively quickly as well. Let us look at an example. Perhaps you have had surgery on your right knee, and the prognosis was originally positive. You begin attending follow-up appointments with a positive outlook, expecting good news. Unfortunately, at the first appointment you receive information that sets back your recovery time. No worries, you shake it off and attend the next appointment. More bad news. After several appointments with this same outcome, you may begin to make assumptions that the appointments will result in unfavorable reports. Your expectation is negative, and understandably so. At this point what has happened in your brain is that neural pathways have been formed surrounding this area of your life. These pathways contain data, based on your experiences, that inform you that these appointments are inherently negative. Whether this has happened in just one aspect of life, but especially when this pattern is repeated across several areas of life, we can begin to have a negative perspective. When this is the case it becomes very difficult to see any positive, regardless of how much may be there. Figuratively speaking we have a negative filter over our eyes. So, what is the prognosis? How do we prevent turning into those people we avoid because they always bring the dark clouds with them? The good news, there is hope in this situation. As mentioned, our brain creates neural pathways, forming information superhighways for the experiences we have during our lifetime. Fortunately, what neuroscience has revealed over the past few decades is that the brain is “plastic”, or capable of updating what scientists used to think was fixed, hard-wired information. We now know that with the use of

therapeutic techniques an individual can rewrite the neural pathways and change the way they think about and react to previously negative situations. Incredible, right? Following are three things we can do to interrupt this pattern. 1. BE MINDFUL. This process begins with noticing how we are feeling in our bodies. During moments of negative thinking when we can identify that automatic response as it is happening in our physical self, we can interrupt the information it is sending us about how to react. For example, returning to a follow-up appointment for your knee you notice that dread is setting in, the heavy anticipation of more bad news. In your state of mindfulness, you recognize this feeling and pay attention to how it affects your body. Is it a tightening in your chest or a difficulty to take a full breath? Or does it feel like a knot in your stomach, throat, or elsewhere? Whatever the feeling, take note of where and how it affects your physical self. Recognizing this sensation is important in interrupting it. 2. IDENTIFY A POSITIVE. Once you understand what your physical reaction is, when it begins to manifest, finding something positive about your situation is crucial. Rather than following the emotions and mindset that typically follow your physical response, instead take a few deep breaths and draw attention to that fact that since your last appointment you have noticed increased mobility in your knee. Although this step may be difficult at first, purposefully shifting your mind away from the negative onto a positive sends signals to the brain to change its focus. Do not skip this step, it is crucial, so search hard for a positive if you must! 3. CREATE NEW RESPONSES. When we recognize how our body has been programmed to react to negative situations, we can begin to retrain it. New neural pathways are formed when we catch the automatic response of dread and replace it with thankfulness, or acknowledgement of positive in the situation. If we apply this to our knee appointment scenario, we have been mindful of how our body felt when the negativity started creeping in. Then we took a moment to identify a positive, and now we add the step of being thankful for the positive item. When we can repeat this process over time, we have the capability to update those superhighways. This may seem fairly simple, and in all transparency the description here is certainly scaled down. While there are hours of work that go into rewriting the brains responses, it is possible, and worth it! Now is a great time to start, and you have the tools you need already. If you are interested in more information about this topic, please reach out! Rachel Sullivan, MFTA Solid Ground Counseling Center 256-503-8586 www.solidgroundmadison.com Inside Medicine | Spring Issue 2019

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Hormones

TALKING ABOUT

by, Donald Aulds, MD

WHAT ARE HORMONES? Hormones are chemicals produced in certain organs of the body and released into the blood stream to act on other areas of the body. Some hormones may have mainly a single action while other such as estrogen may act on multiple areas of the body and produce multiple actions in the body.

Hormones are probably one of the most misunderstood chemicals in the body. The term hormones can stand for multiple chemicals including those from the thyroid gland, adrenal gland, pancreas and of course the ovaries or testes. I will try to approach this from the standpoint of a question and answer approach. 10

Inside Medicine | Spring Issue 2019

HOW DO HORMONES WORK? Hormones act on areas of the cell called receptor sites. The receptor site in the presence of the hormone releases some response in the cell to produce the response that is intended to occur. Some of the receptor sites may be blocked by other chemicals to reduce the response to the hormone. Also, synthetic hormones may incompletely act on the receptor site and not produce the expected response. WHY DO I BEGIN TO HAVE SYMPTOMS RELATED TO HORMONE CHANGES? This is a complicated question, but in order to try to simplify the answer, you must understand that each hormone in the body has a time in which maximum production of the hormone is achieved and production will begin to decrease beyond this point. As a good example, testosterone production peaks in a woman in her later 20’s and in a man in the early 30’s. After this point of life, testosterone will drop in production and symptoms of decreased testosterone can begin. Some conditions or diseases will accelerate the loss of certain hormones. WHY DO I FEEL TIRED OR CAN’T SLEEP? These two problems are often two of the most common complaints that I hear from patients. The can be multifactorial and can not be helped often without measuring hormone levels. These studies can include evaluation of sex hormones, thyroid hormones, and stress hormones. IF HORMONES LEVELS ARE NORMAL, WHY DO I STILL HAVE PROBLEM? Reactions to hormones are also affected by other chemicals of the body particularly vitamin D. Vitamin D is con-

sidered a prohormone meaning the it has to be present for the hormone to produce the response that is expected of the hormone. Without adequate levels of vitamins and minerals in the body, the body just does not respond the way it was intended to work. An example, thyroid hormones must have such chemicals as selenium and boron present to work on certain tissues. WHERE DO THESE CHEMICALS COME FROM? Mainly from foods that we consume or by supplements taken as directed by your physician. The World Health Organization recommends a low caloric diet such as the Mediterranean diet and exercise to boost response of healthy function of our bodies. WHEN DO SYMPTOMS OF DECREASED HORMONES TYPICALLY OCCUR? For most women and men, symptoms usually start or become significant in the 40’s to 50’s. Some symptoms may show up earlier in certain individuals, but some may not occur until later in life. WHAT CAN BE DONE FOR THE SYMPTOMS? I always try to select therapies based on a combination of symptoms reported by the patient and the results of lab tests of the hormones. Specific panels of test of hormones are based on the sex of the person. When lab test results are available approaches of therapy can be planned based on the individual’s needs. AREN’T HORMONES BAD FOR ME? Multiple studies done mainly in Europe have shown that bioidentical hormones (naturally derived hormones) are safe compared to synthetic hormones. One result of a French study showed that testosterone in a woman helps protect against breast cancer along with other benefits to the body. These must be discussed with a physician. HOW LONG WILL I HAVE TO BE ON HORMONE THERAPY? As long as you are getting benefits from the therapy. There are no studies on naturally derived hormones that show or suggest a time limit for therapy. I tell patient daily that length of therapy is a personal choice, but whenever hormones are stopped, symptoms may return. It all depends on how well you feel, if the hormones are helping control the symptoms, and whether you desire to do everything you can to maintain your health. Dr. Donald Aulds is an obstetrician-gynecologist in Huntsville, Alabama and is affiliated with Huntsville Hospital for Women and Children. He received his medical degree from Louisiana State University School of Medicine in New Orleans and has been in practice for more than 25 years.

Inside Medicine | Spring Issue 2019

KNOW YOUR ABCDE's of Skin Cancer by, Traci McCormick, MD

Almost every adult has at least a few moles. Moles that appear in childhood grow along with your body. They can get darker over time. Or lighter. That’s normal. But other changes can be signs of melanoma, the most serious type of skin cancer. Because melanomas can develop quickly, Traci Cole McCormick, MD, a radiation oncologist with Alliance Cancer Care in Decatur, recommends self-examining your moles at home every month following the ABCDE rule:

Asymmetrical: does one half match the other?

Border: is it irregular, with ragged or notched edges? Color: is it the same all over?

Diameter: is it larger than about ¼ inch?

Evolution: is it growing, itching or bleeding?

If you answered “yes” to one or more of those questions, or have a sore on your skin that does not seem to be healing, Dr. McCormick says you should go see a physician right away for a more thorough evaluation. Skin cancers that are found early and removed are almost always curable, but they can be deadly if allowed to grow and spread to other parts of the body. It is estimated that one in five Americans will develop some form of skin cancer by age 70, making it the most frequently diagnosed type of cancer. Basal cell carcinoma is the most common form of skin cancer, which more than four million cases diagnosed every year, followed by squamous cell carcinoma and melanoma. Many cases of skin cancer can be linked to ultraviolet radiation – either from sunlight or commercial tanning beds. Other skin cancer risk factors include fair skin, abnormal moles, family history of skin cancer, and living in a sunny or high-altitude climate. “In hot, sunny climates like Alabama, you really need to take precautions if you’re going to be outside for any length of time,” Dr. McCormick said. “Always apply a broad spectrum sunscreen with an SPF (sun protection factor) of 30 or higher. Protective clothing, wide-brimmed hats and UV-blocking sunglasses are also smart ideas.” Let’s take a closer look at the three most common types of skin cancer. Basal cell carcinoma begins in the basal cells – a type of cell that produces new skin cells as old ones die. It often first appears as a Inside Medicine | Spring Issue 2019

bump on the skin in a part of the body that is regularly exposed to the sun, such as the head or neck. Basal cell carcinomas are easily treated if caught early and rarely spread, or metastasize, beyond the tumor site. Squamous cell carcinoma develops in the squamous cells that make up the middle and outer layers of skin. While it can occur anywhere on the body, it is most often found in areas that get frequent sun exposure such as the face, ears, scalp, lower lip, neck, hands, arms and legs. Squamous cell carcinomas are more common in men, but women under 40 are increasingly affected. Many experts attribute this to use of commercial tanning beds. Melanoma, the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin, the pigment that gives your skin its color. Melanomas often resemble moles and sometimes develop from existing moles. Like basal and squamous cell carcinomas, early detection is the key to successful treatment. Melanomas are much harder to treat, and often fatal, if the disease reaches the lymph nodes or metastasizes to distant organs. Physicians consider a number of factors when deciding how to treat skin cancer, including the location, type and stage of the disease, the patient’s age and overall health, and potential side effects. “Some cancers are better treated with radiation therapy and others with surgical removal of the tumor,” Dr. McCormick said. “Each case is individual and requires a conversation with your doctor.”

Alliance Cancer Care uses external beam radiation therapy (EBRT) to safely and painlessly deliver high-energy X-rays to skin cancer cells while preserving the surrounding, healthy tissue. The X-rays damage the cancer cells so they cannot multiply. The treatments take only about 15 minutes and are offered at all six Alliance locations across Alabama.

Inside Medicine | Spring Issue 2019

HudsonAlpha Institute for Biotechnology and Crestwood Medical Center

COLLABORATIVE ALS PROJECT UNDERWAY by Nikki Rohling

Inside Medicine | Spring Issue 2019

} RESEARCH

Helping patients AND FURTHERING GENOMIC RESEARCH As many as 20,000 Americans live with ALS, and 15 new cases are diagnosed in this country every day. A new HudsonAlpha Institute for Biotechnology project is just underway in collaboration with Crestwood ALS Care Clinic, a National ALS Association Treatment Center of Excellence in Huntsville, Ala. In this project, HudsonAlpha scientists will conduct genomic sequencing and analysis of ALS patients to better understand the underlying cause of the disease. The project is funded through donations made to Impacting ALS, which is part of the HudsonAlpha Foundation’s Memory and Mobility Program. ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease, is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Michelle Amaral, PhD, a senior scientist in the HudsonAlpha Myers Lab, is leading the project. “Through genomic sequencing and analysis, we hope to identify genetic variants that contribute to ALS,” said Amaral. “We want to understand the mechanisms that cause the disease as well as the differences between sporadic and familial ALS. The ultimate goal is to discover biological targets that may be useful for the development of new treatments and therapeutics.” Sherry Kolodziejczak, an occupational therapist and Director of the Crestwood ALS Care Clinic/Cardiac Rehab/Therapy Services/Workers Program, said patients treated at the clinic report a higher quality of life and longer life expectancy. “Our clinic manages each ALS patient case throughout the course of the illness. We have to prevent the crisis before they come, not when they get here, and that's how we can prolong life and give good quality of life,” she said. Led by co-medical directors David White, MD, and Aruna Arora, MD (both neurologists), the Crestwood ALS Care Clinic is the only ALS Association Treatment Center of Excellence in the state of Alabama. The Crestwood ALS Care Clinic is also a Northeast ALS Consortium (NEALS) site. The mission of NEALS is to rapidly translate scientific advances into clinical re-

search and new treatments for people with ALS and motor neuron disease. ALS patient Bryan Stone of Sylacauga, Ala., a NEALS ambassador for the Crestwood ALS Care Clinic, is happy to see that research is happening right here in Huntsville. “It’s exciting to see the testing and the collaboration done here at home and that we can take part in it,” said Stone. “ALS has forced me into retirement and there are a lot of activities that I’m not able to do, but then again, it’s opened up other avenues for me to work with the ALS community and help others.” “Crestwood ALS Clinic physicians and staff really go above and beyond to take care of patients,” said Pam Hudson, MD, CEO of Crestwood Medical Center. “This hopefully will get to the cause of the disease so we don’t have to solely focus on the treatment.”

HudsonAlpha collaborates with institutions all over the world. It is especially exciting to be working on a project like this in Huntsville, so we appreciate Crestwood ’s support and look forward to making even more advances in ALS. – Rick Myers, PhD, HudsonAlpha president and science director

Additional donations are being accepted and will be used to enroll even more patients who are battling ALS. Donations to Impacting ALS can be made at hudsonalpha.org/donate or to the HudsonAlpha Foundation at 601 Genome Way, NW, Huntsville, AL 35806. Inside Medicine | Spring Issue 2019

DOvarian I M I N IReserve SHED } MEDICAL ADVANCEMENT

by Brett Davenport, MD

The biological clock. Every woman feels it to some degree. For some women it is a soft whispering reminder that can be drowned out by life’s boisterous pace. Others may hit the ‘snooze’ button in hopes that the reminder doesn’t resurface too soon. Still for others it is like a deafening smoke alarm that may trigger panic. Regardless, it is a call that should be heard and understood in order for a woman to make a good decision regarding her plans for a family.

WHY IS AGING IMPORTANT TO THE OVARIES? Age is an important factor when talking about fertility because it inversely correlates with a woman’s chances of conception and live birth. Even though the average woman’s reproductive window is quite broad, the overall chances of conceiving begins declining much more rapidly around age 34. In other words, the hill down towards infertility becomes steeper. But it’s important to recognize that it is indeed a hill not a cliff (Figure 1). So, what does that mean? Most of the declining live birth rates as a woman ages are due to the aging of her eggs. Aging has several effects on the eggs, including a steadily diminishing number of eggs, decreasing egg health, and an overall increase in the number of eggs that are genetically abnormal when ovulated. This all translates into a decreased ability to get pregnant (decreased pregnancy rate), stay pregnant (increased miscarriage rate), and deliver a baby (decreased live birth rate).

Figure 1

EGG QUANTITY It may be a sobering fact that a woman who is of reproductive age loses a group of 15-20 eggs each day on average. In fact, by the time a woman is 30 years old, only 12% of her egg population that she had at birth remains. By the time she is 40, she has only 3% of this population remaining. As a result of declining egg quantity, many women will begin to have more frequent periods as their ovarian reserve begins to deplete. This can sometimes mean that an egg will ovulate prior to it being fully mature. It is also not uncommon to skip ovulation cycles as egg reserve becomes very depleted. EGG QUALITY Just as the rest of our organs suffer from ‘wear and tear’ as we age, the ovaries are no exception. In an ovary each egg depends on a cluster of cells around it called the cumulus complex for nourishment. These cumulus cells allow the essential nutrients and hormones from a woman’s bloodstream to reach an egg. As a woman ages, this group of nourishing cells begins to become smaller and smaller, causing each remaining egg to be less healthy than in younger eggs.

Inside Medicine | Spring Issue 2019

INCREASED ANEUPLOIDY OF EGGS Just prior to an egg ovulating it undergoes an equal division of chromosomes (the genetic material passed on to your offspring). If an equal division of these chromosomes does not occur, the egg is said to be aneuploid because it will have one too many or one too few chromosomes. An unequal division can occur in women of all ages. However, with age comes an increasing frequency of unequal division and a greater percentage of a woman’s eggs being aneuploid (figure 2). The large majority of aneuploid eggs will not be able to result in a viable pregnancy due to inability to fertilize or implant, or due to miscarriage. For the rare occurrence that an aneuploid egg does result in pregnancy, the child will usually have a syndrome (Down’s syndrome, etc.). Although a woman’s overall chances of having a baby with an aneuploidy increase with age, the absolute risk for a woman who is less than 40 is only 1.5%.

Figure 2

Inside Medicine | Spring Issue 2019

...cont’d from page 17

HOW DOES A WOMAN KNOW IF SHE HAS DIMINISED OVARIAN RESERVE? If a woman who is less than 35 years old has regular menstrual cycles, she has no reason to be concerned about her ovarian reserve since it is more than likely adequate. However, around age 35 a woman’s level of concern about diminished ovarian reserve should certainly increase. Even though menstrual cycles may remain normal, ovarian reserve is reaching its limits in these women. Several tests exist that will hint at how many and/or the quality of eggs remaining. Antimullerian hormone is a substance secreted by the cumulus cells around the egg, and is a good indicator about the number and/or quality of eggs. FSH during the first few days of a menstrual cycle is also a good indicator of the degree of egg depletion. Finally, an ultrasound can be performed to check the ‘antral follicle count’. This is a snapshot in time of the follicles that are next in the cue to grow and mature, but also hints at how many eggs remain. No test exists that predicts your specific risk of aneuploidy. Aneuploidy rate must be assumed based on your age alone. WHAT IF I DO HAVE DIMINISHED OVARIAN RESERVE? If the above tests do indicate that your ovarian reserve is diminished, here are some things to keep in mind: • You are already on your way to the most important step which is gaining an awareness that time is of the essence. If you are in a life position to have children, do it while you can! • If you are 35 or over and have been trying to conceive unsuccessfully for 6 months or greater, it is prudent to allow for an infertility specialist to perform a thorough infertility work-up that will detect any other potential fertility issues that might further delay or hinder your ability to conceive or carry a child. • An infertility specialist can also help you stimulate multiple eggs each cycle, which will act to increase your overall chances to conceive each cycle. • Because time is of the essence, in vitro fertilization (IVF) may be recommended to you in certain situations or if your DOR is severe. IVF will give you the highest chances for pregnancy in the shortest amount of time. This can also allow you to freeze embryos for future use while you still have eggs left. • Your infertility specialist may recommend antioxidants, which may slow the aging process and possibly decrease the aneuploidy rate of your eggs. • Other supplements like DHEA, growth hormone, transdermal testosterone, and vitamin D have to date been shown to be possibly beneficial in certain patients with DOR. These should be discussed with an infertility specialist to see if any are right for you. 18

Inside Medicine | Spring Issue 2019

CAN I DO ANYTHING TO SLOW OR PREVENT THE AGING OF MY EGGS? In short, ovarian aging cannot be prevented, and the most powerful determinant in ovarian reserve and aging are your genetics. However, as with the rest of our organs in our body, the ovaries age slower when they are subjected to less stress. Healthy eating and exercise are the best place to start. Avoiding stressors like smoking, excessive alcohol, and environmental toxins, and minimizing lifestyle stressors are all good ways to maximize the potential of your ovaries. Antioxidants can also help slow this process and can be found in many dietary sources or supplemented in pill form (e.g. CoQ10). WHAT IF I’M NOT READY TO HAVE CHILDREN UNTIL IT IS TOO LATE? For women who are planning to have children later in life, it might be wise to consider the freezing of some of her eggs while she is in her 20s or early 30s. Even women in their late 30’s who are not yet desiring children may opt for egg freezing before their ovarian reserve is depleted. Cryopreservation of her eggs allows for better pregnancy that are consistent with the age of when the eggs were frozen rather than a patient’s current age. This process is called elective egg freezing.

CONCLUSION No need to panic, but also don’t wait until it’s too late to listen to your biological clock. Several ways exist to test your ovarian reserve, and several interventions are available that may help if your reserve is diminished. Anticipate when you might plan for a family and consider freezing your eggs or embryos if you think you may be older and still desiring to have kids. Lastly, don’t hesitate to call an infertility specialist to help you assess your situation! We are here to help!

Brett Davenport, M.D., Practice Director Fertility Institute of North Alabama 532 Madison Street, Huntsville, AL 35801 Phone: 256-217-9613 Fax: 256-217-9618

READY TO FEEL

BETTER?

WHAT ARE YOU WAITING FOR? There’s no time like the start of a new year to work on a new you! TherapySouth can help you heal, move better and overcome the challenges of your physical life. If you haven’t tried physical therapy for the things that keep you from moving without pain—we’re here for you! We can help you get back to the things you love.

Start now and make 2019 your best year ever! TherapySouth is an outpatient physical therapy practice with a fun, family-oriented environment. Our experienced physical therapists know our patients by name and strive to help you achieve your physical goals. You don’t need a doctor’s referral to see a PT, so give us a call today!

Huntsville 6485 University Drive, Suite C | 256.513.8280 www.therapysouth.com

Drop by and meet Clinic Director Michael Beuoy and his team in Huntsville!

WHO IS

YOUR

PT?

Inside Medicine | Spring Issue 2019

October 13, 2015 by LeChara Fletcher

The events of that day stroll across my mind with untold frequency. Untold, because although those events are familiar to some, the story beneath the story is held dear to my heart and rarely uttered. October 13, 2015 became a milestone day in my life. It was when heartbreak and hope came crashing together. It was the day when my doubts, once buried, resurfaced and presented me with a reality that I thought I had escaped. It was the same narrative with different narrators. Doctor after doctor said the same thing. ‘It’s unlikely that you will be able to conceive naturally.’ I was disappointed but not devastated. I had hope. Doubt would creep in occasionally but I had hope. I had hope for healing but diagnosis remained unchanged. But on a sunny summer day in 2010, change did come. The diagnosis remained unchanged but the pregnancy test was positive. The doctor stared at me for a few moments. I still remember it clearly. He looked at me and said, “Well, congratulations.” He was surprised and so was I. I was on edge; trying to catch up with the reality that this actually happened but also preparing myself for the possibilities. The possibility that something may go wrong, the possibility that this may end abruptly, the possibility of complications, and yes, the possibility of a person, the possibility of being a mom. The healing did not come but the person came. Nothing went wrong and there were no complications. And again in 2014. Nothing went wrong and there were no complications. And there came another person. 20

Inside Medicine | Spring Issue 2019

The next year had it’s challenges but nothing that seemed insurmountable. One day a dear friend was praying with me and she said, “The grace of God is resting on you.” And again she said, “The grace of God is resting on you.” She said it was so heavy that she could feel it. But since nothing seemed insurmountable I didn’t know what to make of it, but I did think about it from time to time. That year ended up being one of the most difficult of my life. My sighs were of relief and I began to give little thought to the medical condition that still lingered with me. So on October 13, 2015, I was excited and expecting person number three. Everything seemed to be going fine; the fatigue, the morning sickness, all of the usual things. One morning I woke up and felt nauseous, as usual, so I went downstairs to get some crackers. That was around 5:00am. Before I could finish the crackers, my stomach began to cramp severely. It was so severe, that I was not sure I could get back upstairs. I kept watching the clock because I was supposed to take my son to the dentist that morning. As the time approached 7:00am, I knew I had to do something because the dentist appointment was at 8:00. I was able to make it upstairs to get ready. My plan was to take my son to the dentist and then return home to lie down. While sitting in the dentist office, the hygienist was cleaning my son's teeth, but I noticed that she kept looking at me. She asked me if I was okay and I told her that I was not feeling well but I was fine. After this

} TESTIMONIAL

short conversation, I got up and went to the restroom; I was leaning over the sink praying for the strength to complete what needed to be done that day. I felt light headed, like I was going to faint. So over the sink, I continued to pray for strength. And God was faithful. After we were done at the dentist, we got in the car and went to school. When his teacher saw me she walked out to greet me. She said I didn't look well and asked if I was okay. I told her the same thing I told the dental hygienist, that I was not feeling well but I was fine. She urged me to sit down; she got one chair for me to sit in and pulled another chair in front of me so that I could put my feet up. The pain was so bad that I could not lift my leg so she lifted both my legs and put them in the chair that was in front of me. She began to encourage me to see a doctor. I told her that I was fine and just needed to go home and lie down. She kept insisting that I see a doctor and I kept insisting that I was fine and needed to leave. I knew she meant well, but I didn't want to hear what she had to say. I knew. I knew something was wrong and I knew I was likely loosing the baby, but the pain was so bad that the thought of going to the doctor and having them poke and prod me was almost unbearable. And I didn’t want to go to the doctor and hear those words that I dreaded hearing. The words that I pushed out of my head because everything went so well with the first two pregnancies. I could not process this failure after two successes. I thought I was past that; I thought the hard part was over. I thought that even though the healing did not come, God was showing Himself to be greater than the diagnosis and showing His power in my life. And I was correct. But His power on this day, on October 13, 2015, came in a different way. It was an unexpected way and surely a way that I would not have chosen for myself. But indeed, He showed Himself powerful. My son’s teacher had someone call my husband at work and ask him to come pick me up. My husband came to

I had to make a decision. I had to decide whether to face this moment or not. Her words would not leave me, so I faced the moment.

the school to pick me up. The teacher walked out to the parking lot with us. She stood between the passenger seat and the door, looked me directly in my eyes and said, 'I know you want to go home but I really think you need to see a doctor.' When the doctor examined me he told me that he thought the pregnancy was ectopic and that the fallopian tube had ruptured but he was not sure because there was so much blood on the ultrasound. That same day I had emergency surgery. Yes, the pregnancy was ectopic; yes, the fallopian tube did rupture; no, there was no person number three. Pain in my stomach and pain in my heart. Questions in my mind and torment inside of me. Was there something that I could have done differently? If I had gone to the hospital at 5:00am would it have made a difference? Is the span of this child’s life six short weeks and then thrown out with medical waste? Could this be? These are the moments I had to face. These are the questions I didn’t utter. When the doctor did his rounds and came to my room, he noted that I looked better than when he saw me in his office a few hours before. And I lightly responded that I was not planning to come in to his office that day, but I was going home to lie down. He told me that if I had not come in, I would have bled to death in my house that same day. He said as soon as he opened my stomach, blood began to gush out of me and he collected three bottles of blood from my stomach. He also said that my blood pressure began to drop while I was on the operating table. The tube ruptured around 5:00am when I was downstairs getting crackers. I was in surgery around noon or so. I had been bleeding internally for about seven hours. And it was at that moment, that I had clarity on the bigger picture and saw the evidence of the grace of God resting upon me as was stated in the prayer a few months earlier. He used that teacher and her persistence to save my life!!!! After I was discharged from the hospital, I called the school and told the teacher everything. I thanked her for her persistence. She told me she knew I didn't want to do what she said and that she also knew it needed to be done and that's why she wouldn't let up. My heart still hurts. I am still silent about it more than I am vocal. But I take comfort in this, the body is just a shell and the earth is just a temporary place. I long to know what my baby looks like or acts like. I long to know who he or she is. But this one thing I do know, he or she did not have to experience the weight of humanity but got to skip the earth and rest in the comfort of God. The powerful One, the faithful One, the One who saved my life on October 13, 2015.

Inside Medicine | Spring Issue 2019

HEALING STARTS HERE. • Knee, Shoulder and Hip Pain • Hand, Wrist and Elbow Injuries • Foot and Ankle Conditions • Arthroscopic Surgery • Joint Replacement • Sports Medicine • Spine Medicine • Neurosurgery • Podiatry

256.881.5151 Huntsville

Inside Medicine | Spring Issue 2019

256.230.9607 Athens

256.306.0800 Decatur

www.sportsmedalabama.com

256.464.8200 Madison

Walk to Fight Suicide

Out of the Darkness™ Community Walks: Sponsorship Opportunities October 13, 2019 • 2:30pm - 4:30pm • Ditto Landing For sponsorship opportunities, contact Kari Kingsley at CarolineEKingsley@gmail.com or 245.335.2566

North Alabama Community Walk afsp.org/NorthAL Inside Medicine | Spring Issue 2019

} HEALTH FEATURE

GET YOUR

BUTT

IN GEAR

Written by Kaki Morrow, Senior Community Development Manager

If you’re 45 or older, have a family history of colorectal cancer, or are showing symtpoms of colorectal cancer, it’s time to get your butt in gear.

the most successfully treated cancers if detected early. The five-year survival rate for colorectal cancers caught in their earliest stage is around 90 percent.

March is recognized as Colorectal Cancer Awareness Month. According to the American Cancer Society, this year more than 135,000 people will be diagnosed with colorectal cancer and over 50,000 will die from the disease. In fact, colorectal cancer is the nation’s third leading cause of cancerrelated deaths for both men and women and the second leading cause of death when sexes are combined.

Regular screening is one of the most powerful weapons for preventing colorectal cancer. If polyps are found during screening, they can be removed before they have the chance to turn into cancer. Screening can also catch colorectal cancer in its earliest stages when it is most treatable and curable.

While a combination of earlier detection, changing patterns in risk factors, and better treatments have led to a 51 percent decline in colorectal cancer death over the past four decades, about 1 in 3 adults who fall within the recommended screening guidelines are still not being tested for colorectal cancer. The good news? Screening can help find and prevent colorectal cancer. It is one of 24

Major strides have been made with screening rates in the United States, but we can do better. Members of The National Colorectal Cancer Roundtable, an organization cofounded by the American Cancer Society and Centers for Disease Control and Prevention have adopted a shared goal to increase the nation’s screening rate to at least 80% in every community. Nonetheless, myths and excuses abound. Don’t let the myths and excuses stop you from making your health a priority! See

Inside Medicine | Spring Issue 2019

common myths on the following page. Join the American Cancer Society in spreading the word this March and beyond. If you haven’t been tested, talk to your care provider. If you have been tested, talk to your family and friends. Make sure that you and your loved ones are equipped with the facts. Together, we can help reduce colorectal cases and colorectal cancer deaths.

Colorectal Cancer At-A-Glance: Prevention

Myth: A colonoscopy is the only reliable way to be screened for colorectal cancer. Fact: A colonoscopy is considered standard for detecting cancer and precancerous polyps, there are several different tests that effectively screen for colon cancer, including stool tests, which can be done at home and sent to a lab. A study found that certain at-home tests are able to spot nearly 80 percent of colorectal cancers.

Myth: Getting screened for colorectal cancer is embarrassing and painful.

Fact: There are a number of different tests and screening methods for colorectal cancer, including simple, take-home options. Each have benefits and limitations. A discussion with your care provider can help determine which option is best for you.

Myth: I’m 36 years old, have no family history of colorectal cancer, but I am having symptoms. I should wait until I’m 45 to be screened.

Fact: While 90% of colorectal cancer cases occur in adults ages 45 and older, if you have symptoms (bloody stools or rectal bleeding, persistent abdominal discomfort, persistent fatigue, unexplained weight loss) you should discuss these with your primary care physician as soon as possible.

• Colorectal cancer is the third most common cancer in both men and women. • Colorectal cancer is a leading cause of cancer deaths in the United States. • Even though the exact cause of most colorectal cancers are unknown, prevention and early detection are possible because most colorectal cancers develop from polyps. • Risk may further be reduced by regular physical activity, getting to and staying at a healthy body weight, limiting intake of high saturatedfat foods – especially red meat and processed meats, not smoking, limiting alcohol intake, eating plenty of fruits, vegetables and whole-grain foods.

Detection

• Colorectal cancers are more successfully treated when detected early. • If you are 45 or have a family history of colorectal cancer, you should be screened for colorectal cancer.

Treatment

• Surgery is the most common treatment for colorectal cancer, usually cancer that has not spread. • Chemotherapy or chemotherapy plus radiation is given before or after surgery for patients whose cancer has spread beyond the colon.

Don’t hesitate to reach out. Help and hope is available 24/7/365. 800.227.2345 | cancer.org

Want to join the fight against cancer? Get involved through one of these fun events! Rocket City Best Fest // 06.08.19 // Big Spring Park

Join the fun in our Inaugural Rocket City Best Fest. The June 8th festival will kick off summer with a sizzle. This outdoor event, hosted in Big Spring Park, will engage community members from all walks of life. Enjoy burger & beer tastings, live entertainment, family fun, kid-friendly activities, and more.

Belles & Beaus Ball // 08.24.19 // VBC

Join the fun at the Belles & Beaus Ball on August 24, 2019 from 5:30 – 11:00pm at the VBC North Hall for a one-of-a-kind evening featuring great food, dancing,

live entertainment, spectacular auctions, and much more.

Real Men Wear Pink // September & October

Real Men Wear Pink is an executivelevel campaign in which men from the Tennessee Valley are hand-selected to wear pink while raising funds & awareness for breast cancer research.

Go Show // 09.14.19 // Huntsville International Airport Attendees of all ages can sit, stand and get behind the wheels of several giant trucks, large vehicles, construction equipment, and more at this inaugural event supporting the fight against

childhood cancer. Along with fire trucks, military vehicles, combines and unusual trucks, a variety of other family-friendly activities will be featured. This event is FREE to the public.

Golf for Life // 10.14.19 // The Ledges

The 34th Annual Golf for Life Tournament is a well-supported community event. This event will offer the best in customer and client entertainment, exclusive club play, unparalleled hospitality, a wonderful lunch, outstanding silent auction items, and an awards reception.

For more information on how to become involved in these events, please contact kaki.morrow@cancer.org or call 256-536-1863. Inside Medicine | Spring Issue 2019

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Inside Medicine | Spring Issue 2019

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} TESTIMONIAL

I CAN’T love them.

I don’t TRUST them. by, Jill Windham

I’ve heard this over and over and over through the years. And while I completely get and agree that trust plays a mighty part in a healthy relationship, Love has no pre-requisite attached to it in order for it to work. God didn’t tell us that our mandate is to trust people.

He told us, and in fact, SHOWED us that our mandate is to LOVE them. Love says, “I see your shortcomings and crappy track record. I don’t trust you with my heart, but I can love you by my actions.” Jesus understood this when He chose a master manipulator who would sell Him to the police to be one of His 12 disciples. We act like Judas caught the Son of God off guard. Jesus knew at the front of the relationship that Judas couldn’t be trusted. But Jesus knew Judas could be loved. What does that look like? What does it look like when you know someone and all their sketchy baggage, but God said for you to love them? It looks like how Jesus loved people. He was sent to a planet that was filled with brokenness. He gave His best physical years to washing the feet of the friends who would be nowhere to be found when He took His last labored breath, naked and alone on a splintered cross. Jesus saw value, not issues. Jesus saw PEOPLE. See, love doesn’t mean a whole lot when it’s only given to the people who make our lives a piece of cake. Love says, “I see you. And even though I don’t like what I see, I choose you.” You can love without being taken advantage of. You can love without agreeing or validating someone’s destructive choices. You can love without enabling. You can love without being sucked in to their cycle. Jesus did it every day. By setting boundaries. By withdrawing. By pushing ahead. By fervently praying for them. By keeping His eyes on the Father’s mandate. Love. Them. Love is a part of trust. But trust isn’t always a part of love.

Inside Medicine | Spring Issue 2019

Braces

they arenâ&#x20AC;&#x2122;t just for kids anymore!

Tooth alignment can be changed at any age if your gums and bone structure are healthy. If youâ&#x20AC;&#x2122;ve ever thought about having orthodontic or cosmetic dental work done as an adult, you are not part of the norm. Most adults donâ&#x20AC;&#x2122;t take the time to improve their smile, teeth alignment, or overall dental health. Someone deep in their career and social groups typically associate this type of correction with teenagers. Just like executing maintenance on our cars and home-improvement projects, creating and having an appropriate dental treatment plan is so important. Unfortunately, just as in my own personal experience, adults are slow to respond or come up with as many excuses as possible to avoid the inevitable. It took the wearing down of my own teeth enamel from clenching and grinding to make me jump on the chance to correct my issues. I should have listened to the advice of the orthodontist sooner. Although wearing Invisalign was simple, I was simply not the best candidate. I had no discipline and I unwillingly admitted this after months of treatment. Therefore, I am now wearing traditional braces. Regardless of title, position, and or parental role, I get to hold on to this as no heavy burden. Teeth are essential to our daily, healthy living. They need maintenance and sometimes upgrades, just as the vehicles we use for transportation. Whether you need esthetic enhance28

Inside Medicine | Spring Issue 2019

by, Kelly Reese

ment, have teeth deformity and/or just the normal wear and tear, I encourage you to visit an orthodontist that is knowledgeable. In my experience, I have been fortunate to have a whole team participate, along with the orthodontist, eager to see me get the results I want and need and do it successfully. There are many orthodontic treatments available and having these treatments at later stages in life can dramatically improve your personal appearance, self-esteem, and often times, overall health. Educate yourself on the provider and their ability to achieve your desired outcome. New techniques and appliances can be used to greatly reduce discomfort levels, decrease the frequency of visits, shorten treatment times, and may allow you to choose from several options. At Durham Orthodontics, you will see, a large percentage of patients are adults. Weather you have crooked teeth, a bad bite contributing to bone loss, tooth decay, abnormal wear of the tooth enamel and surfaces resulting in headaches and jaw joint pain; address your dental work now. They all agree it is never too late to improve your greatest asset - your smile! Durham Orthodontics 256.325.0078 bracesbydurham.com

Inside Medicine | Spring Issue 2019

Colorectal Cancer is...

PREVENTable. TREATable. BEATable.

E.R.

Colorectal cancer is the third most common cancer and the second leading cause of cancer deaths in men and women in the United States.* Colorectal cancer screening saves lives. If everyone who is 45 years of age and up were screened regularly, as many as 60% of deaths from this cancer could be avoided. Schedule your screening today! It could save your life. To schedule a screening at Crestwood, North Alabamaâ&#x20AC;&#x2122;s only ASGE certified Endoscopy Center, call 256-429-4986.

*American Cancer Society

CrestwoodMedCenter.com Inside Medicine | Spring Issue 2019

} HEALTH

Still hurting? Treating Chronic Pain

by Jackie Makowski

Local anesthesiologists specialize in minimally invasive procedures for pain relief

Most everyone has experienced pain and the subsequent pursuit to relieve it. Due to its subjective nature, pain is often difficult to measure but is important to address. Pain serves as the body’s “warning signal” for a problem requiring attention. Fortunately, most cases of pain resolve within a few weeks or months. But for nearly 100 million Americans their pain persists longer than six months – becoming a condition known as “chronic pain.” This statistic has garnered considerable attention from the healthcare community and for good reason. More people live with chronic pain than diabetes, cancer and heart disease combined. Within recent years, many patients suffering with chronic pain have felt a stigma surrounding their condition. Chronic pain can negatively impact a patient’s quality of life, interfering with one’s ability to work, sleep and enjoy social activities. There are safe, proven and effective treatments available to help manage pain when it does not improve with standard treatments such as aspirin or ibuprofen. “The pain management specialty is designed to work with primary care physicians to diagnose the underlying cause of pain and determine an effective treatment plan,” says Ronald Collins, M.D., an anesthesiology and pain management physician with TVPC. “Many people can achieve pain relief without surgical intervention.” The most common conditions treated by pain management specialists include low back and neck pain, neuropathic pain, pre-and post-surgical pain, cancer and shingles-related pain. In recent years, the opioid epidemic has shed light on the issue of opioid abuse. However, the media narrative has left many chronic pain patients feeling stigmatized, mislabeled and fearful of receiving treatment. Pain management physicians such as the anesthesiologists at Tennessee Valley Pain Consultants (TVPC) provide minimally invasive procedural based options for patients with chronic and acute conditions. The most common conditions treated are those of the cervical, thoracic and lumbar spine, joints or nerves. 32

Inside Medicine | Spring Issue 2019

As partners in healthcare with Huntsville Hospital, Tennessee Valley Pain Consultants has the region’s largest team of specialists double board-certified in anesthesiology and pain management. These physicians use the latest in diagnostic technology, along with medical and interventional treatments, to identify the source of pain, treat it and educate patients on how to manage it. “Our goal is to try and change the pain at its source,” says Morris Scherlis, M.D., anesthesiology and pain management physician with TVPC. “This often involves injections under fluoroscopy to specific and precise pain generators.”

Anesthesiologists have specialized training in x-ray guided interventional procedures such as epidural steroid injections, nerve blocks, radiofrequency ablation and implantable pain relief devices. These specialists also offer managed anesthesia care for procedures providing a more comfortable patient experience.

Anesthesiology and pain management physicians offer patients a variety of non-opioid based treatments as well as diagnostic and therapeutic procedures. These physicians collaborate with physical therapists, chiropractors and surgeons when necessary to comprehensively and safely treat chronic pain. “We strive to help reduce the stigma patients experiencing pain may feel and educate the community on the many advanced non-opioid, procedural options available,” says Thomas Kraus, D.O., anesthesiology and pain management physician with TVPC. Education is the best tool for reversing stigma and ultimately improving patient care and quality of life.

ANESTHESIOLOGY & PAIN MANAGEMENT: CONDITIONS TREATED Cervical, Thoracic & Lumbar Spine • Back & Neck pain • Herniated Disc pain • Radicular and Degenerative Disc pain • Pre & Post-surgical pain Joint Pain • Knee & Hip pain • Shoulder pain • Osteoarthritis • Sacroiliac Joint pain

Nerve Pain • Peripheral Neuropathy • Diabetic Neuropathy • Shingles – Acute and Post-herpetic Neuropathy • Occipital Neuralgia • Cancer Pain

Visit tnvalleypain.com to learn more about the non-surgical offerings provided.

MINIMALLY INVASIVE ALTERNATIVES FOR ACUTE AND CHRONIC PAIN

Epidural Steroid Injections: Administered in the epidural space of the spinal cord to relieve inflammation secondary to spinal disc problems or pain associated with pinched nerves. Trigger Point Injections: Performed on site of muscle pain improving blood flow and reducing pain.

Selective Nerve-Root Blocks: Utilized to diagnose the specific source of nerve root pain and for therapeutic relief of low back pain and/ or leg pain. Also, used for post-herpetic neuralgia. Facet Joint Injections: Performed for temporary joint pain relief and in preparation for more long-term treatments such as facet radiofrequecy. Sympathetic Nerve Blocks: Non-steriodal blocks often used for diabetic neuropathy.

Radiofrequency Ablation: Utilized to help patients with chronic low-back and neck pain and pain related to the degeneration of joints typically from arthritis. Physician precisely inserts a needle precisely delivering heat to a specific nerve disrupting the pain signals transmitted to the brain. Pain relief may last for several months to a year. Spinal Cord Stimulation: Performed for patients with nerve root damage or failed back syndrome who have not responded to conservative treatments. This procedure involves implantation of a small, rechargeable device releasing electrode signals to the spinal cord, replacing pain with a more pleasant sensation. Inside Medicine | Spring Issue 2019

Afrin Addiction:

by, Kari Kingsley, MSN, CRNP

I never meant to become a nasal spray junkie! As our population grows, more and more people are becoming addicted to Afrin. What starts out as a couple of squirts of an over-the-counter decongestant during a head cold can lead to years (and sometimes a lifetime) of dependence. Common decongestant vasoconstrictors like Afrin, Dristan, and Vicks Sinex containing oxymetazoline are to blame. Most nasal decongestant sprays come without a prescription and provide temporary relief of nasal congestion caused by conditions such as hay fever, sinusitis, deviated septum, and the common cold. Afrin works by shrinking the blood vessels in the nasal area to reduce swelling and congestion. It’s not a prescription, so it must be safe, right? Sure. If you use it as directed. But using Afrin-like products past the 3- to 4-day mark create a condition of rebound congestion called rhinitis medicamentosa, which is a fancy way of saying, you got yourself hooked on Afrin.

Afrin creates vasoconstriction (shrinkage of the blood vessels) which, over time, depletes healthy nasal tissue of vital oxygen rich blood and nutrients. Your nose tries to compensate for this deficiency by enlarging veins and capillaries. Once the Afrin wears off, rebound congestion occurs. As we use more nasal spray, we develop a tolerance, requiring more and more spray to achieve the initial amount of relief. Rebound congestion leads to a vicious cycle of Afrin dependency. Sort of like a body builder beefing up on steroids, Afrin use over time works to enlarge tissue in the nose, creating a serious problem for users. While Afrin is not considered a drug of abuse, chronic Afrin use can create both a physical and psychological

Inside Medicine | Spring Issue 2019

addiction. Blogs and online support groups are filled with people looking for help. “I got myself back on Afrin May of last year and have been using it twice a day since….” “I’ve tried every prescription and herbal remedy known to man, but nothing works like Afrin….” “I’m desperate! Does anyone have experience with hypnosis curing decongestant addiction?” While Afrin addiction is not exactly a gate way drug to heroin, it can make you miserable both physically and mentally when you try to “hit it and quit it”. Symptoms of Afrin addiction or rhinitis medicamentosa include rebound congestion, nasal drainage, and sneezing. Rebound congestion associated with rhinitis medicamentosa generally occurs after about 5-7 days of continuous use. Instead of your bottled friend helping you to breath better, it begins to severely irritate the lining in the nose. Chronic Afrin use can also lead to structural changes in the nose, eventually leading to permanent turbinate hypertrophy. Tips to trash the Afrin….and no, I won’t say the best way to get off it is to never start it…. (don’t you want to smack people like that?) As with any addiction, treatment for Afrin overuse involves one key process: withdrawal. But you have options (my dad always says “Options are the key to happiness!”. Option 1: Cold Turkey. (I shiver just thinking about it) Benefits to cold turkey are that it’s fast and you’ve eliminated to cause of the problem. Downsides: IT’S COLD TURKEY! As soon as your last hit of Afrin wears off, you’ll be dealing with severe nasal congestion. And depending on the chronicity of use, you may be left with permanent structural issues. Option 2: Weaning. Gradually cut down the amount you are using. Just like with any dependent medication, titration is key. Option 3: Turbinate reduction: an easy procedure to reduce stuffy tissue in the nasal cavity.

Option 4: Even your options have options! Try a combination of the three. Many people elect to have a small nasal procedure combined with quitting Afrin, or using short-term oral steroids and/or switching to non-addictive medications like nasal steroid sprays as well as safer herbal remedies like Xylitol sprays. Be sure to discuss your treatment options as well as alternative medications with your primary care doctor or ENT. Patient expectation is CRUCIAL. When using intranasal steroid and antihistamine sprays, a butter knife is not going to cut like a machete! But how do you eat an elephant? One bite at a time! “Kari Kingsley, MSN, CRNP is an otolaryngology nurse practitioner with over 8 years of ENT experience who currently works at Huntsville ENT (256-882-0165). She is a medical writing consultant for Inside Medicine and enjoys writing articles on pertinent material to keep the residents of North Alabama up to date on the forefront of medicine.”

Our therapists provide highly specialized treatments based on a thorough hands-on manual techniques and exercises to facilitate quick and complete recovery.

Call Today 256.883.063 6

www.focus-physio.com 1140 Eagletree Lane SE • Huntsville, AL 35801

Inside Medicine | Spring Issue 2019

MISSIONS } H E A L T} H

The Lymphatic System

I t 's Role in Wellness by Heather Morse, MS, ATC, OTC

Your lymphatic system plays a huge role in protecting you from disease. We will take a look from a general perspective on what exactly the lymphatic system does and why its important.

One day when thinking on this issue, I thought about sharks needing to constantly move to stay alive. As it turns out, the shark needs to keep oxygen-rich water constantly flowing over the gills. My analogy for those battling depression is to be like a shark. Keep moving. To become motionless threatens our survival.

part of the immune system, helping the body fight infections. Simply put, it’s our body’s sanitation system. If the lymph or white blood cells don’t flow freely through the body, the waste and toxins build up, causing a severely weakened immune system, chronic disease and severe health complications. When the lymphatic system becomes compromised (your lymphatic system is not working properly) toxic liquid fails to filtrate properly. The liquid congeals until it becomes thick, creamy and poisonous. This means toxic cells, which could potentially include cancer cells, get stuck in your body because the body doesn’t have a pump to loosen the congealed substance. Symptoms can include brain fog, poor bowel function, bloating, dry The Internet is full of questionable information about skin, acne breakouts, fatigue, water retention, chronthe body and how to care for its various systems and ic pain, stiffness, swelling, chronic colds, sore throats, organs—and the lymphatic system is no exception. weight gain and even cellulite. A quick Google search brings up articles claiming it needs to be detoxed for optimal body function and bet- HOW DOES THE LYMPHATIC SYSTEM ter overall health and wellness. Bloggers advise doing WORK? things like taking special herbs, dry brushing your skin, When your heart pumps blood to the capillaries, ditching your underwire bra, and yes, even hanging up- the lymph fluid—the watery, nutritious fluid in the side down on an "inversion table" to flush your system blood—needs to go outside the blood vessels into the of toxins—and they claim if you neglect your lymph soft tissues of the body to “feed” them. Once that fluid system, you risk eczema, arthritis, chronic sinusitis, is there, it can’t return through the veins to the heart; chronic pain, cancer and other health issues with vary- it’s up to the lymph system to move the fluid back through the body. The lymph fluid filters through ing degrees of severity. The lymphatic system is a nexus, or series, of ves- lymph nodes. If the lymph nodes detect foreign bodies sels similar to that of the circulatory system—the like bacteria and viruses in the lymph fluid, the nodes branching vessels move vital bodily fluid through- trap the intruders and produce more infection-fightout the body. The lymphatic system is comprised of ing white blood cells to destroy them. From there, the tissues and organs — vessels, ducts, lymph nodes, the lymph travels through the thoracic duct in the chest spleen, the thymus, the adenoids and the tonsils — that or the right lymphatic duct, and then to an area on the help to store, produce and carry white blood cells also side of the neck near the jugular vein, where it joins known as lymphocytes. The lymphatic vessels that run the blood system again. Some lymph also transports throughout the body (with the largest vessel being the fats from your GI tract to your bloodstream. In other thoracic duct, which collects a large portion of the words, the lymph system is a powerful tool for nourbody's lymph); lymph nodes, located in the neck, arm- ishing our tissues and helping our immune system by pit, groin, and inside the center of the chest and abdo- cleaning up bacteria and pathogens. When functioning optimally, the lymphatic system men; the tonsils and adenoids, which are collections of lymphoid tissue similar to lymph nodes; and the spleen defends our bodies against infection and helps mainand thymus, which are lymphoid organs are an integral tain homeostasis, which is the body’s way of managing 36

Inside Medicine | Spring Issue 2019

a continual internal environment when dealing with changes. To sustain homeostasis, the body has two types of immunity—innate immunity and adaptive immunity. Innate immunity consists of alert immune cells ready to fight microbes, and the body’s adaptive immunity gets called into action when the innate immune system is overwhelmed. When the adaptive immune system encounters a pathogen, it remembers it to prevent future encounters of the same bacteria and viruses from becoming problematic. When functioning properly lymph vessels and lymph nodes are the transport system for extracellular fluid that doesn’t return with the blood through the venous circulation. Extracellular fluid is the fluid that flows between cells in the interstitial spaces of bodily tissues—it contains white blood cells (WBCs), lipids (fats), proteins, salts, and water. The interstitial spaces are the narrow areas between tissues and organs. The lymphatic system is often mentioned, but its importance is not always understood. This unique system is absolutely pivotal for optimal health. Additionally, if your diet contains a lot of processed foods, sugar, and chemicals, this adds more for the system to detoxify and can make you nutrient deficient. However, remember if you are not leading an active lifestyle, it is harder for the lymph to move. If the lymph becomes

The Lymphatic System

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overloaded it can lead to more stagnation and chronic disease. When treating the lymphatic system, it is important to address it from many different angles. Diet and exercise are the two major keys to proper drainage and a healthy lymphatic system. Consuming an organic diet whenever possible and incorporating lots of anti-inflammatory leafy greens along with antioxidant rich foods (like berries) can be very helpful. When choosing your diet, make sure to incorporate omega-rich food like wild salmon, free radical scavengers, fiber rich foods like flax and chia, as well as cherries and colorful foods such as beets and pomegranates. Salt on the Rocks utilizes the knowledge and expertise of our Certified Nutrition Counselor, Jessa Hicks. You can find more about her at www.jessahicks.com Exercise plays a vital role in lymphatic health. Movement acts as a natural pump to help stimulate the lymphatic system. The system depends largely on large muscle activity in the body for its circulation. Therefore, stagnation from sitting all day can become a major problem. People who sit at their computers without taking breaks develop a sluggish lymph system because they do not move. The good news is any exercise helps – move around for one to two minutes every 15 – 20 minutes. Small strides such as knee bends, going for a walk during lunch, and stretching throughout the day can help you develop a regular exercise routine. You can also apply gentle exercises like walking, yoga, Pilates, and swimming are great for getting your lymph moving. Overall, exercise is pivotal for moving lymph stagnation. WHAT CAN I DO TO HELP WITH MY “SLUGGISH” LYMPHATIC SYSTEM? 1. Lymphatic drainage massage and lymphatic facials The power of a simple lymph massage must not be overlooked. They do for the entire body what facials do for the face. Manual lymph drainage uses gentle, rhythmic strokes, creating a wave-like sensation in the body that follows the paths towards the lymph nodes where toxins are then filtered out. The specific pumping strokes circulate immune cells through the body and can reduce inflammation. A simple lymphatic self-massage sequence a few nights a week can help reduce breast tenderness and improve digestion. 2. Movement The lymph system depends on muscle movement to pump and decongest stagnant lymph fluid, acting as a natural lymph flush. In other words: exercise is key to lymphatic health. Yoga is a great way to get your move38

Inside Medicine | Spring Issue 2019

ment on because it utilizes your entire muscle network, which pumps lymph through the one-way vessels. 3. Use clean skincare, and reduce environmental and emotional toxins A large percentage of what you put on your body gets absorbed into the lymph system, and chemicals in household products and perfumes should be avoided whenever possible. You can lighten the lymphatic processing load by choosing non-toxic, clean beauty products for your body and home. 4. Make healthy food choices Gut health = lymph health! Eating an anti-inflammatory diet rich in antioxidants and vegetables is optimal. Reduce salt and alcohol intake, find a healthy food plan you can maintain, avoid chemicals in diet foods, and consult with an herbalist about herbs and probiotics to boost your gut health and immunity. 5. Hydrate WATER WATER WATER. You can increase fluid flow and flush out toxins and pathogens by bathing fluids in antioxidants. Additionally, drinking plenty of water with lemon and electrolytes throughout the day will help circulate and nourish your lymph cells. Simples Tonics in Los Angeles has a gently brewed tea that’s specifically designed to support immunity and is super hydrating. 6. Dry brushing Dry brushing is an excellent way to remove dead cells from the surface of your skin so your lymph system doesn’t have to process the extra cellular waste. Brush lightly and towards your heart, but if you have radiated skin or open wounds, avoid the area completely until you’ve consulted with a trained lymphatic practitioner. by Nick Thomas 7. Herbs for Lymph Stimulation Herbs that can help stimulate the lymphatic system include: Chickweed (yes like the weed you have in your yard), bayberry, black walnut, cleavers (also often found in your yard), Echinacea, Fennel and many others. Many of these can be found as an herbal supplement in your health food store or teas in your local Remedy Room. There are many tools that can help to clean up the complicated lymph system. At Salt On The Rocks

Wellness Spa & Remedies we use a combination of lymphatic drainage massage and facials, vibration therapy, and a machine designed specifically for lymphatic drainage called the Delfin. Our detox services help your body to drain harmful toxins, assist with inch-loss, and to contour the body using its own natural drainage processes. Clients immediately see drastic results in the shape of their body and the overall condition of health. To learn more about these or our other new wellness spa services contact 256.429.9160 or visit www.saltontherockshuntsville.com

Heather Morse is the owner of Salt on the Rocks, a new destination experience with Salt Therapy. The Remedy Room inside Salt on the Rocks offers a variety of natural remedies for the beginner, including herbs, oils, teas and tinctures. You can find them at the corner of Bob Wallace and Whitesburg Drive. Visit SaltontheRocksHuntsville.com for more information.

Inside Medicine | Spring Issue 2019

For better or worse HOW GENETICS CAN AFFECT RELATIONSHIPS

Marriage requires working as a team, tackling challenges like joint finances, work-life balance and parenthood. Navigating these challenges impacts how satisfied a couple is in their relationship. Successful problem solving is shaped by factors like communication style, level of trust and a couple’s prior history. Now scientists say genetics might also be a player. Social support – feeling that one partner understands the views, opinions and abilities of the other – is an important measure of marital satisfaction. Another is attachment security, the feeling of emotional safety that comes from others being responsive to our needs. Two scientific publications – one in the Journal of Family Psychology and the other in PLOS One – illustrate how variations in a gene previously linked to personality can also be associated with patterns of behavior and emotional response that ease or increase marital pressures. However, before you conclude that genetics predetermines the fate of our relationships, let’s dig a little deeper in the findings. HOW GENETICS CAN AFFECT OUR RELATIONSHIPS The most recent papers build on already-published research into the effect of variations in OXTR, the Oxytocin Receptor gene. The receptors can modify a range of responses to social stimuli, such as stress or anxiety. DNA changes in OXTR have been connected with several personality traits associated with sociability and bonding. For example, a 2009 paper found people with one specific variation in the OXTR gene thought and behaved less empathetically. That same variation also led people to have a stronger stress response, both mentally and physically. As you can imagine, people with less empathy and higher stress relate differently to other folks and the world at 40

Inside Medicine | Spring Issue 2019

by Neil Lamb, PhD

large. Intuitively, those effects would carry over to marriage. Now researchers can demonstrate that carry-over through careful study. THE ROLE OF GENETICS IN MARRIAGE The team of scientists leading the Journal of Family Psychology study recruited 79 couples and asked each partner to come up with a pressing issue to discuss with the other – a personal problem not linked to their partner or partner’s family. For example, they might discuss a problem with a coworker. The scientists recorded ten minutes of conversation on the subject then analyzed the interaction to see how the partners supported and accepted support from one another. They also surveyed the individual partners to get a broader sense of each spouse’s perceptions about their marriage and obtained saliva samples for genetic testing. Variation along the OXTR gene influenced both the actions and the perception of those actions for men and women. That said, husbands with a specific genetic change (defined as the TT genotype at SNPrs1042778) reported less satisfaction with the recorded interaction with their wives, and lower marital satisfaction overall. The scientists hypothesize that husbands with this variant may have trouble identifying and interpreting the social support signals coming from their partners, and therefore perceive them as being less responsive. The PLOS One study examined 178 midlife and older married couples. Here too, participants provided saliva samples for genetic testing and completed surveys about their feelings of marital security and satisfaction. The study focused on the OXTR variant described above in the 2009 paper (rs53576). When at least one partner had the GG genotype – the opposite of the variation that led to less empathy

and more stress – the couple reported higher satisfaction and security in their marriage than couples without this variant. Individuals with the GG genotype also reported lower levels of anxious attachment, which prior research has shown to be associated with a lower likelihood of jealousy and better relationship quality. Of course, this is still just a small portion of the marriage equation. OUR GENES, OUR BEHAVIORS Genes may have an influence on marriage, but that impact shouldn’t be overstated. The researchers found that the genotypes of both partners combined to account for about 4% of the variance in marital satisfaction. Because both studies analyzed relatively homogeneous populations of caucasian couples, it’s important to replicate these experiments using larger, more diverse populations. However, it’s worth noting that this gene shapes both behaviors and perception of a partner’s behaviors. The authors of the PLOS One study even suggest that the patterns of each partner can rub off on one another over time. Further research could examine how those same genetic variants shape our interactions with positive and negative relationship experiences. After all, marriage often revolves around understanding and context. The genetics likely do as well.

HOW WE LOVE The way we love stems from all kinds of factors, from our upbringing to our genome to the way we respond to the large and small stressors of the moment. Some pieces of our genetic code influence how we process feelings like empathy. So it’s understandable that our DNA recipes play a role in our most important relationships. It’s interesting that we can link genetic variation to how supported a partner feels in a marriage. That certainly seems like a factor that could boost relationship satisfaction. Still, it’s important to realize that the science isn’t saying two people are genetically incompatible because of this one variation — or any other genetic information for that matter. Love, marriage and long-term relationships are complex and we’re just starting to learn more about how genetics play into the way we relate to others.

To see more stories like this, visit www.shareablescience.org

The moment everything changes. Catch your breath. You’re going to do great, and we’re here to help. From pregnancy to birth and all the moments in between, we have everything you need. See why more Moms deliver at our hospitals than any other hospital in Alabama. Visit oHHbaby.org to schedule a tour or to learn more about our dedicated maternity services.

Inside Medicine | Spring Issue 2019

Green

Should be Your New Favorite Color

When we begin a new healthy eating routine one of the meals we tend to automatically go for is salad. Now while this is not a bad idea it does need to be the right “kind” of salad for it to truly benefit our body. Salad can be a sneaky thing, especially if you are eating at a restaurant. Some salads can contain just as much if not more calories as a big hamburger and plate full of French fries. Salad in general can also be incredibly lacking in nutritional value and leave us feeling quite hungry very quickly. However, you can make a fabulous tasting salad that will have great benefit to your nutrition, it’s all about the greens you choose! Let’s just go ahead and say that a salad made up mostly of the pale green iceberg lettuce which is so common will NOT cut it!! Throw it out! We want to build our salad with rich deep greens that pack a huge nutritional punch! Spinach and kale are at the top of this list. These greens not only offer an amazing fiber punch, but spinach is packing a lot of iron your body needs to carry oxygen from your lungs to the rest of your body. Another major asset of eating spinach is the magnesium it provides. Magnesium is a mineral that helps keep things like headaches, muscle cramps, and chronic fatigue at bay. It also helps keep your blood sugar level and thyroid function normal. Finally, potassium is an unexpected component found here which aids in bone growth and may reduce high blood pressure.

Inside Medicine | Spring Issue 2019

by Nick Thomas

Now kale especially contains tons of immune-boosting vitamin A. It also offers vitamin C and RDI which provides a healthy immune system, not to mention a significant amount of vitamin K which your body needs in preventing blood clotting and supporting bone health. Both of these leafy greens have their own incredible benefits as you can see. You can now make an educated salad choice and pick the greens that best help your body. For example, if you are pregnant or have high blood pressure spinach will be your best choice. If you feel like you’re coming down with a cold reach for some kale or just grab a bit of both for good measure. Finally, remember not to destroy your healthy greens by piling them high with poor “toppings”. Keep it smart and tasty with some grilled chicken, olive oil & vinegar for dressing and a few of your favorite veggies! If you’re just not a salad person you might try making a smoothie and adding in a generous handful of these greens to trick yourself into getting the amazing health benefits without the taste. Remember that food should fuel our body. It’s not about how much you eat, it is COMPLETELY about WHAT you eat! For more information regarding a personalized general or sports nutrition plan contact me at Prime Performance 423-805-0870.

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The moment is here. It’s time to trust that all of your preparation was worth it. You are ready. And so are we. From pregnancy to birth and all the moments in between, we have everything you need. See why more Moms deliver at our hospitals than any other hospital in Alabama. Visit oHHbaby.org to schedule a tour or to learn more about our dedicated maternity services.

Inside Medicine | Spring Issue 2019

} COVER FEATURE

THE AGELESS

Prescription by Anne C. Jewell

Numerous medical journals and studies identify the best actions you can take to achieve a longer, fuller life. We know there are no guarantees. We tend to think we are healthy and will remain that way, even as we “age”. But it is never too late to start on the right path to longevity. With this collection of some of the most important longevity tips, you’ll have the path you need to get to age 80, 90, or even 100. Here are 8 ideas to remaining ageless:

1. MINDSET Keep a good attitude. Stay optimistic, hopeful, confident, positive, cheerful, bright, and buoyant. Live life to the fullest. 2. PREVENTION Stay current with preventative care and screenings. Follow your physicians’ advice for any current medical conditions. 3. EXERCISE Take the stairs, park far away at the store, take a walk at lunch. “There is no pill that comes close to what exercise can do,” says Claude Bouchard, director of the human genomics laboratory at Pennington Biomedical Research Center in Louisiana. It benefits your brain, heart, skin, mood and metabolism. Move, move, move. If you want to keep your bones young, use them. Find an activity you enjoy. A University of Maryland study found that Amish men live longer than typical Caucasian men in the United States, and both Amish men and women have lower rates of hospitalization. What are the Amish ways? Lots of physical activity, less smoking and drinking, and a supportive social structure involving family and community.

4. CHALLENGE YOUR BRAIN Your brain is amazing; your brain is you. It defines who you are. Your brain holds every memory and emotion of your life. Every effort should be made to keep your brain young and healthy. Keep your brain challenged, especially with new things. Replace routine with new learning. Seek out new experiences. Your brain thrives on challenges and learning. 5. SLEEP Consistently sleeping less than six hours a night nearly doubles your risk of heart attack and stroke, according to a review of 15 studies published in the European Heart Journal. Another study found that consistently sleep-deprived people were 12 percent more likely to die over the 25-year study period than those who got six to eight hours of sleep a night. Don’t allow yourself to use electronic devices before bedtime as this can stimulate the brain. 6. SOCIALIZATION Studies show that sadness, unhappiness and solitude increase the risk of early death by 45 percent. The immune system can weaken. Blood pressure can increase thus increasing the risk of heart attacks and stroke. By contrast, people with strong ties to friends and family have as much as a 50 percent lower risk of dying, according to a study in PLOS Medicine. A 2016 study by researchers at the University of California, San Diego found that those who use Facebook also live longer, but only when online interactions don’t completely supplant faceto-face social interaction. 7. NUTRITION Food is one of the basics joys of life. Eat often and healthy, lots of vegetables and fruits. Discipline yourself. 8. FAITH The 17th century philosopher, Blaise Pascal, once said, “All of humanity’s problems stem from man’s inability to sit quietly in a room alone.” Our body, mind and spirit need moments of silence. It can be prayer, meditation or just undisturbed silence. These moments can help to comfort and simplify our busy lives. The Bible recognizes that “No discipline seems pleasant at the time, but painful.” (Hebrews 12:11).

Anne Jewell 115 Manning Dr. Ste. 202B Huntsville, AL 35801 256.533.0001 ccox@hiwaay.net coxassociatesinc.com Reference: Guideposts Outreach Publications has a great free eBook by Pastor Kahlil Carmichael “Living Longer, Living Better, Body, Mind, and Spirit” available at: guideposts.org/how-we-help/ outreach-publications/free-ebooks/living-longer 44

Inside Medicine | Spring Issue 2019

The moment your eyes meet. You and your babyâ&#x20AC;&#x2122;s bond is nine months in the making and weâ&#x20AC;&#x2122;re here for you every step of the way. See why more Moms deliver at our hospitals than any other hospital in Alabama. Visit oHHbaby.org to schedule a tour or to learn more about our dedicated maternity services.

Inside Medicine | Spring Issue 2019

} SURGICAL TECHNOLOGY

the

Surgeon

interview

Sitting down with a surgeon can create some anxiety. Obviously if you are needing to consider an operation you have a significant problem, and you are looking for some help. In an emergency setting, the problem or injury is paramount, and the gravity of the situation is the primary driving factor to proceed to the operating room.

Your surgeon will discuss the risks of surgery but generally the risks of not having the operation far outweigh the risks of delaying or avoiding the operation. Even in the emergency setting your surgeon is going to assess you as a patient to predict the potential outcome of your procedure. A surgeon will look at some obvious data like age, gender, and associated health issues. But there are some other not so obvious factors that are important to your surgeon. Let’s discuss. Most orthopedic and specifically spine conditions are chronic and involve pain and functional limitations as the primary issues. In most cases, conservative non-surgical options can be utilized successfully for a while but at some point the decision to consider a surgical approach is contemplated. From a patient’s standpoint, is it a good idea to understand the implications of having an operation. Patients want to know about the surgeon’s reputation and qualifications. How many times has the surgeon performed the procedure? What are the risks and benefits of the surgery? What is the recovery like? What can I expect as the outcome? These are all very reasonable considerations, and I would strongly recommend a patient do their homework before signing up for a surgical procedure. But it is important to understand that just as you are going to evaluate your surgeon, your surgeon is going to evaluate you as well. And this surgeon to patient evaluation is just as important in the outcome of the procedure. The first thing that I assess when I interview a patient is why is he or she here. What are the patient’s motives? What Inside Medicine | Spring Issue 2019

by Larry Parker, MD

do they need help with? Because whatever the problem and whatever the treatment is those are the primary actors that will affect the outcome of the treatment. In fact, I can perform the exact same operation for the exact same clinical problem and the outcome can be entirely different based entirely on the patient’s motives. To say it more simply, a patient is not going to perceive improvement from a procedure if he or she is not motivated to get better. Now you may be surprised by this assessment because you would assume of course every patient wants to get better. Why else would they be considering an operation? Surgeons and physicians call this variable secondary gain. Secondary gain means that patients may have extenuating circumstances that can affect the outcome of the treatment. Patients injured at work or patients who are ready to retire or may be contemplating disability would be examples. Patients injured in a car accident or present with a slip and fall injury may have incentives not to get better if they are involved in a lawsuit. It doesn’t mean that people who face these circumstances are bad folks or even that they don’t have a real problem and need help. From a surgeon’s perspective it is nothing personal against the patient to consider these factors, but it is very important in developing a treatment plan and especially if surgery is involved that THE PATIENT understands these factors may affect outcome! Patients need to understand and be counseled on these issues so that the expectations of results from surgery are understood before the procedure is done. Some more important things that I assess when interviewing a patient is what type of work someone does. If you work on an assembly line or do manual labor the timeline for returning to your regular job duties will be different than if you have a desk job. Is the patient a heavy smoker? How much alcohol or pain medication does a patient use? Does a patient exercise and what kind of physical condition is the patient in? All these variables affect surgical outcome. Sometimes making some corrections on these issues prior to surgery is important and the surgery is delayed. Insurance companies are now denying certain operations on patients who smoke or are significantly obese. To conclude, I think it is important for patients to understand a surgeon is going to interview you as a surgical candidate and that your outcome of a surgical procedure is as much about the patient as it is about the surgeon. So be ready to participate in the discussion so that you can help your surgeon help you!

Inside Medicine | Spring Issue 2019

} COVER FEATURE

the power of people

Benefits of joining professional organizations by, Kari Kingsley, MSN, CRNP

No matter your f ield of study, joining a professional organization can be a win-win. Humans are social creatures (yes, even you Mr. Introvert). People thrive on acceptance and being part of a group. We naturally seek the approval and companionship of others to improve our well-being. Take it from me, literally, the girl who was always picked last for kickball in elementary school. But besides the benefits to our self-esteem and our sense of morale, professional organizations provide so much more. At the request of a mentor, I signed up to become a monitor at the 2008 North Alabama Nurse Practitioner (NANPA) Symposium. She asked me dress up as a cowboy in keeping with that year’s theme. As a baby nurse practitioner student, I was mortified to go around fellow students and future colleagues in such a ridiculous outfit. But the entire event was inspiring. I was in awe of our local organization and the amount of comradery, laughter, and information that was circulated. I volunteered again at the next year’s symposium and by graduation of 2010, not only did I have a job, I had a seat on the Board. To this day, I find myself dressing up each year to suit our theme. Regional, state, and national professional organizations are a great venue to acquire knowledge about your field. Monthly meetings and yearly symposiums provide valuable information on industry standards, codes of ethics, and what’s being done on a legislative level to improve your profession (as well as your life). Professional organizations provide avenues for advocacy on the things you feel are important in your field. Nurse practitioners have fought their way from the ground up to be able to see and treat patients. Their scope of practice has filled giant gaps and provided thousands of patients with competent healthcare. For many careers, public relations are crucial. I would have never considered myself a “networker”. Yet it is amazing the connections I have acquired over the years. As a nurse practitioner, it is beneficial to my patients to have so many colleagues available for their diverse and complex conditions. It’s like being in a really safe, really polite mafia! Not to mention, if you 48

Inside Medicine | Spring Issue 2019

are on the market for a new job, local organizations are a great place to hear through the “grape-vine” about positions that are available as well as places you would love (or not love) to work. For those that don’t work, consider joining a charity. The rewards of helping others are huge. Volunteerism forces virtues out of us that might otherwise remain locked away. Kindness is contagious. It creates a ripple effect that improves humanity. Always pay it forward. Charity doesn’t have to mean opening your checkbook. It can come in the form of physically moving sand bags as flood waters approach or through guiding a loved one through a difficult situation. Charity isn’t an involuntary action. It’s a conscious decision made to help others. The psychological ramifications to both the giver and the recipient create a feeling of belonging desperately sought after by our species. Our local nurse practitioner organization provides monthly meetings hosted at nice restaurants with up-to-date talks on pertinent medical information. Wait.Let me get this straight…. You’re going to feed me steak and lobster while I learn about something pertaining to my field of study and I get to drink a glass of wine and hang out with my friends? Sign me up! Our yearly symposium provides nurse practitioners and medical professionals from all over the southeast an opportunity to sharpen their skill set with up-to-date lectures provided by knowledgeable presenters, all while gaining continuing education credits and eating gourmet cuisine (yeah, food is kind of a big deal for me). But a few words of caution before you go plunging headlong into 10 different professional development organizations. Do it right. Start small. Don’t run for office until you’ve dipped your toes in the pool. Don’t over commit in an effort to become part of the gang. Remember why you are joining. The goal is symbiosis: you get from the group what the group gets from you. Anytime the balance shifts, readjust. Whether that

means establishing boundaries and saying no, or pulling your share of the rope. And remember to be accepting of others. Although humans are social creatures, we wouldnâ&#x20AC;&#x2122;t live in a house with of our 50 closest relatives. Personality types differ. Everyone marches to their own drum. Remember to listen to others in the hopes they will listen to you. My professional organization has provided me with more confidence as a nurse practitioner. I have acquired many lifelong friends and learned more about the field of medicine. I blame them for a gradual 10-pound weight gain over the years, but itâ&#x20AC;&#x2122;s been totally worth it.

Kari Kingsley, MSN, CRNP is an otolaryngology nurse practitioner with over 10 years of ENT experience who currently works at Huntsville ENT (256-882-0165). She is a medical writing consultant for Inside Medicine and enjoys writing articles on pertinent material to keep the residents of North Alabama up to date on the forefront of medicine

Inside Medicine | Spring Issue 2019

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Inside Medicine Magazine 2019 Spring

Articles inside

Braces they aren't just for kids anymore!

The Surgeon Interview

Get Your Butt In Gear

Know Your ABCDE's of Skin Cancer

Afrin Addiction: I never meant to become a nasal spray junkie!

Green Should be a New Favorite Color

Still Hurting? Treating Chronic Pain

Talking About Hormones