Inside Medicine | Summer Issue 2021 1
A new day. A new beginning. It all starts with amazing care in a new facility nestled at the base of Monte Sano – the mountain of health. The Orthopedic & Spine teams move to a new free-standing tower which is likely to become a destination for people seeking life-improving treatment options — a new beginning to do the important things in life. It’s what people want from orthopedic and spine treatment.
Huntsville, Alabama • huntsvillehospital.org/ost
Inside Medicine | Summer Issue 2021 5
features &
CONTENTS
Sharing with Purpose
Inside Medicine | Summer Issue 2021
FEATURES Cervical Spine Disorders
08
problemsn & symptoms
Carbohydrates not all are bad
CONTENT Life after a Mental Health Diagnosis
13
helpful tips on what's next
24
Sports Safety how to keep kids safe
VOL 3
ISSUE 20
CO N T R I B U T O R S
Kimberly Waldrop, MA Winston T. Capel, MD, MBA, FACS,FAANS Rachel Sullivan, LMFT, CFLE-P William Matthew Sykes, DO, CAQSM
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Angie Sandritter Nick Thomas Tripp Skipper Adam Weiger
Healthcare Real Estate
29
Q&A: Infertility
how social media plays a role
purchasing or leasing
40
Sarah Sharman, PhD Lollie Hayles, DVM Kelly Reese Key Common
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
MD
Matthew DeOrio, MD S A L E S & M A R K E T I NG
Kelly Reese, Founder Lisa Layton, VP Sales/Marketing CH I E F E D I T O R I A L W RITER
Kimberly Waldrop, MA PUBLISHERS
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
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. 6
Inside Medicine | Summer Issue 2021
It’s summertime!! Everyone’s favorite season! Time for vacations…staying up later…swimming...enjoying the outdoors…entertaining the kids… This may be the hardest part of summer. A lot of parents utilize summer camps, especially sports camps, to keep the kids busy and moving. But did you know there are certain inherited traits that can lead children to have heart conditions that are dangerous? In this issue, we offer a reminder to have your children checked through a physical before they participate in sports. It can be very educational and eye opening. Summertime also means more time to relax and spend time with family and yourself. Inside Medicine is committed to giving you information on mental health and staying fit and healthy through this season. This time, we have given you articles on how to handle a mental health diagnosis, intermittent fasting (which is great to start in the summer), and my personal favorite, an article about carbohydrates. I love hearing that carbohydrates aren’t all bad! With every issue of our magazine, we are always so excited to share what we have learned through our contributors. It’s so encouraging to have such a wealth of information right here in our community. From sports medicine doctors to investors to real estate, there is so much valuable content. I hope you can take this issue and enjoy it while you sit by a pool. Maybe smelling the grill and soaking in the sun while listening to the kids play. It’s summer! Enjoy!! And, as always, all of us at Inside Medicine appreciate your support. You are the reason we love to put this magazine together!! We are so thankful for our readers!! If you have an ideas or suggestions for us, please let us know! We are continually looking for more community involvement and input.
p o r d l a W y l r e b m i K
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Cervical disorders Spine by: Winston T. Capel, MD, MBA, FACS, FAANS Spinal Neurosurgery
Problemss ptoms Symptoms
Introduction Cervical Spine Disorders are common
in the population. The most common cervical spine problems/symptoms are: 1. Neck Pain 2. Radiculopathy (Arm Pain/numbness caused by nerve compression) 3. Myelopathy (Spinal cord compression by disc, ligament and bone) All 3 problems can exist solitarily or in combination in the same patient.
Neck Pain
A common medical compliant but less frequent than low back pain. It is most commonly due to degeneration of the disc and facet joints. The disc in the cervical spine serves as a shock absorber and allows for motion; it is prone to early degeneration because of its high mobility and frequent motion cycles (head motion). The degeneration of the disc and arthritis of the facet joints is called Spondylosis. As the disc ages (degenerates) it undergoes programed biochemical changes that include weakening (reduced cross linkages of the collagen), reduced blood supply, reduced compacity to resist compression which leads to increased loading of the facet joints with resulting articular cartilage wear. A companion to degeneration is inflammation which leads to the biochemical stimulation of pain receptors. The inflammatory process will cycle randomly or in response to activity/position; in general, pain is proportional to the level of inflammation present. Risk factors for disc degeneration include: genetics, wear and tear, heavy labor, repetitive trauma and nicotine exposure. Most commonly neck pain is intermittent and reoccurring but can be chronic and persistent in up to 10% of the population. All thought Spondylosis is by far the most common cause of neck pain, it can also be caused by: Trauma (fracture/dislocation, ligament injury), tumor and infection. With spondylosis (degenerative disc disease) symptoms are generally worse with prolonged fixed positions: driving, staring at computer monitors/TV or at night sleeping.
WORKUP IMAGING: • if there is a history of trauma or neurologic symptoms (modality: CT/plain x-ray) TREATMENT: • Range of motion and isometric exercises • Treat inflammation: oral and topical anti-inflammatories • Frequent change in position • Heat
Radiculopathy
Radiculopathy is disease of the nerve root. Classic radiculopathy is characterized by descending arm pain with numbness in the distribution of the compressed nerve(s). In more extreme compression muscle weakness can occur. Radiculopathy can be caused by disc herniation and/or bone spurs compressing the nerve in the foramen (where the nerve exits the spine). Radiculopathy can be present without or without neck pain. The natural history is generally favorable with conservative (non-operative) care.
Workup IMAGING: • MRI if symptoms are persistent • EMG/NCS: used when there is diagnostic uncertainty • It can be clinically challenging to differentiate peripheral nerve entrapment (neuropathy) like carpal tunnel disease from radiculopathy (especially C6) and they can frequently coexist. In general peripheral nerve problems ascend and nerve root compression (radiculopathy) descend in symptomatology. An EMG/NCS can help differentiate peripheral nerve disease from nerve root compression. It can quantify advanced disease when axonal degeneration is identified. TREATMENT: • Traction: can be very helpful, 15 pound for 30 minutes twice daily. A home traction device is more cost effective and allows for consistent application of forces that can retract the disc herniation or bone spur away from the affected nerve reducing nerve inflammation and symptoms. • Neuromodulating Drugs (Neurontin, Lyrica): this class of drugs is generally the most effective for nerve pain. Neurontin is commonly under dosed. Titration dosing is required for Neurontin due to the potential side effect of drowsiness or dizziness. It is generally well tolerated if titration is gradual. A common regimen is 300mg increased by one capsule/day until daily dose is 1800mg/day. These drugs are controlled substances because patients need significant supervision in the initiation and termination of their use. Lyrica can be started at a therapeutic dose without titration and increased as needed. Common starting dose for Lyrica is 75mg twice daily. • Surgery: only for intractable symptoms after failed nonoperative care. Rarely a rapidly progressive neurologic deficits will accelerate the need for surgery. Surgical options include: anterior cervical discectomy and Fusion (ACDF) or total disc replacement (TDR). TDR is FDA approved for single level disease and is not covered by some 3rd party payers. It is possible to decompress the affected nerve posteriorly and avoid fusion (motion preservation) but this technique is used much less frequently than anterior approaches especially for disc herniations. Inside Medicine | Summer Issue 2021 9
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Inside Medicine | Summer Issue 2021
Myelopathy
...cont’d from page 9
Myelopathy is disease of the spinal cord. In cervical pathology the cord can be compressed by disc herniation, osteophytes (bone spurs) this is called spondylotic myelopathy. Often cord compression is caused by a combination of bone and disc. The ligament behind the vertebral body and disc (posterior longitudinal ligament can become calcified (ossification) creating an entity called Ossification of the Posterior longitudinal ligament (OPLL). Stenosis is the narrowing of the cord transmitting spinal canal no matter the tissue type causing the compression. Approximately 5% of the population are born with congenital stenosis of the canal; these patients are much more vulnerable to cord compression over their lifetime. The degenerative changes result in disc collapse, bone spur formation that reduces the diameter of the spinal canal. The clinical presentation of cervical myelopathy can be acute but is most
often slow and insidious. It is commonly missed on history and exam due to its slow progression. This delay in diagnosis can lead to major debilitation. The presenting symptoms most often include:
• Bilateral hand numbness that usually involves all 5 fingers, unlike radiculopathy which involves 2 or less fingers in the dermatomes of the affected nerve.
• Decreased fine motor coordination. Patients will often experience dropping things and/or change in hand writing.
• Ataxia: patients will start stumbling and falling which can be dangerous with a narrowed spinal canal (stenosis). Falls call lead to acute spinal cord injury due to the intolerability of the stenotic canal to extreme and sudden hyperextension. A major component of the pathophysiology of stenosis is chronic low blood flow (hypoperfusion) to the spinal cord. This leads to cell loss (atrophy) of the cord. As the atrophy progresses so do symptoms. The central nervous system has very limited capacity to regenerate. When the diagnosis of myelopathy is made surgery is usually required and the goals of surgery are not necessarily to make the patient better but to keep them from getting worse. Surgery is very effective in halting progression of the disease. Surgery will require decompression: removing disc and bone. This will be followed by reconstruction: rebuilding the structures removed using materials like polymers or titanium that will provide structural support for removed structures and contain bone forming material leading to fusion. Fusion is where motion is arrested between vertebrae a tradeoff required in most cases. Fusion requires the use of metallic (titanium) fixation in the form of screws and a plate to stabilize the reconstruction until bone growth is complete (fusion). Once the fusion is complete all reconstructive elements and fixation are inert and it is living bone that is responsible for reconstruction and fusion. In some patients a decompression can be done by removing the lamina (laminectomy) and a reconstruction/fusion are not required.
In summary, the above cervical spinal disorders are the most commonly observed and most have a good prognosis with good opportunity for successful non-surgical care. Surgery can be very effective for failed non-surgical care.
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compasslabservices.com
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1. Get plugged in with a good therapist. While every mental health diagnosis is unique, essentially every diagnosis can be benefitted by working with a therapist. It is most helpful to find a therapist who is knowledgeable about your specific diagnosis and takes into consideration aspects of life that are important to you. Searching for a therapist can be overwhelming, especially when we do not have a personal referral from somebody we trust. A good source for finding a therapist is Psychology Today. This hub allows us to search through verified mental health providers while filtering for items such as who carries our insurance, therapist’s rates, and whether they work with specific populations. Most therapist will allow a brief chat, to see if we feel they will be a good fit, before jumping into a paid appointment. Do not be afraid to call multiple people before establishing a first appointment. This is an important step in your journey to wellness, so make sure to advocate for yourself in the beginning! 2. Conduct research from reputable sources. Not all sources of information are equal! Ensure you are seeking information from sources that will provide you accurate answers, that take into consideration the individuality of you, as well as differences in your symptomology. Your therapist should be able to help you identify resources with reputable information for your specific diagnosis.
3. Work collaboratively to create a plan of action. A competent therapist will assist you with figuring out what you need as a unique individual, based on your diagnosis. This may include small action steps that need to be taken on a regular basis to ensure consistency in your behavior and thoughts or ensuring you know your warning signs of symptoms increasing. Working collaboratively may also mean you give your therapist permission to speak with your physician, psychiatrist, or other specialists you may be seeing. This collaboration serves to ensure you have the most comprehensive care for maximum wellness. 4. Identify your support system. This should be part of what your therapist helps you do, but ensuring this step is in place will allow you to know multiple people on your side to encourage you on the tough days. 5. You are not your diagnosis. When we receive such heavy news, it can be challenging to see ourselves as a person outside of the diagnosis. However, stretching your mind to remember you HAVE a diagnosis, you are not the diagnosis can help keep your journey in perspective. The care you receive following a mental health diagnosis is crucial. While this set of actions is not exhaustive, I do hope this list gets you started to the best days ahead.
Stay well friends, Rachel Sullivan, LMFT, CFLE-P Solid Ground Counseling Center www.solidgroundmadison.com
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1 2
Intermittent fasting signals ketogenesis, aninnate homeostatic mechanism wherebyenergy is derived from fat. Intermittent fasting increases the rate of fatmetabolism and can lower your body fatpercentage. It’s important to note thatintermittent fasting can lead to a loss of musclemass, which makes adequate protein intakeessential.
3
Developing an enjoyable and consistentexercise program while practicing intermittentfasting will signal the body’s innate homeostaticmechanisms to maintain muscle mass, whilepreferentially burning fat for energy.
4
Intermittent fasting can help your stomach“shrink” back to its normal size, and also “reset”your endocrine processes that balance hungerand satiety. The result is you feel full soonerand eat less. Intermittent fasting can lowerinsulin levels, decrease insulin resistance, andincrease natural human growth hormonelevels, and balance estrogen and testosteronelevels in both men and women.
5
Intermittent fasting can lower inflammation. Excess body fat generates chronically elevatedlevels of pro-inflammatory cytokines such astumor necrosis factor, interleukins, andprocalcitonin. Chronic inflammation increasesthe risk of cancer, chronic diseases, and dementia.
6 7
Intermittent fasting has been shown toimprove the neuroplasticity of thehippocampus, an area of the brain that helpsus generate long-term memories. Calorie restriction as a result of practicingintermittent fasting has been shown to protectDNA from oxidative damage, reduce telomereshortening, and slow the rate of ageing.
A CALL FOR CULTURE Will your employees stay or go? by: Angie Sandritter
2020 14.7%
Recently CNBC published an article stating 1 out of 4 employees will be leaving their current companies after things get back to “normal”. If you recall, in April of 2019 the unemployment rate was 3.9% and grew to an all-time high in April, 2020 – 14.7%. As unemployment rates continue to drop to 6% as of March, 2021 and the states continue to open up, employees are considering their work culture and career goals now. Amongst the biggest reasons that people WILL look for a new job - is the company “culture”.
Does company culture allow individuals to feel supported and safe?
unemployment rate
2021 6%
2019 3.9%
SPECIFICALLY, DOES COMPANY CULTURE SUPPORT AN INDIVIDUAL’S: Development desires and career progression goals Wellbeing – by providing the right work environment
Post-Pandemic Work Survey 75%
Endorsement of the company’s mission As an example, at RippleWorx, we surveyed our employees on how they would like to work in the future – remotely, in the office, or hybrid.
50% 25%
As you can see from the survey results, the majority of employees prefer to work part time in-office and part time remotely.
0% IN-OFFICE
18
Code of personal ethics
HYBRID
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REMOTE
SPORTSMEDALABAMA.COM I n s i d e M e d i c i n e | S u m m e r I s s u e 2 0 2 1 19
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It is easy to see how the events of 2020 have set the stage for increased turn-over rates in the following industries. According to the Bureau of Labor Statistics, top industries that show an upward trend in employee turn-over include: Hospitality/Entertainment Healthcare Law enforcement Professional Services/Technology
CONNECTING HOSPITALS
So, how do you retain your top talent? By creating a culture of development and individual growth. RippleWorx's primary mission is to provide a datadriven and actionable view of how your people are doing on a daily basis. We help you understand your employee’s current sentiment and engagement, motivational level, skillset, time in their role and personal career aspirations. We provide your people real-time feedback about their current impact and how to develop within your organization. Keep top talent and reduce turn-over! No matter the position or the role, it is people that propel organizational success. Our mission is to provide a clear individual action plan to help people and organizations be better!
02
GROWTH
SKILLS
How equipped an employee is to be successful in a role
SENTIMENT An employee's attitude about their role and job.
01
PRODUCTIVITY
DOES THAT DESCRIBE YOUR HOSPITAL?
By using Ripple chat, you can share patient records, discuss matters, or simply schedule a meeting, all from the touch of your screen. Reach, any user within the Ripple platform can be reached via Chat, Message, or by scheduling an event within the Ripple calendar. Ripple’s chat module is GDRP and HIPPA certified to protect your conversations and information shared.
HAPPINESS
03
TIME IN ROLE How long an employee has been in a role
PERFORMANCE ACCELERATOR
IT'S TIME. TO BE BETTER. Let RippleWorx drive the overall performance of your people so your organization can thrive!
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256.881.5151
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PREVENTION
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There is a very popular opinion right now that carbohydrates are bad, and should be very limited if not cut from daily consumption. While this may achieve a quick weight loss it is NOT a sustainable or truly healthy choice. Don’t believe the “no carbhype”! The body craves and needs carbs to function properly. The ultimate goal is to lead a healthy life, not just crash diet. When weight is lost it is usually the desire that it STAY gone! If this is to be achieved a total lifestyle change must be made, not just a temporary diet change. This means the correct carbohydrate choices must be made. Yes, there is such a thing as the right carbs. Complex carbs are what is needed for daily consumption. They will give the body the right type of fuel without causing the undesirable effects of simple carbs, such as weight gain. By eating a balance of complex carbs, like sweet potatoes and whole grains along with oatmeal, brown rice and quinoa will allow the body to stay fueled without retaining fat. There are many benefits to keeping complex carbs in a daily diet. Not only does the body slowly break down and make use of the complexcarbs, but research has also shown that these carbs promote the production of serotonin, a chemical in the brain which makes you feel good. When serotonin is produced it helps prevent feelings of depression, anxiety and anger. Those who deprive their bodies of carbs tend to have more of a struggle with these emotions.
Personal Training • General & Sports Nutrition
Another major benefit found in these complex carbs is increased fiber intake which helps weightloss over time. The soluble-fiber found in carb rich foods has been found to lower the bad “LDL”cholesterol while providing good “HDL”cholesterol. This all adds up to major heart benefits. It is important to choose the complex carbs over the simple ones on a daily basis. Enjoy some simple ones from time to time, but focus on a sweet potato with a touch of sea salt and olive oil, or some brown rice or quinoa cooked in chicken broth for extra flavor and steel cut oats in the mornings. Fueling the body with these complex carbs throughout each day will provide mental clarity and energy to sustain peak functionality, especially during physical activity and/or working out.
Owner Nick Thomas is a master certified personal trainer and general/sports nutrition consultant with over 20 years experience.
primeperformancetraining.net 105 East Market Street Athens, Alabama 35611
Billy’s outward focus on life has led him to adopt four children, and start a local initiative called, Lunches of Love, that provides healthy foods and snacks to underprivileged children in Huntsville city schools. His heart of giving has included pledging $350,000 to Huntsville Hospital’s Pediatric Center, sponsoring an annual event to honor law enforcement and first responders, called Back the Blue, and to galvanize churches in North Alabama to adopt villages in remote areas of Guatemala through a non-profit he started called Mission Firefly (missionfirefly.org). Wanting the ripple effects of his life to be felt for generations, Billy has challenged his 1000 employees at Hometown Lenders to take on their most aggressive philanthropic effort yet, raising $1 million dollars in support of St. Jude’s Children’s Hospital in Memphis, Tennessee. In total, Hometown’s newfound effort aims to generate funding to support the mission of St. Jude: Finding cures. Saving children.® As the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children, treatments invented at St. Jude have helped push the overall childhood cancer survival rate from 20 percent to 80 percent since the hospital opened more than 50 years ago. By freely sharing discoveries, every child saved at St. Jude means doctors and scientists worldwide can use that knowledge to save thousands more children. Billy views the partnership as an avenue to serve others, and many of his almost one hundred branches across the country are joining in the ambitious effort. Participating branches will donate a minimum of $50 for every loan closed in 2021 to St. Jude’s, where no family receives a bill for treatment, travel, housing or food – because as Billy says, “all a family should worry about is helping their child live.”. “Our customers and staff always jump at a challenge, and we have intentionally set a bold goal – one that underscores our motto, People over Profits,” said Billy. “Throughout 2021, we will strive to raise our community outreach standard and give back to the local communities in which we live and work by donating hard-earned revenue to a tremendously worthwhile cause. Childhood cancer is a disease that affects so many, and we are eager to join the fight to end it. The St. Jude team does a remarkable job of researching effective treatments and potential cures for our most valuable resources: our young people. I could not be prouder of our team for taking the bull by the horns and raising the bar this year.” Join the St. Jude mission by visiting stjude.org, liking St. Jude on Facebook (facebook.com/stjude), following us on Twitter (@stjude) and Instagram (@stjude) and subscribing to our YouTube channel (youtube.com/user/MyStJude).
For more information visit www.htlenders.com.
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by: Adam Weiger
Leasing Your Office Space FLEXIBILITY: When you lease a property, you typically have more flexibility to relocate your office space as you will likely be signing a 5, 7 or 10-year term. At the end of that initial term, you can easily walk away from the space, relocate to another property, or decide to sign on for another term. You don’t need to prepare the property to sell, list and show the property, or walk through a sale transaction to get out. You simply walk away at the end of the term or you renew the lease. CONCESSIONS: Another great benefit of leasing comes in the way of the concessions that landlords will offer blue chip tenants, like healthcare practices. When you are properly represented and have the appropriate posture and negotiation strategy, many landlords will become more aggressive and stretch further to make a deal with a healthcare provider than with other traditional tenants. Some examples of these concessions are tenant improvement allowances where the landlord will provide money to help build out the space in the property, or a free build out period to complete the construction so the tenant is not paying rent before they occupy the space. It’s also possible to achieve free rent once the practice opens. With expert representation, a healthcare tenant can often times create leverage to demand concessions that reach into the six-figure range, totaling $100,000, $150,000, even $200,000 and more in build out allowances from the landlord, along with 6-12 months of free build out time and additional free rent upon opening. These concessions are huge benefitting factors to leasing verses owning, as it means less money from the tenant on the frontend to get the office up and running, and less money and interest paid to a lender.
AVAILABILITY: An important factor to consider when determining whether to lease or purchase is market availability. If you are in a high-growth, dense urban or downtown area, there may be very few options to purchase. In most markets, lease options outweigh purchase options by 10 to 1, and in more populated markets, the disparity is even greater. It’s important for healthcare providers to not get ‘set’ on only one scenario. The best strategy is to look at the entire market or area, both purchasing and leasing, to find out what property options are available. In these decisions, it is best to keep the needs of the practice as the main priority, as the practice is what drives revenue.
It’s also imperative to look at an all-encompassing apples-to-apples comparison that takes into account the principle paydown, monthly figures, concessions and costs, tax implications and the equity position after 10 years, 15 years and 20 years. Those are the figures that will ensure the decision is informed and factual.
for
LEASE
}MISSIONS
1140 Eagletree Lane SE Huntsville, AL 35801
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Drop by and meet Clinic Director Michael Beuoy and his team in Huntsville!
WHO IS
YOUR
PT?
} HEALTH FEATURE
by: Kelly Reese
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There is no doubt that social media and its instant availability has changed the way we engage with the outside world. As the popularity and influence of sites such as Instagram continue to grow, few can argue that these are now among the most important tools for social contact in the modern world. Social media platforms provide groups of individuals the opportunity to share their experiences and be encouraged in their journey. Pregnant women, for example, can reach out to other expectant mothers who are due to give birth around the same time, tracking each other’s progress, problems and proud moments, providing encouragement and hope along the way. But what about the women that struggle with infertility and negative impacts that social media has on their mental health? While we know that Facebook and Instagram isn’t reality, we are sucked in by the carefully constructed highlights of people’s lives. Posts are all about the latest gender reveals, nursery purchases, and less about women sitting home alone impacted negatively by all the positive news in their feed. Even if deep down we realize Facebook and Instagram is a false presentation of the world our “friends” live in, the risk of comparing ourselves to others is still high, especially among women that are struggling to get pregnant. As women celebrate the joys of being pregnant, we rejoice with them. Life is precious and formation of a babe is nothing short of miraculous. But for every woman that is experiencing unspeakable happiness, others feel defective and incomplete as a result of their infertility. As a mother, I am reminded that, now more than ever, women need to be sensitive to others whose road is much more emotional and painful than those of us that have had children. As infertile women deal with the bitter feelings that come from social media, many of them withdraw from such platforms, wanting to avoid the positive news of others, and avoid the difficult questions that come from friends that are trying to be helpful. Such feelings lead to unhealthy withdrawal from community, which is exactly what women need when struggling with feelings of jealousy, despair, disappointment, envy, and resentment.
Spirit
Wh a t fr u i t s a r e y ou p r od u ci n g fr om t h e s e e d s y ou p l a n t ? by: Key Common
LOVE JOY PEACE PATI ENCE K I N D N E SS G O O D N E SS F A I T H F U L N E SS G E N T L E N E SS SE L F -C O N T R O L
GOODNESS is always doing the right thing even when you are faced with wrong that may look pleasing to the world. How many times have I had to get cross corrected on this one? I am ashamed that I would need a calculator to total the number of times that I can remember, less those times I can't remember. Goodness is often challenged with the enemy or the world system trying to offer you up a different way, a way in which is not Christ-centered. Although we may get hit with an option to do the wrong things, Psalm 23:6 lets up know "Goodness" and mercy pursue us all the days of our lives. Now, isn't that Good News? LONG-SUFFERING is patience when you're being pushed to the limit. Long-suffering is enduring without reaction to the attacks of others and not doing unto them the same measure of mistreatment. I will say, this fruit comes with much grace and all of the above fruits are in the same soil this one is planted in. When I read the passage in Luke 6:29, (to offer up the other side after being struck); I immediately think that's a grand example of long-suffering and Lord I need you to plant my feet. How about you? How do you handle the attacks of others, are you filled with this fruit? GENTLENESS is a gentle type mannerism for being forgiving and gracious rather than angry and vengeful. I think of Christlike meek and mild-natured individuals having this fruit. You can be in an environment with lots of chaos and there is peace the gentle spirit enters the room. Personally, I would much rather have a gentle spirit to calm the atmosphere. 1 Corinthians 4:21 SELF-CONTROL is continence or temperance in all things at all times. When tempted to indulge in wants even when it is not bad for you, do you have the selfcontrol to do what's right? Do you have the discipline to avoid the right side of wrong and not overspend for self-pleasure or idols? Having Self-Control takes practice and must be exercised in all we do. Our desires can hurt deeply after the pleasure has passed and we think about our decisions if we are not careful. 2 Timothy 3: 1-5 [ But mark this: There will be terrible times in the last days. 2 People will be lovers of themselves, lovers of money, boastful, proud, abusive, disobedient to their parents, ungrateful, unholy, 3 without love, unforgiving, slanderous, without selfcontrol, brutal, not lovers of the good, 4 treacherous, rash, conceited, lovers of pleasure rather than lovers of God— 5 having a form of godliness but denying its power. Have nothing to do with such people.] This passage, I felt needed to be written out in case you don't go back and look at them yourself. Not that one is more or less important, it just hit differently as I was reading it.
Now that we have reviewed these together and possibly opened some deep internal discussions about our own action, let do some homework. First, ask yourself this question, "are you filled with the Fruits of the Spirit"? Can you recall a time you've received the harvest of someone else's fruitful display in action? Here's one more question to ask yourself, "what seeds are you sowing if you are not filled with the Fruits of the Spirit"? We know from Gen 8:22, there is seedtime and harvest, and Galatians 6:7 tells us, "a man reaps what he sows". Guys, It is very important that we never forget every seed planted produces a harvest good or bad. We want to look like the produce section at the grocery store and see a beautiful and plentiful harvest from the seeds we sow in the earth. Although, unlike natural crops we don’t know when the harvest will come, therefore we sow in love and faith according to our belief, "that it shall be"! Go today and plant your seed on good grounds and watch the harvest grow.
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Inside Medicine | Summer Issue 2021
