Inside Medicine Volume 3 Issue 19 by Inside Medicine

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A Time To Shine Infection Control During a Pandemic By Macy Magnusson, MS

Hospitals are a place of healing and recovery. Unfortunately, they are also a place where infections can spread rapidly if proper precautions are not taken. According to the Centers for Disease Control and Prevention (CDC), 1 in 25 hospitalized patients will get an infection as a result of the care that they receive, and an estimated 75,000 patients with healthcare-associated infections will die each year. Because these infections pose a major threat to patient safety and in turn the safety of the community, hospitals have made the prevention and reduction of infections a top priority, depending upon their Infection Control teams to lead the charge. At Crestwood Medical Center, a lot of time, hard work, research, and education goes into preventing the spread of infection. Crestwood’s Infection Control Team is made up of 2 Infection Preventionists, Amy Stephens, RN, and Roslyn Richardson, RN. Infection Preventionists are experts on practical methods of preventing and controlling the spread of infectious diseases. They tend to wear many hats. They look for patterns of infection within the facility; provide education to patients and staff members; audit practices; develop, review, and update the facility’s protocols and procedures for infection control; investigate infections and outbreaks; advise hospital leaders and other professionals; and coordinate with local and national public health agencies. Their roles and responsibilities require expertise in microbiology, epidemiology, statistics, human resources, education, public policy, and clinical practice. Most of the work Stephens and Richardson do is typically done behind the scenes. When COVID-19 hit, they found themselves in the spotlight, their roles proving to be more critical than ever before. Their primary roles immediately shifted to the hospital’s preparation and response to potential COVID-19 cases. Each day, Stephens and Richardson are responsible for reviewing the guidelines and recommendations on safely caring for patients with suspected and confirmed COVID from governing bodies like the Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), World Health Organization (WHO), and Alabama Department of Public Health (ADPH). From those guidelines, they 34

Inside Medicine |

Vo l u m e 3 I s s u e 1 7

Roslyn Richardson, RN, & Amy Stephens, RN

have written and implemented policies and procedures for preventing the transmission of COVID-19 within the facility. They have been involved in key decision-making and planning with regard to issues like personal protective equipment (PPE) supply and use, to ensure that all staff members had appropriate PPE at all times, and helping to optimize infection control in the design and set up of Crestwood’s COVID units. In addition to researching and planning, Stephens and Richardson have worked closely with the clinical staff, educating them on hand hygiene and appropriate PPE usage and addressing any issues that the staff encountered along the way. Because of the excellent job that Stephens and Richardson have done, as of the date of this publication, Crestwood has been able to keep 100% of its team members healthy, provide appropriate PPE to all of its staff during the country’s PPE shortage, and continue to give excellent care to all patients. Their hard work and dedication to keeping everyone safe also reduced the risk of spread within the community. In moments of crisis, there are always helpers and heroes. For Infection Preventionists like Stephens and Richardson, this pandemic has been their time to shine. They have shown our community just how important infection control is and the positive effects infection control can have on keeping everyone safe and healthy.

IF IT’S AN EMERGENCY, YOU AREN’T SAFER AT HOME. We know you are concerned about your health. We are, too. And if you experience sudden symptoms of an emergency, getting fast medical care could save your live. We are taking extraordinary precautions to be sure our emergency room and other care settings are safe. So, don’t delay care in an emergency. If you experience chest pain, sudden dizziness, weakness or numbness in your arms or legs, severe abdominal pain, high fever, or any other symptoms of a possible medical emergency, seek emergency care immediately.

Learn how we’re keeping patients safe. Visit CrestwoodMedCenter.com/COVID-19

In an emergency, call 911.

NATIONALLY RECOGNIZED for HEART CARE — again. We put our hearts into providing quality care ... and it shows.

} FROM THE EDITOR

features &

CONTENTS S har ing with P ur p ose

I n s i d e M e d i c i n e | V o l u m e 3 I s sue 19

Dear Readers– VOL 3

ISSUE 19

C ONT RI BU T O RS

FEATURES COVID 19 Vaccines

CONTENT 38

the importance of getting the vaccine and important information regarding them

Mask ACNE Are you suffering from "maskne"?

Gut Health Did you ever think one part of your body controlled so much? Get your gut healthy!

Kimberly Waldrop, MA

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editorial contribution or advertising, please contact Kelly Reese at

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Making a Difference

Shushruth Yellumahanthi

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 |

Vo l u m e 3 I s s u e 1 9

S A LE S & M A R K E TIN G

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

Kimberly Waldrop, MA P U B LI S H E R S

Blake Bentley, President

GOD ONLY KNOWS

Dear Readers– Wow. Would we have ever imagined we would have lived through a pandemic??? We are hopefully on the upside of the crisis but every day It’s kind of unsettling to look ahead to next year. What does 2021 brings about something new. New data, new stories, new trials and have in store for all of us? After a year of so many ups and downs… new successes, we are watching so much unravel before us. Everyone the downs far exceeded our expectations…it feels natural to be seems to have opinions and everyone is looking for answers. apprehensive about a new year. This time last year, it seemed like Putting together this issue of Inside Medicine has been quite different. the world was coasting along, not a care to be seen, and then We have worked tirelessly to bring you very informative, up to date boom….it all changed. The world became uncertain in a pandemic information while staying true to our calling. It is such a blessing to be that overflowed into every facet of everyone’s lives. a part of this publication that allows us to meet so many people and As Christians, it should be easy for us to feel peace. We know who bring their stories and expertise to you in print form. holds the past, the present, and the future. Unfortunately, the Whilehuman this is an unprecedented time for all of us,the I’mspiritual excited for side of us all sometimes overtakes sideyou and we to see what weforget have to offerhands this gowe round. I just know arealmighty going tohand almost Who’s rest in. We rest you in the enjoy this and learnbe something or have something to share praise to Him. new Without it, we would have no hope of edition God and with others. I hope and pray you come away after reading through our and no future. stories, more knowledgeable, moreas caring, andinto more up we to speed on the 2021, know that But, we do…and with that, we head the world around us. knows what’s coming is GOD. Only Him…Only God only ONE that

GODonly knows

Onceknows…. again, Kari Kingsley gives us a great editorial. This time, she explains meditation andissue how of it helps her life. we Shetake challenges In this special InsideinMedicine a goodthe look at reader some to joinissues her and let faced go of because worries of and restlessness. Along the we’ve 2020. Rachel Sullivan’s article, same lines, we have 2 more health pieces in this issue. Instinct, goesmental right along with the theme we areRachel trusting in Survival Sullivanfor gives insight onyear. findingWith our own mechanisms while she theusupcoming her coping professional background, Elissa Brooks explains howof wethings can find ourselves whilefor dealing withgoing gives us an outline we can hold onto positivity whatever comes along.no Allmatter three articles are great into a situation, what it looks like. examples of many things weDr. areElizabeth all lookingMcClesky for help with these times. has during provided us trying with an editorial about present in the moment. Sometimes we don’t realize the need being Also in this edition of Inside Medicine, you will find quotes from we have for relationships and personal connections. Just looking teachers dealing with teaching during quarantine, how a local hospital over the past year, our day to day dealings with friends handles infection control, opinions on whether to wear a mask or not and evolved changed. Through itwhile all though, to wearcounterparts a mask, how has surgeons areand dealing with operations being the human connection and need for it remains the same. It has safe, telemedicine, and even a story about high tech pain relief. There so important. become a gift that most didn’t realize was is so much good information packed in this time! You’llatalso findMedicine some helpful information inproviding this edition. article Our team Inside is passionate about you An with about eye issues that develop because of overuse of electronics, the best information out there. We also want our readers to know we spinal COVID and has affected are praying forfusion you allinformation, and sendinghow well wishes love to allhealthcare, of you! As and much more. always, we hope you enjoy our magazine and will share it with others. of us Inside Medicine hope youfor have a healthy and If you everAllhave anyatquestions or concerns, ideas stories, or want to safe holiday season as well as a prosperous New Year! As always, our be a contributor, please let us know! prayer is to be a light in our community, for you as our neighbors and also for our Savior. Please let us know if you have an idea or would like to contribute to our magazine. We love you! And cheers to 2021! Remember…faithfully, Only God knows….

Kimberly Waldrop

www.in s idem edic in emagazine.com I n s i d e M e d i c i n e | Vo l u m e 3 I s s u e 1 78

FROM THE EDITOR

Dear Readers-

excited for the normal

Listen. Can you hear it? It’s the sound of “normal” creeping back into our lives. We have been living in such questionable times and I think most of us are starting to see a light at the end of this proverbial tunnel. As we have been balancing our lives with uncertainty, it is so wonderful to me how the natural world around us has continued on without a care. The seasons have changed, the weather remains on cycle, the animals continue to sing and thrive, and the world keeps turning on its axis. So it goes with our God. He has been constant and never changing. He hasn’t gone anywhere and He has been with us to pull us through to where we are today. I am so excited and thankful for this edition of Inside Medicine. This magazine has a heart of gold… to give back to the community by providing valuable information and by glorifying God in the process. The pandemic has offered us some experiences we never thought would happen. We are here talking about “maskne” (acne caused by wearing masks) and new vaccines from many different pharmaceutical companies that most of us have never heard of it. We have two great articles in this issue that give us a tutorial on what all of this means to us. We have also been awarded the gift of more family time. Time that we aren’t necessarily sure what to do with or how to keep a sense of sanity through it all. In her article, Rachel Sullivan helps us piece together ways to stay calm and serene even though feelings of stress try to take over our lives. In this issue, we also have helpful information for providers that deal with landlords that happen to be their patients and how they can get professionals to step in for guidance. We also learn about gut health in a special editorial as well as a new treatment for chronic pain. As always, all of us at Inside Medicine appreciate your support. We are continually looking for more community involvement and input. If you have any ideas for us, please let us know!! We look forward to serving you from this issue to the next….

Kimberly Waldrop

(continued from p.13)

Helping others increases positive brain chemicals. Why do you find it hard to stay home? If you are a natural extrovert who thrives on interaction, try phone or video chat to check on others that may not have family available. What about a volunteer organization or even getting to know a neighbor who may need you to run an errand? Let’s put your strength as an extrovert to work and boost those brain chemicals. Tidy environments reduce stress and improve sleep. Is your home or yard so out of control you don’t know where to start? Start with admitting there is a problem with where to begin. Maybe a peek at a website or a call to someone whose home/yard you admire can provide suggestions and motivation. But if push comes to shove, just pick up that sock and into the hamper it goes. Make the bed. Then fold that basket of clothes and put them away. Next, pull all those clothes off the pseudo clothes rack (i.e., exercise bike) and get them sorted and into the washing machine. One task at a time will lead to a much tidier room, and tidier rooms lead to a tidier home. Reducing negative exposure reduces overall depression and anxiety. Limit news watching to no more than 30 minutes twice a day. Too much bad news increases your stress hormones driving up blood pressure and blood sugar. Counteract negative thoughts by recording a daily gratitude list and spend an equal amount of time (i.e, one hour) enjoying hobbies, music, etc. Picking up a new healthy habit can reduce or prevent chronic diseases. Binge watching and eating junk food can result in weight gain and chronic diseases not limited to those of the brain like dementia or addiction. Let’s look at some healthy habits you can establish over time which support the brain or reduce the progression of debilitating disease. • Get plenty of sleep; it builds neurons and restores the body. • Learn to cook healthy meals; they contain the body’s building blocks which originate in unprocessed foods. • Get moving. No need to join a gym; a 30-minute walk after a meal can decrease blood sugars and improve mood and sleep. • Learn something new through a self-improvement program that teaches you to play an instrument, master a new language, explore your genealogy, pursue a new hobby or learn new skills related to an old one. You will be helping your body to build neurons, reducing stress, and maybe making new friends. While none of us has asked for this challenge, let’s try to use it advantageously. It is an opportunity, so let’s come out of it on the other side better and brighter and filled with the hope of the “best of times.”

Board Certified in Family and Lifestyle Medicine Madison, AL 256-280-3990 HealthStylesDr.com Inside Medicine |

For Emergencies 911 Boys Town for Kids, Teens, & Parents 1-800-448-3000 Substance Abuse & Mental Health Services Administration National Helpline 1-800-662-HELP (4357) National Suicide Prevention Line 1-800-273-TALK (8255) Veterans’ Crisis Line 1-800-273-8255 National Domestic Violence Hotline 1-800-799-7233 or 1-800-787-3224 (TTY for the Deaf) Disaster Distress Helpline 1-800-985-5990 National Alliance on Mental Illness 1-800-950-NAMI (6264) | Nami.org

Dr. Elizabeth McCleskey

Most of us have not experienced loss, empty store shelves, empty wallets, or stay-at-home orders. If you experience worsening depression, anxiety, substance use, hunger, suicidal thoughts, or are a victim of abuse, please contact one of these national organizations for referral to resources local to your area.

Vo l u m e 3 I s s u e 1 7

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TESTIMONIAL F E A T U R E

1 John 4:19 reminds us, we love him because He first loved us.

Love

f l e s r u f o l e Y s r u Yo by: Key Common

Today I decided to do some soulsearching. I looked back over my life’s many trials and tribulations and many highs and lows and came up with one main point that really stood out to me. I realized that I’ve had an issue many times in my life with feeling overlooked, unappreciated, not accepted; just many times in trials of my life I placed it all in the hands of someone else to validate me. Psalm 139:14 - I praise you, for I am fearfully and wonderfully made. Wonderful are your works my soul knows it very well.

I question that today, why? You see the issue that I came up with at the root of that problem was actually my own self. I didn’t accept myself. Had I done so, I would never be concerned about the acceptance of others. Had I had a boldness in my life and a security within myself I would not need validation from anyone else. I know that Christ accepts me. But even in that, it’s hard sometimes to make yourself believe it. Ultimately, it’s like faith and it’s not tangible. We need to love and accept ourselves, despite anything anyone else thinks. It has taken me many years to do this but we need to love ourselves because God first loved us! Psalm 139:14 - I praise you, for I am fearfully and wonderfully made. Wonderful are your works my soul knows it very well.

That scripture is confirmation that I have no reason to be concerned about someone else's acceptance. If I accept myself and if I am made fearfully and wonderfully, what more could I be looking for? Wonderful are my works, my soul knows it well… WOW! That means I am an amazing prize. So I am going to accept myself. I’m going to take off the lashes, wipe off the makeup, let my hair down, throw on an oversized T-shirt and maybe even some jeans with holes and just love on myself because without all of the extra I am still fearfully and wonderfully made. God created me with his bare hands; he knows every hair on my head. He had a purpose and a plan for my life. He designed me for a specific work on the Earth...that is top shelf if I may say so. So I don’t care how anyone else perceives me. I know how God sees me and He accepts me for whom He has created me to be. Yes, there are bumps and bruises. Yes, there may be a crack and a scar here and there. But it’s refined by His glory. His glory that shines in the oil of his anointing that brings out all of the sparkle. That is something to be proud of. That is the acceptance we all need. If you’re not accepted by someone else, with all of the love of God, then they are not for you and you are not for them. Lace up your sandals of peace and take a walk out the door with your head held high. For not other reason than the reminder of Psalm 139:14 YOU are fearfully and wonderfully made.

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TESTIMONIAL F E A T U R E

Basic Instructions Before Leaving Earth

If I continue to be concerned by the world and the world’s standards, then I would be in a world of trouble. We are reminded in Titus 2:12 to renounce ungodly and worldly passions and to live self-controlled, upright, Godly lives in the present age. Once I am no longer concerned with the world's statue and the world standard, I can keep a focus on what God wants for me. It is great to see how God perceived me and how God created me and reference that the B.I.B.L.E (basic instructions before leaving earth) is where the plan is found. Thankfully, the plan and purpose for our life is already made and laid out. We should just follow it! He said to keep our eyes on Him and He’ll keep us in perfect peace. In peace we are not concerned about how anyone else feels about us. We accept ourselves for who we are and who we’ve been created to be. We are a chosen race, royal priesthood, a holy nation. He made us to be called out of the darkness into His marvelous light. We know that His hand is upon us. He will never leave nor forsake us. This is the peace we need to be comfortable in the skin we’re in. We should walk with a fierce mentality. Not with arrogance but with spiritual boldness that will illuminate any room. The Holy Spirit goes before us and there is a light of glory shining upon us. We need to love and accept ourselves, despite anything anyone else thinks. It has taken me many years to do this but we need to love ourselves because God first loved us!

1 John 4:19 reminds us, we love him because He first loved us. Therefore, I am worthy of loving myself. He loves me just because, just because…I am fearfully and wonderfully made. We seek other’s acceptance despite God’s truth and His word. Oftentimes, we also find ourselves longing for or wishing we had something someone else has. It could be in possessions or physical appearance. The comparison to others goes on and on. We look at ourselves and wonder why don’t I have that? Why can’t I look like that? All of this comparison actually defines the character within us and of not accepting ourselves. Actually, we should embrace the total beauty of having life. Acceptance is embracing our reality, by definition. It's accepting who you are. You don’t have to agree with how it looks or what you have but rather than wasting time questioning it, decide to accept it. Love who you are created to be! This has been a hard lesson to learn and I am growing in it every day. I’m so happy that I have chosen to love myself. I accept all of me, as I stand on the potter's wheel and let the Lord continue to do the work He has planned in my life and make only the changes that His word declares for me. I don’t think anything else could be as accepting as this.

Inside Medicine | Volume 3 Issue 19

& Orthopaedic Surgery C VID-19 By the time this article is printed and available to read this summer, the impact and threat of the novel 2019 coronavirus pandemic will have changed - hopefully for the better! As I write this article on Monday, April 6, 2020, the coronavirus just like the weather, is in full bloom. The current projection is that the hospital admission rate will peak in 12 days on April 18, so there is hope that by the time you are reading this article our lives will be closer to some normalcy, though what was considered normal just a few weeks ago could be redefined for a long time to come. In our communities here in Huntsville and Madison, the hospitals are under a state mandated moratorium on elective surgery. Orthopaedic surgery is largely elective because patients can limp around on an arthritic knee or hip for a few extra weeks or months because their condition is not necessarily life threatening. However, several orthopaedic conditions that involve trauma and spine related conditions can be emergent or at least urgent. Hip fractures or other broken bones and disc herniations with neurologic deficits are examples of conditions that must be taken care of expeditiously. Fortunately those patients are being taken care of if surgery is needed without hesitation. I have been overwhelmingly impressed by the adjustments being made on a daily basis to provide safe surgical care. The nurses and OR technicians and anesthesia care providers are truly heroes in the effort to take care of patients. In times like these, the true heart of the healthcare worker shines brightly. The Orthopaedic Center is considered an essential business, and our clinics are open and seeing patients every day. We have implemented the practice of social distancing in the waiting rooms. Patients can sign in

By Larry M. Parker, MD

and wait in their cars then receive a text when it is time to go back into the exam room. TOC is also providing telemedicine appointments to evaluate and treat patients remotely. The coronavirus pandemic has created a huge impact on the orthopaedic community for both doctors and patients: Some of the changes that are taking place will probably change the delivery of healthcare for a long time, and some of the changes could be permanent, but I am confident that we will always be able to provide quality orthopaedic care both in the clinic and in the operating room just as we always have. I look forward to reading this article in June, and hopefully we will be in a much better position with regards to this viral pandemic here in the Tennessee Valley and around the country. Be safe! Sincerely, Dr. Larry Parker

I n s i d e M e d i c i n e | Vo l u m e 3 I s s u e 1 7

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REAL ESTATE F E A T U R E

What If My Landlord Is Also My Patient? By: Adam Weiger CARR

How do you handle a real estate negotiation if your landlord is

also your patient?

Many healthcare tenants find themselves in this situation when approaching a lease renewal or relocation. Compounding the situation, is that most healthcare professionals are not prone to conflict or confrontation and would prefer to avoid them. This creates a scenario where tenants want to obtain the best terms possible for their practice without upsetting their landlord and losing them as a patient. In an ideal world, you could tell people exactly what you hope to achieve and then expect to receive a fair response. Unfortunately, commercial real estate is not one of those worlds! The difference between a properly or poorly negotiated lease or purchase contract can benefit or cost you tens to hundreds of thousands of dollars over a ten-year period. Understanding how much is really at stake during a commercial real estate negotiation changes how you should approach every transaction.

REAL ESTATE F E A T U R E

To help your perspective, look at these foundational questions: Do you realize your landlord’s objective is to maximize their investment and achieve the highest returns? Do you realize that just like your landlord comes to you for healthcare services because they are not trained in your specialty, that you should follow the same approach and go to others that are trained in specialties that you are not trained in, such as commercial real estate? Would you rather risk losing a patient or overpaying by tens to hundreds of thousands over a ten-year period? If your landlord is only your patient so they can get away with overcharging you, do you really want them as a patient? If a listing agent is your point of contact, do you realize it is against most state’s real estate laws for that person to give you any advice that would provide you any advantage in the negotiation? Do you understand the listing agent is hired to protect and advocate for the landlord, not you? If your landlord has been overcharging you for years, do you think they will voluntarily cut their profit by tens of

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Inside Medicine | Volume 3 Issue 19

Inside

CONTENT INCLUDES FALL 2016-NOW ISSUE 18

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orthopaedic/neurology/ mental health /infertility/urology/ENT/ spine surgery/rehabilitation/dentistry/ pain management/anesthesia/dermatology/endocrinology/ cardiology/podiatry/oncology/internal medicine/ family medicine/pediatrics/lifestyle medicine/critical care /infectious disease/pathology/radiology /vascular

editorial

contribution

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kellyreese.im@gmail.com or 256.652.8089

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REAL ESTATE F E A T U R E

Nearly every major corporation in the world utilizes trained specialists that negotiate professionally for a living to handle their commercial real estate needs. That being the case, why would you assume you could achieve better results yourself against professional negotiators? Do you have the resources and ability to dedicate dozens of hours to fully comb the market, understand all your top options, obtain and organize data and then execute a strategy to maximize your profitability? Do you understand that hiring representation will remove you from conversations with your landlord and increase your ability to maintain a healthier relationship when the negotiation is complete?

Conclusion: Most landlords will respect a person who realizes they are not professionally trained in commercial real estate, especially when a large amount money is at stake. Any landlord who tries to convince a tenant not to hire representation isn’t looking out for that tenant, they are looking out for themselves. Telling a doctor or office administrator that they should operate outside their expertise should be seen as ingenuine, deceptive and untrustworthy. If a landlord would not perform their own healthcare, why would a healthcare professional try to negotiate their own commercial real estate terms? Representing yourself against a landlord and / or listing agent who is trained to negotiate professionally and who’s objective is to make as much money as they can is reckless, especially when there is so much money and liability at stake? Most landlord’s definition of a market lease rate is the highest they can get a tenant to pay. That should open the eyes of healthcare professionals to realize they need help if they are going to achieve the most favorable terms possible. Whether you intend to renew your lease, purchase your property or relocate… do yourself, your staff, your patients and everyone tied to your practice a big favor. Take the same approach to maximizing your profitability through real estate that the most successful companies in the world do. Hire professional representation and then execute on a real strategy… whether your current landlord or future landlord is a patient or not. ADAM WEIGER Agent | Huntsville Commercial & Healthcare Realty

256.836.4473 adam.weiger@carr.us

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Inside Medicine | Volume 3 Issue 19

MENTAL HEALTH FEATURE

Healthy Family Dynamics pay attention to the normalcy by: Rachel Sullivan, MFTA, CFLE-P

Less is more. Pay attention to the little things.

What a strange year it has been. As a Marriage and Family Therapist, I have had the honor of sitting with many families over the past year who are struggling in some way. It is all understandable. Our normal outlets were cut off, routines disrupted, families were thrust into unemployment, or working from home if they were lucky.

Most children had to make an abrupt transition to virtual learning, and the whole atmosphere of our lives was changed, at least in small ways. The news of what was happening across the globe became increasingly overwhelming, even paralyzing at times. I find many families are still in this place, showing up each day to get by, but struggling to get the same joy from the day to day. While there are many reasons for this, I believe a big one was the sudden weight of stress from so many changes at once. The shock of having to find new ways to function in so many areas of life left us feeling exhausted and defeated. I wanted to share practical tips I used in my home, as well as the office to build continuity within our family units during this challenging time. I hope as you read you will be encouraged by the simple actions we can engage in to keep ourselves mentally healthy in the midst of uncertainty.

Pay attention to the little things. When it started to become apparent that life was going to be overturned for longer than we first anticipated, I recall feeling this panic about how long this would be so… uncomfortable. One way that I reset was to give myself permission to stop seeing the chaos of the world and instead focus on the little things that were happening in my family. Teeth were still getting loose and falling out. Knees were scraped. Homework needed tending to. Underwear was dirty. Allowing myself to pay attention to the normalcy of the things within my household helped me to see how much had stayed the same. This shift in focus created room for me to filter the worldly things with a much healthier perspective. We cannot change what is happening across the globe and are likely to stay in a constant state of stress if we do. However, we can acknowledge that we play an important part in the lives of our family members. Perhaps today you need to give yourself permission to stop trying to solve all the problems, and instead focus on a little way you can make a big difference within the walls of your home.

Play is a crucial component in child development..

Our normal outlets were cut off, routines disrupted, families were thrust into unemployment, or working from home if they were lucky. Inside Medicine | Volume 3 Issue 19

HEALTH FEATURE

Play together. We have always been a game family. Board games, card games, dice games, learning games, TV game shows, we love it all! Over the past year, we have stepped up our game collection a few notches. Play is a crucial component in child development. There were so many areas where school did not return to campus. As a result, children were lacking that time to play with peers that school used to provide. While the environment is not identical, playing with your children at home has several great benefits. Play helps children learn, process stress, build critical thinking, and even improve conflict resolution skills. Play gives our children time to connect with us and create their identities as well. Guess what? Play is also great for adults! We tend to engage in less play as we get older, but the research shows play still provides us great benefits. Playing with our children also helps us to pay attention to the little things. I love that online stores were still delivering during COVID, so we could do some safe shopping to pick out some games. It may also be fun to engage in a game swap with friends you feel comfortable doing so with. 20 Inside Medicine | Volume 3 I ssue 19

Keep the conversation going. It is common for humans to shut down when we feel stress. As parents we may have felt like “it is all I can do to keep everyone fed and mostly clean, there is no energy for engaging in big conversations.” I can completely relate! Talking with our kids is important though. I love that conversation with children (even the older ones!) can be much simpler than we tend to make it. Adults typically ask a LOT of questions – far more than we really need to. There does not need to be a constant stream of talking happening for you to keep the conversation going. Instead, it is more about facilitating an environment that allows the family to talk when someone feels the need to. A great way to ensure you have the capacity to give children attention for chatting, without coming up with tons of questions is to let them lead. When they start talking, just listen! As they take a natural pause, repeat back a little of what they said, or reflect an emotion they mentioned. “Oh, when you were on class today Sally kept talking over you, and that frustrated you.” We do not need to solve all the problems (see number 1!!).

By just allowing our children to feel heard we encourage ongoing communication. This creates a safe place that our children feel comfortable bringing their thoughts and takes the pressure off us parents to have an answer for everything. An awesome platform for practicing this skill of reflecting is through play. While I know there are so many more components to healthy family dynamics, I hope something from this article clicks for you. If you find yourself still struggling, I encourage you to reach out. There is great power in connection, Stay well friends.

Rachel Sullivan, MFTA, CFLE-P Solid Ground Counseling Center www.solidgroundmadison.com

Be Still My

Fitness

Beating Mind By Kari Kingsley, MSN, CRNP

he roots of my struggle with meditation run deep. Every time I attempted to meditate, the stillness and calm was bombarded by the never-ending adulting To-Do list on autorepeat in my mind. My type A, getit-right-the-first-time personality wanted not only to learn how to meditate, but to master it. I wanted to be the World Champion Meditator. (Because that’s a thing…) The funny thing about meditation is, the harder you try to do it perfectly, the harder it is. Meditation can especially be a white whale for control freaks like me. I developed a sort-of meditation stage-fright. Telling my mind to be still felt like trying to hush a room full of Kindergarteners hyped up on Mountain Dew. I have this major affliction that if I can’t do something well, I’d rather not do it. Each time I sat down to meditate, I failed. Thoughts screamed in my brain and the last thing I felt was inner peace. I stopped wanting to try. Meditation has been around for centuries. You can take classes on meditation, read books, listen to podcasts, and, yes, there’s an app for that. Oxford defines meditation as “the practice of focusing your mind in silence, especially for religious reasons

Inside Medicine |

or in order to make your mind calm.” Simple enough, right? But how? You are what you think. Negative subconscious thoughts or paradigms give way to negative attitudes and those negative attitudes get married and have little baby negative attitudes. Meditation is a wonderful way to reset your daily intentions and turn that brain frown upside down. (Subtract 2 points from article quality for cheesiness). Meditation also has positive physiologic effects including anxiety reduction, lowered blood pressure, and improved sleep quality. Mental health providers encourage meditation to help treat PTSD, depression, anxiety, and bipolar disorder. Scientists suggest it improves brain plasticity. It literally rewires your brain circuits to improve your physical and mental health. Cool. It’s like a facelift for your gray matter. In my research, I kept coming across the term “mindfulness.” Mind-full-ness. I think they meant mind-empty-ness. My brain was anything but empty. Things changed when a friend suggested listening to a guided imagery meditation. For the first time I felt my brain relax and let go. As the soothing voice of the narrator guided my thoughts through

Vo l u m e 3 I s s u e 1 7

a forest and down a gentle stream, I could feel my brain emptying of the constant background noise. The peace I felt afterwards was indescribable. Days later, I tried again, only to fail (or so I thought). I then set out on a journey to learn how to meditate. I had to break down the failure. Who was judging this as a fail? I was. Who was I trying to impress with my outstanding meditation skills? Me. Who would be missing out if I never learned to meditate? I would. I put a gag on the internal judge and decided to be kinder to myself. Instead of saying that failure is not an option, I took failure off the table. Learning what I want and need from the practice led me to the biggest breakthrough in my meditation journey. The opposite of a cracked-out hamster doing an Iron Man on his tiny wheel after slamming a case of Red Bull. I began to realize the encouraging fact that I had been meditating all my life. One familiar example is the twilight between wakefulness and sleep. Those sacred few moments lying in bed when the brain begins to let go of the day’s events and becomes still. As meditation became less unknown, I recognized it all over the place. Each time I closed my eyes and opened my mind to my senses Inside Medicine | Volume 3 Issue 19

Wave of Relief

Radiofrequency ablation targets chronic back pain at its source

HEALTH FEATURE

“Our goal is to notonly manage pain butto try and change the pain at its source,” says Dr. Scherlis. “This often involves injections or ablation under fluoroscopy to specific and precise pain generators.”

Chronic back and neck pain can disrupt nearly every aspect of life. A minimally invasive treatment option is turning the tables by disrupting pain at its source. Radiofrequency ablation (RFA) is a nonsurgical procedure for patients suffering from recurrent pain in the lower back, neck and arthritic joints. RFA uses radiofrequency waves to ablate or “turn off” the specific nerves transmitting pain signals to the brain. This minimally invasive technique can provide extended pain relief, improved mobility and a quick recovery time – with no incision. “Radiofrequency ablation is a great option for patients experiencing facet-mediated low back or neck pain,” says Morris Scherlis, M.D., anesthesiology & pain management physician with Tennessee Valley Pain Consultants. “These patients often experience localized pain and stiffness which can increase with prolonged periods of inactivity.” The facet joints are pairs of small joints between each vertebrae in the spine. They help stabilize and limit excessive spinal motion. Each facet joint contains small nerves called medial branch nerves which carry pain signals to the brain. These nerves become painful when the facet joints are inflamed, injured or arthritic. This is known as Facet Joint Syndrome.” A variety of conditions can lead to inflammation of the facet joints including spinal stenosis and osteoarthritis. Trauma to the spine such as a car accident can also lead to inflammation. Common symptoms of facet joint syndrome in the lumbar spine include localized pain over the affected joint segment, referred pain to the buttock, hip or back of thighs and stiffness. Patients often describe increased stiffness typically in the morning after sleep. Patients experiencing cervical facet pain often describe pain in the base of the skull, neck, upper back or even shoulders. Some patients may present with frequent headaches. Physicians specializing in interventional pain management and non-surgical spine procedures can provide a thorough diagnostic exam to determine if a patient’s back pain stems from the facet joints. A history and physical are gathered

access timeline and triggers of pain along with imaging scans to determine a diagnosis. “Our goal is to not only manage pain but to try and change the pain at its source,” says Dr. Scherlis. “This often involves injections or ablation under fluoroscopy to specific and precise pain generators.” Conservative treatment measures such as therapy are usually combined with a course of anti-inflammatory medications to decrease inflammation. Facet joint injections and medial branch blocks using steroid medications are also used to help localize and reduce pain. If facet pain is temporarily improved or resolved by these injections radiofrequency ablation may be suggested. “When considering a patient for radiofrequency ablation, we will perform a diagnostic medial branch block to pinpoint the exact nerves for treatment” says Dr. Roddie Gantt, anesthesiology & pain management physician with Tennessee Valley Pain Consultants.If a patient is a candidate, radiofrequency ablation is performed safely using fluoroscopic X-ray guidance in an outpatient setting. During the procedure, a physician inserts a small needle-like tube to the back of the spine next to the medial branch nerves. A radiofrequency electrode is inserted through the tube to heat the cells that act like insulation around the nerves. This “turns the nerves off” without damage and blocks pain signals from transmitting to the brain.The procedure takes approximately 15-45 minutes with minimal recovery time. Patients are able to go home after typically 30 minutes to an hour of monitoring. While some patients experience immediate relief, it may take up to 10 days to experience full pain relief from RFA. “Depending on a patient’s lifestyle and physicality of work, pain relief may last 6 months to a year,” says Dr. Gantt. “When the insulation cells around the nerves begin to function normally again ablation may be repeated if necessary.” RFA is also offered for severe knee pain patients suffering from progressive diseases like osteoarthritis. Pain can also present after a partial or total knee replacement. For these patients, a Genicular Knee Block or Ablation can be performed and works similarly to RFA by targeting three medial branch nerves in the knee. The physicians at Tennessee Valley Pain Consultants, Drs. Ronald Collins, Morris Scherlis, Roddie Gantt, John Roberts and Thomas Kraus, perform Radiofrequency Ablation for the cervical and lumbar spine as well as the knee. All five physicians are double board-certified in anesthesiology and pain management and offer non-surgical treatment options for common spine, nerve and joint conditions. To learn more, ask your physician or visit www.tnvalleypain.com.

Inside Medicine | Volume 3 Issue 19

HEALTH FEATURE

THE RECOMMENDED

FACE MASK

and the associated skin problems by D Kishore Yellumahanthi, MD, MPH, FAAFP

The Covid-19 pandemic, needless to say, has changed many ways we live. One of the significant changes that it brought into our lives is daily usage of facial masks. The Centers for Disease Control and Prevention (CDC) recommends that people wear masks in public settings, at events and gatherings, and anywhere they will be around other people. Currently, masks are also required on air planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations. While, undoubtedly, wearing these masks reduce our risk of contacting corona virus, they seem to be causing some skin issues in certain individuals. In this article, we will discuss briefly the type of skin issues that can occur secondary to wearing facial masks, how masks cause these skin issues and what can be done to reduce their chances of occurrence. .

HEALTH FEATURE

What skin issues can facial masks cause? The common skin issues that are being encountered due to wearing masks are acne and other break outs of the skin, itching, dryness of the skin that is right under the mask. ‘Maskne’ is the word coined during

Take a 15-minute mask break every 4 hours. Please make sure you remove your mask when it’s safe to do so and after washing your hands. Examples of safe places to remove your mask include: At home

Covid-19 pandemic to describe the acne that

Inside your car when you are alone

occurred secondary to wearing facial masks.

Outdoors, when you can stay at

How do facial masks cause skin issues?

least six feet away from people

Acne: There are two ways how masks can cause acne. 1. Wearing masks can create a humid “tropical” skin microclimate. This humid environment causes acne as it leads to

Wear the right mask. To reduce the possibility of having skin problems, choose the masks that offer the following: At least two layers of fabric

build up of sweat and oil on the skin under

100% cotton fabric, on the inside

the mask.

layer that rests against your skin

2. By simple pilosebaceous duct occlusion

A snug, but make sure it is a

due to local pressure on the skin from the close‐fitting masks. Non-acne

breakouts

the

skin:

Sometimes skin break out in the mask area can occur due to contact dermatitis to the material of the mask that is right above the skin. Dryness: Some masks can absorb the natural moisture on the face and can cause drying out of the skin in the area. Itching: Any of the above can cause itching.

What can be done to prevent them? Cleanse your face daily. Gentle skin care can prevent skin problems. When washing the face, usage of a mild, fragrance-free

cleanser

comfortable fit.

If a cloth mask, is allowed in your work area and you wish to wear one, wearing a 100% cotton cloth mask is recommended. Also, washing your cloth masks daily is recommended. Washing it removes oils and skin cells that collect inside the mask, that could lead to a skin problem. You can wash a cloth mask in a washing machine or by hand. Both ways remove germs and other particles. Make

sure

the

washing

instructions on each mask. Washing the masks in hot water is preferable, unless the instructions say otherwise. Use a fragrancefree, hypoallergenic laundry detergent.

recommended. As dry skin is a common face mask skin

Despite following the above measures, if

problem, applying moisturizer daily

contact your healthcare provider for advice.

would be also helpful

Also, I would like to emphasize that these

Skip the makeup when wearing a

skin issues caused by facial masks, should

mask. Beneath a mask, makeup is

not prevent you from wearing them and

more likely to clog the pores and lead

facial masks need to be worn at all times

and at all places recommended by CDC

breakouts.

makeup

really

necessary, please make sure products labeled “non-comedogenic” or “won't clog pores.” are only used.

still

and

skin

issues

your

are

State

persisting,

Public

please

health

professionals. Reference: www. aad.org

Inside Medicine | Volume 3 Issue 19

HEALTH FEATURE

PRP

FOR

Platelet-rich plasma (PRP)

by: Matthew Sykes, DO, CAQSM

Platelet-Rich Plasma Therapy (PRPT) is a new, exciting, emerging, minimallyinvasive regenerative therapy which utilizes current medical and laboratory technology as a means to concentrate the body’s own innate capacity for tissue healing and restoration.

26 Inside Medicine | Volume 3 I ssue 19

Platelet-Rich Plasma Therapy (PRPT) is a new, exciting, emerging, minimally-invasive regenerative therapy which utilizes current medical and laboratory technology as a means to concentrate the body’s own innate capacity for tissue healing and restoration. Platelets are our smallest blood cells, and contain essential growth factors, such as fibroblast growth factor, platelet-derived growth factor, transforming growth factor-ß, epidermal growth factor, vascular endothelial growth factor, and insulinlike growth factor, which are involved in stimulating our stem cells to promote the growth of new, healthy tissues. The process of obtaining platelet-rich plasma (PRP), involves drawing as little as 10 mL of blood one's blood into a vial, and concentrating platelets which can then be extracted into a syringe for injection into damaged tissue. The most current applications for PRPT are in the fields of orthopedics and sports medicine for treatment of chronic tendinitis

and small muscle tears. Historically the best use case for PRP has been in the treatment of tennis elbow otherwise known as lateral epicondylitis. While acute inflammation can be beneficial in tissue healing, chronic inflammation can lead to the replacement of the normal tendon and muscle tissue with scar tissue. Scar tissue is functionally very different than tendon tissue: it lacks elasticity and the ability to contract; therefore excess scar tissue can lead to tendon and muscle weakness, stiffness, predisposition to re-tearing, or even a rupture of muscle or tendon if significant tissue degeneration has occurred. PRP has been shown to decrease tendon inflammation, while also promoting thickening of the tendon, and also restoration of the normal tissue architecture, which ultimately results in renewed ability of the tendons and muscle to function optimally.

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HEALTH FEATURE

PRPT is also being used in the field of dermatology for treatment of hair loss, skin rejuvenation, wound healing, and also in the reduction of scar formation after surgery, as well as in the improvement of keloids and acne scars. PRPT decreases the need for antiinflammatory medications which can, in theory, slow the body’s innate healing mechanisms and also increase the risk of heart attack, stroke, kidney impairment, gastrointestinal disease, and bleeding disorders. Advancements in the image quality of sonographic imaging have improved the accuracy of PRP therapy. Using high-quality ultrasound, areas of tendinosis or chronic muscle and/or tendon tears can be identified and targeted specifically using image guidance to direct the needle to deliver PRP to the appropriate location in the body. Advancements in the preparation, standardization, and PRP administration will continue to lower the overall cost of PRPT, while also improving the quality of therapy, predictability of results, and patient access.

identifying and targeting areas using high-quality ultrasound

Matthew Sykes, DO, CAQSM, is a board-certified family medicine physician and fellowship-trained in sports medicine and non-operative orthopedics. Dr. Sykes specializes in ultrasound-guided procedures, including:

platelet-rich plasma (PRP) therapy large joint viscosupplementation non-surgical fracture management diagnostic musculoskeletal ultrasound sideline medical coverage concussion management and the management of sports and exercise injuries .

Inside Medicine | Volume 3 Issue 19

INNOVATIVE F E A T U R E

HUNTSVILLE

CHOOSES makes innovative

INVESTMENT IN POLICE FORCE Contact Information: RippleWorx Gillian Gormley

RippleWorx, today announces that they have been hired by the Huntsville Police Department to address police officer wellness and resiliency through a partnership with proathlete trainer, Ed Downs.

RippleWorx, the award-winning, business intelligence technology leader for wellness and performance acceleration, announces the partnership with the Huntsville Police Department and Ed Downs, Pro-Athlete Trainer who has trained elite athletes such as Dwayne Wade, LeBron James, Alex Rodriguez as well as members of our military Special Operations, to offer a holistic approach for wellness and resiliency of police officers. Today, chronic and critical stress is threatening the well-being of police officers. Without proper tools for monitoring and resolving the stress, the negative impact on performance will continue to threaten the police officers and impact communities at large. The RippleWorx software has shown that through proven science, repeated and unresolved physical and mental stresses have a direct correlation to an individual’s ability to perform. This partnership will offer a holistic solution to understand the root cause of the physical and mental stresses, as well as implement the methodologies to improve performance, resiliency and wellness. “We care about our officers and we care about our employees. We want to find ways to do more - to do better. We recognize that things cannot continue as is.” states, Captain DeWayne McCarver. We started working with Dr. Sandritter and Angie Sandritter, leaders of RippleWorx, because of the platform they already have in place for athlete’s performance and the detection of stress and injuries. Their willingness to modify their approach to address the specific needs of police department and to bring in the most qualified resources to address the whole situation, is why we chose them to solve this challenge. ``

30 Inside Medicine | Volume 3 I ssue 19

Angie Sandritter, CEO RippleWorx RippleWorx, is a digital solution designed to provide a holistic approach to human performance and engagement - emotional, cognitive, and physical performance.

INNOVATIVE F E A T U R E

“This is big. This is just the beginning. We can use this tool to do something different and dynamic for our police department and the citizens of Huntsville,” said Devyn Keith, Council Member District 1.

“We’re passionate about this! - About creating a positive impact in people who then in turn can create a positive impact in their organizations and the community” states Dr. Timo Sandritter, co-founder of RippleWorx. “And we’re impressed with the Huntsville Police Department’s willingness to innovate together to come up with a solution that works. Huntsville has been esteemed for innovation from space command to putting the first American’s on the moon. We see a huge opportunity to pull these resources together to develop a solution that will change how police departments recruit, train and continue to develop officers for many years to come.” RippleWorx continues to demonstrate success and real improvements by employing the right, continuous actions, over time, to generate lasting desired results. “Our software will capture the regular sentiment of officers correlated with their workloads and performance -all the while, employing methodologies from experts, like Ed Downs, to shape cognitive and physical resiliency.” Angie Sandritter, CEO for RippleWorx explains “When we focus on the desired outcomes and what is preventing us from getting there, this is when we will see results. To put it more plainly, our desire is to help everyone sleep better at night – our officers and our community. This is the ripple effect we want to help shape.” “I am very happy to be teaming up with RippleWorx, to help out the Huntsville Police Department's overall performance,” states Ed Downs, Professional Trainer. “What is even more important is those cognitive features. I hear guys talk about being able to read defense, situational awareness, pattern recognition and see what they did in previous quarters. It is the same type of skill sets that police officers need every day in their unknown environments. I believe if we can help improve these skills sets, it will overall improve decision making.” RippleWorx is the only mobile app and SaaS software solution that looks at the whole picture- the emotional, physical, and cognitive well-being of the individual to allow people to perform at their best. Once we analyze the feedback, we put actions into easy, attainable tasks and goals - so officers can see and measure results. This is the Ripple Effect – Not only do we analyze, we actionize to succeed!

Police officers all over the country experience a high level of stress. Whether it’s based on their shift schedule, their workload, or the impact that the “crimes” play in their life, I believe that there is a high level of PTSD associated with the job. I am genuinely excited to help counter the police officers' hypervigilance by looking at them on a more holistic approach. We have always said that the emotional, cognitive, and mental well-being is closely connected, and this partnership will offer the holistic solution to understand the root cause of the physical and mental stresses, as well as implement the methodologies to improve performance, resiliency and wellness. Our goal is to make their jobs easier and improve their overall daily lives. I hope that our pilot program with the Huntsville Police Department will create a positive impact on not only our local officers but police departments all over the country." - Dr. Timo Sandritter President, Founder

Inside Medicine | Volume 3 Issue 19

Inside

CONTENT INCLUDES FALL 2016-NOW ISSUE 18

download the app

orthopaedic/neurology/ spine pain

mental

health

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surgery/rehabilitation/dentistry/

management/anesthesia/dermatology/endocrinology/ cardiology/podiatry/oncology/internal

family

medicine/pediatrics/lifestyle

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editorial/contribution/advertising kellyreese.im@gmail.com or 256.652.8089

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TO MASK OR NOT TO MASK? By Kari Kingsley, MSN, CRNP

COVID-19 is changing the way we live our lives from the ground up. The new (and sometimes incorrect) recommendations circulating can leave us in a tailspin. Most people get the basics. Wash your hands. No, really, wash your hands. Sing “Happy Birthday” … count to twenty… do whatever you have to do to make sure your hands get the just came off a fishing charter, changed a baby diaper, and then cut raw chicken deep scrubbing they deserve. Or use an alcohol-based hand sanitizer. Don’t touch your face. Ok, louder, for those of you in the back. DON’T TOUCH YOUR FACE. Easier said than done. The average person touches their face up to 3000 times a day. That’s a little over 2-3 times a minute. Avoid sick people. Like the plague. If you get sick, don’t panic. Get a COVID-19 test if you meet the requirements (fever, cough, shortness of breath, you get the gist). Then avoid people like the plague. Stay home from work, school, and for

Inside Medicine |

Vo l u m e 3 I s s u e 1 7

the love of all things healthy, stay out of Walmart. Practice good manners and cover that cough. Use proper etiquette by coughing into your elbow. Maintain social distancing measures, especially in areas of potential community-based transmission. While this remedial information may seem like COVID 101, there is still a lot of confusion circulating on when to mask and when not to mask. Recommendations seem to change rapidly and casual grocery store people watching reveals we may not all be acting as we should. At the present time, the Center for Disease Control has recommended using simple cloth face coverings to slow the spread of the COVID-19 and prevent asymptomatic carriers from transmitting the virus. What are the appropriate recommendations for when and where to wear a mask? We asked a local Infectious Disease Specialist, Ali Hassoun, MD, FACP, AAHIVS, FIDSA, to weigh in.

by: Tiernan O'Neill

From the start and throughout the COVID-19 pandemic the health care industry has seen the proliferation and use of telemedicine as an alternative safe method to continue to ?see? and treat patients, as well as keep their offices operational. This has led many industry insiders and patients alike to question as to whether telemedicine would become the new standard of care and how it could best be used within health care and its business operations. However, I think many essential components of health care visits are completely absent in telemedicine which would not make it as a sustainable substitute for the good old fashioned in person office visit. The typical in-patient encounter incorporates multiple health care personnel to meet the needs and goals of an office visit. Administrative personnel are typically verifying insurance, updating demographic information, collecting monies checking/checking out patients and setting up future appointments. Aside from personnel possibly connecting the call and maybe collecting monies over the phone, their normal utility and responsibilities are often cut out of the telemedicine system. While this may seem appealing to office managers or owners, considering the large amount of overhead that payroll can consume, it would be foolish to overlook the contribution

34 Inside Medicine | Volume 3 I ssue 19

these personnel add to the overall patient encounter experience. Contributions which include representing the office; greeting new and established patients alike; keeping patients informed of potential upcoming office changes; discussing benefits and limitations of various insurance plans patients may choose from; and overall setting the atmosphere and human touch to the office which is unfortunately a short coming within the medical field even during the best of times. I have witnessed and preached as long as I have been involved in the day-to-day operations of health care that patients may often choose their doctor not on their sole skills, aptitude or personality of the doctor themselves but instead they frequently judge a practice by the staff itself. A good staff can make an office while a bad staff can overwhelmingly destroy a patient?s perception of the office regardless of their thoughts on the physician they are actually visiting with. Additionally, staff?s observations, feedback and involvement in patient encounters office can be an invaluable resource for medical providers. They notice changes in established patients or may know/research other influencing factors in patient personal affairs which may help the doctors a better understanding of their current state or demeanor. Often support staff spend more time with the

DR. SHANE O'NEILL DR. KEALAN O’NEILL

PROVIDING PREMIER HEALTHCARE

WAITING FOR A DOCTOR ON-LINE? NEVER FOREGO THE PERSONAL SIDE OF HEALTHCARE

PANACEA’s philosophy quality

healthcare

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medicine

management)

for

goal

heal

problems, the

issues solve

and the

work

(exercise,

aim

always and

of be

with

disease family.

simply

the

with

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etc…)

has

COME VISIT US

for

all

and

solution.

and

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care

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provide

Our core

health

patients

symptoms

clinic

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this to

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assess

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combination

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O’Neill 104

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patients from encounter to encounter as providers try to keep up with the numbers game, and by doing this they sometimes have a greater familiarity of the entire picture of a patient's life that they then can relay to the treating provider. One of the most obvious deficiencies of telemedicine is the lack of procedures and supporting evidence in the visit as a result of remote care. All patients should always be advised form the start of a telemedicine encounter that this method of meeting with a patient is less than ideal and is not a good replacement from in person visits. Modern medicine has evolved far beyond the days of shamanism and the bevy of diagnostic or screening tools which are at our disposal should never be overlooked or made less significant. At best, a doctor may be able to get some of the information they need by sending patients elsewhere for specimen collections and testing, but far too often the doctors feel limited in what they can obtain or order and end of settling for the minimal and easiest options. This is no way to accomplish obtaining a complete diagnostic picture and close the care patients so rightfully seek and deserve. Even beyond the most standard or sophisticated tests doctors have come to rely on in better circumstances, it should never be overlooked of the value and importance of obtaining simple clinical information such as vitals collection which goes by the wayside in telemedicine. Basic forms of vital information such as blood pressure or weight can be an incredibly telling sign of the state or more importantly change of state in a patient. Either entirely forgoing or improperly obtaining this information can lead to many undiscovered diagnoses and ruin the aim of preventative medicine which should be the goal of any good health care provider.

36 Inside Medicine | Volume 3 I ssue 19

Lastly, the absence of in person encounters between patients and providers is immeasurable. This goes far beyond the human contact we should always view as a basic human need, and a part of healthcare which has been recognized and relied on for centuries. A physical encounter where a provider can see and put their hands-on sites of interest is a basic component of in person care. Stemming and advancing from that concept are many other useful tools within an in-person encounter. The ability of providers seeing and putting their hands on what may seem as irrelevant sites of interest, to the patient at least, is crucial in ruling out all sinister causes of a disease process. Not failing to mention a doctor utilizing the space and opportunity of "oh by the way" in a reverse fashion where they can question a patient's appearance or a peculiar site of their interest which hasn't been brought up as an encounter reason by the patient themself. So, while telemedicine has been a useful alternative both in treatment and operations of medicine through the pandemic its limitations and shortcomings seem to far outweigh its benefit. Providers may be curious or encouraged to experiment further as a streamlined business model. And patients may be enticed by the convenience of not having to attend in person appointments breaking up their day. But losing out on essential components of any encounter which include the total contributions of support staff, procedural and diagnostic tools only found in person, a doctor's ability to see the patient and their condition in its entirety and finally the personal and human interactions inherent to all of the above will never seemingly to be easily replaced by a phone, video or any other means of disconnected provider-patient contact.

UNDERSTANDING

COVID19 V A C C I N E S

THEIR IMPORTANCE by Shushruth Yellumahanthi

THE IMPACT OF COVID-19 PANDEMIC It has fundamentally changed the way we live.

THE NEED FOR THE VACCINE & IT BECOMING A REALITY The only solution to end the pandemic seemed to be by accomplishing herd immunity through a vaccine.

HOW DOES THESE VACCINES WORK? mRNA vaccines and the DNA inserted into Adenovirus Vaccine

IMPORTANCE OF GETTING VACCINATED In order for this to work, at least 70% of the population needs to be vaccinated in order for the herd immunity to be attained. Continue reading on next page >

As we all know, Covid-19, colloquially known as Covid has been the buzz since the early part of 2020. On December 31, 2019, China reported to the World Health Organization (WHO) that there was a cluster of cases of an unknown pneumonia in its city of Wuhan in the Hebei Province. It was later determined that these cases of unknown pneumonia were caused by a novel coronavirus. Later studies showed that the virus was actually prevalent in China from as back as September 2019. The coronavirus was officially named COVID-19 by the WHO on February 11, 2020. On March 11, 2020, the WHO declared COVID-19 a pandemic. The cause of this pandemic is still unknown and under investigation.

THE IMPACT OF COVID-19 PANDEMIC: The COVID-19 pandemic has become the greatest challenge our world has faced since the Second World War. It has fundamentally changed the way we live. Many

people had to stay home and do their work. Students had to attend classes virtually and thus were deprived a year of their precious campus life. Graduations, which is supposed to be one of the memorable events of anyone’s life, were also done virtually. People could not go to restaurants, tourist attractions, and sporting events. The chants of ‘Roll Tide’ and ‘Go War Eagles’ had to be confined to four walls for most part. The traditional Thanksgiving and Christmas festivals were greeted with mute celebrations. The pandemic has infected over 100 million people and has caused over two million deaths worldwide. The virus has caused about 400 million job losses and economic recession has hit all five continents. It has caused 24 million children to be out of school worldwide. This virus first reported from Wuhan has cost the world 16 trillion dollars in 2020. The travel and tourism industry fell by 42.1%. Passenger aviation is estimated to have lost $314 billion.

Global trade has declined around 9.2% annually. The food and beverage industry declined 22% and automobile industry declined 20%. West Asia lost $270 billion worth of oil income due to the pandemic. 26% of businesses around the world were closed at one point or the other due to the pandemic. Around 100,000 businesses have shut down in the United States. There was a 57% increase in insolvencies in North America due to the virus. The pandemic has caused prominent companies such as J.C. Penny, Aldo, Virgin Atlantic, Aldo, J. Crew, Thai Airways, and California Pizza Kitchen to file for bankruptcy.

AMERICA’S GDP CONTRACTED BY 3.5% IN 2020, THE WORST SINCE 1946. AMERICA’S UNEMPLOYMENT HIT 14.7%, THE HIGHEST SINCE WORLD WAR 2.

COVID IMPACT

COVID 19 Infected over 100 million people

2M JOB LOSSES

The virus has caused about 400 million job losses and economic recession has hit all five continents.

24M COST

This virus first reported from Wuhan has cost the world 16 trillion dollars in 2020.

100M COVID DEATHS Caused over two million deaths worldwide.

400M EDUCATION Caused 24 million children to be out of school worldwide.

16T LOST REVENUE

$314B TRADE IMPACT Global trade has declined around 9.2% annually.

The travel and tourism industry fell by 42.1%. Passenger aviation is estimated to have lost $314 billion.

-9.2% INDUSTRY

-22% OIL REVENUE LOST West Asia lost $270 billion worth of oil income due to the pandemic.

26% SHUT DOWNS

Around 100,000 businesses have shut down in the United States.

57% BANKRUPTCY

The pandemic has caused prominent companies such as J.C. Penney, Aldo, Virgin Atlantic, Aldo, J. Crew, Thai Airways, and California Pizza Kitchen to file for bankruptcy.

3.5% UNEMPLOYMENT America’s unemployment hit 14.7%, the highest since World War 2.

The food and beverage industry declined 22% and automobile industry declined 20%.

$270B CLOSED BUSIINESSES 26% of businesses around the world were closed at one point or the other due to the pandemic.

100K INSOLVENCIES There was a 57% increase in insolvencies in North America due to the virus.

2020 GDP America’s GDP contracted by 3.5% in 2020, the worst since 1946.

14.7%

HEALTH FEATURE

THE ONLY SOLUTION TO END THE PANDEMIC IS BY ACCOMPLISHING HERD IMMUNITY THROUGH A VACCINE.

40 Inside Medicine | Volume 3 I ssue 19

HEALTH FEATURE

THE NEED FOR THE VACCINE & IT BECOMING A REALITY: Globally, the number of new cases of Covid-19 seemed to stay significant to keep the pandemic alive. The only solution to end the pandemic seemed to be by accomplishing herd immunity through a vaccine. Thanks to the scientific community, scientists all over the world have pioneered and massproduced excellent vaccines for COVID-19 at a record pace. This was done while holding the vaccines to a high level of safety standards as all vaccines passed through all of the safety checks governments have in place. This was truly a remarkable feat which will go down as one of the greatest achievements of mankind. The United States has currently approved the Pfizer/BioNTech vaccine and the Moderna vaccine. Other prominent vaccine candidates expected to receive approval are the AstraZeneca vaccine and the Johnson & Johnson vaccine. These vaccines can be placed into two categories: mRNA vaccines and DNA inserted into an adenovirus vaccine. Below is a simple description of the mechanism of these types of vaccines to help better understand what the vaccine does once it is inside your body.

HOW DO THESE VACCINES WORK?

mRNA vaccines: The Pfizer/BioNTech vaccine and the Moderna vaccines come under the category of mRNA vaccines. They both use the same mechanism and both need to be given as two shot series. The difference is the two shots of Pfizer vaccine are administered 21 days apart, that of Moderna is 28 days. Pfizer vaccine requires a more stringent cold chain than that of Moderna to store and transport the vaccine.

These vaccines target the “spike proteins” which cover the coronavirus. The virus utilizes these proteins to enter human cells. So, they would make a good target to neutralize. To do this, these vaccines use a genetic material called messenger RNA, or mRNA. This is the material used by our cells to make proteins in a process called mRNA translation. These vaccines will use the mRNA combination which codes for the spike protein. Since, the mRNA cannot cross the plasma membrane which protects the cells on its own, it is surrounded by lipid nanoparticles which form a lipid “bubble” around the mRNA. These lipid nanoparticles are the reason why these vaccines must be kept at an ultra-low temperature as that is the optimal temperature for these lipid nanoparticles. Since, the plasma membrane is lipid friendly, the lipid “bubble” will enable the mRNA to enter the cell. Once inside the cell, the process of mRNA translation takes place and the spike protein is made. These spike proteins will be sticking out of the plasma membrane which will make recognizable by the immune system. Please note that the creation of the spike protein within the cell does not mean that the cell has become the virus. The composition of a virus is completely different from that of a cell. Once these spike proteins are sticking out on the surface of the cell, they will be recognized and picked up by helper T cells. These helper T cells will activate B cells. The B cells will generate antibodies which can target and destroy the spike protein. The vaccine also has the ability to destroy cells which have been infected with COVID-19. This will be done by a different type of T cell called the killer T cell. It is still unknown as to how long the immune system will be able to remember the antibodies which destroy the spike protein. This is still under study by Pfizer and Moderna.

DNA INSERTED INTO ADENOVIRUS VACCINE: The Johnson & Johnson vaccine and AstraZeneca vaccine come under this category. They have not been approved in the US yet but are expected to be approved very soon. AstraZeneca’s vaccine has already been approved by a huge number of countries worldwide. Just like the Pfizer and Moderna vaccines, these vaccines also attempt to neutralize the spike protein on the coronavirus. However, the route taken by these vaccines is completely different. These vaccines add the gene which codes for the spike protein and insert it into a type of adenovirus. This adenovirus is then injected into the body as the vaccine. The AstraZeneca vaccine uses a modified chimpanzee adenovirus and Johnson & Johnson uses a version of adenovirus called “Adenovirus 26”. Adenoviruses are a very common type of virus which causes the common cold in many people. The adenovirus used in these vaccines are modified so they can’t cause an illness when injected into the body. The use of an adenovirus enables the vaccine to be more durable than the mRNA ones. It also allows the vaccine to be stored in a refrigerator and an ultra-cold storage isn’t needed. This makes this vaccine very useful for lower income nations who cannot afford or do not have the ultra-cold storage to store the Pfizer and Moderna vaccines. Once, the vaccine enters the body, the modified adenovirus with the gene for the spike protein will be engulfed by a cell in a process called phagocytosis. Once inside the cell, the adenovirus will travel to the nucleus of the cell. This is where the cell’s DNA is located. Here, the adenovirus will release its DNA into the nucleus. Once the DNA is inside the nucleus, it will undergo the

Inside Medicine | Volume 3 Issue 19

HEALTH FEATURE

process of transcription where the DNA will be converted to mRNA. The mRNA will undergo translation and the spike proteins will be created. From here, the process is the same as the Pfizer and Moderna vaccines. The spike proteins which are protruding from the cell membrane will be recognized by helper T cells. The helper T cells will activate B cells. The B cells will create antibodies which can target and destroy the spike protein. Just like the other vaccines, it is unknown how long the protection will last. This is still under study. The Johnson & Johnson vaccine is the only vaccine among these four that is given only as single shot.

IMPORTANCE OF GETTING VACCINATED: The vaccines have offered hope that this virus can be defeated and life can return to what it once was. In order for this to work, at least 70% of the population needs to be vaccinated in order for the herd immunity to be attained. Scientists have done their part by coming out with a vaccine in record time. It is now time for the rest of the people to do their part by coming forward and getting vaccinated when it is their turn.

42 Inside Medicine | Volume 3 I ssue 19

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Researchers and healthcare professionals seem to be assure about the safety of the vaccine. They seem to be telling us that the only new thing which enters one’s body through vaccination is either the mRNA for the spike protein or the gene for the spike protein. Either one of these will be broken up by the cell very quickly. As was explained above, all the mechanisms which will occur inside the body once the vaccine is administered are natural things which occur in the body and nothing new.

It will take a collective effort from everyone to defeat this virus. Now healthcare professionals are stating that our initial preventive measures need to be supplemented with vaccination for us to have any shot at defeating this ‘invisible enemy’. So, it is important to come forward and get the vaccine administered once your turn comes and strictly follow the advice and guidelines put out by the local, state, and federal health departments so that collectively we all can defeat this pandemic at the earliest.

NYTIMES.COM/INTERACTIVE/2020/HEALTH/PFIZER-BIONTECH-COVID-19-VACCINE.HTML NYTIMES.COM/INTERACTIVE/2020/HEALTH/MODERNA-COVID-19-VACCINE.HTML NYTIMES.COM/INTERACTIVE/2020/HEALTH/OXFORD-ASTRAZENECA-COVID-19-VACCINE.HTML NYTIMES.COM/INTERACTIVE/2020/HEALTH/OXFORD-ASTRAZENECA-COVID-19-VACCINE.HTML CNBC.COM/2020/09/15/AT-LEAST-24-MILLION-STUDENTS-COULD-DROP-OUT-OF-SCHOOL-DUE-TO-THE-CORONAVIRUS-UN-SAYS.HTML CNBC.COM/2020/06/30/CORONAVIRUS-EXPECTED-TO-COST-400-MILLION-JOBS-IN-THE-SECOND-QUARTER.HTML NEWS.HARVARD.EDU/GAZETTE/STORY/2020/11/WHAT-MIGHT-COVID-COST-THE-U-S-EXPERTS-EYE-16-TRILLION/ DATA.WORLDBANK.ORG/INDICATOR/NY.GDP.MKTP.KD.ZG?NAME_DESC=FALSE DATA.WORLDBANK.ORG/INDICATOR/NY.GDP.MKTP.KD.ZG?LOCATIONS=US

Inside Medicine | Volume 3 Issue 19

GUT CHECK

how your GUT HEALTH AND IMMUNITY are inextricably linked together

Inextricably-in a way that is impossible to disentangle or separate.

by: Crystal Barber MBA, Heather Morse MS, ATC, OTC

When you think of staying healthy and supporting your immune system, what’s the first thing that comes to mind? Washing your hands? Avoiding germs? Maybe taking lots of vitamin C? These approaches might help ward off illness, but do you want to know the real secret to a stronger and healthier immune system? It’s in your gut. One would argue that gut health is hardly cocktail party conversation, but some would say that it’s on its way to becoming just that. Not only is gut health a popular topic in scientific research, but it also has a following in food circles and generates millions of followers and dollars on social media. Gaining an understanding of the association between food intake and the gut for increased immunity and overall health is gaining momentum, as is the research and development role in preventing disease through the promotion of a gut-healthy diet.

Continue reading on next page >

HEALTH FEATURE

What Is Gut Health AND WHY IS IT IMPORTANT? While there’s no clear definition of gut health other than a general absence of disease or GI issues its far more complex than that. “Gut health" describes the function and balance of bacteria of the many parts of the gastrointestinal tract. Until recently we did not understand the importance or complexity of this system of bacteria now being labeled by researchers as the "Second Brain." Science has begun to look more closely at how this enormous system of organisms influences—and even improves—health conditions, from heart disease to arthritis to cancer. But understanding how the gut microbiota works, and how you may benefit, can be daunting. Hidden in the walls of the digestive system, this “brain in your gut” is revolutionizing medicine's understanding of the links between digestion, mood, immune health and even the way you think. Scientists call this little brain the enteric nervous system (ENS). Yet it's not so little. It contains some 500 million neurons and controls important reflexes, the contraction of muscles in the gut to enable digestion and is a critical part of the gut-brain axis---through which the gut communicates with the brain. This fact makes the gut unique among the other internal organs, in that it has its very own nervous system which can also operate autonomously. And indeed, the gut actually talks to the brain, releasing hormones into the bloodstream that, over the course of about 10 minutes, tell us how hungry it is, or that we shouldn’t have eaten an entire pizza. But recent evidence reveals the gut has a much more direct connection to the brain through a neural circuit that

inside the gut

allows it to transmit signals in mere seconds. The findings could lead to new treatments for obesity, eating disorders, autoimmune disorders, and even depression and autism— all of which have been linked to a malfunctioning gut. The Intestinal microbiota, or gut flora, and the gut barrier determine gut health. Inside the gut are about 100 trillion live microorganisms that aid in normal GI function, protect the body from infection, and regulate metabolism and the mucosal immune system. In fact, they make up between 70% to 80% of the immune system. Also important is their role in maintaining and protecting the GI barrier. A healthy GI barrier maintains gut function, while a problem with its microbiota composition will affect the body’s defense systems and can create a condition known as leaky gut syndrome, which can compromise gut health and lead to diseases such as inflammatory breast cancer, chronic fatigue syndrome, and hormone imbalance issues. The microbes and their metabolites influence physiological function (particularly metabolism), local mucosal homeostasis, inflammation, and interactions between multiple body systems. Therefore, an imbalanced intestinal microbiota has system-wide effects and contributes to blunted immune reactivity. Gut microbiota alterations due to unhealthy lifestyle factors and dietary triggers contribute to inflammation, intestinal permeability, immune system dysfunction, and the pathogenesis of a broad spectrum of chronic diseases.

Inside the gut are about 100 trillion live microorgani sms that aid in normal GI function, protect the body from infection, and regulate metabolism and the mucosal immune system.

gut function In fact, they make up between 70% to 80% of the immune system. Also important is their role in maintaining and protecting the GI barrier. A healthy GI barrier maintains gut function, while a problem with its microbiota composition will affect the body’s defense systems and can create a condition known as leaky gut syndrome, which can compromise gut health and lead to diseases such as inflammatory breast cancer, chronic fatigue syndrome, and hormone imbalance issues.

hormone secretion the gut actually talks to the brain, releasing hormones into the bloodstream that, over the course of about 10 minutes, tell us how hungry it is, or that we shouldn’t have eaten an entire pizza

Inside Medicine | Volume 3 Issue 19

NUTRITION MONTH National Nutrition Month in the USA is a nutrition education and information campaign created annually in

March by the

Academy of Nutrition and Dietetics. The campaign focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits.

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DESIGN

Diet-Induced Dysbiosis The Intestinal microbiota, or gut flora, and the gut barrier determine gut health. Inside the gut are about 100 trillion live microorganisms that aid in normal GI function, protect the body from infection, and regulate metabolism and the mucosal immune system. In fact, they make up between 70% to 80% of the immune system. Also important is their role in maintaining and protecting the GI barrier. A healthy GI barrier maintains gut function, while a problem with its microbiota composition will affect the body’s defense systems and can create a condition known as leaky gut syndrome, which can compromise gut health and lead to diseases such as inflammatory breast cancer, chronic fatigue syndrome, and hormone imbalance issues. The microbes and their metabolites influence physiological function (particularly metabolism), local mucosal homeostasis, inflammation, and interactions between multiple body systems. Therefore, an imbalanced intestinal microbiota has system-wide effects and contributes to blunted immune reactivity. Gut microbiota alterations due to unhealthy lifestyle factors and dietary triggers contribute to inflammation, intestinal permeability, immune system dysfunction, and the pathogenesis of a broad spectrum of chronic diseases.

OF THE INTESTINAL MICROBIOTA AND THE EFFECTS OF IMMUNITY AND DISEASE

An imbalanced microbiome is known as dysbiosis. Dysbiosis occurs when invading microorganisms populate your gut and crowd out your “good” bacteria. This interferes with your gut’s ability to properly communicate and coordinate with your immune system. Worse yet, dysbiosis can cause your immune system to become overworked and hypervigilant – leading your body to mistakenly begin attacking its own cells. It was originally believed that the composition of the intestinal microbiota was relatively stable from early childhood; however, recent evidence suggests that diet can cause dysbiosis, an alteration in the composition of the microbiota, which could lead to aberrant immune responses. An unhealthy gut leaks harmful substances into your bloodstream leading to body inflammation. Y

our immune system can and/or will then go into overdrive in an attempt to address the perceived threats. Due to the damage to your intestinal lining, your gut cannot properly digest food. This will disrupt your microbiome’s homeostasis. Dysbiosis results. The dysbiosis then triggers your immune system causing your body to ramp up its immune response. The ramped up immune response kicks off a chain reaction of rampant inflammation and increased dysbiosis. The result? Even more damage to the lining of your gut. This downward spiral of dysbiosis and inflammation burns out your immune system – leaving it with less and less energy to fight off foreign invaders. Several recent studies have shown that dietary factors alter the microbial community resulting in biological changes to the host. Overall, dietary changes could explain 57% of the total structural variation in gut microbiota whereas changes in genetics accounted for no more than 12%. Making the old statement " we are what we eat" more important than ever.

DID YOU KNOW?

Inside the gut are about 100 trillion live microorganisms that aid in normal GI function, protect the body from infection, and regulate metabolism and the mucosal immune system. In fact, they make up between 70% to 80% of

the immune system. Inside Medicine | Volume 3 Issue 19

HOW GUT HEALTH PLAYS A ROLE IN

HORMONE BALANCE Evidence has suggested that gender may also play an important role in infectious disease susceptibility. It is well studied that females generate more robust and potentially protective humoral and cell-mediated immune responses following antigenic challenge than their male counterparts.

Among other functions, gut microbiota are responsible for synthesizing, releasing, and regulating many of your hormones as well as telling the other glands in the body how much or how little of each hormone they should be creating and releasing. Sex hormones of reproductive system are one of the major factors that regulate immune system due to the presence of hormone receptors on immune cells. The interaction of sex hormones and immune cells through the receptors on these cells effect the release of cytokines which determines the proliferation, differentiation, and maturation of different types of immunocytes and as a result the outcome of inflammatory or autoimmune diseases. But still the mechanism of regulation of immune system by hormones is not very clear.

48 Inside Medicine | Volume 3 I ssue 19

However, it is apparent that the immune system interacts with the most of our body systems and the system that modulates the immune system the most is the reproductive system. The interaction of reproductive system with that of immune system is attributed to the sex hormones and their hormone receptors on immune cells. The regulation of immune response is different in males and females due to the presence of different hormones. In males it is testosterone that plays a major role as sex hormones and in females the predominant role is that of estrogen and progesterone. Female hormones have strong influence on the production and functioning of immune system cells and molecules. This difference in hormone levels in both sexes leads to immune dimorphism. Estradiol is a female sex steroid, and its actions extend far beyond reproduction. Estradiol plays an important role in modulating immune response. It seems appropriate to talk about sex steroids in the context of SARSCoV-2 as it appears that men and women are equally likely to contract the virus, but recent studies show men have a more difficult time fighting off the virus. Clinical studies reveal stark inequality between how men and women’s bodies handle infections. Women have evolved to be particularly robust as estradiol is one of the regulators of immune molecules like cytokines. This immune protection, however, comes at a cost – women are also more likely than men to develop autoimmune diseases. This immune protection, however, comes at a cost – women are also more likely than men to develop autoimmune diseases. Gender has been a contributory factor in the incidence and progression of disorders associated with immune system. Evidence has suggested that gender may also play an important role in infectious disease susceptibility. It is well studied that females generate more robust and potentially protective humoral and cell-mediated immune responses following antigenic challenge than their male counterparts.

HEALTH FEATURE

Healing Your Gut to Help Boost Your Immunity Looking after your gut health by optimizing your nutrition and balancing your hormones are the best ways you can give your immune system the tools it needs to help to function optimally. As we optimize our hormone and gut health, many crucial functions of the body are supported. Everything from how we sleep and how our bodies respond to fighting foreign invaders can continue to function correctly. For example, consuming a diverse array of fruits and vegetables rich in antioxidants, anti-inflammatory nutrients, and phytochemicals helps to reduce oxidative stress, support the liver to promote efficient biotransformation and detoxification, and boost overall immune system function. These same foods also contain soluble fibers that “feed” the commensal microbial community in the colon to optimize gut balance and hormone health. Healthy lifestyle factors, including a diversified diet, limited consumption of processed and refined foods, and consumption of adequate dietary fiber, can all promote a healthy microbiome. Along with a healthy diet, balanced hormone levels can help optimize the body’s immune response. Everyone at some point experiences digestive problems such as abdominal pain, bloating, loose stools, constipation, heartburn, nausea or vomiting.

When symptoms persist, it may be a sign of an underlying problem that needs medical attention. Sudden weight loss without a good reason, blood in the stool, black stool (a sign of bleeding in the gut), severe vomiting, fever, severe stomachaches, trouble swallowing food, pain in the throat or chest when food is swallowed, or jaundice (a yellow discoloration of the skin or eyes) could potentially indicate an underlying gastrointestinal problem with serious consequences. You should consult a doctor if any of these symptoms occur.

REFERENCES HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/A RTICLES/PMC2515351/ HTTPS://WWW.IMMUNOLOGY.ORG/PUBLI C-INFORMATION/BITESIZEDIMMUNOLOGY/ORGANS-ANDTISSUES/IMMUNITY-IN-THE-GUT HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/A RTICLES/PMC3337124/ HTTPS://WWW.HEALTH.HARVARD.EDU/BL OG/LEAKY-GUT-WHAT-IS-IT-AND-WHATDOES-IT-MEAN-FOR-YOU-2017092212451 HTTPS://ACADEMIC.OUP.COM/JN/ARTICLE/ 141/5/769/4600243 KHAN, D. AND S. ANSAR AHMED, THE IMMUNE SYSTEM IS A NATURAL TARGET FOR ESTROGEN ACTION: OPPOSING EFFECTS OF ESTROGEN IN TWO PROTOTYPICAL AUTOIMMUNE DISEASES. FRONT IMMUNOL, 2015. 6: P. 635. HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/A RTICLES/PMC6119719/

Where can you find help? Supporting a healthy microbiome is a cornerstone in our Integrated Functional Medicine Program and essential for strengthening immune responses and improving overall health. As the time frame of the current pandemic continues to expand, implementing personalized treatment approaches that support the health and balance of the intestinal microbiome are essential to not only strengthen resilience for high-risk chronic disease patients, but also to optimize immune function and disease prevention for healthy patients. At Traditional Family Medical Center, we provide personalized therapeutic interventions that focus on modifiable lifestyle factors to improve immune system function while supporting gut health. Traditional Family Medical Center is a family practice clinic and is a partner with Salt on the Rocks, a holistic wellness spa. Author: Crystal Barber MBA, Heather Morse MS, ATC, OTC (contributing material) Brett Enabnit RPh, Kiyo Holmes, FNP-C

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The excitement and anticipation of bringing home a baby has to be one of the most, if not the most, wonderful things anyone can experience. A new mommy can just imagine the picturesque moments of snuggling, loving, and watching her baby grow. While she prepares the nursery, gathers clothes and blankets, bath supplies, car seats and strollers, a mommy is always faced with the question of whether or not she will breastfeed.

Why is it important to advocate organic based formula as opposed to alternative formulas?

The books make it look so easy. Mommy and baby staring into each other’s eyes during nursing moments. Everyone looks so happy and content and healthy. Unfortunately, it doesn’t always turn out that way. Many times, circumstances evolve that won’t allow a mommy to follow through with the words we hear so often, “breast is best”.

Every parent wants what is best for their children. This is no question! But what happens when breastfeeding isn’t an option, or more so, what if a mommy just isn’t interested in breastfeeding?

Dr. Brett Davenport, a Reproductive Endocrinology and Infertility specialist, is passionate about providing excellent patient care, and is committed to providing the most state-of-the-art solutions in all aspects o f infertility and reproductive endocrinology.

There are so many formula options available. But which one compares in nutrients to that of breastmilk? How does a health conscious mommy make the right decision? The answer is in the ingredients. Have you ever taken a good look at the ingredients of baby formula? There are many ingredients included that a lot of parents wouldn’t want to eat themselves, much less give them to their baby 5 times a day. The best choice is a formula that uses 100% grass fed organic cow’s milk, natural ingredients, and zero GMOs. And our babies deserve the best! On the technical side of this let's dig a little deeper. We've now established the need for expecting mothers to address the concerns around Nutritional values regarding the formula they decide to feed their newborn. We sat down with Crystal Barber and asked these questions.

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Turns out there are a ton of benefits for both mom and baby. And in fact, these compelling reasons should help you switch them to an organic diet.

organic for your littles

Consider the benefits of organic formula for your newborn infant.

The benefits of eating organic are widely known in the adult population. However especially for babies, it is important to consider foods that are organically grown. In the US, foods that are certified organic are grown without the use of synthetic pesticides, bioengineered genes (GMOs), petroleum-based fertilizers, and sewage sludge-based fertilizers. It is the lack of chemical exposure that makes organic baby food a safer choice. The toxins in pesticides can cause a host of problems that can affect brain development, growth rate, and overall health. The American Academy of Pediatrics has taken the unprecedented step of issuing a policy statement that calls on the government, schools, parents and medical professionals to take concerted action to protect children from pesticides.

The prestigious 60,000-member physician organization rarely involves itself in politics and governmental affairs but reported that chronic health implications from both acute and chronic exposure is emerging as children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Also stating “Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems.” Studies indicate chronic toxicity end points identified in epidemiologic studies include adverse birth outcomes including preterm birth, low birth weight, and congenital anomalies, pediatric cancers, neurobehavioral and cognitive deficits, and asthma.

OK, so you have sold yourself on the idea that eating organic is helpful for adults. But what about an infant? What benefits could they get from doing so?

HEALTH FEATURE

The organization's decision to sound alarms against pesticides is motivated by the growing body of scientific evidence that links these toxic chemicals not only to outright poisoning but also to subtle and sometimes life-altering health problems to which children are especially vulnerable. Chemical agribusiness spokespeople, including those with the Alliance for Food and Farming, contend that low-level exposures to pesticides pose no risks to human health. However, The American Academy of Pediatricians clearly disagrees. Its policy statement, crafted in the measured scientific language, expresses its members' deep concern about the sometimes-irreversible damage that pesticides may be doing to their young patients. The evidence base is most robust for associations to pediatric cancer and adverse neurodevelopment. Prospective contemporary birth cohort studies in the United States link early-life exposure to organophosphate insecticides with reductions in IQ and abnormal behaviors associated with attention-deficit/ hyperactivity disorder and autism. Having such a prestigious group of physicians as the Academy expressing this level of urgency over the risks that pesticides pose to children's health is concerning. The Academy is calling for more study, and well they should. But it is their call to action that is most striking.

52 Inside Medicine | Volume 3 I ssue 19

The alarms have spawned multiple studies including the governmentcommissioned study, Pesticides in the Diets of Infants and Children. The study concluded that it is impossible to know for certain whether children are over-exposed to pesticide residues because federal standards for what is "safe" are based on an adult's intake. Unlike adults, children, and especially infants, often eat large amounts of only one fruit or vegetable for a month or more - potentially exposing them to a much larger quantity of pesticide residues in that food. And they eat more, relative to their body weight, than adults do. Infant bodies are also more vulnerable to chemical exposure because their organs and immune systems are still developing.

The NAS research authored by toxicologists, pediatricians and food manufacturers - warned that current regulations for controlling pesticide residues in foods do not adequately protect infants and children. The Environmental Working Group, a nonprofit research organization in Washington, D.C., calculated that children may receive up to 35 percent of their entire lifetime dose of some carcinogenic pesticides by age 5. Infants and children are "routinely exposed" to combinations of two or three pesticides per food, the group warned. Since then, the National Academy of Sciences and the Environmental Working Group have been urging the federal government to set much stricter exposure standards for infants and children - 10 times more stringent than those previously used, according to the National Academy of Sciences. So far, that has not happened.

HEALTH FEATURE

The Infant Microbiome Implications for Infant Health and Neurocognitive Development

The most dramatic changes in the composition of the intestinal microbiome begin during the first year of life. Research suggests that the microbial population that develops during the early months of a newborn’s life varies highly from infant to infant and that the newborn diet is the essential factor related to the establishment of healthy gut microbiota. Infants are born with essentially no microbiome and a very immature immune system. The two develop together, informing each other. The microbiome is important for many aspects of health, from gut health to mental health to immune health, and we're finding that the first couple of months of life is a really critical window for its development. When the immune system does not develop properly, there can be a greater risk of developing future health problems. Beginning at birth, the microbes in the gut perform essential duties related to the digestion and metabolism of food, the development and activation of the immune system, and the production of neurotransmitters that affect behavior and cognitive function. The first years of life are a time of rapid change in both the gut microbiome and the developing infant CNS. As a result, the microbiome has increasingly become a focus of clinical and preclinical studies of neurocognitive and emotional development. While studies in humans are just beginning, growing evidence suggests the gut microbiome exerts influence over a range of developmental indices, from cognition to anxiety, mood, and even sociability. An enhanced understanding of how the microbiome-gut-brain axis operates during infancy may thus provide novel insights into early-life neurocognitive and emotional development.

Babies gut microbiome serve as a barrier against the proliferation of pathogenic organisms and play an important role in the digestion and metabolism of colostrum, breast milk, formula, and weaning foods in infants. Diet composition and patterns during the first three years of life impact the diversity and functional capacity of the gut microbiome with potential downstream effects on infant development and disease risk. Understanding the colonization patterns of the gut microbiota during infancy and early childhood, the factors that influence colonization, and the mechanisms through which the gut microbiota interact with immune regulation, the endocrine system, and metabolism may help in the development of strategies to guide the formation of health-promoting microbiotas that could then be maintained throughout the lifespan. As a population, we encounter pesticides daily in air, food, dust, and soil and on surfaces through home and public lawn or garden application, household insecticide use, application to pets, and agricultural product residues. Both parents and pediatricians should regard the Academy and other supporting evidence urgency around pesticide risks seriously. While we cannot limit all our children’s exposures to toxins in the environment, we do have a say in the food they eat. And one of the best ways to limit exposure to these chemicals is to choose an organic diet in early stages of development. Do not forget to remember these words when you hear spokespeople from the pesticide industry and chemical agriculture trying to convince you that it is perfectly safe to consume these toxic chemicals in the food we eat.

https://pediatrics.aappublications.org/content/130/6/e1757 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681407/

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(continued from p.26)

I crave moments of solitude because that is how I re-fuel. Yet I never asked for time alone. Working out is one of my greatest joys, but I kept sacrificing my own workout time to work more hours at the gym. I was dying to the wrong things. There are things in life that we have to do that might not be our preference. I do not enjoy doing dishes. It always feels like a chore! The dishes still have to be done. Yet there are many other things in life I still have the choice to say “yes”, “no”, or “not now”. Are you, am I, saying yes to the right things? Over about a 9 month period, I began to adjust my schedule. My husband helped me create better boundaries because he recognized the exhausted wife, mother, and person I had become. He helped me commit to not taking on a second early morning class at the gym and made me promise to him I would only do one early morning each week. We re-worked our budget in order for me to have more time at home. I gave myself permission to say “no” to lunch meetings if I needed some solitude - and refused to feel guilty about it! I prioritized getting my own personal workouts each week. And in the middle of this pandemic - spring 2020??? I reminded myself that I love to read. I love it! Since fitness centers are still closed and my work hours are different, I have given myself permission to pick up some fictional novels that I have wanted to read for a long time. I continue to find that when I say yes to things that bring life to my soul, I am a better mother, wife, and friend. I have a fullness of life to share with others, instead of little bits of leftovers. One simple but profound way to help find out if you are dying to the wrong things is to make two simple lists. Make a list of the things that fill you up. Bring you joy. Maybe it is time in nature, or time with friends. Whatever those things are - write them down! Then write a second list of things that drain you. Be honest on both. Then compare. Our pastor suggested doing this as we look at our Sabbath days, the day we need to take rest. Rest is not doing nothing! Rest is taking time for what fills you up! Ask yourself: is my life filled more with things that energize me? Or is it filled with things that drain me? If you find yourself constantly exhausted and irritable, perhaps it is time to begin to make adjustments. Adjustments take time. You and I cannot wave a magic wand over our schedule and repair what we have been overcrowding for years. But we can take one step at a time to make a difference so that we enjoy fullness of life. Each small step of weeding out something that drains you and creating space for people and activities that fill your soul to the brim matters. I promise that you will find yourself as you do it! The girl inside me that laughs, jokes, hugs more, is patient, silly, energetic … she comes out more and more when I am careful to live for the right things and give myself freedom to die to the wrong things. Each season of life provides us moments of growth if we are willing to embrace growth and change. Sometimes change can feel scary or simply unknown! This season is no exception: the opportunity lies before you. Don’t sit and wait for COVID-19 to disappear and life to return to “normal”. You can find life and beauty even right now - make the choice to live for those things!

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