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features &
CONTENTS
Sharing with Purpose
Inside Medicine | summer 2017
FEATURES PTSD job duties result in traumatic effect on the physical psyche Impacting Alzheimer’s Disease institutionalized research finding on Alzheimer’s
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Weekend Warrior working hard, injury free on the weekend
C O N TRI B U TOR S
Maureen Mack
CONTENT Kenya Relief local physician’s medical journey
Vol u m e 1 , I s s ue 5
8
Lisa Layton Traci McCormick, M.D. Kari Kingsley, MSN, CRNP Troy Layton, M.D. Tiernan O’Neill Larry Parker, M.D. Cara Greco, M.D.
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Regina Mobbs, R.N. Neena Singhal James, O.D. Christie Gover Kevin E. Fernandez Brett Davenport, M.D. Donald Lewis, LPTA
Lean Not on Your Own Understanding seeing small glimpses of God’s promises
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Rehabilitation the journey to recovery through physical therapy
40
Neeta Kohli-Dang, M.D.
S A L E S & M A RKETING
Kelly Reese, Co-Owner Lisa Layton, VP Sales/Marketing Join our mission to establish and grow an alliance among our community and healthcare
C H I E F E D I TO RI A L W R ITER
Kimberly Waldrop, MA
providers. Together, we can change the way healthcare information
G RA P H I C D E S IGN
has been and will be distributed
Allison Richter
for years to come. To reach our readers, whether through editorial contribution or advertising, please contact Kelly Reese at kelly@insidemedicine.biz or 256.652.8089 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. 4
Inside Medicine | summer 2017
P U B L I S H ER
Brandon Reese, President Blake Bentley, Vice President w w w . in s id e me d i ci ne .bi z
} FROM THE EDITOR
Dear Readers–
SUMMER MUST READS, FAITH & HOPE
Unfortunately, it is inevitable…bad things are going to happen. We are going to have rough days and there are going to be times we want to give up. The rough times will come and go and often times the glass will seem half empty instead of half full. It’s our calling to become a beacon of light in a dark world that sees no “light at the end of the tunnel”. As Christians, we know who to call upon and we hope to spread that light to others. In this edition of Inside Medicine, there is a resounding theme of responding in a positive and Godly manner while picking up where you are and letting God take control. People learn to make the best out of tough situations and realize there is always a “bright side”. Christie Gover’s story is one of hope. Despite a diagnosis of a mental illness, she continues to work, benefit her community and help others. She is an inspiration and a reminder to take care of yourself and to seek help. It’s so amazing how God works and leads us. Lean Not on Your Own Understanding is an editorial filled with small promises of His hands. Regina Mobbs tells her story of how she unknowingly but willingly lived out God’s purpose on the mission field in Guatemala. In addition, the mission and medical field in Kenya has been blessed by the work of Julian and Amy Billings. Their work through Kenya Relief is a delightful look at someone answering the call and benefiting others medically and spiritually. The stories of people struggling with gluten intolerance can even lead to a plea of help. Dealing with bouts of depression, stomach troubles, and sleepless nights can make you feel desperate. There is help though and sometimes it’s as simple as a little change in diet… and lots of prayer! :) As always, along with inspirational stories, this edition is packed full of useful medical information. Dealing with back pain associated with pregnancy, the importance of yearly eye exams, signs of hypothyroidism, and prostate cancer are just a few of the expert articles highlighted in this issue. As always, our prayer at Inside Medicine is to display passion for our community and our Savior. Feel free to contact us if you ever have an idea for a story or want to be included in our magazine. We love hearing from you and appreciate your support!
Kimberly Waldrop Inside Medicine | summer 2017
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Inside Medicine | summer 2017
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Inside Medicine | summer 2017
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} FEATURE
Kenya Relief by Lisa Layton
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Inside Medicine | summer 20017
Approximately 7,993 miles away from Huntsville, Alabama there is a place where people have the ability to thrive on scarcity. They battle with disease, injuries and physical impairments, but amid their hardships, it is a place where love abounds, joy is prevalent, and smiles are bright. It is a place where a piece of a Huntsville couple’s hearts will live forever. This place is Migori, Kenya and the loving hearts belong to Amy and Julian Billings. Amy and Julian met while attending UAB Medical School. Amy specialized in pediatrics and Julian chose gastroenterology. Once they finished their training, they began their busy lives in Huntsville as practicing physicians and parents to their three sons, Grant, Jackson and Charlie. They became active members of Cove Church where missions are greatly supported. Amy and Julian always felt their calling to missions was more on the local level until Julian had the opportunity to meet Steve James, the founder of Kenya Relief, a missions organization originally dedicated to providing better health care in Kenya. After hearing him speak at Cove Church, Julian asked about the capability to do GI work in Kenya and quickly discovered that type of treatment was too expensive, and unfortunately, many patients who suffer from severe GI problems there do not survive. The phrase “we can only do what we can do” did not sit well with the Billings and their quest to change this situation soon began…Julian felt the nudge, the calling, the God whisper that it was time to make a difference. A couple of years passed and a team from Cove Church planned a mission trip with Kenya Relief. Julian was on his way to Migori and an experience that would change him, and would soon change Amy, forever. His first trip was in 2015 and he went, not just as a gastroenterologist, but as a multi-specialty internist. He treated many medical issues outside of his specialty that he had not seen in years. He had to rely on his faith, and with no internet access, medical books, to guide him and to refresh his knowledge from the early years of medical training. While in Kenya, Julian “fell in love with the idea of just practicing medicine in this kind of pure way that is not encumbered with managed care and paperwork and the pressures”. He went on to say “this is why you wanted to be a doctor” and in Kenya, this is the way you were able to practice medicine. “You were there to help people and to love on people”. He was so passionate about his trip that he met again with Steve James about doing
more. He set his sights on finding a way to help those afflicted with GI problems. Julian spent the next twelve months trying to find medical equipment to take back with him on his second mission trip which would take place in 2016. He was able to get the needed equipment donated by Madison Surgery Center, medical equipment reps, and Huntsville Endoscopy Center. He also found pieces of equipment which were donated from across the country. He was determined to have the means to do endoscopy procedures as the nearest facility with that capability was six to eight hours away. It was God at work again as he was able to acquire and send over $400,000 worth of donated equipment to Migori to enable him to perform GI procedures to properly treat this community of people. Now, Crestwood Hospital as well as other facilities, are contacting Julian with a surplus of supplies and equipment to send. When Steve James first started the medical portion of Kenya Relief in 2002, he ran a clinic in the back of a pick-up truck. Since then, it has grown into a facility with two exam rooms, two functional operating rooms, a room for ophthalmology and dentistry, a lab and a recovery area. A 20 bed hospital is currently being built to accommodate in-patient care. The Billings’ calling and determination along with God’s help has played a part in expanding the medical care being offered. A year prior to Julian’s first trip, the Billings family began to sponsor two children through Kenya Relief. One of the most touching experiences during the mission trip was the time spent getting to know the children that they sponsor. Julian loved that you get to love them and hug them and “let them know their life is of value”. You get to tell them they have a God who cares greatly for them. When Julian came home after the first trip, Amy said that “he was just transformed, he was not the same person. He just left part of his heart in Kenya and was obsessed and enmeshed with this place”. She shared in his excitement, however she just did not feel the call upon her heart to join him. She could not go “on her own strength” and if God were going to call her, he would have to equip her to do it. She felt the responsibility of her two sons at home, (oldest son Grant is now serving as a full time missionary), and having both parents leave them for two weeks for a mission trip posed its own challenges. In God’s perfect timing, things were soon to change for Amy…
Inside Medicine | summer 2017
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} FEATURE
Not only has Kenya Relief grown the medical portion of their organization, but they also have created an orphanage that houses 50 boys and 50 girls. They have started Kenya Relief Academy, which is a K-8 school for 700 students with over a 400 student waiting list. “The birth of Kenya Relief is a testimony to one life leaving a lasting impact in the world.” To learn more about Steve James and Kenya Relief, please visit www.kenyarelief.org
“I see the work of Your hands Galaxies spin in a Heavenly dance oh God All that You are is so overwhelming” “Overwhelmed” by Big Daddy Weave
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Inside Medicine | summer 2017
Amy knew that when she got to the clinic she would be treating adults, and that was intimidating as she had not treated adults in 17 years. The first day she felt overwhelmed, but by the second day, she realized what she had to offer was better than what they had. Again, she leaned on her faith that “if God calls you, he is going to equip you and it will be spectacular”. While there, Amy realized this was the first time that she and Julian had ever had the opportunity to team up and practice medicine together, and she felt that experience actually enriched their marriage. Looking back now, Amy cannot believe it took her so long to get to Kenya and when her time came to leave, she said it was “gut wrenching”. Kenya is like a “joy we don’t have here, even in the face of such extreme poverty and overwhelming needs, they have a joy that we don’t have and you just realize in some ways we feel sorry for them, but we are the ones to be pitied. We have so much stuff here and we don’t feel real joy”. Amy said she would go back tomorrow if she had the opportunity. It is in her soul. In fact, she said they are going back in June, 2018 and that date cannot get here soon enough. When asked about their most profound Kenyan experience aside from medicine, they both agreed it was the children. At 4:30 am the children would be washing their two articles of clothing before school. Amy said they would wake up to the children at the water pump actually singing! “The children also don’t know selfishness. If one of them gets a candy bar, they are going to take it and break it into tiny pieces and share with everyone. There is not a tiny cell in their being that says this is mine”. They were both amazed that the children and adults as well have such an unselfish ability to love, harboring no bitterness, despite their horrific conditions. They are completely joyful and thankful for their good fortune. Once back home, Amy said she would wake up in the morning and still hear the singing, the voices, and the laughter and she would miss it so much. “The whole experience of what Kenya Relief is doing is so special and such a beautiful thing”.
No matter what the Billings have planned for their future, this experience has shown them that God’s plans are so much bigger. They will go back and their work will continue, but the work that takes place in the hearts of Amy and Julian is a far greater gift than they could ever have imagined. I want to personally thank Amy and Julian Billings for sharing their experience and their hearts with “Inside Medicine”. It was truly an honor and privilege to spend time with them and see God’s light shine through them.
KENYA
One day while Julian was away on his second mission to Kenya, Amy dropped her sons off at school and she heard a song by Big Daddy Weave called “Overwhelmed”. The lyrics had such an impact on her that she went home and found the video and lyrics online. Little did she know, the actual music video was filmed in Tanzania which was about 20 miles from Migori, where Julian was serving. Everything that Julian had described to Amy about his experience was being played out before her eyes while watching this video. She said, “I wept and felt like my heart was there with him [Julian], and I could understand and get a sense of what captured him”. Amy said, “It was just crazy the way God knit our hearts together from across the world in a way I could understand how it [Kenya] gripped him so much”. Despite this, she still did not feel the calling, because she felt she had every reason not to go. Events started happening and Julian needed Amy to go as another doctor to help carry out the plan for his third trip. Amy realized for her to go would be an act of obedience. “God does not call us to live a faith of comfort, He wants us to be bold, He wants us to step out”, so the time had come, and Amy agreed to go to Africa.
Inside Medicine | summer 2017
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}RESEARCH
HudsonAlpha: Impacting by Maureen Mack
HudsonAlpha Institute for Biotechnology
The statistics surrounding Alzheimer disease are staggering and frightening. More than five million Americans have Alzheimer disease. The cost of Alzheimer: $259 billion in 2017 alone. The human cost of Alzheimer and other dementias also continues to grow. According to the Alzheimer Association, the number of deaths from Alzheimer has increased 89% since 2000. At HudsonAlpha Institute for Biotechnology, scientists are on the forefront of leading technology to help us better understand Alzheimer disease and other neurological diseases.
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Disease samples to learn more about the genetic causes of Alzheimer disease and related disorders. Identifying New Causes This unique group of patient samples is comprised of a mix of early onset Alzheimer disease patients, typical Alzheimer patients, those suffering from other dementias and “control” cases. The early onset cases are of particular interest to the science team at HudsonAlpha.
“We know there is a significant genetic component to Alzheimer and related dementias,” said Rick Myers, PhD, president and science director of HudsonAlpha. “Now, we can truly begin to explore those root causes and search for new therapies and prevention strategies.”
“Researching early onset cases increases chances of finding new, causative genes at a lower cost and less time. Hopefully with this large group of rare, early onset patient samples, we can more quickly identify new genes associated with Alzheimer disease in a more cost effective manner,” explained Dr. Myers.
HudsonAlpha scientists will apply a number of different methodologies and experimental processes to a large set of patient
Using a collaborative approach, HudsonAlpha will share findings with the entire research community, which will increase the power to
Inside Medicine | summer 2017
identify new genes with confidence. This will aid in developing new, targeted medicines that benefit patients. “This is a huge opportunity to advance our knowledge of why some people get these diseases and others don’t,” said Dr. Myers. “Our findings could lead to better screening tools, early detection, prevention, improved medicines and possibly cures.”
Using knowledge from their successful program with another neurological disease, they will explore the potential for gene regulation with Alzheimer disease by identifying all the “on/off ” switches for known Alzheimer disease genes. By learning how to turn off the abnormal genes, research may lead to completely new therapeutic approaches that could significantly slow or stop progression of Alzheimer disease.
Early Detection Based on recent research, it is known that the underlying disease process starts decades before symptoms. If the process can be targeted before symptoms that would be a much better option as early detection of Alzheimer disease is known to improve treatment outcomes. HudsonAlpha will apply its expertise in immunogenomics (applying genomic technologies to better understand the immune system) to help identify the earliest onset of Alzheimer disease. By analyzing the immune response found in the blood of Alzheimer patients, HudsonAlpha can generate a picture of health – called the immune repertoire – that may allow clinicians to detect disease long before symptoms appear or are recognized, making early drug therapies more effective. If successful, this new diagnostic test could offer patients alternatives to the current more expensive tests. Discovering New Therapeutic Approaches All genes have an “on/off ”switch. Controlling how genes are turned on and off is an important process called gene regulation. HudsonAlpha scientists are experts in this method and have experienced positive results.
Live cells from human skin cells that have been grown in the lab as neurons. Watching the cells while they are alive provides valuable insight, such as reaction to treatment. Photo credit: Nick Cochran, PhD
“Often what people really want to know is how close we are to effective therapies, which can be almost as good as a cure,” said Nick Cochran, PhD, a postdoctoral fellow in the Myers lab at HudsonAlpha. “The first key idea is that prevention is going to be the name of the game.” To learn more and support HudsonAlpha’s Alzheimer disease research, visit http://hudsonalpha.org/memory-and-mobility-fund.
By the Numbers: (Alzheimer’s Association) More than
5 million
Americans are living with Alzheimer disease today; that number will triple by 2050
Dr. Myers
Every
66 Seconds
someone in the U.S. develops Alzheimer disease
Nick Cochran, PhD
$259 billion cost for people with Alzheimer
and other dementias to the nation Inside Medicine | summer 2017
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} HEALTH PREVENTION
How to Prevent Prostate Cancer by Traci McCormick, MD
]
Many of you have been eating a typical American diet since the day you were born. It can be really hard to implement change in your life, but you can do it. Just take one step at a time.
***To all the female readers: If you are considering skipping this article because prostate cancer is a man’s issue— I beg you to keep reading. If you have any men (or boys) in your life—especially if you buy their food or cook their meals—this is important information for you to know.
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Inside Medicine | summer 2017
Did you know that you could fill two college football stadiums with the men that are diagnosed with prostate cancer in our country each year? That’s 180,000 men. 180,000 of our friends, neighbors, and loved ones. 180,000 of our husbands, fathers, and sons. 180,000 men that have been struck by a disease that most people believe cannot be prevented.
Can You Prevent Prostate Cancer? What if I told you that there is a diet that has not only been proven to prevent prostate cancer but has also been proven to slow or even reverse its growth? What if I told you that there is an overwhelming amount of evidence in the medical literature supporting this claim? I bet, if such a diet exists, that you’d expect to be able to ask your doctor and hear all about it, right? Wrong. Despite the enormity of data that is available, the vast majority of physicians know nothing about the connection between this diet and prostate cancer. Although there is plenty of evidence to the contrary, most physicians are taught that prostate cancer is not preventable. Miracle Diet? One of the most infamous studies to prove that prostate cancer can be affected by lifestyle modification was completed by the famous Dr. Dean Ornish and was published in the Journal of Urology in 2005. This study included men who had been diagnosed with prostate cancer and who had opted not to do traditional treatment. The men were assigned randomly into one of two groups. The first group of men underwent intense lifestyle modification with a special diet. The second group of men continued with their usual diet and exercise habits. When the study concluded, the researchers found the cancer had progressed so much in some of the men that they had to undergo surgery or radiation to treat the disease. All of these men were in the group that had been eating their usual diet. Within the group assigned to lifestyle modification, there was not a single man that required surgery or radiation at the conclusion of the study. What’s even more impressive is that the blood marker used to detect prostate cancer, called the PSA, decreased in the group of men who underwent lifestyle modification, while the PSA increased in the group of men
who continued their usual way of life. This means that the prostate cancer regressed in the group who ate this special diet and progressed in the men that continued their typical diets. The researchers also found that when they placed blood from the men who modified their lifestyle into a petri dish with prostate cancer cells, their blood stopped or slowed the growth of 70% of the cancer cells. As a responsible physician, I want to emphasize that this special diet did NOT get rid of their cancer, but it was certainly able to slow it down! The Diet that “Stopped” Prostate Cancer What were these men doing in the lifestyle modification piece of Dr. Ornish’s study? What was the miracle diet? What magic herbs were they taking? It turns out what they did was fairly simple.
• They ate a low-fat vegan diet full of vegetables, fruits, whole grains, nuts, seeds, and legumes. • They walked 30 minutes, six times per week. • They did some form of stress reduction through meditation, deep breathing, or yoga for one hour each day. • They took supplements of soy, vitamin E, vitamin C, and selenium.
The Evidence is Overwhelming There are dozens upon dozens of studies connecting animal protein, saturated fat, and refined grains to an increased risk of prostate cancer. There are even more studies that show that you can decrease your prostate cancer risk by eating a variety of plant-based foods. The best prostate cancer prevention diet is a plant-based diet with a variety of fruits, vegetables, whole grains, legumes, seeds, and nuts. Animal products should be consumed sparingly. Refined carbohydrates should be avoided as much as possible. I hope this post has motivated you to take a hard look at your diet and make the changes necessary to live your healthiest life and give the healthiest diet to the males in your lives. We truly hold the power to change our lives by making wise decisions about the food we put in our bodies.
Inside Medicine | summer 2017
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PTSD
} PERSONAL INTEREST
It was a normal night and I was sound asleep. Out of nowhere, I was awakened with shortness of breath, chest pains, arm pain, and nausea. I definitely thought I was having a heart attack. I immediately knew I needed to get myself to the hospital. Knowing I shouldn’t drive myself, I was thankful my sister was in town to take me. We needed to get there fast….I was just sleeping soundly…I am glad she’s here to help. All of these thoughts were racing through my head as I battled to keep calm and make rational decisions. This was the first night I ever experienced an episode of this nature. I was told it was a panic attack. Panic? While I’m sleeping? You must be kidding! This was no joke. I was, in fact, having a panic attack. Why? I had no idea. The emergency room doctor advised me to follow up with my family doctor and gave me some medicine to help keep me calm. In the summer of 2012, that’s exactly what happened.
I remember what triggered the panic attack. A teenager had taken his life. I was the “on call” detective. I made a call to a friend of mine, who worked in the medical field, and learned his son had taken his life in a similar fashion. I never knew and I was crippled by this news. I felt terrible for having reminded a by Christie Gover dear friend of mine of a terrible event. Those events weighed on my subconscious more than I was aware. After my ER visit, I stopped eating. I was nauseous for weeks and therefore I lived off of diet soda and crackers.
job duties result in traumatic effect on the physical psyche
In most cases, weight loss is great for self-esteem and a goal for most. But it was happening to me, out of my control, and a bad diet such as this can be detrimental to our bodies, both mentally and physically. It wasn’t until I saw my orthopedic surgeon that I realized something was wrong. During a routine visit, my doctor had a concerned look on his face. He said, “Are you okay? Because you look sick. Very sick. You are skin and bones.” I told him what had happened and again, I was urged me to see my family doctor.
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} PERSONAL INTEREST
PTSD? That isn’t possible! I’m not a war veteran! There has to be something else. Apparently, the six years I served as a crime scene detective did little good for my mind. Recurring images of death haunted me day and night. I had no outlet for the negative input. I kept telling myself I was tough and could handle it. I’m a police officer. If I tell anyone at work I’m having a problem, they’re going to commit me! I had no one I could trust to tell at work and I convinced myself that I didn’t need help. I could not have been more wrong. I finally sought treatment from local psychiatrists. I ended my treatment with a rather interesting session involving hypnotherapy. I was no longer haunted by a troublesome case, but I was so “freaked out” by the session that I did not return. It wasn’t the doctor performing the therapy, it was my choice and personal discomfort level of the whole experience that prevented my return. Medication after medication was doled out as a cure all. Most things I tried had the opposite effect. It wasn’t until 2017 that I realized I needed to treat the problems plaguing me. It is difficult to find fault in ourselves; moreover, it’s most difficult to seek help for those faults. Since I had a traumatic brain injury in 1996 as a result of a car accident, I elected to undergo neuropsychological evaluations. My doctor and his staff were amazing. I am happy to say that I have no significant neurological deficits! However, I do have lingering issues that need to be addressed in order for me to continue on my path towards recovery. During my testing the symptoms of PTSD reared their ugly head resulting in the grand appearance of anxiety and depression.
My doctor recommended I see a specialist for treatment. He said he would be the one who could both help me and interpret my test results. I have since visited him multiple times and he is allowing me to take things at my own pace. I’m eager to see progress. I don’t expect to be healed overnight, nor am I excited about having to take any medication. But, I will work with my physicians and help them find the best course of treatment for me. I am no longer embarrassed by my diagnosis. It is relatively impossible to battle this alone. The problem has been identified and now we will work towards a solution. If you, or someone you know, is battling mental illness, please seek help. It is not a “quick fix”. From recognizing and admitting that something is not right, to seeking help and getting a proper course of treatment, expect a long journey. You have to identify what is broken in order to fix it. That is the first step to healing. I waited and suffered long enough, but it is better than not getting help at all. I look forward to everything that life holds for me, and I will take one day at a time. I appreciate all of the help I have been given. I am truly thankful there is a wealth of knowledge and information out there and medical professionals are learning more about these mental conditions every day.
E CR RI IME S M E S CENE CE CR NE IM ES CR CEN IM E ES CR IM CE ES N
I delayed the appointment long enough, but when I finally saw my family physician, he looked at me and said some words I was not prepared to hear: “You have post-traumatic stress disorder.”
Christie Gover is a law enforcement officer with 18 years of experience with Madison Police Department. She has served as a patrol officer and crime scene investigator. She is currently assigned to the Investigations Division, where she specializes in crimes against children. As part of her duties, she has held the certification of Rape Aggression Defense Systems, Inc., instructor since 2001. She is a decorated officer and an advocate for the safety and wellness of children.
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}PREVENTION
For most people, the end of a long work week is the beginning of rest and recovery in preparation for another Monday. For a small but growing population, the end of the workday on Friday signals the start of 1-2 days of sports or activities. These people are typically referred to as, “weekend warriors”. The “weekend warrior” means different things to different people. The generally accepted description is a 30-50 year old male attempting to compress 7 days of little activity into 1-2 days of vigorous activity. The definition is changing to now include an increasing number of females and the age is truly 20-60. A surprising find in a recent study showed that only 1-3% of Americans are truly a “weekend warrior”.
The benefits of exercise are commonly accepted but the amount is always debatable. The CDC recommends 150 minutes of vigorous activity per week. The growing population of weekend warriors are only able to get this in on Saturday and Sunday. There are risks and benefits of being a Saturday athlete. The obvious risk is physical injury due to lack of conditioning or not being in shape. We know that more injuries occur over the weekend than during the week. A commonly quoted fact is that we spend 70% more time exercising over the weekend as compared to Monday through Friday. Even more so, as the weather warms, outdoor activities increase and therefore the chance for injury goes up as well. The weekend warrior has an even higher chance of injury. Some believe this is due to increasing intensity and longer duration than seen during the week. Sports injuries are second only to the common cold as a reason for doctor visits. The weekend warrior sustains the
injury
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prevention
Inside Medicine | summer 2017
same type of injuries I routinely see in my sports medicine practice. Some weekend warrior injuries include: 1) 2) 3) 4) 5) 6)
Ankle sprains Calf strains and Achilles ruptures Knee injuries Shoulder injuries Tennis or Golfer’s elbow Lumbar strains
All of these injuries are treatable, but the emphasis should be on prevention. The most common, but unlikely way for the Saturday athlete to lessen chance of injury would be to train more Monday through Friday. Since this rarely happens, the weekend warrior should warm-up and stretch prior to every activity. This gets the blood pumping and the muscles warm before jumping into that Sunday game. This simple 5-10 minutes would help since our muscles, tendons and bones weaken as we age. Bone density decreases yearly at a steady rate beginning around age 30. Muscle loss can decrease 1% per year starting around age 40 and tendon strength deteriorates with age as well. The positive results of exercise for the 1 in 10 Americans that regularly get the 150 minutes per week is that the risk of cardiovascular disease (and some say cancer risk) decreases. Yes, this benefit is even seen in those that compress 7 days of activity into Saturday and Sunday. The weekend warrior lifestyle has a greater risk of injury, but the benefits certainly outweigh a lifestyle of little to no activity.
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Inside Medicine | summer 2017
Do You Have a Hidden Gluten Sensitivity? The Trouble with Gluten by Traci McCormick, MD
Are you tired? Moody? Irritable? Maybe you’re a little depressed or anxious? Maybe you have joint pain? Chronic headaches? A little bloating or tummy trouble? Trouble sleeping? Perhaps you’re having trouble losing weight? Or maybe you can’t seem to gain weight no matter how much you try? Thinning hair? Bumps on the back of your arms? Acne? Hormonal issues? Trouble getting pregnant? Multiple miscarriages? Thyroid problems? Chronic headaches? Migraines? Are you saying yes, yes, yes to any of these? If so, you could be suffering from a gluten-related disorder. Gluten—the tiny little protein that is part of wheat, barley, and rye can really cause all of this damage to your body. It seems impossible, but it is true! For people who are sensitive to gluten, the ingestion of gluten-containing foods sets off an immune response in the body that can affect everything from the gut to the brain. You could be living with a gluten sensitivity and have no idea anything is wrong. It happens all the time and definitely happened to me. I had symptoms that I thought were normal for all human beings—until I went gluten-free and discovered that what I was experiencing wasn’t normal at all. It compares to knowing people who have had diarrhea their entire life and had no idea that it was abnormal because it’s the only thing they ever knew. It is also much like someone who gets glasses and sees the world as it is supposed to be seen for the first time in their life. They never knew how much they couldn’t see until they could. If you think you may have a sensitivity to gluten, visit my blog and identify some concerns. www.tracimccormickmd.com
Jennifer’s Story My friend Jennifer had “tummy trouble” for years. She had a sensitive stomach and was prone to alternating bouts of diarrhea and constipation. She often had
stomach cramps and bloating, but nothing she thought was abnormal. She casually mentioned her issues to her doctor. He told her it was all perfectly normal and she might have a touch of IBS (irritable bowel syndrome). He said there was nothing to be done about it—she just had a sensitive stomach. A few years later, Jennifer read an article about how to lose weight by eliminating grain from her diet. To her surprise, not only did she lose 20 pounds, but all of her “normal” tummy troubles disappeared.
Steve’s Story Steve had been low on energy for quite some time. His doctor diagnosed him with iron deficiency anemia. He was also going in once a month for Vitamin B12 injections because his levels were abnormally low. When Steve asked why he would have low iron and low B12, his doctor just shook his head and said: “it just happens sometimes”. A few months later, Steve’s wife put them on a gluten-free diet because she had heard it was healthy from some of her friends. Steve immediately began to have more energy and within just a few months, Steve’s anemia resolved and he no longer had to take iron or B12.
Samantha’s Story Samantha had chronic headaches that kept her from feeling her best. Sometimes they were full-blown migraines, but most days the headaches were just bad enough that she wasn’t fully present. I bet by now you can guess what happened. Yes, she went on a gluten-free diet and the headaches went away. There are dozens of stories like these!! People who have had life-changing results from going gluten-free. I know multiple women who were having trouble getting pregnant until they went on a gluten-free diet. I know several people with children that had eczema that disappeared after going gluten-free. Just yesterday, someone was telling me that they went gluten-free a few weeks ago. They already feel like a fog has been lifted and they feel much more energetic. continued on pg 22
Inside Medicine | summer 2017
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An Important Message
Neurological and Mental Health Symptoms
I am determined to spread the message that, for a large group of people, gluten can have a serious impact on health, happiness, and quality of life. I’m passionate about this because I know there are people out there that are suffering needlessly, much like I was before my diagnosis. There are mothers that are too tired to interact with their kids or ache so much they can’t get down on the floor to play. There are people who are in the depths of depression who might be helped by changing the way they eat. There are relationships that are deteriorating because of the irritability and moodiness that gluten can cause. There are children that are not growing and developing to their full potential because gluten is stealing their nutrients away. Now, I’m not claiming that going gluten-free is the answer for everyone. But I am certain that it is the answer for a lot of people. I’m definitely not the only one that knows this to be true. The leading experts estimate that 97% of Americans suffering from a gluten-related disorder have no idea they have it. There are over 350 symptoms and signs of gluten sensitivity. Some of the most common are listed below.
Neurological symptoms can include chronic headaches, migraines, seizures, ataxia, peripheral neuropathy, and autistic-like behavior. Poor memory and brain fog are very, very, common. I’ve seen this improve dramatically when people are placed on a gluten-free diet. Other mental health symptoms include depression, anxiety, moodiness, irritability, anger, and ADHD.
Gastrointestinal symptoms I want you to know that people with celiac disease or non-celiac gluten sensitivity do not always have gastrointestinal symptoms. In reality, only 35% of people have diarrhea at the time of diagnosis despite the fact that most people (even doctors) believe that diarrhea must be present if you have a gluten-related disorder. I delayed my own diagnosis for at least a year because I was taught in medical school that the only gluten-related disorder was celiac disease and that celiac disease always shows up with gastrointestinal symptoms. This is simply not true. Gastrointestinal problems include diarrhea, constipation, bloating, gas, abdominal pain, steatorrhea (pale, foul-smelling stool that floats and is hard to flush), vomiting, reflux or heartburn, lactose intolerance, irritable bowel syndrome, or inflammatory bowel disease.
Nutritional Deficiencies The damage gluten causes in the gut can also cause nutritional deficiencies. We can see decreased absorption of iron and folate, which often shows as anemia. We can also see deficiencies of calcium, vitamin B12, and the fat-soluble vitamins—A, D, E, and K.
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Hormonal Issues Gluten-related disorders are known to cause hormone imbalances that can lead to premenstrual syndrome, premenstrual dysphoric disorder, infertility, hot flashes, menstrual irregularities, delayed puberty, and even miscarriages.
Autoimmune Conditions Almost all autoimmune conditions are made worse by gluten. There are many documented cases of people who were able to cure themselves of their own autoimmune conditions by following a gluten-free diet. These disorders include Hashimoto’s thyroiditis, Graves’ disease, lupus, rheumatoid arthritis, endometriosis, juvenile diabetes, multiple sclerosis, psoriasis, eosinophilic esophagitis, and 150 other autoimmune conditions.
Musculoskeletal Pain Gluten can cause or worsen fibromyalgia, arthritis, joint pain, bone pain, and muscle tenderness. Joint pain is one of the most common of all the gluten-related symptoms.
Skin and Teeth Recurrent canker sores, mouth ulcers, thinning of the hair, bone loss, eczema, psoriasis, acne, hair loss, keratosis pilaris (tiny bumps on the back of the arms), skin rashes, discolored teeth, and enamel loss can all be symptoms of a gluten-related disorder.
Growth and Weight Weight gain, weight loss, muscle wasting, short stature, developmental delay, and poor growth are all commonly seen with celiac disease or gluten sensitivity.
Energy Celiac disease and gluten-sensitivity can commonly cause chronic fatigue, hypothyroidism, and exhaustion. The road to getting diagnosed with celiac disease or non-celiac gluten sensitivity can be a long and complicated one. There are resources available to help!
Inside Medicine | summer 2017
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THE EMOTIONAL pLIGHT OF INFERTILITY:
YOU ARE NOT ALONE by: Brett Davenport, MD
“My husband and I have stopped using birth control, why aren’t we getting pregnant?” This is a common sentiment that I encounter each week in my clinic as couples struggle with a roller coaster of emotions. It comes natural for most to dream of a future with children. Because conception is a natural expectation it becomes quite frustrating and disappointing when plans do not become reality on demand. Many couples will uniquely relay to me the heartaches of a lonely struggle. As they are surrounded by friends, family, neighbors, and co-workers who conceive easily, the frequent refrain is “what’s wrong with me?” The struggle all too often becomes personal. Many approach fertility with unrealistic expectations, and still more lack an understanding of just how common infertility is. Below are a few general observations from my daily clinical encounters with infertile couples.
The Loneliness of Infertility For most couples, attempting to conceive a child is a very intimate process that is clothed in privacy…and rightly so. But because of the quiet nature of this process, those who are unable to voluntarily conceive often suffer in private as well. Infertility is spoken of far too seldom in our society, which makes those couples that are experiencing infertility feel as if they are on an island. Even more, the relationship between intimate partners is often greatly affected by infertility.
Reactions of Men vs. Women In general, men and women deal with infertility in different ways. It has been shown that women are quicker to become distressed about infertility than their male partner, and often struggle with jealousy when another person around them conceives. My experience supports this data. Additionally, both men and women tend to have lowered self-esteem if the diagnosis or perception of the problem is related to his/her body, respectively. Men frequently even deny that they could be a contributing factor until it has been demonstrated to them objectively. All of these differences place a strain on the ability of a couple to empathize with one another appropriately during a time that they desperately need each other’s support.
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Sex Strains During a couple’s struggle with infertility, it is very common to see sex become a chore rather than a show of intimacy. The mental association that a woman may develop between sex and failure may make it to where she is only interested in sex around the time of ovulation. Conversely, misconceptions about the optimal frequency and timing of intercourse in order to conceive often results in couples having intercourse much more frequently than is even enjoyable for either of them.
Misdirected Expectations I also commonly see couples who have unrealistic expectations about how soon they should conceive. If there is a reason to think that there is a problem, professional help should absolutely be sought. But if there are no physical or historical reasons to explain why fertility may be difficult, where should a couple’s expectations lie? Most couples don’t realize: • The average couple in their 20’s with no fertility disorder has around a 20% chance of conceiving each month with regular random intercourse in the absence of contraception. • The overall chances of pregnancy after 1 year of regular random intercourse in the absence of contraception is approximately 80%. • Infertility is the absence of a pregnancy after 1 year of trying to conceive with regular intercourse in the absence of contraception if you are less than 35 years old. • If you are 35 years or older, infertility is the absence of pregnancy after only 6 months while still meeting the same criteria above. • Approximately 10-15% of all couples in the United States struggle with infertility. That’s approximately 1 out of 8 couples!
We have to help each other! If you are struggling with infertility, here are some tips to stay mentally strong: • Know that it is normal to have sad and disappointed feelings. This is not something to feel guilty about, but rather a normal response to a real problem. Allow yourself to express your emotions. • Getting mentally connected and understood is a huge step toward healthy coping. Find a friend to confide in. If you have not yet told anybody but your partner about your struggle, you need to! Even if that person has not undergone infertility, they are now on the journey with you. • Find a support group: whether online or locally, this will allow you to hear of what other couples are going through or went through and will validate your emotions. It will make you feel less isolated and will empower you with knowledge. • Journaling: this has been shown to provide clarity of thought as to what you are feeling. It will allow you to understand yourself even more. • Exercise. If you do not already have one, pick up a regular exercise routine. You will find that your hyper-focus on fertility can be re-directed toward a workout, and your stress greatly reduced as a byproduct. Technology has come a long way to help couples reach their pregnancy goals so that there is much hope for those struggling. The above are just a few tips that may help couples feel less lonely and endure the emotional roller coaster of infertility. Our infertility clinic is also designed to personally assist you through this tough time. Don’t hesitate to call if we can help!
Inside Medicine | summer 2017
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Spine Center
Mechanical back pain Herniated and dislocated discs Arthritis Bone spurs Pinched nerves Osteoporosis Neck pain Spinal treatment of the cervical, thoracic & lumbar regions Spinal stenosis (narrowing of the spinal canal) Fractures of the vertebrae Muscle and ligament strain Degenerative joint disease Sciatica Scoliosis Spondylolisthesis Spinal trauma
Larry M. Parker, M.D.
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Inside Medicine | summer 2017
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The Triple Whammy of Having a Child
Back Pain and Pregnancy: by Larry M. Parker, MD
1. Pregnancy We all understand that pregnancy is associated with weight gain (20 to 35 pounds is recommended) with most of the increased weight distributed in the abdomen. This increased abdominal weight creates an increase in lumbar lordosis (the amount of arch in the low back) which can strain the joints of the lumbar spine. Pregnancy is also associated with hormonal changes that relax ligaments and joints to prepare the pelvis for delivery which can further aggravate the lower spine and pelvis.
2. Delivery After nine months of changes to a woman’s body associated with full-term pregnancy the big day arrives— the delivery! Delivery may involve a vaginal delivery or a Cesarean section. You don’t need me to tell you that having a child is a lifealtering experience for any woman. But as an orthopedic spine specialist, I do see a lot of patients in their first year after delivery who were not expecting to deal with low back pain as part of their childbearing experience. In fact, a recent article published in the Journal of American Academy of Orthopaedic Surgeons reports at least a 50 percent incidence of low back pain in first-time pregnancies. So why is low back pain such a common problem for pregnant and postpartum women? To put it simply, it has to do with what I call the “triple whammy” of having a child:
Pregnancy Delivery Childcare
1. A natural vaginal delivery involves a massive expansion of the pelvis to allow passage of the newborn through the birth canal. 2. A C-section requires surgically dividing the muscles of the abdominal wall. In either case, delivery of a full-term baby (or babies in the case of twins, etc.) is very traumatic to a woman’s body.
3. Childcare After nine months of pregnancy and the trauma of delivery, any lady deserves a vacation but in fact, rarely if ever does that occur, because usually childcare starts immediately. Most new moms have very little time to rest and recover. Eight hours of sleep is uncommon. To make matters worse, childcare usually entails new strain on your back, such as hoisting the car seat with the baby in it into the car, carrying a heavy diaper bag over one shoulder, and more. The “triple whammy” of pregnancy is a reality for most new mothers, and back pain can make the experience of having a child more challenging. Talk to your physician about how to relive back pain and ways to avoid irreparable damage. It is such a special time in a woman’s life and the less there is to “deal” with, the better.
Inside Medicine | summer 2017
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}HEALTH
How to Live to Be 100: Lessons Learned from The Blue Zones
Do you want to know how to live to be 100? Honestly, living to be 100 doesn’t interest me that much. However, I am interested in knowing how I can live the highest quality life possible until God determines my time here on Earth is done.
If the book ended here, it would be a great read, and I’d highly recommend it. However, it gets even better.
Whether you want to live long or live well, I have just finished a book that you will find inspiring. The Blue Zones tells the story of five unique regions of the world that author, Dan Buettner, has visited during his travels with National Geographic. He calls these special areas “The Blue Zones.”
I’ll touch briefly on each one, but I highly encourage you to read the book to get all the details. Some of the lessons are things you probably expect, but I think a few will surprise you.
by Traci McCormick, MD
In these five pockets of the world, an extraordinary number of individuals live well into their 100s. But what he found most astonishing about these people wasn’t just their age, it was the quality of their lives. The vast majority of these people were living full, happy, relatively independent lives. They weren’t withering away in a nursing home unable to care for themselves. They were spending their time laughing with family and friends, drinking good wine, enjoying their hobbies, and living life with purpose. Buettner wanted to know what it was about these “Blue Zones” that allowed people to live so well for so long. Why were people here seldom sick? Why was heart disease, diabetes, or cancer almost unheard of in these communities? How were these people still thriving at an age that most people are already dead? The book follows Buettner’s travels to the five “Blue Zones”: Sardinia, Italy; Okinawa, Japan; Loma Linda, California; Hojancha, Costa Rica; and Ikaria, Greece. Each “Blue Zone” has its own chapter in which Buettner recounts his visits to each community and tells the stories of the people he met along the way. There are dozens of interviews with centenarians (people in their 100s) which will inspire you to take a good long look at how you are living your life. 28
Inside Medicine | summer 2017
How to Live to Be 100 Buettner was able to determine what these communities had in common that explained their excellent health and longevity. He talks about each in detail and breaks them down into nine lessons that he calls “Your Personal Blue Zone.”
Lesson 1: Move Naturally The first lesson is to be active without having to think about it. People in all five “Blue Zones” are active as part of daily routine. Most walk a lot, garden, or find another way to make exercise a natural part of their day. Lesson 2: Hara Hachi Bu The second lesson is this Confucian-inspired saying means “stop eating when you are 80% full.” Each “Blue Zone” has a philosophy similar to this that encourages them to eat in moderation. They enjoy and celebrate food, but they do not eat mindlessly, and they stop eating when they are no longer hungry. Lesson 3: Plant Slant The third lesson is to avoid meat and processed food. People in the “Blue Zones” eat simple diets consisting of grains, fruits, nuts, beans, and vegetables. They eat things that grow from the ground they tend. Meat is only for special occasions, and they never eat processed foods. Lesson 4: Grapes of Life Lesson number four is to drink alcohol regularly and in moderation. The people living in the “Blue Zones” relax with red wine, sake, or other local spirits each day. But, it is always just a glass or two.
Lesson 5: Purpose Now The fifth lesson is to take the time to see the big picture and wake each day with a sense of purpose. Centenarians in the “Blue Zones” still have daily goals and ways they still contribute to their communities. Lesson 6: Downshift Lesson number six is to take the time to relieve stress. Each of the “Blue Zone” communities has daily or weekly rituals which allow them to disconnect from being busy. They slow the mind. They relax with family and friends. Lesson 7: Belong Lesson seven is to participate in a spiritual community. All of the “Blue Zone” centenarians have deep faith and belong to active religious communities. The Sardinians and Nicoyans are Catholic. The Okinawans have a blended religion. Ikarians are Greek Orthodox, and most people in Loma Linda are Seventh-day Adventists. Lesson 8: Loved Ones First Lesson number eight is to make family a priority. In the “Blue Zone” communities, centenarians have a strong sense of duty when it comes to family. They live close together and have established family rituals or traditions. Shared meals and activities play an important part of their everyday lives. Lesson 9: Right Tribe The last lesson is to surround yourself with people that share “Blue Zone” values. These people are your tribe. “Blue Zone” communities have close social circles that they count on in difficult times and with whom they create strong bonds of friendship. Live Long and Live Well in Your Own “Blue Zone” If you have any interest in living long and living well, I encourage you to pick up a copy of this book. It’s full of valuable information and inspiring stories. After you read it, share your ideas of “Blue Zone” communities with others. For more information visit Traci’s blog at tracimccormickmd.com
100 years old
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}MISSIONS
by Regina Mobbs, R.N.
Lean Not
On Your Own Understanding As a candy striper at the age of 14, I knew that my place in life was to be a nurse. I found a sense of purpose when I entered a hospital or medical facility and knew that God was calling me to serve in that field. I made a vow to God while in nursing school that if He would get me through, I would serve Him in any way He saw fit. Since that time I have traveled internationally and domestically serving Him in medical missions. Each trip I’ve taken has brought me a little closer to Him and His sovereignty, His purpose, and His plan. A few years ago while planning for a trip to Guatemala, other nurses and I were gathering supplies and medications to take for our medical clinics. I always found myself in awe of God’s provisions for each trip I had taken and this one was no different. The multiple boxes and bottles of vitamins, pain relievers, fever reducers, and GI meds had been abundantly donated. Of course the restriction on the weight of luggage placed by the airlines limited our ability to take the donations in their original containers. I, along with the other nurses would work our day jobs, care for our families and then before bed, we would each count out individual doses of the medications from their containers and place them in their own zip top bags and label them. This allowed us to pack many more medicines since the original packaging was bulky and heavy. I often saw bottles of Tylenol and Ibuprofen tablets as I drifted off to sleep. Counting thousands of pills for several weeks prior to our departure was tiresome, monotonous, and time consuming. You can imagine my surprise when a sweet little old lady from church came to me one Sunday and handed me a large garbage bag full of medicine bottles that she had laboriously saved, cleaned, and made label free. While keeping a grateful smile on my face I was thinking to myself, “how am I going to tell her I can’t possible fit those bottles into our luggage”? After all, I had just spent weeks counting pills into small baggies to eliminate bulky bottles. I accepted her gift of 100 medicine bottles and prayed I would find a way to pack them. As luck would have it,
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Inside Medicine | summer 2017
Trust in the LORD with all your heart and lean not on your own understanding; in all your ways sumbit to him, and he will make your paths straight. Proverbs 3:5
the same Sunday at church an older man approached me to give me 100 insulin syringes. He said “I know there must be someone who needs these in Guatemala and I want to donate them”. There I was again, forced to smile and extend gratitude for something I knew I would have a challenge getting to Guatemala. As the time approached for us to pack and depart, I managed to squeeze a bottle here and there and tuck in the syringes in various places as well. My shoes and socks had syringes in them and the pockets of my clothes all held medicine bottles, all along thinking it was a useless task. When we arrived at our mission site we gathered for planning, prayer and to set the agenda for the week. We had planned 4 clinics for the people there and would simultaneously hold Bible stories and crafts for the children. The missionaries shared how the greatest challenge in the lives of the people there was clean water for drinking and cooking. They went on to share that the people did not often have the resources to boil the water, nor did they have the means to purchase water purifiers, filters, or bottled water. The missionary then shared how they had tried to teach the people to put Clorox in the water to purify it because it did not involve having electricity or fire to boil and it was accessible to all. The problem was that they didn’t have the money to buy the Clorox. Well you know how the Holy Spirit just falls all over you and opens your eye to His plan? That’s when it hit me. We can put Clorox in the medicine bottles and give each family a bottle and a syringe. Our time in Guatemala was then spent holding classes about proper hygiene and handwashing, along with sharing the gospel. We showed the people how to use the insulin syringe to draw up .2 cc’s of Clorox and drop into 2 liters of water and allow it to sit for 6 hours to kill all of the unseen parasites and make it suitable for use. We were able to give 100 families the means to purify their water and take one step closer to healthier living. While we had the attention of the people we used the analogy of how we can’t see the sin in our lives but we know it’s there. We can’t expect to continue to drink and cook with dirty water and expect not to have a poor outcome and illness. That’s how sin is in our life. It’s in many of our actions, words, and works and we don’t often realize it. We used the opportunity to share how we can be delivered from the illness of sin and the consequences of sin. Following up with the revelation that only the blood of Jesus can purify us. I’ve reflected on that experience many times. Often when I am given an insurmountable challenge, something tangible for no known reason, or find myself having an unexpected encounter with someone, I think about all of those medicine bottles and syringes. I have to remind myself to “not lean on my own understanding” but know that He will direct me as long as I seek Him and His purpose. Proverbs 3:5-6 Lean not on your own understanding, but in all your ways acknowledge Him and He will direct your path. Regina Mobbs, RN Missionary Nurse Liaison for Baptist Nursing Fellowship www.mwu.org/BNF
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Your Vision Is Worth Protecting by Dr. Neena Singhal James, Optometrist
Many of us take the proper precautions when it comes to financial security, home security and the safety of our families, but what if you were already having something stolen and you didn’t even know it? Many ocular diseases, left untreated, may be slowly “stealing your vision”. This theft may be slow and unnoticed, but the damage can be irreversible. Ocular diseases are not uncommon; people with “perfect vision” can also be susceptible without any symptoms or forewarning. When caught early, many ocular diseases can be managed by less invasive treatment such as eye drops and vitamin therapy at the discretion of an eye doctor. The health of our eyes is something that is often taken for granted. Working with my patients and my time volunteering at the Perkins School for the Blind, I have been able to see first-hand how devastating and life changing vision loss can be. Vision loss
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can also often impact the entire family’s way of life and quality of life in many ways. Glaucoma affects over 3 million people in the United States. This disease can first take the peripheral vision, making daily tasks such as driving a car, working, and active sports and hobbies nearly impossible. Macular degeneration causes distortions in your central vision making watching TV, reading a book, or simply eating dinner difficult tasks to overcome. Children cannot always tell us what is wrong and often times signs are very difficult for parents to detect. Diseases like Amblyopia, also known as “lazy eye”, can result in uncorrectable vision loss if not treated during early childhood. A simple check-up can result in detection and help. During dilated eye health exams, doctors are able to see ocular diseases such as glaucoma and macular degeneration as well as detect cataracts, dry eye disease, retinal detachments, signs of diabetes and even hypertension. Imagine how your world would be changed if your vision was compromised. Don’t get left “in the dark”! Make sure to take time each year for a simple visit to your eye doctor. Isn’t it worth taking some security measures to protect your eyes?
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Call us today to SEE what you’ve been missing HUNTSVILLE: GUNTERSVILLE: 256.533.0315 256.582.1211 www.maynorandmitchell.com Inside Medicine | summer 2017
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} PERSONAL INTEREST
The Power of Prayer John and Cara Greco are both physicians in Huntsville. Dr. John Greco is a Sports Orthopedist with TOC and Dr. Cara Greco is an anesthesiologist at the Surgery Center Huntsville.
by Dr. Cara Greco
It’s amazing how your world can stop spinning in a single moment. All the hectic, hustle and bustle of our busy lives just comes to a halt when you are facing a major health crisis with a loved one. Especially if your loved one is your child. I remember that moment very well. It was April 4, 2004. Our youngest child, Cole, was a normal rambunctious five- year old boy. He was always outside playing, climbing trees, riding his bike and throwing the football. He had just started T-ball that spring. We had noticed during one of his practices that he seemed to be running a little strange. He didn’t complain of any pain. His dad performed a thorough orthopedic exam and found nothing wrong. We thought maybe he was just going through the normal stages of a growth spurt and decided there was nothing to worry about. We paid close enough attention and John examined him every few days, but he had no complaints or obvious abnormalities. A few weeks later, he started having a slight limp. Again, he had no complaints of pain. On that fateful April day, I picked him up from preschool and noticed the limp seemed more pronounced in just walking to the car. I was sure there was nothing to worry about, but just to be certain, I took him to his dad’s office and asked for an X-Ray of both hips and legs. I was not prepared for what it revealed. Cole had a very large defect in his right hip. It was so large that he had little hip joint remaining. The X-Ray couldn’t tell us what process was causing the defect, just that his hip joint was almost gone.
didn’t know if it was benign or malignant, but we knew that our sweet boy would not walk again for at least 3 months. In surgery, the defect was found to be a unicameral bone cyst. This type of cyst is benign, but can still grow aggressively, displacing normal compact bone with fluid. Cole’s cyst was extremely large and located in the neck of the femur, which put his hip joint at risk. It was so large in fact, that Dr. Killian said he was steps away from having total collapse of his hip. We were so thankful that it was benign, but we still had a long road to recovery. Cole was placed in a body cast for six weeks, then in a wheel chair for another four weeks, then needed a walker for another three weeks. Telling a five -year old boy that he couldn’t walk for three months was very painful, but Cole never complained. His positive, loving spirit was an inspiration to us all. He even tried to comfort me. I will never forget the time that he grabbed my hand and said, “Mommy, don’t worry. I’m going to be OK.”
“Mommy, don’t worry. I’m going to be OK.”
My first action after driving home and settling Cole down for a nap, was to fall to my knees and pray. John was in the middle of an operation in Scottsboro when I called to tell him what the X-Ray revealed. He also sat down, bowed his head and prayed. I will never forget that despite both of us being physicians, with immediate access to medical care, radiology equipment, and orthopedic specialists, we both turned to our Lord first. The next 24 hours was heart wrenching. Afte r consulting with Dr. Ken Jaffe and Dr. John Killian in Birmingham, it was decided that Cole needed immediate surgery to stabilize his hip and determine what this process was. At this point we
The outpouring of love and support from our family and friends sustained us through that time. We had multiple prayer groups and churches praying for Cole. We even had a prayer group from a church other than our own come to our home to pray by Cole’s bedside. His sweet friends came to visit often. Cole healed over the summer and started kindergarten on time with the use of a walker. Unfortunately, the cyst would come back twice over the next five years. Each time Cole had to undergo surgery again, and be non- weight bearing for weeks, requiring him to use a wheel chair and crutches. But, he never complained. After 5 years, the cyst finally quit reforming and we were able to stop the constant worry and follow-up X-rays. Today, he is a strong, athletic teenager who plays football and baseball. He barely remembers his ordeal. We will always be grateful for the support and love received from our family and friends, and most of all, for God’s precious gift of healing.
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What’s Your Financial Blueprint? Don’t let finances STRESS YOU by Kevin Fernandez Don’t STRESS . . . by Kimberly Waldrop Your overall health can certainly be affected by stress. Stress can be caused by relationship struggles, workload, diet, and other things. One of the main causes of stress in our society is financial worries. Chances are, at some point, you have/will experience some level of financial stress. It can cause ulcers, headaches and heart attacks. If you consume your thoughts with how much money you have, how you are going to pay a bill, or feed your family; you can develop stress-related health conditions. These conditions do not need to go unnoticed or untreated. The first step in getting the financial stress under control is to tackle it head on. Being concerned with your finances and getting a handle on them will help your worry and ease your mind. Therefore, the stress you are feeling should diminish. Our friends at Fernandez Financial Group have offered some tips to help deal with finances. We hope these ideas help you control any financial stress and moreover, help you have a healthy life.
What Is Your Money Blueprint? 5 Habits for Building a Blueprint for Financial Success For the past 6 years, I have been helping clients take the right steps toward financial freedom. A big part of my job is to help them make the right decisions with their money. I’ve helped people from all paths of life - people who are starting out their careers, just gotten married, just had kids, and people on the other end of the spectrum who are retired or are ready to retire, who are empty nesters or may have had their kids graduate college and come back home (which seems to be normal nowadays). I’ve helped people that earn $50,000 per year and I’ve helped people making over $1,000,000 per year. What I’ve found is that those on their path toward achieving true financial freedom or those who achieved true financial freedom, have done it with a very simple reason - excellent money habits. Right now, your bank account balance and your retirement account balance are a result of your habits. Are you a spender or a saver? Do you follow a strategic plan with your money? If you’re right where you’d like to be financially, that’s excellent! If you’re not, maybe you should allow me to suggest that there are some productive money habits and/or some knowledge you may be lacking. I want to give you some ideas that I wholeheartedly believe can improve your financial life immediately…if implemented.
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Habit #1: Set Solid Financial Goals It may seem obvious to some, but this is absolutely critical. We all have goals whether we admit what they are or not, whether we’ve written them down or not. If you don’t take the time to figure out what true financial freedom means to you, how will you know if you’re on the right path? Everyone has a different definition of success and the same goes for financial success. Once you set your long term goals, make a decision to get started right away. Why? - Compound interest. Compound interest will work its magic in your favor; and the sooner you get started, the more powerful it will be for you. By having solid financial goals, you’ll have a reason to stop yourself from spending all your hard earned money today. Decide what true financial success means to you, and then think about how good it will feel when you achieve your goal; but also think about how painful it will be if you don’t achieve your goal. This will help you stay motivated and disciplined!
Habit #2: Pay Yourself First One of the best possible habits I’ve seen in financially successful people is the habit of paying themselves first. From every paycheck you receive, you should allocate a certain percentage towards your financial goals. Try starting with 10% of every check. If that’s truly not possible for you right now, start with whatever you can afford and build the habit of paying yourself first starting right now! If you’re already saving 10%, then stretch yourself and take it up to 15% or 20%. If your income doesn’t permit this, then find a way to increase your income. You should always be looking for ways to increase your income to match that of the lifestyle you truly desire. There’s nothing inspiring about setting low goals just to stay within our means. Now, it’s obviously important to be financially responsible, so I’m not saying that you shouldn’t live within your means; but, what I am saying is that you need to decide what you truly want and figure out a way to earn the necessary income to achieve your desired lifestyle
Habit #3: Create a Budget and Be Disciplined Once you have the end goal in mind, it’s time to create the roadmap that will get you there. This is much easier to do once you have goals and know what’s most important. You’ll be able to see where your money has been going and whatever doesn’t align with your goals can be adjusted. You can eat out less or travel less for a limited time. Again, you should always be looking for ways to increase your income. As your income increases, you will be able to allocate more money to certain things while still staying on track toward your financial freedom.
Habit #4: Build an Emergency Fund If you’re like most people, unexpected expenses happen rather regularly. Maybe there was a storm and you had some roof damage, or the AC unit broke down, or you got a flat tire, etc. All these things, however big or small they may seem, tend to add up. If you don’t have an emergency fund, you will end up having to borrow to cover these unexpected expenses and that can be costly. Credit cards can charge in excess of 20% for borrowed money, and that will be a lot of unnecessary interest you will have to pay that could have otherwise gone toward your financial goals. A small tip that I would like to give you from personal experience is to keep your emergency fund away from where you keep your checking/savings account. Why? Because with technology nowadays, it’s so easy to transfer money from your savings account to your checking account (if they’re within the same bank) on your phone. This makes it easy for people to use their “emergency fund” money for impulse purchases that they shouldn’t make. If you need to keep an item you didn’t need at a store for 3 days while you’re waiting for your money, chances are you will not go back for it and make the logical decision that aligns with your financial goals. Emotions can hurt your financial goals when you make an impulse purchase decision, so why not protect yourself from yourself by making it harder for you to access your emergency fund? While you can still get your money quickly, transferring the money from one institution to another may take 1-2 business days, which may be long enough for you to get over wanting to make that unnecessary purchase.
Habit #5: Make Logical Investment Decisions While this may sound overly simplistic, this is the biggest mistake people make when investing for their long term goals. Why? It’s simple - emotions. We all know that the secret to making money in the markets (Stock Market/Real Estate Market) is to “buy low and sell high” - to buy when the value of the stock or the property is down and sell it later when the value is up so you make as much profit as possible. However, not many people follow that advice over the long term. When the market is going down, people experience fear; therefore, they do not want to put money into the markets, and a lot of people actually get out of the market which is a big mistake since they’re “selling low.” On the other end, when the market is high and doing great people get excited and buy more. Buying more is not necessarily wrong, but remember that when the market is doing well you’re “buying high.” A simple way to make logical decisions is to use what’s called “Annual Asset Re-Allocation.” Let’s say you chose to invest your money 50% in stocks and 50% in bonds. If the market has done well, it is possible that by the end of that year your account may look more like 60% stocks and 40% bonds. Using this method, you would sell off the profits from the stocks (selling high) and invest that money in the bonds portion, bringing your asset mix back to 50/50. Conversely, when the stock market has gone down, your portfolio may look more like 40% stocks and 60% bonds. You would take 10% of the money from the bonds portion and invest it in the stocks portion (buying low) to bring your asset mix back to 50/50. Follow this approach over the long term and don’t try to time the market. Remember, it’s not about timing the market; it’s about time in the market.
Make sure to implement and build these 5 habits into your life starting right away and see how your finances change over the next few years. No matter what life throws at you financially, you will have peace of mind and confidence because your financial house has a very strong foundation. Having this foundation can also ease any financial stress you could endure. A healthy life and a healthy financial picture go hand in hand. If we can ever be of help to you with any of your financial goals, please can contact us. We would love to help you!
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“Yersinia pestis bacteria on the flea” Photo credit: Centers for Disease Control and Prevention website: https://phil.cdc.gov/phil/details.asp?pid=18130
The New Arms Race: superbugs by Nemil Shah, M.D. Death; quite often the result of once common bacterial infections. Over 20,000 deaths can be attributed to people infected with bacteria that do not respond to antibiotics. Bacterial machinery and human defenses are at an all-time epic battle. Just as quickly as humans find defenses against their pathogenic adversaries, these bacteria mutate and become resistant to common antibiotics that are used to treat them. More and more bacterial species, and even fungal species such as yeast, are finding mechanisms of resistance to treatment options. Therefore, the so called “super bugs” are becoming more prevalent. Who is to blame for the birth of these killers? We are all responsible for the rise of these multi-drug resistant bacterial pathogens from years of misusing antibiotics. This includes the over or under dosing of the medication, using antibiotics for viral illness such as the common cold which do not respond to antibiotics, or not finishing the
recommended dosing schedule prescribed for the illness. What can we do to help fight in this arms race? As humans, we need to educate ourselves on appropriate uses for antibiotics. As physicians, we need to be more judicious in prescribing them and helping patients understand the different symptoms commonly due to viral illnesses versus bacterial illness. For example, a simple cough and sinus congestion DO NOT initially warrant antibiotics. If the symptoms continue for 7 days or worsen with yellow/ green saliva/mucus with fever, only then do antibiotics become a reasonable option. Having the artillery to combat sickness is comforting. However, let’s refrain from dropping bombs on our friendly invaders when we can help it. Who do you think is to blame for our growing bug drug resistance problem? Those who demand the antibiotics or those who prescribe them?
* DID YOU KNOW: More germs are transferred shaking hands than kissing. 38
Inside Medicine | summer 2017
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Rehabilitation by Donald Lewis, LPTA
When recovering from an injury, disease, illness or surgical procedure, rehabilitation is a major step in achieving optimal health for the patient. The goal for patient rehabilitation is to gain and restore sensory and mental capabilities, as well as motor skills lost. Rehabilitation for patients includes the evaluation and diagnosis of need for short or long-term care. The consult is generated after certain types of injury, illness, or disease, including amputations, arthritis, cancer, cardiac disease, neurological problems, orthopedic injuries, spinal cord injuries, stroke, and traumatic brain injuries. The Institute of Medicine has estimated that as many as 14% of all Americans may be disabled at any given time. The definition of rehabilitation is a treatment or treatments designed to enable the patient’s recovery and consists of restoration of the patient’s physical, sensory, and mental states to compensate for deficits that cannot be reversed medically. Rehabilitation should only be carried out by qualified therapists. Patients and their physician must take into account any and all deficits the patient may present. Rehabilitation addresses the patient’s physical, psychological, and environmental needs. It is achieved by restoring the patient’s physical functions and/or modifying the patient’s physical and social environment. Types of rehabilitation include physical, occupational, and speech therapy. Patients seeking rehabilitation should have a tailored program designed to address the individual patient’s needs. The program can include one or more types The plan for patient of therapy, depending upon the deficit and desired outcome. The rehabilitation is to gain patient’s physician coordinates the efforts of the rehabilitation and and restore sensory, consults with team members on the physical, occupational, speech, or other therapeutic teams to establish consistency and the highest mental capabilities, quality of care. Many referring physicians compose a team of nurses, and loss of motor skills physiatrists (physical medicine), psychologists, and/or orthotics (indue to injury, disease dividuals making devices to straighten out curved or poorly shaped or complication. bones such as a prostheses) to coordinate the rehabilitative needs of the patient. In keeping with a physician’s commitment to assure optimal patient care, specialists in physical medicine and rehabilitation are consulted. Physical therapy helps the patient restore the use of muscles, bones, and the nervous system through the use of heat, cold, massage, whirlpool baths, ultrasound, exercise, and other techniques. It seeks to relieve pain, improve strength and mobility, and train the patient to perform important everyday tasks.
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We move people by helping them move. We hear people by helping them speak. We touch people by helping them hear.
WE CHANGE LIVES. This is our passion.
continued from pg. 40
Physical therapy may be prescribed to rehabilitate a patient after any of the disease, injury or illness described previously. The duration of the physical therapy program varies based upon the deficit being treated and the patient’s response ttherapy. Exercise is the most widely used and best known type of physical therapy. Depending on the patient’s condition, exercises may be performed by the patient alone or with the therapist’s help, or even with the therapist moving the patient’s limbs. Exercise equipment for physical therapy could include an exercise table or mat, a stationary bicycle, walking aids, a wheelchair, practice stairs, parallel bars, pulleys and weights. Heat treatment, applied with hot-water compresses, infrared lamps, short-wave radiation, high frequency electrical current, ultrasound, paraffin wax, or warm baths, is used to stimulate the patient’s circulation, relax muscles, and relieve pain. Cold treatment is applied with ice packs or cold-water soaking. Soaking in a whirlpool can ease muscle spasm pain and help strengthen movements. Massage aids circulation, helps the patient relax, relieves pain and muscle spasms, and reduces swelling. Very low strength electrical currents applied through the skin stimulate muscles and cause them to contract, helping paralyzed or weakened muscles respond again. Occupational therapy helps residents regain the ability to perform daily tasks. This can be achieved by restoring previous skills or teaching new skills to adjust to disabilities. Adaptive equipment, orthotics, and home modifications are tools that occupational therapist use to help residents adjust. Adaptive equipment can be used to improve self-care tasks, for instance bathing, grooming, and dressing. Occupational therapy can evaluate a resident’s home and mobility needs. After the evaluation, recommendations and assistive devices are provided to improve the resident’s safety. The duration of occupational therapy varies depending on the disability and how the patient responds to therapy services
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Speech therapy aims to provide interventions to improve and maintain patient’s communication skills with treatment targeting cognition, speech, language, hearing, and voice with a variety of population groups including patients who have experienced traumatic brain injury, stroke, patients with degenerative neurological diseases, dementia, head and neck cancer, etc. Additionally speech therapy services provide swallowing interventions to strengthen and coordinate oral, pharyngeal, and laryngeal muscles for safe swallowing and decreased risk of aspiration. Therapy activities are designed to improve functional communication skills and swallowing using a variety of tools ranging from use of augmentative/alternative communication devices, techniques for improving memory, strategies to aid with intelligible speech, adjusting patient’s diet to decrease aspiration risk, use of neuromuscular stimulation in combination with strengthening exercises for improved swallowing, etc. Speech therapy collaborates with dieticians, audiologist, nursing staff, and other therapy team members to gain a holistic perspective to patient healing and progress. Audiologists help diagnose the patient’s hearing loss and recommend solutions. Dietitians provide dietary advice to help the patient recover from or avoid specific problems or diseases. Rehabilitation services are provided in a variety of settings including clinical and office practices, hospitals, skilled-care nursing homes, sports medicine clinics, and some health maintenance organizations. Some therapists even make home visits. Advice on choosing the appropriate type of therapy and therapist is provided by the patient’s medical team. Note: Information in this article was found online in the Medical Dictionary and the website for SportsMED Orthopaedic Surgery & Spine Center.
Life is full of peaks and valleys...
Where you can view a valley as your peak to recovery.
WE CHANGE LIVES. This is our passion.
The hard knock life by Kari Kingsley, MSN, CRNP
Slowly peeling the label on my grande iced vanilla latte, sitting across the table at Starbucks from an attractive, 24-yearold financial advisor, I underestimated the emotional response I would have to the story he was willing to share. In a society where first impressions are everything, many times we are only able to appreciate the tip of the iceberg known as the “human spirit”. After meeting Will Steward, you would never guess that, just under a year ago, a skateboarding accident significantly affected this 23-year-old’s life and appearance. Will Steward comes across as an endearing and intelligent conversationalist with a zest for life that would rival most dare-devils. He currently works for Raymond James and Associates as a financial consultant, or “financial architect”, as he likes to tell his clients, helping them to design and build their futures. He loves chocolate milk, surfing, cutting grass, doubles sand volleyball, Taylor Swift, Donato’s pepperoni pizza, and cultivating relationships with people. He does not like shots or “pointy things that poke him” (luckily he didn’t realize I was a nurse practitioner until after our interview concluded), camel crickets, Instagram, and self-absorbed people. Will was quick to tell me he loves Mondays. I rolled my eyes and blurted out, “Who says that??” His motto is “attitude is everything” and he is grateful for the opportunities and possibilities that each week holds. He seems like a pretty regular guy, right? But there is so much more beneath the surface of the iceberg. June 16, 2016 everything changed for Will. During a downhill longboard run (longboards are similar to skateboards for those of us less athletically inclined), Will lost control of his board. He suffered a traumatic brain injury in which he struck the back of his head on the pavement causing multiple frontal, parietal and occipital fractures, as well as a left frontal subdural hematoma and bilateral frontal contusions. The injury caused extensive brain and neurologic damage. Will was bleeding from his nose, ears, and mouth as HEMSI carried him to our nearby level one trauma center. Upon arrival, he was diagnosed with a severe head injury, giving him the worst possible long-term prognosis. After 10 hours in Huntsville Hospital’s Neuro ICU, the pressure in his skull began to 44
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rise uncontrollably. Will’s neurosurgeon, Dr. Jason T. Banks later said, “A life-saving operation was an option to try to save his life, but could also allow him to survive in a neurologically devastated state. The possibility that he may never wake up or have a meaningful recovery was imminent.” Dramatic television shows containing this heavy content can be gut-wrenching to watch. But this wasn’t a TV show. This was a 23-year-old son, brother, and friend whose loved ones were all too aware that if he were to somehow miraculously survive, he would likely be mentally impaired for the remainder of his life. Take a deep breath and slowly play back your most favorite memory. How old were you? What scents, sounds, and sights do you recall? My favorite, most peaceful memory is frozen in my brain, as if it were painted on an oil canvas. I am lying on the pier at our family lake house in Waterloo, Alabama, surrounded by the people I love the most. I can smell the sweet but pungent river water as the hot sun bounces off my skin. My younger brother is telling a snarky joke and my parents and I are laughing. I was 26. I might have missed this memory if I were in Will’s place. At 23 years old, Will had not yet even begun to live. And his life nearly ended. Until finally he woke up July 3, 2016. His first memory was his Dad saying, “See this on my face?” pointing to his smile. “You’ve been given a gift most people will never get.” This gift was in the form of a miracle, a blessing, a phenomenon. Whatever words you choose to call it, the merry-go-round of life had decided not to throw Will off. His accident left him in a coma for nearly 3 weeks at Huntsville Hospital’s Neuro ICU. He has a very vague account of the accident and the weeks following. When I asked him to describe his most terrifying moment in this horrendous ordeal, he smiled and said, “I don’t remember a lot of fear from this. I’m not trying to sound macho, but I only saw more life”. He recalls flirting with nurses and eating full meals early on, even though his doctors told him he wouldn’t have an appetite. His first day in recovery, Will didn’t realize he was a patient. He passed out business cards and even became slightly belligerent with a nurse who wouldn’t bring him his keys and phone so he could go home. To control the swelling in Will’s brain, Dr. Banks of Huntsville Hospital’s Spine and Neuro Center performed a
craniectomy to control the massive intracranial pressure. Will had severely fractured his frontal bone which was removed and pieced back together, then placed in a storage freezer until it could be reattached after the swelling had subsided. During the reconstruction, the previously removed craniotomy flap was replaced with titanium screws. At this meeting with Will, my ever present foot-in-mouth personality joked, “Oh, so you have a few screws loose?” Will took my hand and pressed it to his right temple where I could feel a small but definite indentation. He politely said, “I assure you, my screws are fully tightened.” Where most of us might shrink into our obscure lives, merely grateful to be alive, Will awoke with a newly invigorated passion to live. Instead of wallowing in self-pity over facing reconstructive procedures, losing his sense of smell, and dropping nearly 40 pounds from his athletic frame, he considered his accident a blessing. Will’s near-death experience encouraged him to create Flatline Surf Company out of his vision for a fearless and persistent pursuit of life. His mission: “All of Flatline’s hand-crafted boards and products carry with them a reminder to use life’s difficulties as an opportunity to overcome adversity through a spirit of adventure.” All Flatline products are made in America. Will has also created the Flatline Foundation at Huntsville Hospital, dedicating 5% of his company’s profits, in addition to other donations and fundraiser proceeds, to traumatic brain injury research, as well as giving back to the Huntsville Hospital employees who were instrumental in saving his life. Although Will’s sheepskin degree comes in the form of a Bachelor’s in Finance from Mississippi State University, no one can argue he’s graduated summa cum laude from the school of hard knocks. Will struggled after the accident to rebuild his mental and physical deficits. He recalls that his muscles had not relearned the speed to which his brain was asking them to perform. He spent months in rehabilitation facilities and the gym to overcome his obstacles. He jokes, “It’s easier to have ‘will-power’ when Will is in your name”. Will would make a remarkable motivational speaker. For example, my first impression of him (which as I previously mentioned, in this world, can be everything) was that in our first encounter he was accidentally running 5 minutes late. He apologized, saying, “I went to the wrong Starbucks. Inside Medicine | summer 2017
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Who is Actually Responsible by Tiernan O’Neill
The current state of health care and the business realities of the industry have seen an ever-increasing list of certain policies enacted at many offices in recent years. These policies can often come across as strict, inconvenient or unwelcoming to many patients. These rules and regulations are more readily seen in smaller private office settings. Prior to any individual throwing an absolute fit aimed at the office or more specifically the staff enforcing such policies, it would be best to better understand the background and possible necessity of such rules. The first root of many office policies in fact stem from the unfortunate history and lessons learned from previous patient encounters. Methods by which offices deliver health care in the most efficient and conscientious way possible can often be obstructed by difficult, unreasonable or unruly patients. After such circumstances and upon further review, typically the physician and management of the office will collaborate to develop policies in the future to avoid similar problems of a specific encounter or pattern of encounters. These policies are usually well thought out and tough to adopt, as no office wants to create lists upon lists of restrictions in providing health care. Often it is also unfortunate these general blanket type changes have to be made due to isolated incidents. But they are enacted primarily to avoid repeated, disruptive and threatening events experienced in the past; it really often boils down to a classic example of a few bad apples always ruin it for the bunch. The second cause and genesis of many office policies is the office and physician are being unreasonably expected to meet demands dictated by insurance companies or others in the health care environment. Often mandates or expectations are thrust upon those providing the actual health care which they have never agreed to or have even been included in the decision making process. Typically the expectations cause major disruptions to well es46
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For office policies tablished office operations and also excessive burden to its time and resources. As a result, you will see office’s either unwilling to comply to expectations created but never agreed to by third parties, or more so generating additional fees and costs they will transfer on to the patient. Again, no office or physician wants to add a never ending list of additional fees to the delivery of health care as we are all too aware of the increasing cost patients encounter in receiving affordable treatment. There is one additional perceived cause of such policies, which should be adamantly debunked. That is these office policies and subsequent enforcement are generated by and the responsibility of the office staff. It is rarely the case that general staff members are ever responsible for such rules and restrictions. This is an important fact to understand as too often it is these such employees who are left to follow, enforce and receive the ire of patients when they are unhappy with such policies. Unfortunately too often patients or other individuals take out their frustrations on employees who are simply doing their job and have no way in waiving or changing office policies ordered by their employer. Furthermore, many of these hostile encounters can cause strained relationships with patients and for the most part staff who are dedicated and well intentioned in their role in delivering excellent health care. Possible solutions to the above would be the following suggestions. First fully understand where such policies come from. Second, empathize and reason whether these are necessary policies. Third, provide reasonable feedback to appropriate management or physicians. As mentioned before, these policies are typically well thought out and good intentioned. But having said that it is possible they have unintended consequences and may need to be altered or removed entirely. The majority of physicians and management professionals I have come in contact with are always
willing and eager to receive such feedback, cooperation and input from patients. But a caution should be to all there is little entertaining, progress made or ultimate satisfaction ever gained from treating staff not responsible in such decisions as whipping posts for those to take out their frustrations.
RESPECT
is everyone’s responsibility
Patients Visitors Workers Doctors
continued from pg. 45
Forgive me, I had a brain injury.” You’d never know it to meet him. Because as I said, we so often only see the tip of the iceberg. Will is articulate and well-spoken. His zeal and passion for life are contagious. After spending 2 short hours with him, I walked away feeling better about life with more happiness and hope for the future in general. Will’s motto is “attitude is everything”. His other motto is to “recover quickly and recover with strength”. People like Will are examples of life winking at us, telling us to shoot for the stars and to be happy when you land on the moon. I asked him, as a motivational speaker what would you tell your audience? He responded, “Life’s biggest blessings come from our biggest challenges. Fly through life. But it’s probably better to do it with a helmet on.” Writing this story provided many twists and turns for a novice journalist like myself. As my first human interest piece, it became crucial to me that I nail this article… knock it out of the park, so to speak. Will reminded me that the beauty in life is in the imperfections. No one really likes perfection. It’s boring. I’m reminded of the Japanese form of art known as kintsukukuroi that repairs broken pottery with lacquer resin mixed with powdered gold, silver, platinum, copper or bronze. Instead of concealing or hiding the cracks and damage, they accentuate it. This philosophical theory is similar to wabi-sabi and is a concept that discovers beauty in the imperfections and yet also
accepts the natural cycle of life and death. Leonard Cohen tells us, “there is a crack in everything and that is how the light gets in.” Perhaps when Will cracked his skull, he was given a gift, allowing more light to shine through.
Will Steward 256.517.1703 (Raymond Jones Office) 256.542.8195 (c) will.steward@raymondjames.com
“Kari Kingsley, MSN, CRNP is an otolaryngology nurse practitioner and medical writing consultant for Inside Medicine who enjoys writing articles on pertinent material to keep the residents of North Alabama up to date on the forefront of medicine.”
Inside Medicine | summer 2017
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Inside Medicine | summer 2017
DREAM BIG Chapter 1:
Dream-walking, the start
by Nemil Shah, M.D.
Steve Jobs once said, “The people who are crazy enough to think they can change the world are the ones who do.” Everything we see in the world around us has been created by people who believed it possible. The majority is comprised of naysayers. The thinkers, the dreamers, and the DO-ers represent such as small fraction of all of us. Most people wait until their head rests comfortably on their pillow tops to dream big. We all have dreams or thoughts to make life a little bit easier, a little bit better. I’m not any different. One of my mother’s fondest memories of my childhood is asking her “Mom, everything already exists, what is left for me to invent?” Nearly three decades later I still hear her proudly retelling the story at community dinner parties, “there is a lot in this world that is left to invent and you still have a lot of time to think about those things, Nemil.” It seems even as a child, I dreamed to discover and make things just a little easier. The nurturing and influence of my parents and my older sister led to a successful graduation from UAB’s prestigious medical program. However, like many of us, I still found myself dreaming to reach my potential as a human-being. And things aren’t always so easy having a vivid imagination. At times, I find
my mind obsessing trying to find simple solutions to seemingly difficult problems. My soul gravitates towards bringing those simple solutions to the world to experience like a proud star chef at their restaurants. This self-awareness brought me to the conclusion that I would never be happy with the status quo. Thus, began action from years of inaction. During my first year of medical school at UAB, I became a patient after being diagnosed with a major health issue. I experienced high wait times to both make and get appointments, long wait times in the healthcare facility lobbies after getting an appointment, and still more waiting alone in the clinical exam room. I hated going to the doctor then -- and I hate going to the doctor now. Yes. It’s true. Even doctors need doctors. The inefficient, frustrating healthcare access barrier, is why many patients, like myself, alienate patients from their doctor. The poor customer experience for a simple health check-up is one major reason why many patients suffer from conditions that can be easily managed. The system is broken for physicians as well. As a physician, we are emotionally tied to the wellness of our patients, and on most nights, we think about the patients we care for. We want our patients to be Inside Medicine | summer 2017
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continued from pg. 49
At The Center for Hearing, our specialists work closely to diagnose your hearing loss and provide you with the best lifestyle solution.
able to access us when they are vulnerable to sickness or need comfort. However, the treacherous road through the healthcare system needs a better solution for us, all of us: the patients and those of us who provide their care. It was not until my last year of internal medicine training when I lost my best friend to suicide that something changed. I didn’t know it at the time but his passing would have a profound impact on the trajectory of my life. There are so many questions that one asks in the untimely demise of a loved one. Could earlier intervention to depression and easier access to healthcare have saved him? After his passing, the thought occurred to me, life is short. It is way too short to wait on the world to change. In the very recent past, you would have met a very different version of who I am today. Someone with the tendency to take the path with the least amount of resistance and friction. Thus, I embarked on the journey of bridging the healthcare access gap through ApproXie, a digital healthcare start-up. Although, tough and lonely, at times, I fear having a rocking chair moment with regret. I dream that my thoughts on a rocking chair will feel similar to Andy Dufrense’s blissful “sud’s on the rooftop” from Shawshank. I’m not sure where this journey will end but I do know that the first and most important step of the journey was the decision to start. With faith and courage, you too, can free your mind to dream big.
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The Zorces of Hoarseness by Kari Kingsley, MSN, CRNP and Neeta Kohli-Dang, M.D. In nurse practitioner school, we were taught to identify the zebras in medicine. While most of what we come across on a day-to-day basis as medical providers will be a variety of horses (sinus infection, UTI, or hypertension). Rarely we’ll catch a once in a life-time diagnosis, a zebra, causing us to call in our collaborative teammates to marvel at the medical complexities while appropriately treating this unique patient. Basically, the medical community is trained to identify the zebras, but expect to catch the horses. A while back, I had a lovely experience visiting a local drive-through animal zoo. Sometime between the man-sized emu ripping the food cup from my hand (as I shrieked like a 5-year-old girl) and before the giant water buffalo licked my steering wheel, I came across an unusual creature that appeared to be half zebra and half horse. A zorce. Knowing that I have an immense passion for writing and for treating ENT conditions, this peculiar little creature peaked not only my equine-passion (my dad didn’t get me a horse for my 13th birthday and I’m still not over it) but also fired up my left-brain hamster-wheel motor neurons alerting me that my article on hoarseness should include the theory 52
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that not all hoarseness equals common horses. While zebras are rare, we are seeing more and more zorces. Hoarseness is a medical symptom described as a harsh, raspy, breathy, or strained voice caused by a multitude of conditions. Generally, hoarseness stems from a problem involving the vocal cords or “voice box”. The most common “horses” we find in otolaryngology include reflux, irritant laryngitis, and post nasal drip with allergies. Laryngopharyngeal reflux (or LPR) is a common condition found in the ENT world and involves stomach acid that refluxes up the esophagus and through the upper esophageal sphincter causing backflow onto the voice box. Associated symptoms include dry cough, globus (sensation of a lump in the throat), and repeated throat clearing. Postnasal drainage from allergic and nonallergic rhinitis can also cause laryngitis with thick mucus irritating the delicate vocal cord mucosa. Other common primary causes of hoarseness include acute laryngitis, sinusitis, and vocal cord strain. Most of these conditions, once identified, can be treated appropriately based upon diagnosis.
Now let’s delve into horses of a different color: the zorces and sometimes zebras of hoarseness. Vocal hemorrhage, laryngeal cancer, vocal polyps, thyroid cancer, post-surgical vocal cord paralysis, lung cancer, esophageal cancer, neurological diseases, and neck trauma are the causes of hoarseness you don’t want to miss as a clinician. As a provider, the appropriate question is, “When do I refer a patient with hoarseness to the ENT for further evaluation?” According to the American Academy of Otolaryngology – Head and Neck Surgery, hoarseness that persists beyond three weeks should be evaluated. Smokers are at particularly high risk and so consider referral sooner. Hoarseness with difficulty breathing warrants urgent intervention. Additional symptoms such as coughing up blood, difficulty swallowing, neck mass, and pain when speaking or swallowing are suggestive of malignancy. What should you and your patients expect when coming to an ENT for evaluation of hoarseness? A detailed history of present illness is crucial, followed by a thorough ENT head and neck examination. ENTs can visualize the vocal cords via indirect examination
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using a mirror placed at the back of the tongue or with a flexible laryngoscope. The latter procedure utilizes a tiny fiber-optic scope that is slowly passed through the nose and down towards the larynx to visualize the vocal cords in more detail. We take the time to numb the patient well with nasal and throat sprays. “Trust me, I’m a wimp and I’ve had it done” is usually the first thing I tell my patients that are tough guys when their eyes get wide at the first sight of our tiny scope. We even pass out our popular candy lollypops to help clear the taste of the numbing sprays, like in the good ‘ole days. Appropriate treatment is recommended based upon visualization of the vocal cords. We sometimes have our speech pathologist perform a video stroboscopy in the office which displays the vocal cords on a large TV monitor allowing slow motion assessment for better visualization and understanding of vocal cord mobility. This is especially useful in patients with vocal cord dysfunction, laryngospasm, muscle tension dysphonia, and vocal cord nodules. Our speech pathologist’s name is Bambi and she’s actually cuter than a zorce! In the primary care world, prevention is critical. Teaching your patients to quit smoking, stay hydrated, and to treat allergies and reflux certainly helps. Encourage patients with hoarseness to use a microphone for public speaking, or avoid speaking or singing all together if the voice is weak or hoarse. And if ever you are concerned that you might have a zorce on your hands, lasso that baby, and send them over to ENT!
Kari Kingsley is a board certified acute nurse practitioner, having worked in otolaryngology since January 2010. She is a UAH graduate with a Master’s of Science in Nursing. She maintained a 4.0 GPA throughout her training and graduated with honors. Kari currently works for Dr. Neeta Kohli-Dang at Huntsville Ear, Nose, and Throat. She serves on the Board of the North Alabama Nurse Practitioner Association, the Angel of Hope Memorial Group, and is the Chair-person for the Huntsville Chapter of the American Foundation for Suicide Prevention. Dr. Neeta Kohli-Dang is a board-certified otolaryngologist and a Fellow of the Royal College of Physicians and Surgeons. She has been practicing in Huntsville for about 20 years with regional and international patients. She was selected to participate in a national multi-centric study involving chronic sinusitis and balloon sinuplasty with subsequent publication regarding its efficacy.
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WARNING
SIGNS OF HYPOTHYROIDISM
by Traci McCormick, MD
Hypothyroidism affects over 20 million Americans and 1 out of 8 women. Amazingly, it is estimated that 60% of people with a low thyroid remain undiagnosed. Undiagnosed hypothyroidism can lead to serious health consequences including infertility, heart problems, severe mental health issues, and nerve damage. When functioning properly, the thyroid gland secretes just the right amount of thyroid hormone. Thyroid hormone controls your body’s metabolism—the rate at which nutrients and oxygen are converted into energy. Too much thyroid hormone causes your metabolic rate to be too high. Too little thyroid hormone causes your metabolism to slow way down. That slow metabolism can create havoc on your body. Here are ten signs of hypothyroidism that you should look for. You do NOT have to have all of these symptoms but the more you have, the more likely it is that you would be identified as suffering from hypothyroidism.
1. Fatigue Exhausted? Too tired to peel yourself off the couch after working all day? A low thyroid can make you tired, even when you have adequate rest. You may wake up tired or run out of energy early in the day.
2. You Are Cold All the Time Do you often feel cold when everyone else in the room is comfortable? Have cold hands or feet? If you have a low thyroid, you are likely to have a low body temperature that keeps you feeling cold even when the thermostat says you shouldn’t.
3. Weight Gain Are you gaining weight or are you unable to lose weight despite watching your calories? This is a classic sign of thyroid trouble.
4. Thinning Hair Is your hair thinning or are you losing more hair than normal? You may notice more hair in your hairbrush or hair loss when you shampoo. If so, it’s time to get your thyroid checked.
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5. Dry Skin Should you own stock in skin lotions? Dry skin, especially of the legs and feet, is a very common sign of hypothyroidism.
6. Constipation Slow to go? A low thyroid causes everything in your body to slow down, including your bowels. If you are frequently constipated, your thyroid could definitely be the problem.
7. Depression Feeling down? If your thyroid is low, it can affect your mood. Depression is one of the most common signs of hypothyroidism.
8. Muscle or Joint Pain Do you have tender places in your muscles or joints that are swollen and achy? It could be because of a low thyroid.
9. Low or No Sex Drive Lost that lovin’ feeling? It’s very common for an under-functioning thyroid to cause a decrease in your sex drive.
10. Poor Memory or Brain Fog Feeling forgetful or having a hard time concentrating? Your thyroid may be the cause. When your body’s metabolic rate is low, the brain does not function as best as it could. See Your Doctor If you think you have any of these signs of hypothyroidism, please consult your doctor. Make a list of the signs and symptoms you have a give it to your physician. Unfortunately, hypothyroidism can often be difficult to diagnose. A lot of doctors only do one or two common tests that frequently miss the problem. If you have been told your thyroid is normal, but you still suspect you may have a thyroid problem, you should ask for advanced thyroid testing, including free T3 and thyroid antibodies.
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