Inside Medicine Tuscaloosa

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(205) 758-9041 SCHEDULE AN APPOINTMENT WE TREAT YOU LIKE FAMILY! As Alabama’s premier ENT practice for the greater west Alabama area, Tuscaloosa ENT Center strives to provide compassionate care and service to all patients. DR.GARYM.LAKE DR.DAVIDB.ROSENSTIEL DR.LEEH.LOFTIN DR.CARLISLER.STEPHENSON

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Who would benefit from Pelvic Health Physical Therapy?

Although commonly referred to as “Women’s Health”, everyone with a pelvis could benefit fromPelvicHealthPT.Peopleofallgendersand ages,includingchildren,aresuccessfullytreated for urine leakage, fecal leakage/streaking, constipation or difficulty passing bowel movements, pelvic pain, abdominal pain, neuralgia also known as sensation changes in the pelvic floor and/or genitalia, scar tissue frominjuryorsurgery,andrecurringorchronic backorhippain.

Common ailments specifically seen in men benefitting from Pelvic Health PT include erectile dysfunction, post-traumatic pain and dysfunction often seen following vehicular accidents or military-related injuries, BPHrelated pelvic floor dysfunction, and postprostatectomy treatment to restore sensation andfunction.

Children with complaints of bed-wetting, constipation, urine or fecal leakage when playing or exercising, pelvic/abdominal/back pain, and incomplete voiding of urine also benefitfromPelvicHealthPT.

Women are also seeing the health benefits of receivingtreatmenttominimizerisksduring pregnancy, delivery and postpartum recovery, addressingsexualhealthcomplaintssuchas pain, changes in sensation or dryness, tissue mobility,painandmotorcontroldeficitsrelated to endometriosis, abdominal surgery, or other trauma to tissues, and pelvic girdle instability such as SI Joint pain with or without pain into thethighs/legs.

How do I seek help?

What do Pelvic Health Physical Therapy Assessments look like?

Theinitialassessmenthasmultiplecomponents that will be performed over 1-3 visits. Due to theextensiveamountofeducationandtraining Therapistsprovidepatientsduringsessions, dividing the examination into portions concurrent with treatment allows patients a better opportunity to absorb and apply newly acquiredknowledge.

Along with the interview to obtain the patient’s historyofsymptoms,PelvicHealthPhysical Therapists use a variety of methods to assess thequalityoftheinvolvedtissuesandthebrainbody connection in order to determine the most efficient treatment pathway to restore function and eliminate pain. Examination techniques may include such things as palpation or directly touching the involved and surrounding tissues to assess pliability, tenderness, length:tension ratios, symmetry, and quality of muscle contractions, EMG performance testing commonly referred to as Biofeedback, functional movement assessment, muscle strength testing, and postural assessment.

Not all tests and assessments are needed or evenappropriateforallpatients.Therapists provide education and instruction throughout testing and treatment to maximize understanding and patient comfort, which sometimesrequiresaspectsofexaminationsbe deferredtolatersessionsorentirely.

Obtaining a Physical Therapy referral from your Medical Doctor, Nurse Practitioner, Dentist or Chiropractor is the first step. Just like a prescription for medication, the referral is yours to use at the Physical Therapy clinic of your choice. Pelvic Health Physical Therapy is a specialty that is not offered at all Physical Therapy clinics, so be sure to check that the clinic offers full Pelvic Health servicespriortomakingyourappointment.

Further,callyourstatelegislatorstodemandDirectAccesstoPhysicalTherapybesignedintolaw.

Alabama is one of only a few remaining states in the U.S.A. that limits Direct Access to Physical Therapy,whichincreasestheburdenoftime,co-pays,andefforttoaccessquality,specializedcare andforcespatientstounnecessarilysufferfromtreatableailments.

11 Tuscaloosa

C. Donald Howe, M.D.

J. DeWayne Tooson, M.D.

Jennifer Palmer, M.D.

Michael Palmer, M.D.

Stephanie Dillard, M.D.

S.B. Sundar, M.D.

Jesslyn Marlar, PA-C

Priya Patel, PA-C

Colleen Valdez, PA-C

Grace Thompson, PA-C

Krystal Tubbs, PA-C

Mary Fil, PA-C

G.I. Associates of West Alabama, P.C. is the premier subspecialty gastroenterology practice for Tuscaloosa and surrounding communities in West Alabama. All providers are board certified. Main Office 1774 McFarland Boulevard North Tuscaloosa, AL 35406 Phone: (205) 759-2920
Regional Medical Center 809 University Blvd E Tuscaloosa, AL 35401-2029 Phone: (205) 759-7111 North River Surgical Center 301 Rice Mine Road NE Tuscaloosa, AL 35406-2403 Phone: (205) 750-0022 eating healthy foods. Experience giwestal.com
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The Joy in the Sea

childhood, I mostly have fond memories. I was fortunate to be a member of a military family that traveled to many wonderful places. My exposure to different cultures, religions,andperspectiveswasvast. I enjoyed our adventures. If you asked my childhood self, “Are you happy?” the answer would be “Yes.” IfIequatedmyearlychildhoodtoa largebodyofwatersuchasthesea,I would say it was very calm and beautiful. But, I think my viewpoint ofthisseaofmylifewaswhatIsaw as I stood on the beach at a distance.

Duringmyearlyadolescence,Ihada wonderful time making friends, excelling in school, playing sports, and learning many new things. Life was good. Then, in my fourteenth year, my grandmother passed away suddenly. I felt like someone had punched me in the stomach. I believed in God, but I could not understand why he would let this happen. I cried until there were no more tears left. Someone tried to comfort me by saying something about sorrow may endure for the night, but joy will come in the morning.Myteenageselfsaidthank you without comprehension of that statement.IthoughtIwouldnotbe happy for a long time. To me, happiness and joy were one in the same.

Mycalmseaoflifenowexperienced its first noticeable ripple. I was no longerviewingmyseaatadistance from the beach. I felt like I had stumbled to the water’s edge and disrupted the calm of my sea. . The ripple of my sorrow and raw emotion eventually vanished. If I asked my adolescent self, “Are you happy?”

the overall answer would be a more slowly answered, “Yes.” Young adulthood was a whirlwind. Many wonderful things such as graduations,travel,andrelationships happened.Alongwiththegoodalso came the bad such as broken relation- ships, death, stress, and unexpecteddetours.Inmyseaoflife atthispoint,Iwasdeepinthewater. The ripples were more frequent and larger. At times, I felt like I was sinking. When I reached a point when there were more ripples than calm, I prayed. I needed saving. At this point, I officially accepted Jesus as my savior. If I asked my young adult self “Are you happy?”, the answerwouldbe,“Ishappinessreally thegoal?”

AsIgrewinmyfaith,Iremembered the comment made after my grandmother’s death. “Sorrow enduresforthenight,butjoycomes in the morning.” I had always thoughthappinessandjoywerethe same. I was wrong. Happiness does not last. It fluctuates depending on the situation. In my faith, I have learned that true joy does not fluctuate. Joy is a constant sense of peace that God’s grace gives us. It remainsinthegoodandbadtimes.I nowwantjoy.

Fouryearsago,theseaofmylifewas in a raging storm. The skies above were dark and waves were monstrous. There was nothing I could do but endure. I was not floatinginthisseaalone.Inowhada boat…God. I survived that storm in mysea.Ihaveyettoobtainpurejoy.I stillworryandtrytohandlethingson myownsometimes.Thedifferenceis now that I have experienced moments of joy and the peace only mysaviorcangive,Iwillworktoward pure joy. My search for joy has now surpassedmydesireforhappiness.

The word happiness originated from the word happen- stance, meaning coincidence or by chance. Happiness, by definition, is dependent upon circumstance. Arainyday,alossbyyourfavorite sports team, or getting bad news can all rob you of your happiness. Likewise,asunnyday,abigsports victory, or a promotion at work canbringtemporaryhappinessto yourlife.

Happiness is not a bad thing, but happiness is fragile and inconsistent,andisoftendictated by circumstances outside of your control.TheBibledoesn’tpromise happi- ness; it promises joy. Joy is an unwavering emotion that is rooted in faith in Jesus. Joy pursues the good in every situation, even the worst of situations.

James1:2says,“countitalljoy,my brother, when you meet trials of various kinds…” Having trials of various kinds will definitely not lead to happiness. But look what Jamessaysinthenexttwoverses, “For you know that the testing of yourfaithproducessteadfastness. Andlet steadfastness have its full effect, that you may be perfect andcomplete,lackinginnothing.”

Joyisanattitudeoftheheartthat anticipates the spiritual growth thatfollowstimesofsuffering.Joy is the Christian pursuit of being perfected and complete inChrist. Happiness comes and goes, but joyinChristiseternal.

When I reflect on my early JoyORHAPPINESS?
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Wthout doubt, our western medical model is the best in the world for diagnosing and treating physical disease. But what if, a percentage of the time, these realphysiologicalsymptomsstemfromrootcausesof illnessthatbeganasthoughts,beliefs,andfeelingsin the mind that got converted into physiology in the body? What if one became susceptible to a strep infection because chronic stress weakened the immune system? These concepts and many more are discussed in the book The Healing Self with strategiestostrengthentheimmunesystem.

For those desiring a more ‘hands-on’ approach there are programs at major academic centers such as the Benson-Henry Institute for Mind Body Medicine at Harvard or the Mayo Clinic Stress Management Program. These clinics see outpatients on an ongoing basis; and also are certifying practitioners in the practice of Mind-Body Medicine. The programs incorporate structured SMART approaches and action plans to lessen stress and increase resilience. TheacronymSMARTstandsforStressManagement AndResilienceTraining.

In short: Mind-Body Medicine taps the untapped potential of the ‘healing-self’ by merging the healer and the healed to foster self healing….while working in concert with conventional medicine therapy practitioners.

There is great hope and future opportunity - in spite of the complexities we now face with the delivery of healthcareintheUS-fortheindividualtoplaymuch greater role in their health maintenance, and develop their own effective and personalized path to selfhealing.

Stay tuned! There is much more to ponder with respect to the untapped power of the mind and humanconsciousness.

Mind-Body

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upon myshoulders Weight

On July 7, 2016 at 12:13 AM my wife was dying. She just had an emergency C-section and went into shock. I stood by her head while she was bleeding out and remembered every fght we ever had and the things I never did for her. I couldn’t let her know how scared I was. I stood in front of my wife saying my fnal good bye! What do you say to someone knowing it’s going to be the last time you talk to them? I tried so hard to comfort her and tell her everything is okay. I tried to smile and pretend that it’s all part of the operation. They called a code blue and people started rushing into the room. She was shaking so much!!! I kissed her and asked God “please don’t take her home.” I thought about all the times I missed church at Way of Life. I thought about how to tell my new family the bad news. So much was going through my mind that I had no time to enjoy my son. I had to be strong for my family. I had to put the weight upon my shoulders and walk with this load of having my wife pass in the operating room. I didn’t know what to say. I didn’t want to pray because I thought God would shun me for not being a good Christian. I was so sorry and asked God if somehow he could just hear this last request. I was rushed to a diferent room and waited for about 10 minutes. Jackie fnally showed up and my heart was so so so so heavy with grief. I wanted to pick her up and carry her out of the hospital as if everything would be fne. I wanted to leave and have this nightmare be over! I stood with Jackie for about 3 minutes and the worst happened. She lost about 1 litter of blood in a couple seconds. I didn’t say anything, I was so scared. I just looked at my wife and couldn’t utter a word. I wanted to say I love you and tell her it’s okay. I wanted to help her as much as I could. I wanted to stop everything and start all over again. I knew she was dying in front of me. They called another code blue! This time my heart stopped. I thought why didn’t I pray every night! Why didn’t I love her like God has loved me! I died in that room! I truly died! I didn’t know what to do again. I watched helplessly as they tried to save my wife. People were running and pushing me farther away from her. She fnally uttered a word and it was like the room went silent. She asked for some water and I knew she was leaving earth. They took me and my newborn son to another room. As we were walking I saw my mom and family. I wanted so hard for someone to hold me. I wanted someone to carry me like a kid and tell me it’s gonna be okay. I didn’t want to be a man anymore. I wanted

uponmyshoulders

to cry! I wanted to cry out to God and ask him why! I stood by my family for about 2 minutes looking at everyone and holding back all of my emotions. My mother asked me “How is Jackie?” I almost lost it and cried like a baby. I just shrugged my shoulders and said I don’t know yet. I was lying, I knew she was in really bad shape. I wanted to run back in the room and hold her but I had to take care of my son now. He had to be given antibiotics to prevent an infection from starting. After about 5 minutes I asked the nurses if I can go see my wife and they reluctantly said yes. The hallway to where my wife was is about 40 yards. I walked about 5 yards and started crying alone. I couldn’t keep up this persona for much longer. I was scared to walk back and hear the news. I wanted my dad to comfort me! I’m still his little boy! I had around 30 something yards to walk and God spoke to me. Gabriel my son I love you more than you can imagine. I heard you and I was there! I saw the c section. I helped the doctors fnd the problem. I saw when she hemorrhaged and made sure they caught it really quick. I was waiting for you in this hallway when you wanted your father. It’s okay to call on me. I will always love you. Just as you asked to save your wife. I’ve been asking my father to save yours. I walked with more love in my heart for everything in that moment. My wife and son are doing great and will be discharged Sunday. If you see me at church don’t ask me where I have been. Just say I’m glad to see you’re home!!’

SAVE Your KNEEs

Theknee is the largest joint in the body. It is also one of the most complex and most vulnerable joints in the body. The knee is comprised of 2 joints, 4 bones, and 14 ligaments. It requires at least 12 muscles and perfect balance between the hip and ankle to function properly. While walking, our knees support 1.5 times our body weight; when climbing stairs it’s about 4 times our body weight; and when squatting it’s about 8 times our body weight.

The knee joint doesn’t have much protection from the daily stress we put on them. Dr. Brett Franklin, knee specialist at SportsMED Orthopaedic Surgery and Spine center notes, “Knee pain is one of the most common complaints bringing people to the orthopaedic ofce. There are multiple causes including traumatic and chronic conditions.”

The most common knee injuries are acute injuries, or sudden injuries resulting from a traumatic event, such as a fall, collision, or twisting motion while the foot is planted in the ground. Examples of acute injuries include: fractures and dislocations, sprains and strains, tendon tears, meniscus tears, and ligament tears. Acute injuries happen quickly, and you usually know just how bad the damage is immediately after the injury occurs.

Symptoms caused by Acute Trauma to the Knee

• Signifcant swelling and stifness

• Pain, tenderness, and warm to the touch

• Weakness or instability of the knee joint

• Hear a popping or crunching noise at the time of injury

• Locking, or inability to straighten the leg

Treating for Knee Injuries with the R.I.C.E. Method

• Rest: reduce daily activity, or take a few days of from intense activity

• Ice: 20 minutes every 4 hours for 2-3 days to help with pain and swelling

• Compression: use an elastic bandage or wrap to keep swelling down and add support to the knee joint

• Elevation: place a pillow under your heel when you are sitting or lying down to reduce swelling

Overuse injuries are another cause of knee pain. Overuse injuries are common among weekend warriors, and can be the result of the sudden changes in activity level. A pickup game of basketball or the start of a new slow-pitch softball season is a distinct change in activity level that can result in overuse injuries. Overuse injuries are easily identifable and symptoms appear almost immediately.

How to Prevent Overuse Injuries:

• Warm up properly before and after any activity

• Daily exercise and stretching keep muscles strong, fexible, and ready for activity

• Gradually increase your activity level

• Wear activity specifc shoes with good arch support

• Give your body time to recover

Another common cause for knee pain is chronic repetitive stress. These types of injuries can be a bit of a head scratcher to diagnose, because unlike acute trauma or a sudden change in activity level, there usually isn’t a specifc event that caused the issue. Repetitive stress injuries develop slowly over time, and are caused by the gradual buildup of irritation to the tissues in the knee joint. An example would be a painter who works for years with no problems, until one day notices some discomfort in their knee. Knee injuries from repetitive stress can often times be the most difcult for people to overcome.

How to Reduce Knee Pain cause by Repetitive Stress

• Physical Therapy program designed specifcally to your needs

• Exercise using low impact activities such as elliptical, bicycles, or swimming pools

• Braces can help reduce pain and improve mobility

• Anti-infammatory medications

• Joint injections

• Surgery

Dr. Brett Franklin adds, “Most knee conditions can be managed and evaluated in a conservative manner. Physical therapy, bracing and joint injections can help alleviate pain and improve daily function. If conservative treatments are unsuccessful, it might be time to consider surgical intervention.”

Do these therapy exercises regularly and

Your KNEEs will

Thank you

Quad Set: Slight Flexion

1. Tense muscles on top of thigh, hold 5 seconds

2. 10 repetitions per set, 1 set per session, 2 times per day

Straight Leg Raise

1. Tighten muscles on front of thigh, then lift leg 8-10” from surface, keeping knee locked

2. 30 repetitions per set, 1 set per session, 2 times per day

Wall Slide

1. Leaning on wall, slowly lower buttocks until thighs are parallel to foor

2. Hold 5 seconds

3. Tighten thigh muscles and return

4. 10-30 repetitions per set, 1 set per session, 2 times per day

Terminal Knee Extension

1. Face anchor with knee slightly bent and tubing just above the knee

2. Gently pull the knee back straight

3. Do not overextend knee

4. 30 repetitions per set, 1 set per session, 2 times per day

Heel Raise: Bilateral (standing)

1. Rise on ball of feet, lower back down

2. 30 repetitions per set, 1 set per session, 2 times per day

Be Still My Beating Mind

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

Meditation has been around for centuries. You can take classes on meditation, read books, listen to podcasts, and, yes, there’s an app for that. Oxford defines meditation as “the practice of focusing your mind in silence, especially for religious reasons

or in order to make your mind calm.” Simple enough, right? But how?

You are what you think. Negative subconscious thoughts or paradigms give way to negative attitudes and those negative attitudes get married and have little baby negative attitudes. Meditation is a wonderful way to reset your daily intentions and turn that brain frown upside down. (Subtract 2 points from article quality for cheesiness). Meditation also has positive physiologic effects including anxiety reduction, lowered blood pressure, and improved sleep quality. Mental health providers encourage meditation to help treat PTSD, depression, anxiety, and bipolar disorder. Scientists suggest it improves brain plasticity. It literally rewires your brain circuits to improve your physical and mental health. Cool. It’s like a facelift for your gray matter.

In my research, I kept coming across the term “mindfulness.” Mind-full-ness. I think they meant mind-empty-ness. My brain was anything but empty. Things changed when a friend suggested listening to a guided imagery meditation. For the first time I felt my brain relax and let go. As the soothing voice of the narrator guided my thoughts through

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

Comfort ...in your own home

Death is Coming

There comes a point in time when a treatment is worse than the disease, when medications and procedures do not help and physical and emotional sufering is not relieved. Many people fnd death is too disturbing to discuss and therefore avoid talking about it. Talking openly about death and dying may be considered disrespectful and some believe that it will lead to despair or even accelerate the process of dying. Some patients fear that entering hospice care represents that they have been given up on, hastens death

or shortens one’s life. This is misconception and studies demonstrate a 100-day survival advantage with end stage heart failure patients. Such attitudes in the general public can cause delayed treatment with palliative care services and increase the amount of sufering.

Discussions on death, palliative care, and hospice need to be made early in any terminal disease process between a patient and their health care provider. Hospice care provides medical care and support to patients with a life limiting illness and focuses on quality of life rather

Te hospice philosophy focuses on a death with dignity without pain or sufering.

than curing the illness. The hospice philosophy focuses on a death with dignity without pain or sufering. The care and treatment provided are based on the patient’s and family’s goals and values. This holistic approach focuses on symptom management, support, and assistance by way of communication and providing coordination of care. Hospice is appropriate when patients are entering the last months to weeks of life and when decisions are made to stop disease modifying therapies and focus on maximizing comfort and quality of life. The World Health Organization has identifed the most common conditions that require palliative care for adults and include dementia, cancer, cardiovascular disease, cirrhosis, COPD, diabetes, HIV/AIDS, kidney failure, multiple sclerosis, ALS, Parkinson’s disease, stroke, lupus, rheumatoid arthritis. and drug resistant tuberculosis. An individual is referred to hospice when the life expectancy is less than 6 months and it is especially important if the goals of care are comfort, being at home, and staying in control. This timeline is difcult to estimate in advanced illness due to efective new therapies, psychological reasons to maintain hope, and the clinician’s overly optimistic desire to cure disease. It becomes easier to predict death when the end is closer and usually less than 3 weeks. These individuals can beneft from hospice care as long as they continue to exhibit a decline consistent with the progression of the disease process.

Many symptoms are demonstrated in the last phase of life. These can be disturbing to family members and health care providers alike. A decrease in heart function and blood volume leads to diminished or increased heart rate, low blood pressure, cooling in the extremities, discoloration of the skin, and loss of peripheral pulses. Families cannot rely on vital signs alone to determine impending death. Infections and febrile episodes are among the most common acute complications by terminally ill patients and may represent the end. Neurological changes such as decreasing levels of consciousness leading to coma, delirium with confusion, restlessness, agitation, and day to night reversal may also occur. Moaning, groaning, and grimacing may accompany the delirium, but may be misinterpreted as uncontrolled pain. Some will have hallucinations that involve deceased individuals from the past and make references to “going home” or dying. Breathing may become shallow and labored with periods of absent breathing where family members perceive this pattern as holding her breath or breathlessness. Breathing difculties may be reduced with oxygen through a nasal cannula or face mask and bedside fan may relieve the sensation of being short of breath. The buildup of saliva and secretions may lead to gurgling, crackling or rattling sounds with each breath, which is sometimes referred to as the death rattle. This can lead to inability to rest, worsening shortness of breath, coughing spells, predispose to infections, and increase distress to family. Proper positioning, cleansing the mouth with sponge sticks, and suctioning to clear secretions are appropriate for short term benefts. As patients near death, they spend more time in bed or a chair and one of the most signifcant milestones of functional decline is the loss of ability to independently transfer from bed to chair. Assis-

Family is encouraged to stay with patients to improve comfort and safety and one on one sitters may be needed.
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LongTerm Care Women

Why is Long Term Care important to Women? Could it be that women live longer than men? Do women become disabled more often? Do women end up with more chronic illnesses? Could women become impoverished as they age as widows? It has a lot to do with: "Longevity and Caregiving". Statistically, womenoutlivemen. erefore,theyarefar more likely to need care when they get older. Women are natural and lifelong caregivers.  ey take care of their spouses, kids, grandparents, grandchildren, and even the family pets. Informal unpaid caregiving falls on women heavily.  is includes the stress when taking care of sick children and later in life, most commonly, taking care of their elderly parents.

Women are masters at multitasking and they keep everyone on their toes and moving like a straight arrow. Mothers, sisters, wives, daughters and friends care for others, inde nitely.  ey put aside their ownneedsandallowtheirhealthtofail. e burden they often carry,  nancially, emotionally,physicallyand

piritually, can break a woman's soul and pocketbook. If you think about all the peopleinyourlifewhoare“madetolast”I believetheobviousanswerwouldinclude the women in your life.Women today haveagreaterriskofneedingLongTerm Care services. It's very important for women to develop a Long Term Care strategy to help preserve their family, career, lifestyle, health and total  nancial future.

Long Term Care protection can save a womanfromthehighcostsofcare.Italso providesthemwithchoice,independence andmostimportantly,tonotbeaburden on loved ones. By arranging Long Term Care protection for others, women can stayontracktoprotecttheirsavingsand keeptheircareer.

Chances are that you have experienced caring for a loved one at some point in your life, so you know how demanding it can be. Your love for others is why you should do something bold and begin planningforLongTermCarenow.

COPING WITH & ENJOYING

Menopause

Mood Swings Weight Gain Sexuality Hot Flashes

For women, the dreaded word MENOPAUSE can elicit fear and anxiety. To say DREAD is an understatement indeed. Women fear menopause because most think this means THE END in so many ways. The END of sexual desire, the END of nicehair,skinandnails,andtheENDoffemininity. But,thisisnottheend….justanewbeginning.Itis time to change the narrative; menopause is NOT a disease. Menopause is a normal part of the life cycle.

So, let’s dig in. What does MENOPAUSE actually mean? By definition, it is the permanent cessation of menstrual periods for a twelve month window. 95%ofwomenreachmenopausebetweenages4555 in the United States. Signs and symptoms of menopause can include irregular periods, vaginal dryness, hot flashes, sleep disturbances, mood swings,increasedabdominalfat,thinninghair,dry skin, and loss of breast fullness. Some confuse perimenopause with menopause. Perimenopause is the time around or leading up to menopause. This is the period of time when women begin to experience some of the signs and symptoms above. This is where the roller-coaster of hormone levels begins. During this time, it is still possible to get pregnant but there are indeed lower fertility rates.

Let’stakeacloserlookatafewsymptomsthatare themostbothersome:moodswings,weight gain,sexuality,andhotflashes.

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THE STIGMA OF Mental Illness

What if we talked about mental health as openly as physical health? Imagine what our communities would look like if individuals affected by a mental illness were able to gain support from their family and neighbors for their depression, the same as when they are post-opfromaheartsurgery.

There is such a stigma surrounding mental health. A stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” Layer that over mental health, and specifically mental illness and now the definition reads “a mark of disgrace associated with mental illness.” Ouch. It breaks my heart that mental illness continues to carry a mark of disgrace with it, especially with the high prevalence in our communities.

Didyouknowthatanestimated1in5adults struggle with a mental illness? When we include youth and children in this estimate, the percentage rises. With such significant numbers, the fact that mental health is still discussed minimally, if at all, is discouraging. We know that individuals with a mental health diagnosis are at a greater risk for social isolation, have greater difficulty developing fulfilling relationships, and that there is a correlation between untreated mental illness and suicide risk. Despite the known complications, as well as the known benefits of treatment, conversations about mental illness continue to happen below the thresholdnecessarytoencouragechange.

TO THE YOUNG GIRL THINKING OF

Becoming a Nurse...

(a note to myself at 17)

No one tells you that you will be scared–Of the pressure. Of messing up. Of not knowing something. Of doing the wrong thing. Of letting down your medical team. No one tells you this will make you a better nurse.

No one tells you the ways patients will afect you–With their struggles. With their stories. With their faith. With their determination. With their fght.

No one tells you this will make you fght harder.

No one tells you there will be days when your faith becomes shaken–When you don’t think you can. When you don’t know what to do next. When you just want to walk out of the patient’s room.

When you think, “Why am I here and how do I fght harder for this life?”

No one tells you that you will start to believe in you.

miracle of life.

No one tells you that your character will strengthen through empathy and grace.

No one tells you how your coworkers will infuence you–

To want to be a part of a work family. To understand sometimes all there is left to do is pray.

To learn to be a better listener and supporter. To realize that you are not in control. To realize who is.

No one tells you that you will learn another side of the meaning of love.

No one tells you that you will have days when you feel the fragile ficker of mortality–

When a patient gets better and then back to worse in the blink of an eye.

When you code a patient for the frst time. When you have your hands on a chest praying for that life to stay grounded.

When that life breaks it’s earthly chains.

No one tells you that patients and families will change you–With their harsh words as they are at their worst.

With their loss as if it’s your own. With their happiness in the successes of small daily battles.

With their joys in new beginnings and the

No one tells you that you will, in these moments, recognize that there are two types of patients–those who should be able to be saved, and despite all medical resources, aren’t. Tose that shouldn’t have a chance to survive, and by divine medicine, do.

No one tells you that you will go to church in a patient’s room–

When your patient just needs to talk or hold your hand.

When your patient’s family members want answers you don’t, and won’t ever, have. When you and your team have exhausted

The world will speak at you in many ways. You will read how the medical world is full of red tape, rules, ratios and never ending charting, but there are a few things they are missing. The world needs good nurses called into the profession; and you, girl, can make a diference. Here is what no one tells you...
Bobi Jo Creel, MSN, CRNP

TakeTwoDays attheBeach& CallMeinaWeek

Many of us have had beach vacations, or know someone who has, where our lives just seem to melt away the moment our toes hit that warm sand. We let the cares of our daily responsibilities disappear, and we become totally ab-sorbed in that moment. Our bodies and our spirits feel instantly better. For some, the mere presence of the warm sunshine makes us feel completely renewed.

It would make sense that decompressing makes us feel better, but I think there is more to it than just that. There are some physiologic reasons that contribute to our new onset sense of peace and balance. Being in that setting may actually replenishthingsthatwelackphysically.

The first benefit is the most obvious which is temporarily removing the daily stressors in our lives. For that designated time, we don’t have to worry about our jobs, our businesses, our homes, our usual commitments, etc. We can just relax enjoyingthesand,water,sunshine,andbreeze.

There is a hormone called cortisol that is released by our adrenal glands, which sit on top of our kidneys.Thereisanormaldailypattern orrhythm

of cortisol release with our levels being highest in the morning after we awaken with the level slowly dropping during the day. It has a number of different functions such as controlling immune function and inflammation. Additional spikes of cortisol are released as it prepares our bodies for the physiologic demands common in stressful situation whether it is mental, physical, or both. These spikes are meant to be temporary with a quick return to baseline levels once the stressor is gone.

Regretfully, many of us have filled our lives with continuous or frequent repetitive stressors so that we have chronically high cortisol levels that can have damaging health effects. Paradoxically, prolonged high stressful situations can eventually leadtoverylowlevelsofcortisol,whichcanalsobe dangerous,becauseouradrenalglandsexperience fatigue and can no longer maintain even normal cortisollevels.

Spending those several days without long traffic lines, incessant phone ringing, people yelling, or whatever is relevant to you can give our adrenal glandsmuchneededrest.

Preventing Provider BurnOUT

DON’T FAL !L

Traditional recommendations to older individuals regarding fall prevention is stay on the couch and and avoid putting yourself at risk of injury due to a fall.Whatifimbalancewasn’tinevitable,whatifyou don’thavetogiveupyourmobilitytostaysafe?

It’s is true that falls are the most common cause of traumatic injuries in individuals over 65. It’s not true that there’s nothing you can do about it. At FYZICAL balance & fall prevention centers, we use technology developed to rehabilitate astronauts from vestibular (inner ear) issues upon returning from space. What is the connection between astronauts and age related vestibular dysfunction? It’sactuallysimilarinnereardysfunctionthatoccurs to young astronauts when their body stops using the information from their inner ear to inform their centralnervoussystemwheretheyareinspace.The same thing occurs with aging. The best part of this discoveryisthatitisreversibleregardless ofage!

The old adage “use it or lose it” is absolutely at workhere.Ahospitalizedpatientwholaysimmobile forlongperiodsoftimeneedsrehabilitationtowalk again. Fitness of the musculoskeletal system responds to use by building muscle mass and bone strength. In the inner ear there are organs that sensewhereyouareinspacethroughtheactionof the earth’s gravitational force. As we age, we don’t move around as much due to musculoskeletal issues. The connections in our brains between neurons diminish. This is part of the reason you couldrunupstepswithoutlookinginyouryouth.As you age, your body turns to the visual information tokeeptrackofyourpositioninspace.Hence,older individuals are obliged to look at their feet while they move around. In the elderly, one of the most common scenarios leading to a fall is getting up at night, when the lighting is low. There is minimal input coming to your brain about where you are in space,andfallinginthisscenarioisquitecommon.

Thegoodnewsisregardlessofage,neuroplastisty ispresent.Thatisthebiologicalprocesswedepend on at FYZICAL balance & fall prevention centers to rehabilitatefolkswithimbalance.Oncetheintensive physical therapy work is done, we teach patients exercises that they can do at home to maintain the gainstheyexperienceintherapy.

Myrecommendationisnottoquitthethingsyou love to do because of fear of falling! Get up off the couch and seek out help at your closest FYZICAL balancecenter&Loveyourlife(LYL).

(205) 758-9041 SCHEDULE AN APPOINTMENT WE TR MILY! As Alabama’s premier ENT practice for the greater west Alabama area, Tuscaloosa ENT Center strives to provide compassionate care and service to all patients. DR.GARYM.LAKE DR.DAVIDB.ROSENSTIEL DR.LEEH.LOFTIN DR.CARLISLER.STEPHENSON
Guidedassistanceinlosingweight Focusonhealthyweightloss Trainingyourmindandyourbodyinto forminghealthyhabits Treatmentofunderlyingissues Improvedself-confidence MedicalWeight Loss Medicalweightlosscanhelpyoulose weightandkeepitoff,butsomeofthe otherbenefitsyou’llloveinclude: 205.462.3334 100TowncenterBlvdSuite112 Tuscaloosa,AL35406

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