June 2012 JMSMA by Journal MSMA

June

VOL. LIII

2012

No. 6

Go Paperless and Get Paid Register NOW for CMS Electronic Health Record Incentives

The Centers for Medicare & Medicaid Services (CMS) is giving incentive payments to eligible professionals, hospitals, and critical access hospitals that demonstrate meaningful use of certified electronic health record (EHR) technology.

Incentive payments will include: • Up to $44,000 for eligible professionals in the Medicare EHR Incentive Program • Up to $63,750 for eligible professionals in the Medicaid EHR Incentive Program • A base payment of $2 million for eligible hospitals and critical access hospitals, depending on certain factors Get started today! To maximize your Medicare EHR incentive payment you need to begin participating in 2012; Medicaid EHR incentive payments are also highest in the first year of participation.

www.cms.gov/EHRIncentivePrograms For additional resources and support in adopting certified EHR technology, visit the Office of the National Coordinator for Health Information Technology (ONC):

www.HealthIT.gov

Lucius M. Lampton, MD Editor D. Stanley Hartness, MD Richard D. deShazo, MD AssociAtE Editors Karen A. Evers MAnAging Editor PublicAtions coMMittEE Dwalia S. South, MD chair Philip T. Merideth, MD, JD Martin M. Pomphrey, MD Leslie E. England, MD, Ex-Officio Myron W. Lockey, MD, Ex-Officio and the editors thE AssociAtion Steven L. Demetropoulos, MD president James A. Rish, MD president-elect J. Clay Hays, Jr., MD secretary-treasurer Lee Giffin, MD speaker Geri Lee Weiland, MD vice speaker Charmain Kanosky executive director Journal of the Mississippi state Medical association (issn 0026-6396) is owned and published monthly by the Mississippi State Medical Association, founded 1856, located at 408 West Parkway Place, Ridgeland, Mississippi 39158-2548. (ISSN# 0026-6396 as mandated by section E211.10, Domestic Mail Manual). Periodicals postage paid at Jackson, MS and at additional mailing offices. correspondence: Journal MSMA, Managing editor, Karen a. evers, p.o. Box 2548, ridgeland, Ms 39158-2548, ph.: (601) 853-6733, fax: (601)853-6746, www.MsMaonline.com. suBscription rate: $83.00 per annum; $96.00 per annum for foreign subscriptions; $7.00 per copy, $10.00 per foreign copy, as available. advertising rates: furnished on request. cristen hemmins, hemmins hall, inc. advertising, p.o. Box 1112, oxford, Mississippi 38655, ph: (662) 236-1700, fax: (662) 236-7011, email: cristenh@watervalley.net postMaster: send address changes to Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS 39158-2548. The views expressed in this publication reflect the opinions of the authors and do not necessarily state the opinions or policies of the Mississippi State Medical Association. copyright© 2012 Mississippi state Medical association.

JUNE 2012

VOLUME 53

NUMBER 6

Special article

Southern Remedy’s Healthy Living Fitness Program

171

Josie Bidwell, MSN, CNP and Richard D. deShazo, MD

inStructionS for authorS

211

about the cover:

Garden Girl – Martin M. Pomphrey, Jr., MD, who serves on the MSMA Committee on Publications, photographed his granddaughter at about age six in the main garden at his home in Mayhew, Mississippi. Caroline’s other interests include dancing, basketball, soccer, and piano. She has even tried her hand at songwriting. Dr. Pomphrey says she is a rabid Auburn fan except when she attends Mississippi State games. Her grandfather enjoys teasing her by shouting “Roll Tide” when Auburn is playing Alabama. Dr. Pomphrey is a semi-retired orthopaedic surgeon sub-specializing in sports medicine who practiced with Oktibbeha County Hospital (OCH) Bone and Joint Clinic in Starkville. r June

VOL. LIII

2012

No. 6

From The Editor s physicians around the state await “with bated breath and whispering humbleness” (to borrow Shakespeare’s phrase) the U.S. Supreme Court decision on PPACA, I am reminded that whatever is decided, we must continue to fight for our patients and our profession. Physicians have a primary obligation to our patients, that’s what our oath says, not to the federal government, not to hospitals, and not to insurance companies. We must always be first and foremost patient advocates. Yes, we have other responsibilities, Lucius M. Lampton, MD Editor but they are all secondary to our primary duty, which is to that one patient sitting in front of us, trusting his or her life to us. There is no doubt fundamental and exponential change is on hand for our profession and our patients. Hopefully, as physicians, we can shape and influence that change in a manner which preserves the patient/physician relationship. My

continued on next page official publication of the MsMa since 1959

June 2012 JOURNAL MSMA 169

From the Editor continued from previous page

other “favorite” past AMA president (besides my friend and hero Dr. Edward Hill) is the eternally bow-tied Dr. Daniel “Stormy” Johnson of Louisiana. I always enjoy his comments on the floor of the AMA House of Delegates, and I especially enjoyed his reflection last year that the end result of health system reform must place “the patient in the driver’s seat, but the physician riding shotgun!” And he’s right, that’s what must evolve in this ongoing health system reform mess: the patient in the driver’s seat, but our profession riding shotgun, watching out for the patient’s best interests. I call your attention to the special article in this issue on Southern Remedy’s Healthy Living fitness program for Mississippi. As patient advocates, we must empower our patients to heal themselves and contribute to their own wellness through preventive measures and healthy lifestyles. Southern Remedy’s programs on diet and fitness can help physicians create a healthier Mississippi (and that healthier Mississippi begins in our local towns and cities!). Immediate MSMA Past President Dr. Tom Joiner commented in his official address in early June that one of the ways component societies can step up and take on active leadership roles in their

communities is through such projects as Southern Remedy’s Healthy Living programs. He advised component societies to coordinate with their alliances introducing this program to their communities, churches, and schools. He noted that this “would make a great difference in our fight against obesity and its comorbidities.” Dr. Joiner is right, and component societies should seize this opportunity to promote Southern Remedy’s diet and Lampton, MD exercise guides to encourage healthy lifestylesLucius at theM.local level. Editor Reflecting the best evidence at hand and created with the leadership of our Associate Editor Dr. Rick deShazo, the fitness program published in this issue is intended for individuals who don’t have a regular exercise program and desire to initiate one to complement calorie restriction and weight control. (See the December 2011 JMSMA for a copy of the first component in this series which focused on weight, calorie, and portion control.) This issue’s fitness program will help our patients battle not only obesity, but also other chronic illnesses directly related to a sedentary lifestyle. Here is another weapon for Mississippi’s physicians in our daily battles for the health of our patients. — Lucius “Luke” Lampton, MD, Editor

Journal Editorial Advisory Board R. Scott Anderson, MD, FACR Chair, Journal Editorial Advisory Board Radiation Oncologist and Medical Director, Anderson Regional Cancer Center, Meridian Diane K. Beebe, MD Professor and Chair, Department of Family Medicine, University of MS Medical Center, Jackson Claude D. Brunson, MD Senior Advisor to the Vice Chancellor for External Affairs, University of Mississippi Medical Center, Jackson Jeffrey D. Carron, MD, FAAP, FACS Associate Professor, Department of Otolaryngology & Communicative Sciences, University of Mississippi Medical Center, Jackson Gordon (Mike) Castleberry, MD Urologist, Starkville Urology Clinic Mary Currier, MD, MPH State Health Officer Mississippi State Department of Health, Jackson Thomas E. Dobbs, MD, MPH Health Officer, District VII/VIII Mississippi State Department of Health, Hattiesburg Sharon Douglas, MD Chair, AMA Council on Ethical & Judicial Affairs Professor of Medicine and Associate Dean for V A Education, University of Mississippi School of Medicine, Associate Chief of Staff for Education and Ethics, G.V. Montgomery VA Medical Center, Jackson Daniel P. Edney, MD Executive Committee Member, National Disaster Life Support Education Consortium, Internist The Street Clinic, Vicksburg

170 170 JOURNAL JOURNAL MSMA MSMA

JJune UNE 2012 2012

Owen B. Evans, MD Professor of Pediatrics and Neurology University of Mississippi Medical Center, Jackson Maxie L. Gordon, MD Assistant Professor, Department of Psychiatry and Human Behavior, Director of the Adult Inpatient Psychiatry Unit and Medical Student Education, University of Mississippi Medical Center, Jackson Scott Hambleton, MD Medical Director Mississippi Professionals Health Program, Ridgeland John Edward Hill, MD, FAAFP Residency Program Director North Mississippi Medical Center, Tupelo John D. Isaacs, Jr., MD Infertility Specialist, Mississippi Fertility Institute at Women’s Specialty Center, Jackson Kent A Kirchner, MD Chief of Staff G.V. Montgomery VA Medical Center, Jackson Brett C. Lampton, MD Internist/Hospitalist Baptist Memorial Hospital, Oxford Philip L. Levin, MD President, Gulf Coast Writers Association Emergency Medicine Physician, Gulfport William Lineaweaver, MD, FACS Editor, Annals of Plastic Surgery Medical Director JMS Burn and Reconstruction Center, Brandon John F. Lucas,III, MD Surgeon Greenwood Leflore Hospital

Gailen D. Marshall, Jr., MD, PhD, FACP Professor of Medicine and Pediatrics, Vice Chair for Research, Director, Division of Clinical Immunology and Allergy, Chief, Laboratory of Behavioral Immunology Research The University of Mississippi Medical Center, Jackson Alan R. Moore, MD Clinical Neurophysiologist Muscle and Nerve, Jackson Paul “Hal” Moore Jr., MD, FACR Radiologist Singing River Radiology Group, Pascagoula Jason G. Murphy, MD Surgeon Surgical Clinic Associates, Jackson Ann Myers, MD Rheumatologist Mississippi Arthritis Clinic, Jackson Jimmy L. Stewart, Jr., MD Program Director, Combined Internal Medicine/ Pediatrics Residency Program, Associate Professor of Medicine and Pediatrics University of Mississippi Medical Center, Jackson Samuel Calvin Thigpen, MD Hematology-Oncology Fellow, Department of Medicine University of Mississippi Medical Center, Jackson Thad F. Waites, MD, FACC Clinical Cardiologist, Hattiesburg Clinic Chris E. Wiggins, MD Orthopaedic Surgeon Bienville Orthopaedic Specialists, Pascagoula John E. Wilkaitis, MD, MBA, CPE, MS Chief Medical Officer Brentwood Behavioral Healthcare, Flowood

• Special article • [In the December 2011 issue of JMSMA, the first component of a new weight, calorie and portion control program was published. That program, Southern Remedy’s Healthy Living, offered materials for use with adult and pediatric patients, including training materials for office staff and lay personnel to use in teaching the program. With this issue, we offer the companion piece, the Fitness Prescription. Data on weight management now suggest that the combination of calorie and portion control with moderate aerobic exercise produces better weight loss results and lower levels of recidivism. The Fitness Prescription offers aerobic exercise information for adults at all fitness levels, beginning with an aerobic program to optimize weight control. It also offers a flexibility and resistance component. Flexibility and resistance exercises have been demonstrated to decrease falls and osteoporosis and slow the rate of muscle mass associated with aging. We hope you will consider training your office staff to share these materials with your patients as well as taking them into community settings, such as churches and civic organizations. They will be updated from time to time, on the internet. To the best of our knowledge represent these recommendations reflect the best evidence at hand. All of these materials are available at www. southernremedy.org for reproduction in your office or use by commercial printers, if you wish. If you wish to co-brand your own practice, hospital or other sponsoring organization with the principle sponsor, Mississippi Public Broadcasting, you are welcome to do. If you would like a CD of Southern Remedy’s Healthy Living to take to a printer, we will provide you a CD and copyright release (required by professional printers) by mail. Please email your request to healthyliving@southernremedy.org. You will need to include your name, contact number, and mailing address.]—Richard D. deShazo, MD, Associate Editor

HealtHy living Program

June 2012 JOURNAL MSMA 171

Healthy Living

Southern Remedy

Fitness Program

Fitness Navigation

Let’s Get Physical

Chart

Southern Remedy, a health initiative of Mississippi Public Broadcasting, has developed Southern Remedy’s Healthy Living. This program includes Southern Remedy’s Food Challenge, Healthy Living Plates for Adults and Children, and the Fitness Prescription. Although calorie control with good nutrition is the most important thing you can do for weight control, physical activity assists in calorie balance and has additional health benefits.

Problem Solution Chart

Not regularly active*, over the age of 45 years for men or 55 years for women, or with medical problems - Try -

Physical Activity 3 Improves blood pressure 3 Improves cholesterol levels (by raising the good and lowering the bad)

No matter what your age or fitness level, there are easy to use fitness suggestions for you right here. The payoff is big and worth your effort! Please see the chart on the left to get started

For Sure!

Not Sure?

See Page 173 See Page 2

Are You Ready To Get Fit?

Speak to your health care provider first. You may need evaluation prior to starting a fitness program.

Not regularly active*, under the age of 45 years for men or 55 years for women, with no medical problems

Already active** but ready for more

- Try -

Southern Remedy Beginner Fitness Program : Walking

Southern Remedy Advanced Fitness Program: Walking/Jogging

3 Improves blood sugar levels 3 Improves bone density 3 Increases strength and flexibility 3 Promotes well-being and happiness 3 Decreases risk of falls

Southern Remedy Flexibility and Resistance Program

*Not regularly active= less than 150 minutes of physical activity per week **Already active= 150 minutes or more of physical activity per week

172 JOURNAL MSMA June 2012 2 Southern Remedy Healthy Living Program

Southern Remedy Advanced Fitness Program

Southern Remedy Flexibility and Resistance Program

Healthy Living

Fitness Program

Not Sure?

• Review the benefits of physical activity provided in this material. • Think about how these benefits will improve your health and well-being. • Fill in the blank below: ________________________ keeps me from being physically active (or as active as I would like to be). Did you say: 3 Lack of time, motivation, support, knowledge, or facilities? 3 Current disease, disability, fear of injury? 3 Past failure? You are not alone! These are some of the most common reasons that people are not physically active. The information in this toolkit will address all of these issues and help you establish a physical activity plan just for you!

Problem & Solution Lack of time Solution: Starting with as little as 10 minutes of physical activity per day can have positive health benefits.

Lack of motivation/ support Solution: Physical activity has many great health benefits. Try to find a friend, co-worker, or family member who is physically active. Exercising together is a great way to stay motivated. Get jumpstarted with a quick and easy change. (Keep reading for tips!)

Lack of knowLedge and faciLities Solution: Being physically active doesn’t require a gym membership or a personal trainer. This toolkit will give you easy and inexpensive ways to get active.

current disease/ disabiLity or fear of injury Solution: Being physically active is an important part of becoming and staying healthy. In most cases, light to moderate intensity activity is safe for everyone. Speak with your healthcare provider before beginning a new program if you are concerned. Don’t forget to warm up and cool down with each workout.

past faiLures Solution: To be successful, you need realistic goals. Our program walks you through each step of the activity and gives you clear goals for each week or month. See Losing Focus: Don’t Give Up! on page 4 for more tips.

Get Jump-Started! Quick and Easy Changes 1. Take the stairs instead of the escalator or elevator. 2. Park in the back of the lot at the grocery store, mall, or work, and walk to the entrance. 3. Take a trip to the mall to “window shop.” 4. March in place during commercial breaks on television.

June 2012 JOURNAL MSMA Southern Remedy Healthy Living Program 3173

Healthy Living

Fitness Program

For Sure! get fit

Know Your Limits the “talk test” is an easy way to judge the intensity of your activity. Light no noticeable changes in breathing. you can carry on a full conversation or even sing. moderate Breathing effort increases without being out of breath. you can have a conversation but not sing. vigorous Breathing is deep and rapid. you can’t say more than a few words without pausing for breath.

Pick Your Activity the Southern Remedy Fitness Prescription is designed as a walking/jogging program. other activities can be substituted, just remember to match up the intensity using the “ “talk test.”

Swimming

174 JOURNAL MSMA June 2012 4 Southern Remedy Healthy Living Program

Bicycling

Dancing

Healthy Living

Fitness Program

Losing Focus: Don’t Give Up! We all have habits that we have developed over the years that are hard to change. many of these habits are triggered by particular situations. For example, we all have bad days at work that just make us want to crawl in bed or relax in front of the tv. What about when you are sick? the last thing you want to do is exercise. then, you quickly find yourself back in the cycle of inactivity. the best way to deal with a situation like this is to be prepared. We generally recommend physical activity at least 5 days per week. Don’t schedule the days you “will not excercise.” instead plan to be active every day. then, if something comes up that keeps you from being active, it won’t derail all your efforts. When you do slip up, don’t beat yourself up. Use the following system, or one you develop on your own, to figure out why you slipped and how not to do it again.

don’t beat yourself up! SteP 1 stop and think • identify thoughts or actions that are causing you to lose focus • think of strategies to combat these thoughts or actions.

SteP 2 don’t panic! • one slip up does not equal failure!

SteP 3 modify your fitness program • review the reasons you started a fitness program. • modify your fitness goals if needed. • think of fun, new activities to energize you.

SteP 4 act immediateLy • Don’t blame yourself! everyone will have slip-ups. • Start back on your fitness program as soon as possible.

SteP 5 seek heLp • Don’t be shy! ask for help and encouragement from family, friends, or co-workers.

Warning Signs

! To help prevent problems

exercise is usually a safe and beneficial activity. However, there are certain warning signs you should never ignore if they happen during exercise. you should contact your healthcare provider immediately if these occur. • Dizziness, nausea, clammy skin • Hot, flushed, dry skin (you have stopped sweating) • Chest pain, arm tingling, jaw pain, or sudden shortness of breath

avoid exercising during the hottest part of the day.

Drink plenty of fluids.

remember to always warm-up and cool-down.

Don’t do too much too quick

June 2012 JOURNAL MSMA Southern Remedy Healthy Living Program 5175

Healthy Living

Fitness Program

Beginner Fitness Program We recommend a warm-up and cool-down activity each time you exercise. We SuggeSt Week 1

Week 2-7

Week 8 and beyond

Slow, easy walking pace for a few

Slow, easy walking pace for 5

Slow, easy walking pace for 5-10

minutes before and after activity.

ReADY To WoRKoUT Beginner Fitness Program Light week 1

week 2

60 minutes weekly Light intensity walking* for a total of 20 minutes per day (may be done in two 10 minute bursts), 3 days per week

week 3

week 4

90 minutes weekly 75 minutes weekly Continue light intensity walking.* Increase to 25 minutes per day, 3 days per week

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Continue light intensity walking.* Increase to 30 minutes per day, 3 days per week

120 minutes weekly Continue light intensity walking.* for 30 minuties per day, increase to 4 days per week

Suggestion If at any point you donâ&#x20AC;&#x2122;t feel ready to move to the next stage, spend another week in your current stage. This does not equal failure.

*See Know your limit for exercise intensity in page 2

Moderate week 5&6

week 7

120 minutes weekly Increase to moderate intensity walking* for 30 minutes per day, 4 days per week

week 8

maintenance

150 minutes weekly 135 minutes weekly Continue moderate intensity walking* for 30 minutes per day, 4 days per week. Add another day of moderate intensity walking for 15 minutes.

Continue moderate intensity walking.* Increase to 30 minutes per day, 5 days per week

150 minutes weekly Continue moderate intensity walking* for 30 minutes per day, 5 days per week

June 2012 JOURNAL MSMA Southern Remedy Healthy Living Program 7 177

Healthy Living

Fitness Program

once the Beginner Fitness Program is complete, please choose one of the following three options:

1 2 3

178 MSMA June 2012 8 JOURNAL Southern Remedy Healthy Living Program

Continue moderate intensity walking for a total of 30 minutes daily for 5 days per week. Continue on to the advanced Fitness Program (more walking/jogging) for added health benefits! Continue on the Flexibility and resistance training Program (stretching and weights) for added health benefits!

Healthy Living

Fitness Program

Keep Track of Your Progress Use this form to write down the amount and intensity of the exercise you are doing. You can compare your weekly total to the total weekly time goals provided in the program. If you donâ&#x20AC;&#x2122;t meet the designated goal, refer back to Losing Focus: Donâ&#x20AC;&#x2122;t Give Up!

week 1

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

minutes intensity minutes

intensity minutes

8 weekly Total

intensity minutes intensity

June 2012 JOURNAL MSMA Southern Remedy Healthy Living Program 9179

Healthy Living

Fitness Program

Congratulations! If you have made it to this portion of the Fitness Prescription, you have either completed the Beginner Fitness Program, Advanced Fitness Program, or both! This is a wonderful accomplishment, and you should be very proud of yourself!

Now is a great time to reward yourself. Don’t choose food rewards. Instead think of things that will be a treat but also keep you on the road to continued health. Some great choices are:

• new exerciSe cloTheS

• a greaT pair of aThleTic ShoeS

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• a maSSage

Healthy Living

Fitness Program

Sources America On the Move Foundation. (2008). 100 ways to add 2,000 steps. Retrieved November 8, 2011 from http://www. americaonthemove.org Brownell, K.D. (1994). The LEARN Program for Weight Control (6th edition). Dallas, TX: American Health Publishing Company. Bushman, B. (Ed.). (2011). American College of Sports Medicineâ&#x20AC;&#x2122;s Complete guide to fitness and health: Physical activity and nutrition guidelines for every age. Champaign, IL: Human Kinetics. Centers for Disease Control and Prevention. (2011). Measuring physical activity intensity. Retrieved December 30, 2011, from http://www.cdc.gov/physicalactivity/everyone/measuring/index.html Centers for Disease Control and Prevention. (2011). Overcoming barriers to physical activity. Retrieved November 8, 2011 from www.cdc.gov/physicalactivity/everyone/getactive/barriers.html Mayo Foundation for Medical Education and Research. (2011). Barriers to fitness: Overcoming common challenges. Retrieved November 8, 2011, from http://www.mayoclinic.com/health/fitness/SMOOO85_D Mayo Foundation for Medical Education and Research. (2011). Heat and exericise: Keeping cool in hot weather. Retrieved from http://www.mayoclinic.com/health/exercise/HQ00316 Thompson, W.R., Gordon, N.F., & Pescatello, L.S. (Eds.). (2010). American College of Sports Medicineâ&#x20AC;&#x2122;s Guidelines for exercise testing and prescription (8th ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins. United States Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved from: http://www.health.gov/paguidelines

June 2012 JOURNAL MSMA 181 Southern Remedy Healthy Living Program 11

Healthy Living

Fitness Program

Advanced Fitness Program We recommend a warm-up and cool-down activity each time you exercise. We suggest using a comfortable walking pace for 5-10 minutes before and after each activity.

ReADY To WoRKoUT advanced Fitness Program

week 1&2

week 3

200 minutes weekly Moderate intensity walking* for a total of 40 minutes per day, 5 days per week.

225 minutes weekly Continue moderate intensity walking.* Increase to 45 minutes per day, 5 days per week

week 4

250 minutes weekly (moderate) Continue moderate intensity walking.* Increase to 50 minutes per day, 5 days per week.

-or- 125 minutes weekly (vigorous) Begin vigorous intensity jogging* for 25 minutes per day, 5 days per week

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week 5

275 minutes weekly (moderate) Continue moderate intensity walking.* Increase to 55 minutes per day, 5 days per week.

-or- 135 minutes weekly (vigorous) Continue vigorous intensity jogging.* Increase to 27 minutes per day, 5 days per week

Tips if at any point you donâ&#x20AC;&#x2122;t feel ready to move to the next stage, spend another week in your current stage. this does not equal failure.

*See Know your limits for exercise intensity on page 2

week 6

300 minutes weekly (moderate) Continue moderate intensity walking.* Increase 60 minutes per day, 5 days per week.

-or- 150 minutes weekly (vigorous) Continue vigorous intensity jogging.* Increase 30 minutes per day, 5 days per week

maintenance

300 minutes weekly (moderate) Continue moderate intensity walking.* for 60 minutes per day, 5 days per week.

-or- 150 minutes weekly (vigorous) Continue vigorous intensity jogging* for 30 minutes per day, 5 days per week

-or- 200 minutes weekly (moderate) plUS 50 minutes weekly (vigorous) Combine moderate* and vigorous* activities on alternate days of the week.

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Healthy Living

Fitness Program

Extra Tips once the advanced Fitness Program is complete, please choose one of the following two options: 1. Continue the maintenance stage of the advanced Fitness Program. 2. Continue on the Flexibility and resistance training Program (stretching and weights) for added health benefits!

See page 179 to track your progress. 184 MSMA June 2012 14 JOURNAL Southern Remedy Healthy Living Program

Healthy Living

Fitness Program

Flexibility and Resistance Training Program

whaT iS iT?

flexibility Training involves stretching exercises to improve joint and muscle function. Stretching can be an important part of a complete physical activity program when combined with aerobic exercises (walking or jogging) and anaerobic exercises (lifting weights).

STepS

machines to increase muscle strength and endurance.

of the flexibility and resistance Training program

If you have a history of heart disease or high blood pressure, you should speak with your healthcare provider prior to starting a resistance training program.

WARm UP 5 minutes of walking at a comfortable pace. WoRKoUT Resistance Exercises CooL DoWn Flexibility Exercises

resistance Training is the use of weights and/or

equipment

make Your own Dumbbells

No gym membership? No worries. These exercises use only your own body, dumbbells, steps, and chair. Dumbbells are available at most sporting goods stores. Donâ&#x20AC;&#x2122;t have those either? Make your own. For Dumbbells use: 15oz soup cans, 16-20oz water bottles or half-gallon plastic milk jugs filled halfway with water (for heavier weights) Remember to always start with the lowest weight that is comfortable for you before moving up.

15 oz soup can

16-20 oz water bottle

half-gallon milk jug

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Healthy Living

Fitness Program

Resistance Training Program

Beginner

Advanced Beginner

(1-2 months) number of repetitions: 8 - 12 (one set) number of Sets: 1 exercises: WALL SITTING BEGINNER CURL-UP KNEELING HIP EXTENSION SIDE-LYING LEG RAISES MODIFIED INCLINE PUSH-UP CALF RAISES

(1-2 months) number of repetitions: 8 - 12 (one set) number of Sets: 1 exercises:

workout stage

CHAIR SQUATS BEGINNER SEATED PRESS-UP ADvANCED BEGINNER CURL-UP MODIFIED KNEE PUSH-UP CALF RAISES DUMBBELL ROW STEP-UP MODIFIED PRONE PLANK

Intermediate

(usually lasts 3-6 months but may take up to 1 year) number of repetitions: 8 - 12 (one set) number of Sets: 1 exercises: SQUATS PUSH-UP CURL-UP SEATED PRESS-UP STEP-UP CALF RAISES BICEPS CURL DUMBBELL ROWS PRONE AND SIDE PLANKS

186 MSMA June 2012 18 JOURNAL Southern Remedy Healthy Living Program

expert Contact a fitness professional at your local YMCA or gym. You can also make an appointment with a physical therapist.

Healthy Living

Fitness Program

Resistance Exercises

Wall Sitting Stand 1-2 feet away from a wall and place your back against the wall. Slide your body down the wall until your knees form a 90 degree angle. Hold this position for 20-30 seconds and return to the starting position. This is one repetition. Only 6-8 repetitions of this exercise are required to equal one set.

modified Incline Push-Up

a. Standing a few feet from the wall, place your palms on the wall at shoulder height, slightly wider than your shoulders. b. Bend your elbows until your face almost touches the wall. Your back should stay straight. Hold this position briefly and then return to the starting position. This is one repetition. Too Easy? Try using your kitchen counter instead of a wall. This increases the incline and makes you work harder.

Chair Squat Stand with your back facing a chair and your hands held out in front of you. Keeping your back straight, sit down in the chair. Return to the starting position. This is one repetition.

Squat Stand with your knees and feet shoulder width apart and your arms held out in front of you. Lean slightly forward at the hips and bend your knees until they are parallel to the floor. Hold this position briefly and then shand back up. This is one repetition.

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Fitness Program

Resistance Exercises a

modified Knee Push-Up a. Get down on your knees and hands with your hands slightly wider than your shoulders. Lift your feet off the floor and cross your ankles. b. Bend your elbows and slowly lower your chest towards the floor. Stop when you are 3-4 inches from the floor or your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.

Push-Up

a. Place your toes and hands on the floor, with your hands placed slightly wider than your shoulders. Keep your back and arms straight. b. Bend your elbows and slowly lower your chest towards the floor. Stop when you are 3-4 inches from the floor or your elbows are at a 90 degree angle. Push back up to the starting position. This is one repetition.

Beginner Curl-Up a. While lying flat on your back, bend your knees and hips to 90 degrees and place your arms by your sides. Lift your shoulders and upper back off the floor. b. Hold this position briefly and then return your back to the floor. This is one repetition.

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Fitness Program

Resistance Exercises

Advanced Beginner Curl-Up

a. While lying flat on your back, bend your knees and hips to 90 degrees and cross your arms over your chest. b. Lift your shoulders and upper back off the floor. Hold this position briefly and then return your back to the floor. This is one repetition.

Curl-Up a. While lying flat on your back, bend your knees and hips to 90 degrees and place your hands behind your head. a. Lift your shoulders and upper back off the floor. Do not pull on your neck. Hold this position briefly and then return your back to the floor. This is one repetition.

Kneeling Hip extension

a. Place your palms and knees on the floor in the crawl position. b. Lift and straighten your right leg until it is parallel with the floor. Keep your shoulders and hips level. Hold this position briefly and return your right knee to the floor. Repeat with the left leg. This is one repetition. b

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Fitness Program

Resistance Exercises

Side-Lying Leg Raises

a. Lie on your right side with your right leg slightly bent and your left leg straight. Place your right arm under your head and your left arm, palm down in front of your chest for balance. b. While keeping your abdominal muscles tight, lift your left leg until it is level with the hip. Hold this position briefly and then return to the starting position. This is one repetition. Remember repeat on the other leg.

a b

Calf Raises a. Place the balls of your feet on a step with your heels hanging off the back of the step. Use a handrail to help maintain your balance. b. Raise your heels until you are standing on your tip-toes. Hold this position briefly and then return to the starting position. This is one repetition.

Beginner Seated Press-Up a. Face forward while sitting in a chair. Place your palms flat on the chair bottom beside your thighs. b. Push downward with your palms to lift your buttocks off the chair. Leave your feet on the floor but do not use your feet to aid in lifting. Hold briefly and return to the starting position. This is one repetition.

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Healthy Living

Fitness Program

Resistance Exercises

Seated Press-Up Face forward while sitting in a chair. Place your palms flat on the chair bottom beside your thighs. Lift your feet slightly off the floor. Push downward with your palms to lift your buttocks off the chair. Hold briefly and return to the starting position. This is one repetition.

Dumbbell Row a. Standing on the left side of a bench, put your right knee and palm of your right hand on the bench surface. Your back and arm should be straight. Extend your left arm straight down and hold your dumbbell with your left hand. b. Pull your dumbbell upwards by bending your elbow and shoulder. Lower your left hand back

Step-Up a. Stand and face a step approximately 6-15 inches in height. (The higher the step, the harder the exercise). Place your right foot completely on the step. b. Transfer your weight to the heel of your foot and press down into the step while straightening your leg. Touch your left toe to the step but do not put your weight on this foot. Return to starting position. This is one repetition.

June 2012 JOURNAL MSMA 191 Southern Remedy Healthy Living Program 23

Healthy Living

Fitness Program

Resistance Exercises

Biceps Curl a. Stand upright with your feet shoulder width apart. Your arms should be by your side and you should hold a dumbbell in each hand with palm side of hand facing out. b. Bend your elbows and bring your hands upward toward your shoulders. Straighten your elbows and return your hands to your side. This is one repetition. a b

modified Prone Plank Lay face down on the floor. Rise up on your forearms and your knees. Your back and neck should remain straight. Continue to breath normally. Hold for 10-20 seconds. This is one repetition. Only 5-8 repetitions are required of this exercise to equal one set.

Prone Plank Lay face down on the floor. Rise up on your forearms and your toes. Your back and neck should remain straight. Continue to breath normally. Hold for 20-30 seconds. This is one repetition.

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Side Plank Lay on your side with your legs straight. Your weight should be supported on your bottom arm. Use your abdominal muscles to keep your hip in line with your shoulders. Hold for 20-30 seconds. This is one repetition. Only 4-6 repititions are required for prone and side planks to equal one set

Healthy Living

Fitness Program

Stretches for Flexibility Good Stretches

Stretching works best when done for at least 10 minutes, 2-3 days per week. Stretching has the most benefit when performed after your fitness or resistance exercises when your muscles are already warmed up. Stretches should be held for 15-60 seconds and repeated 4 times. You should never stretch to the point of pain.

lateral flexion: Face forward and move your head to the side like you are placing your ear on your shoulder. Repeat with both sides of the neck. You should feel this stretch on the opposite side of your neck.

neck eck forward flexion: Face forward and move your head forward like you are placing your chin on your chest. You should feel this stretch in the back of your neck and upper back.

retraction: Sit upright in a chair and rest your arms by your sides. Pick a spot on the wall to focus on and keep your head level. Keep your back against the chair and extend your neck by sticking your chin out. You should feel this stretch behind your ears and down your neck.

Shoulder Arms across chest: Face forward, straighten your right arm, and move it across your chest. Hold your right arm with your left hand and use gentle pressure on your right arm. Repeat with the left arm. You should feel this stretch in your shoulder.

Upper Back Upper Back: Crisscross your arms over the front of your upper chest, point your elbows forward, and give a gentle squeeze. This is just like giving yourself a hug. You should feel this stretch in the middle of your upper back between your shoulder blades.

June 2012 JOURNAL MSMA 193 Southern Remedy Healthy Living Program 25

Healthy Living

Fitness Program

Stretches for Flexibility

Lower Back Lower Back: Lie flat on your back with your legs straight out in front of you and your heels on the floor. Pull your right knee up toward your chest. You can keep your other leg straight or bend it. Repeat with the other leg. You should feel this stretch in your lower back. Do not perform this stretch if you have osteoporosis.

Triceps Elbow behind the head: Face forward, lift your right arm straight up, bend at the elbow and reach for your left shoulder. You can support your right arm with your left hand. Repeat on the left side. You should feel this stretch in your triceps (underside of the top part of your arm).

Chest Stretch Chest Stretch: Face forward, straighten your arms, and raise them up to your sides and slightly toward your back. Make sure to keep your shoulders relaxed and your arms slightly lower than your shoulders. You should feel this stretch across your upper chest.

Biceps

Hips

Wall Stretch: Touch the wall with your right palm and forearm and slowly turn your body away from the wall. Repeat on the left side. You should feel this stretch in your bicep muscle (top part of your upper arm) and across your upper chest.

Butterfly stretch: Sit on the floor, bend your knees, and touch the soles of your feet together. Lean slightly forward and use your elbows to gently press down on your knees. You should feel this stretch in your upper thighs.

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Healthy Living

Fitness Program

Stretches for Flexibility

Kneeling Hip Flexor Stretch b

a. Kneeling Hip Flexor Stretch: Place your left foot and right knee on the floor. Both of your legs should now form a 90 degree angle. b. Shift your weight forward to your left knee. Repeat on the right side. You should feel this stretch on the inside of your hip.

Hamstring Seated Hamstring Stretch: Sit on the floor with both legs straight out in front of you. Place your hands on your thighs and slowly move your hands toward your feet. Keep your chest lifted up. You should feel the most stretch in your hamstring (back of your thighs) and some stretch in your calves.

Quadriceps Standing Quadriceps Stretch: While standing, bend your left knee toward your buttocks. Hold your left ankle with your right hand and gently pull back on your thigh. You may use a chair or the wall for support. Repeat with the right leg. You should feel this stretch in your front thigh.

Calves Standing Calf Step Stretch: While standing straight on a step, move your right foot slightly backward. Your heel should be off the edge of the step. Lower your right heel slowly to stretch your calf. Repeat on the left side. Remember to use a handrail to keep yourself steady. You should feel this stretch in your calves (back of your lower leg).

June 2012 JOURNAL MSMA 195 Southern Remedy Healthy Living Program 27

Healthy Living

Fitness Program

Hurdler Stretch

Bad Stretches Some stretches put unnecessary strain on your muscles and joints. For this reason, there are some stretches you should avoid or only use under the direction of a physical therapist.

Standing Toe Touch

196 MSMA June 2012 28 JOURNAL Southern Remedy Healthy Living Program

Hyperextension of the back

Healthy Living Youth Fitness

SOUTHERN REMED

Y HEALTHY LIvING

yoUTh fiTneSStrs

N N ot e t o P a r e

Physical activity is a very important part of overall health, especially in children. regular physical activity improves the function of the heart and lungs, strengthens muscles, makes bones stronger, decreases body fat, and improves mood. the results are healthier children and adolescents who will grow into healthy adults. How often and how much of each? endurance activities should make up the largest portion of the 60 minutes of daily exercise. muscle-strengthening or bone-strengthening activities should be included in the 60 minutes of daily exercise for three days of each week.

Physical activity is a very important part of overall health, especially in children.

June 2012 JOURNAL MSMA 197 Southern Remedy Healthy Living Program 29

Healthy Living Youth Fitness

60 Minutes Activity

HOW MUCH ACTIvITY IS ENOUGH? the goals

How much activity is enough? the best evidence suggests that children and adolescents 6-17 years of age need 60 minutes of physical activity every day.

What Kind of activity is Best?

there are 3 kinds of activity: endurance, muscle-strengthening, bone-strengthening. each is important in its own way.

How often and How much of each?

endurance activities should make up the largest portion of the 60 minutes of daily exercise. muscle-strengthening or bone-strengthening activities should be included in the 60 minutes of daily exercise for three days of each week.

198 MSMA June 2012 30 JOURNAL Southern Remedy Healthy Living Program

Healthy Living Youth Fitness

REPRESENTATIvE EXERCISE for chilDren anD aDoleScenTS

endurance Children (6-12 years of age)

Adolescents (13-17 years of age)

Bicycle riding running Soccer Basketball Swimming active games (such as freeze tag)

Bicycle riding lawn mowing (push) Baseball/Softball Soccer Basketball Swimming running

muscle-strengthening Children (6-12 years of age)

Adolescents (13-17 years of age)

climbing monkey bars playing tug of war Sit-ups climbing rope

push-ups pull-ups Sit-ups climbing rock wall

Bone-strengthening Children (6-12 years of age)

Adolescents (13-17 years of age)

playing hopscotch Jumping rope hopping/skipping

Jumping rope running Tennis Volleyball

June 2012 JOURNAL MSMA 199 Southern Remedy Healthy Living Program 31

Healthy Living Youth Fitness

Choose the arrow that represents your child or adolescentâ&#x20AC;&#x2122;s present physical activity level to move forward.

less than

60 Minutes physical activity

less Than 60 minutes Every day Children should increase their physical activity gradually over time. If your child is active for 60 minutes per day but not EvERY day, increase the number of days that he or she is active. If your child is active EvERY day but not for at least 60 minutes, increase the time he or she is active. Remember that short bursts (10 minutes) count! Add them up to reach the goal!!

200 MSMA June 2012 32 JOURNAL Southern Remedy Healthy Living Program

Healthy Living Youth Fitness

60 Minutes

60 minutes Every day Do even more! In general, children should not be inactive for more than 2 hours at a time when awake.

physical activity

more than

more than 60 minutes Every day Continue current physical activity routine!

Minutes physical activity

June 2012 JOURNAL MSMA 201 Southern Remedy Healthy Living Program 33

Healthy Living Youth Fitness

WEEKLY EXERCISE PROGRAM Sample Weekly exerciSe program Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Endurance (40 minutes)

Musclestrengthening (20 minutes)

Bonestrengthening (20 minutes)

Musclestrengthening (20 minutes)

Bonestrengthening (20 minutes)

Musclestrengthening (20 minutes)

Endurance (60 minutes) - or Boneany of the Bone strengthening and Muscle (20 minutes) strengthening

Safety First

STOP

• remember to use appropriate safety gear during physical activity (bicycle helmets, elbow pads, knee pads) • never swim alone. • avoid obvious dangers such as allowing children to ride on all terrain vehicles.

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Sunday

Healthy Living

Fitness Program

June 2012 JOURNAL MSMA 203 Southern Remedy Healthy Living Program 35

Acknowledgements Many individuals played important roles in the production of Southern Remedy Healthy Living. Debbie Minor, PharmD, Olivia Henry, PhD,RD, and I worked with Leigh Wright, BA, on the original version, and Josie Bidwell, CNP, led the effort on the Fitness Prescription component. The Healthy Living plate was adapted from the USDAâ&#x20AC;&#x2122;s Choose My Plate program. Southern Remedy Healthy Living is a work in progress. It will be updated on the MPB website www.southernremedy.org. We anticipate others will come along to help. A superb committee of medical experts contributed at many levels and reviewed the final product. These include: Hillary Freeman, PharmD; Lissa Kay, PharmD; Yana Nikitina RN, MD; Faiza Qureshi, MD; Paula Stubbs, PT; Lindsey Tillman, PharmD; Mark Weber, PT. We would also like to thank Monica Watkins, administrative assistant III at UMMC and Christy Chamblee, graphic designer; Margaret McPhillips, public relations director; Nancy Perkins, marketing & development; and Jenny Wilburn, executive producer with MPB. Scientific data strongly suggests that any weight management and fitness program is more successful when implemented with a group. We strongly encourage the use of the materials in small groups to include church, civic, and at-work groups. For instance, hosting weigh-ins at regular intervals with prizes for success are effective and fun. The body immediately releases gastrointestinal hormones after weight reduction, which increase appetite and tend to decrease interest in physical activity. It is a constant fight to overcome these hormones, which stay elevated for many months after weight loss. Doing this as a group and making sure the exercise component is always a part of the calorie restriction are key. All of us wish you success in moving toward a more healthy lifestyle. Remember, a little effort goes a long way!

Richard D. deShazo, MD Professor of Medicine and Pediatrics University of Mississippi Medical Center

204 MSMA June 36 JOURNAL Southern Remedy Healthy Living2012 Program

DID YOUR LAST MEETING LEAVE YOU FEELING A TAD

“ECTOPIC” If so, you should consider having your next meeting in Tupelo!

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Express your opinion in the JMSMA

en is Mighter The P Than the Sword through a letter to the editor or guest editorial. The Journal MSMA welcomes letters to the editor. Letters for publication should be less than 300 words. Guest editorials or comments may be longer, with an average of 600 words All letters are subject to editing for length and clarity. If you are writing in response to a particular article, please mention the headline and issue date in your letter. Also include your contact information. While we do not publish street addresses, e-mail addresses or telephone numbers, we do verify authorship, as well as try to clear up ambiguities, to protect our letter-writers. You can submit your letter via email to KEvers@MSMA online.com or mail to the Journal office at MSMA headquarters: P.O. Box 2548, Ridgeland, MS 39158-2548.

June 2012 JOURNAL MSMA 205

PHYSICIANS NEEDED Internists, Cardiologists, Ophthalmologists, Pediatricians, Orthopedists, Neurologists, Psychiatrists, etc. interested in performing consultative evaluations according to Social Security guidelines.

OR Physicians to review Social Security disability claims at the

Mississippi Department of Rehabilitation Services (MDRS) in Madison MS.

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reserve Your rooM by calling 800-320-8115 (group code: 22J7R8). *Group rates significantly lower than previous years! Questions? JWhite@MSMAonline.com or 601-853-6733, Ext. 332 206 JOURNAL MSMA

June 2012

Medical Assurance Company of Mississippi An outside perspective and appreciation of MACM My position on the American Board of Family Medicine’s credentials committee gives me new insight and appreciation for the critical role that MACM plays in the lives of our state physicians. MACM’s involvement with its insureds — from risk management to liability and scope of practice issues — has their best interest, and that of the public they serve, at heart.

“

Particularly at the level of the Risk Management Committee, many of these issues are handled constructively and effectively to improve and ensure quality care for patients, while guiding physicians from potential hazards. In many states, without the commitment of an organization like MACM, physicians and patients are far less protected and similar issues result in adverse actions that often result in licensure and practice restrictions.

“

All insureds of MACM should be grateful for the role MACM and their experts in Risk Management play in keeping us (physicians and patients) safe.

Diane Beebe, MD Family Medicine Jackson, Mississippi

For over 30 years, Mississippi physicians have looked to Medical Assurance Company of Mississippi for their professional liability needs. Today, MACM is an integral part of the health care community through its dedication to risk management services for our insureds. A dedicated staﬀ and physician involvement at every level guarantees that the interests of our policyholders remain the top priority. This, combined with the many years of loyalty and support from our insureds, is what allows us to be the carrier of choice in Mississippi. Please call on us to assist with your professional liability needs.

1.800.325.4172 • www.macm.net

In Partnership with Insureds June 2012 JOURNAL MSMA 207

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Mississippi Physicians Don’t Miss a Thing with ONLINE CME from MSMA Now, you can earn CME credits where and when it is most convenient for you. Online courses provide the educational content you need, from a source you can trust, and without taking time away from your busy practice. Registering and participating in online CME is easy. Simply visit http://MSMAonline.inreachce.com, browse the MSMA catalog, and choose your courses.

Online CME from MSMA. Don’t Miss a Thing. June 2012 JOURNAL MSMA 209

MEA Medical Clinics Announces Openings for Board Certified Family Medicine Physicians in our Jackson and Laurel Area Clinics Guaranteed Base Compensation • Incentive Bonus Profit Sharing • Flexible Scheduling • CME Allowance Malpractice Insurance • Health Insurance • Life Insurance Disability Insurance • Much More!

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1-800-844-6503 Recruiter@mms-ms.com

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be healthy. eat healthy.

210 JOURNAL MSMA

June 2012

• InstructIons for Authors • The Journal of the Mississippi State Medical Association (JMSMA) welcomes material for publication submitted in accordance with the following guidelines. Address all correspondence to the Editor, Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS, 391582548. Contact Karen Evers, managing editor, with any questions concerning these guidelines: (601)853-6733, ext. 323. Style: Articles should be consistent with JAMA/ JMSMA style. Please refer to explanations in the AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007. JAMA and JMSMA style differs from APA style. JAMA: http://jama.ama-assn.org/misc/ifora.dtl Quick reference quide:http://www.docstyles.com/amastat.htm Any manuscript that does not conform to the AMA Manual of Style, 10th edition will be returned for revision. ManuScriptS should be of an appropriate length due to the policy of the Journal to feature concise but complete articles. (Some subjects may necessitate exception to this policy and will be reviewed and published at the Editor’s discretion.) The language and vocabulary of the manuscript should be understandable and not beyond the comprehension of the general readership of the Journal. The Journal attempts to avoid the use of medical jargon and abbreviations. All abbreviations, especially of laboratory and diagnostic procedures, must be identified in the text. Manuscripts must be typed, double-spaced with adequate margins. (This applies to all manuscript elements including text, references, legends, footnotes, etc.) the original and one duplicate hard copy should be submitted. in addition, the Journal also requires manuscripts in the form stated above be supplied in Windows OS-compatible digital format. you may email digital files as attachments to Kevers@MSMaonline.com or supply them on a portable memory storage medium. All graphic images should be included as individual separate files in TIFF, PDF or EPS format. Please identify the word processing program used and the file name. Pages should be numbered. An accompanying cover letter should designate one author as correspondent and include his/her address and telephone number. Manuscripts are received with the explicit understanding that they have not been previously published and are not under consideration by any other publication. Manuscripts are subject to editorial revisions as deemed necessary by the editors and to such modifications as to bring them into conformity with Journal style. The authors clearly bear the full responsibility for all statements made and the veracity of the work reported therein. revieWing prOceSS: Each manuscript is received by the managing editor, and reviewed by the Editor and/or Associate Editor and/or other members of the MSMA Committee on Publications and its review board. The acceptability of a manuscript is determined by such factors as the quality of the manuscript, perceived interest to Journal readers, and usefulness or importance to physicians. Authors are notified upon the acceptance or rejection of their manuscript. Accepted

28 JOURNAL MSMA

January 2012

manuscripts become the property of the Journal and may not be published elsewhere, in part or in whole, without permission from the Journal MSMA. title page should carry [1] the title of the manuscript, which should be concise but informative; [2] full name of each author, with highest academic degree(s), listed in descending order of magnitude of contribution (only the names of those who have contributed materially to the preparation of the manuscript should be included); [3] a one- to two-sentence biographical description for each author which should include specialty, practice location, academic appointments, primary hospital affiliation, or other credits; [4] name and address of author to whom requests for reprints should be addressed, or a statement that reprints will not be available. abStract, if included, should be on the second page and consist of no more than 150 words. It is designed to acquaint the potential reader with the essence of the text and should be factual and informative rather than descriptive. The abstract should be intelligible when divorced from the article, devoid of undefined abbreviations. The abstract should contain: [1] a brief statement of the manuscript’s purpose; [2] the approach used; [3] the material studied; [4] the results obtained. Emphasize new and important aspects of the study or observations. The abstract may be graphically boxed and printed as part of the published manuscript. Key WOrdS should follow the abstract and be identified as such. Provide three to five key words or short phrases that will assist indexers in cross indexing your article. Use terms from the Medical Subject Heading list from Index Medicus when possible. Available at: http://www.nlm.nih.gov/mesh/authors. html. SubheadS are strongly encouraged. They should provide guidance for the reader and serve to break the typographic monotony of the text. The format is flexible but subheads ordinarily include: Methods and Materials, Case Reports, Symptoms, Examination, Treatment and Technique, Results, Discussion, and Summary. referenceS must be double spaced on a separate sheet of paper and limited to a reasonable number. They will be critically examined at the time of review and must be kept to a minimum. You may find it helpful to use the PubMed Single Citation Matcher available online at: http://www.ncbi.nlm.nih. gov/ entrez/query/static/citmatch.html to find PubMed citations. All references must be cited in the text and the list should be arranged in order of citation, not alphabetically. Reference numbers should appear in superscript at the end of a sentence outside the period unless the text cited is in the middle of the sentence in which case the numeral should appear in superscript at the right end of the word or the phrase being cited. No parenthesis or brackets should surround the reference numbers. Personal communications and unpublished data should not be included in references, but should be incorporated in the text.

June 2012 JOURNAL MSMA 211

References must conform to proper style to be eligible for review. Contact managing editor Karen Evers for an easy-to-follow guide with examples of how to use JMSMA/ JAMA reference citation format. The following form should be followed: Journals: [1] author(s). Use the surname followed by initial without punctuation. The names of all authors should be given unless there are more than three, in which case the names of the first three authors are used, followed by “et al.” [2] title of article. Capitalize only the first letter of the first word. [3] name of Journal. Abbreviate and italicize, according to the listing in the current Index Medicus available online at http://www.nlm.nih.gov/bsd/aim.html. [4] year of publication; [5] volume number: Do not include issue number or month except in the case of a supplement or when pagination is not consecutive throughout the volume. [6] inclusive page numbers. Do not omit digits. Do not include spaces between digits of the year, volume and page numbers. example: Bora LI, Dannem FJ, Stanford W, et al. A guideline for blood use during surgery. Am J Clin Pathol. 1979;71:680-692.

books: [1] author(s). Use the surname followed by initials without punctuation. The names of all authors should be given unless there are more than three, in which case the names of the first three authors are used followed by “et al.” [2] title. Italicize title and capitalize the first and last word and each word that is not an article, preposition, or conjunction, of less than four letters. [3] edition number, [4] editor’s name. [5] place of publication, [6] publisher, [7] year, [8] inclusive page numbers. Do not omit digits. example: DeGole EL, Spann E, Hurst RA Jr, et al. Bedside Examination, in Cardiovascular Medicine, ed 2, Smith JT (ed). New York, NY: McGraw Hill Co; 1986:23-27.

figureS require high resolution digital scans to be provided. Printed copies should also be submitted in duplicate in an envelope (paper clips should not be used on illustrations since the indentation they make may show on reproduction). Legends should be typed, double-spaced on a separate sheet of paper. Photographic material should be high-contrast glossy prints. Patients must be unrecognizable in photographs unless specific written consent has been obtained, in which case a copy of the authorization should accompany the manuscript. All illustrations should be referred to in the body of the text. Omit illustrations which do not increase understanding of text. illustrations must be limited to a reasonable number. (Four illustrations should be adequate for a manuscript of 4 to 5 typed pages.) The following information should be typed on a label and affixed to the back of each illustration: figure number, title of manuscript, name of senior author, and arrow indicating top. tableS should be self-explanatory and should supplement, not duplicate, the text. The brief descriptive title, usually written as a phrase rather than a sentence, appears above to distinguish the table from other data displays in the article. Data should be aligned horizontally not to exceed 6.5". Tables should be numbered and supplied on individual pages separate from manuscript body text

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with placement indicated within. See Section 4 of the "AMA Manual of Style" for specific Figure and Table components and proper presentation of data. acKnOWledgMentS are the author’s prerogative; however, acknowledgment of technicians and other remunerated personnel for carrying out routine operations or of resident physicians who merely care for patients as part of their hospital duties is discouraged. More acceptable acknowledgements include those of intellectual or professional participation. The recognition of assistance should be stated as simply as possible, without effusiveness or superlatives. SubMiSSiOnS tO JMSMA Scientific SerieS top 10 facts you need to Know Series The purpose of this series of articles is to provide referenced information on clinical management of medical conditions in a concise fashion. The submissions should be directed toward practitioners who do not have specialty training on the specific topic as a matter of general information. The author of the best submission for each year will receive a prize. guidelines: 1) Articles should consist of 10 numbered paragraphs. Each of the paragraphs will begin with a fact that physicians need to know and a brief explanation of why. Facts will be referenced for each of the 10 points. 2) Suggested organization of manuscript is Introduction, Point 1, Point 2, etc., Conclusion, and References. 3) Articles will be about 3 pages (about 700 words) in length written at a level that can be easily understood by a practicing physician of any specialty. 4) A reference supporting the fact offered should be provided for each of the 10 points. Citations should not be review articles. 5) If there are specialty society guidelines in the area being discussed, the essential features of the recommendations should be included in the official guidelines cited in the references. uptodate Series The purpose of this series of articles is to provide brief reviews on topics of general interest to the practicing physicians of Mississippi in areas where recent developments in diagnosis or treatment have occurred. guidelines: 1) Articles should be practical and useful to physicians in office or hospital practice. 2) Suggested organization of manuscripts is Introduction, Diagnosis, Recent developments, Conclusion, and References. 3) Articles will be about 6 pages (1500 words) or so in length written at a level that can be easily understood by a practicing physician of any specialty. 4) Only include those references useful to physicians who desire further information in the area. Five to eight references that will be useful to those who desire further information should be included. 5) Figures are great as are “callouts,” i.e., boxes with key points to remember emphasizing the “take home” messages. 6) If there are specialty society guidelines on the topic, the essential features of the recommendations should be summarized in the text and the official guidelines should be cited in the references. galley prOOf - The principal author will receive a PDF via email to review. It is the author's responsibility to proof and approve it. Corrections should be clearly marked and returned promptly. If you desire reprints, inquire about prices to order. r

January 2012 JOURNAL MSMA 29

What’s Your Specialty? Our specialty is NETWORKING... TPAs Physicians

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MPCN - THE OBVIOUS CHOICE Change Networks. Not Doctors. 601-605-4756 • www.mpcn-ms.com Sponsored by the Mississippi State Medical Association

Have You Considered a Life Settlement For Your Old Life Insurance Policy? What is a Life Settlement? A life settlement is the sale of an existing life insurance policy on the secondary market to a third party investor.

Who or What May Qualify?  If the person insured by the policy is age 70 or older  If the person insured has any major medical conditions  If the policy has a death beneﬁt of $250,000 or more  Policies including, but not limited to, universal life, term insurance, variable life insurance or whole life insurance  If any cash value exists in the policy, the amount is relatively small

For More Information on Life Settlements, contact: H. Larry Fortenberry, CPA, CLU, ChFC Executive Planning Group, PA 1640 Lelia Drive, Suite 220 PO Box 16566 Jackson, MS 39216 (601) 982-3000

Why Use a Life Settlement?  Term life insurance policy will expire  Old policy that is no longer needed or premiums cannot be paid  A policy that was purchased for a business buy/sell and is no longer needed  A policy was purchased for a business that has been sold or is not needed  There may be a better policy available at a lower cost

 Estate value has changed and the policy is no longer needed

Securities Offered Through ValMark Securities, Inc. Member FINRA, SIPC Investment Advisory Services Offered Through ValMark Advisers, Inc. a SEC Registered Investment Advisor 130 Springside Drive, Suite 300 Akron, Ohio 44333-2431* 1-800-765-5201 Executive Planning Group is a separate entity from ValMark Securities, Inc. and ValMark Advisers, Inc. In a life settlement agreement, the current life insurance policy owner transfers the ownership and beneficiary designations to a third party, who receives the death proceeds at the passing of the insured. As a result, this buyer has a financial interest in the seller’s death. When an individual decides to sell their policy, he or she must provide complete access to his or her medical history, and other personal information, that may affect his or her life expectancy. This information is requested during the initial application for a life settlement. After the completion of the sale, there may be an ongoing obligation to disclose similar and additional information at a later date. A life settlement may affect the seller’s eligibility for certain public assistance programs, such as Medicaid, and there may be tax consequences. Individuals should discuss the taxation of the proceeds received with their tax advisor. ValMark Securities considers a life settlement a security transaction. ValMark and its registered representatives act as brokers on the transaction and may receive a fee from the purchaser. A life settlement transaction may require an extended period of time to complete. Due to complexity of the transaction, fees and costs incurred with the life settlement transaction may be substantially higher than other securities.