PROVIDING NORTHEAST ARKANSAS AND THE SURROUNDING AREA WITH HEALTHFUL INFORMATION
ISSUE 4 • Fall/ 2006
Commit to be
JUNIOR
Fit
M A R AT H
ON
BREAST CANCER
Prevention
Carroll Scroggin, Jr, M.D.
Is it a Freckle or Cancer? HPV - There's a VACCINE! Is Your JOB Affecting Your SLEEP?
Announcing
Conquer Those Fitness Excuses
Manage Your Pain What is Hope?
an affiliate of CARTI
HEALTH
com
Ask-the-Doctor Checklist Before the visit: • Observe the problem. When did it start? What are the symptoms? Are you in pain? • Make a list of any medications you are currently taking. • If you have seen a doctor before for a similar problem, take the record from the visit with you. During the visit: • State your main problem first. • Describe your symptoms. • Describe your past experiences with the same problem. After the visit, write down: • What's wrong. • What might happen next. • What you can do at home.
Your One-Stop Source for Health Information • Research Any Health Topic • Link to Other Resources • Stay Informed
For medications, tests, and treatments, you may want to ask: • What's the name of the medication (or test, or procedure)? • Why do I need it? • What are the risks? • Are there alternatives? • What happens if I do nothing? • (For medications) How do I take this? • (For tests) How do I prepare? At the end of the visit, ask: • Do I need to return for another visit? • Can I phone in for test results? • What danger signs should I look for? • When do I need to report back about my condition? • What else do I need to know?
S t a y i n f o r m e d a t w w w. N E A H e a l t h . c o m
NEA Health magazine benefits the programs of
NEA Clinic Charitable Foundation has a mission to help change lives through the programs and services it supports in Northeast Arkansas. The Foundation, through the generous gifts of our community, touches every community member and every corner of Northeast Arkansas.
On The Cover
Thanks to all of our advertisers! PUBLICATION OFFICE 1835 Grant Ave. Jonesboro, AR 72401 h_acebo@neaclinic.com www.neaclinic.com Holly Acebo, Executive Director NEA Clinic Charitable Foundation Director of Marketing NEA Clinic, NEA Medical Center Kim Provost, Advertising Nicole Frakes, Graphic Design Karin Hill, Assistant Editor NEA Health is published bi-annually for the purpose of conveying health-related information for the well-being of residents of Northeast Arkansas and Southeast Missouri. The information contained in NEA Health is not intended for the purpose of diagnosing or prescribing. Please consult your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. Editorial, advertising and general business information can be obtained by phoning 870-9345101 or by writing in care of this publication to: PO Box 1960, Jonesboro, Arkansas 72403. You may also e-mail h_acebo@neaclinic.com and put “NEA Health” in the subject line. Copyright© 2006 NEA Clinic Charitable Foundation. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording and any information storage retrieval system, without written permission from NEA Clinic Charitable Foundation.
Carroll Scroggin, Jr., M.D. has practiced medical oncology and hematology since joining NEA Clinic in 1991. He is originally from Palos Verdes Estates, California and graduated cum laude from Claremont McKenna College in California where he majored in Biology and Anthropology. Dr. Scroggin attended medical school at the University of Arkansas for Medical Sciences. He completed his residency in Internal Medicine at UAMS and a fellowship in oncology and hematology at UAMS/Arkansas Cancer Research Center. He is board certified in Internal Medicine, Medical Oncology, and Hematology. He is a member of the Arkansas Medical Society, American College of Physicians and American Society of Clinical Oncology. Dr. Scroggin has acted as a clinical research investigator for many clinical trials involving new treatments for cancer and blood disorders. He participates in Southwest Oncology Group clinical trials, Sarah Cannon Cancer Treatment clinical trials and in various pharmaceutical studies. Dr. Scroggin is on active staff at NEA Medical Center, Surgical Hospital of Jonesboro and St. Bernards. He is currently serving as the president of NEA Clinic Charitable Foundation and is a member of the NEA Medical Center Board of Trustees. He has completed a program for Education for Physicians on End of Life Care and is the medical director of St. Bernards Hospice. He and his wife, Ruth, live in Jonesboro. He is an avid tennis player and enjoys working out at NEA Clinic Wellness Center. He is a member of St. Mark’s Episcopal Church.
Background Cover photo: “Blessing” displayed in NEA Clinic Charitable Foundation’s HopeCircle.
1. NEA HEALTH • Fall 2006
CONTENTS
from the editor
20+
If you are like me, you work hard to make wise decisions about your health and your family's health. It's important to me because I know the health of my family depends on me. I make sure my children eat healthy foods, wear sun block and keep up to date on shot records and flu vaccines. There is an abundance of great information out there – the problem is sorting through all of it. In this day and age, we have many sources of health information: TV, radio, Internet, printed publications, etc. It can be an overwhelming task to make sense of it all! As we finish up our fourth NEA Health publication, we feel like we are meeting the need of health related topics and information – written by your physicians right here in Northeast Arkansas! Through NEA Health magazine and our online NEAHealth.com, we want to provide healthful information at your fingertips. It is our goal to provide concise yet comprehensive information on topics that are of interest to a wide variety of people. And we hope that this resource helps you learn new ways to improve your health and the health of your family. Our cover story this month features Dr. Carroll Scroggin, President of NEA Clinic Charitable Foundation and Oncologist with NEA Clinic. Dr. Scroggin's insight on breast cancer prevention is timely with our announcement of NEA Cancer Institute and Research Center. The community has been exceptional to support our mission of a Health conscious magazine ... keep it up Northeast Arkansas! Enjoy reading the healthful information. I welcome your feedback and comments or suggestions for future publications. As the weather turns colder, always remember to try to stay active. Keep running, walking or golfing every chance you get. Take your kids to the park, and make healthy choices at meal time! Have a healthy and blessed day!
pages of advice from doctors you know and trust. 6 Pain Management As
You Age - Dr. Maglothin 8 Your Internal Clock VS.
The Punch Clock - Dr. Nichols 10 Exercise in Older Adults -
What’s In It For You? - Dr. Covert 12 Diabetic Retinopathy -
What You Should Know - Dr. Margolis 18 HPV Vaccine - Dr. Barker 20 Breast Cancer Prevention
- Dr. Scroggin 24 Preventing “Boomeritis”
- Dr. Brandt 26 Sunshine and the Skin
- Dr. Towry 30 Rehabiltation & Parkinson’s
Disease - Health South 38 What is Family Medicine?
- Dr. Shown 2 From the Editor 4 What is Hope? 16 Hope Week 17 Solutions to Top Fitness
Excuses 20 Announcing NEA Cancer
Institute & Research Center 29 Does the Shoe Fit? 32 What is an APN? 35 NEA Clinic, Growing with
the Community “Alone we can do little; together we can do so much.” - Helen Keller
36 Healthy Eating 39 List of Advertisers 40 Commit to be Fit
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Loc al Ownership & Hometown C ar ing...World Class Te chnology & Ser v i ce! ©
3. NEA HEALTH • Fall 2006
s I t a HOPE? h W
WHAT IS
“HOPE is a thing with feathers that perches in the soul and sings the tune without the words and never stops at all.”
he Foundation of Hope in Alberta, Canada asked that question, along with other HOPE related questions in over 2,000 research protocols. Their general findings reported that HOPE is virtually always related to more beneficial life outcomes.
T
How many aspects of our life would be different if we didn’t have HOPE? I invite you to consider your own beliefs about HOPE through these HOPE focused questions from The Foundation of Hope.
Sometimes HOPE lends a hand. Sometimes it needs a hand. Sooner or later life introduces us vividly to our need for HOPE. Some people believe Hope is an attitude, an optimism, or faith that everything will be okay regardless of the outcome. Ellen Stovall, of the National Coalition of Cancer Survivorship, is quoted saying, “There is no such thing as false HOPE.”
- Is HOPE an attitude or belief that can be learned and practiced?
The absence of HOPE may be our greatest teacher. As a mental health nurse, one of the most important factors in evaluating mental well being is the degree of HOPE vs. HOPELESSNESS. The word HOPE is often used as if it holds equal value in expressions like “I HOPE it rains” or “I HOPE we find a cure for cancer.” In the process of becoming one of those catch-all words it may have lost some of its significance. How often do we use the word HOPE to mean our wishes, our desires, or our dreams? Many times HOPE is tied to an outcome; however, Emily Dickinson expressed HOPE as being intrinsic in nature. Her quote has been a favorite of NEA Clinic Charitable Foundation’s HopeCircle. “HOPE is a thing with feathers that perches in the soul and sings the tune without the words and never stops at all.” Ninety-five percent of the people we talk to tell us they find their HOPE through faith or prayer. Henri Nouwen stated, “Every prayer is an expression of HOPE.”
4. NEA HEALTH • Fall 2006
- What is HOPE to you? - Who/what makes you feel hopeful and why? - Rate your HOPE on a scale of zero to ten with zero meaning no HOPE. - What is it that most threatens your HOPE? - Name an activity (event, person) that tends to increase/decrease your HOPE. - What might you do to make HOPE visible at times when you don’t see HOPE? - What are ways you can bring HOPE to the lives of others? During a recent planning session for the NEA Clinic Charitable Foundation’s week-long “Celebration of HOPE,” we were considering symbols that would represent HOPE. Artist Nicole Frakes was working on the event. She awakened during the night and drew a dandelion on a scratch piece of paper. It was not an expected symbol for HOPE, but it was a wonderful metaphor for HOPE and a symbol we quickly grew to love. HOPE is like the dandelion gently blowing across the field. HOPE flourishes in unexpected places and thrives in unfertile soil. HOPE spreads rapidly and is very difficult to kill. And, HOPE always brings a smile to the face of everyone it touches. HOPE is – the breath of life. Ronna Jevne, Ph.D. of The Foundation of Hope describes HOPE this way: HOPE is the art of living. In the heart of each of us, there is a voice, a small voice that yearns to say “yes” to life. If
s Hope?
HopeCircle Resource Center Lending Library Free Computer Access Supportive Counseling Family Support Educational Programs & Resources Spirituality & Illness Support Group Community Events & Educational Programs Crisis Intervention
nurtured and strengthened, it invites, encourages, pulls, pushes, cajoles and seduces us to go forward. Whether viewed as a human need, a biological life force, a mental perspective or an eternal pull to transcend self, HOPE is capable of changing lives.
Support Groups Hospital Visitation HopeCircle Volunteers
Upon my graduation as a parish nurse, a priest at St. Louis Catholic Church delivered a mass on HOPE. He charged medical providers with the responsibility of nurturing and caring for a person’s HOPE. He expressed a HOPE that is much deeper and more tangible than our optimism. He concluded the mass by saying, “HOPE is another way God says your name, and in HOPE may others see God’s face in you.”
Youth Volunteers “Life’s Tapestry” “I’m Still A Parent” All provided free of charge from NEA Clinic Charitable Foundation!
Brenda Wiseman, R.N.,C. NEA Clinic Charitable Foundation HopeCircle – 870.934.5214
www.neacfoundation.org 870.934.5214
Single Source, Total Health
NEA PremierCare includes:
• • • •
NEA Clinic NEA Medical Center The Surgical Hospital of Jonesboro Independent Physicians
To find out if your health plan is in-network, please call us at (870) 932-0023
Quality
Choice
Access
Value 5. NEA HEALTH • Fall 2006
Pain
MANAGEMENT AS
You Age
Physical methods - Heat, cold, massage, and rubs applied to the skin; topical rubs containing menthol, salicylate, or even an extract of hot peppers (capsaicin) that give a sensation of heat or cold. Heat or cold should be applied 15-20 minutes at a time.
P
ain is a common complaint among older adults, but should not be considered a normal part of getting older. Pain is usually characterized as acute or chronic. Acute pain begins abruptly and lasts only a short time. In contrast, chronic pain lasts 3-6 months or longer. Chronic pain may affect quality of life physically, socially and psychologically. For instance, pain can result in difficulty in performing everyday activities, problems thinking, depression, anxiety, social isolation, loss of appetite, and sleep problems. Pain differs from person to person, even when there are similar problems. Because there are no laboratory tests for pain, various rating scales have been developed to help assess pain more accurately. When reporting pain to a health professional, you may be asked to rate your pain by using numbers, such as “rate the pain from 1 to 10, with 10 being the worst pain imaginable.” The treatment approach to acute pain and chronic pain differs. Acute pain is usually controlled by treating the underlying disease and by using short-term pain relievers. Chronic pain, however, usually requires several approaches, including various behavioral and coping strategies, in addition to pain relievers and other medications.
Biofeedback, relaxation, and hypnosis – Music, meditation, or prayer can be effective in controlling pain. Activities, exercise, and recreation – Exercise can make you feel better mentally and physically. It can also help take your mind off the pain. Medications used to control pain – Acetaminophen (Tylenol®) nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium; adequate fluid intake, and antidepressants or anti-seizure medications. This happens only rarely. The important factor is to treat the pain rather than to withhold medicine merely due to the patient’s fear of addiction. Dealing with pain involves much more than just taking pain medication. It involves a good relationship with your doctor and a willingness to work with other tools to overcome the pain.
The American Geriatrics Society ww.americangeriatrics.org NEA Health.com www.neahealth.com
Options may include: Transcutaneous electrical nerve stimulation (TENS) – This is a small device attached to the body that works on painful nerves caused by diabetes, shoulder pain or bursitis, and fractured ribs.
Doug Maglothin, M.D. Family Practice NEA Clinic – Windover Clinic 870.935.5432
◆ www.neahealth.com keyword: pain management 6. NEA HEALTH • Fall 2006
Location, Location, Location While most folks don’t plan for emergencies, we do. Expanding to more locations spread throughout Northeast Arkansas and Southeast Missouri means Medic One is near by when you need us. Licensed paramedics, 24-hour dispatch, and pinpoint mapping software are just a few of the ways we’re thinking of you even before you call.
>
1000 E. Johnson
N 617 W. Nettleton 3606 E. Highland 3301 S. Caraway
MISSOURI CAMPBELL. KENNETT, MALDEN, SENATH ARKANSAS BLYTHEVILLE, JONESBORO, MANILA, OSCEOLA, POCAHONTAS, WALNUT RIDGE
870-972-0708
Visit www.medic-one.info for the location nearest you & remember dialing direct saves time!
SATURDAY, OCTOBER 21 BETTER LIFE COUNSELING CENTER, BEHIND THE YMCA ON NETTLETON
Join other riders for a 10 mile, 20 mile or 62 mile bike ride through the scenic Crowley’s Ridge area near Jonesboro!
Registration begins at 7:15 a.m.
Area businesses are invited to form teams.
Visit www.betterlife.org for all the details including entry forms, fees and route information. The Better LIfe Counseling Center is a non-profit organization that provides Christian counseling to families, couples and individuals based on their financial need.
eing a member of the 21st Century brings with it many advantages and conveniences in our daily lives. Thanks to scientific and technological advances our lives are made easier and more enjoyable. Medical research has helped us to live longer and has developed excellent treatment for controlling and reducing the risk of many of society’s chronic illnesses like diabetes, hypertension and heart disease.
B
But along with these advances has come a continuing push to be a 24/7 society. We have expectations of finding services, shopping, dining, and entertainment available around the clock. More and more of the workforce needed to operate our 24/7 society finds itself expected to work at nontraditional times. This expectation is not limited to the service industry but includes the traditional manufacturing jobs as well. Many companies are forced, for economic and productivity reasons, to utilize an around-the-clock workforce. It is estimated that about 20 percent of our workforce has a job that requires work hours outside the traditional 7 a.m. to 6 p.m. workday on a regular basis. This number is likely to rise as the requirement for mandatory overtime and second jobbing becomes more commonplace. So, what’s the problem with this picture? One just sleeps at a different time. No big deal, the clock has 24 hours and you take your sleep time where you must, and move on! This philosophy is fine for the 80 percent of workers fortunate enough to work during the daylight and be in their beds during the typical night sleep times. But those who work the “night and early AM shift times” find themselves either getting up very early to make the pre-dawn start-times, or, even worse, find themselves working all through 8. NEA HEALTH • Fall 2006
the night. They soon discover that man is not wired to work at night and sleep during the day. Many shift workers find great difficulty with this nontraditional and un-natural schedule. Their problems fit into a describable medical diagnosis called a circadian rhythm sleep disorder, shift-work type.
estimate may be inaccurate and likely understates the magnitude of the problem. It is also known that certain workers are more likely to develop problems coping with the rigors of shift work. Individuals older than 50 years, those with a history of gastrointestinal problems, psychiatric illness, previous sleep disorders, diabetes, epilepsy or heart disease are typically more prone to suffer from this sleep disorder. Also more susceptible are those working second jobs or having heavy domestic responsibilities. An individual’s sleep time preferences can be either a plus or a minus in this situation. The “morning person” suffers with the night shift, while the “night owl” does especially well.
The International Classification for Sleep Disorders tells us that the circadian rhythm sleep disorder, shiftwork type, is characterized by complaints of insomnia or excessive sleepiness occurring in relation to the working of night and early morning shifts. These workers typically report curtailed total sleep times from one to four hours. Their sleep quality is perceived as unsatisfactory. There often is the complaint of difficulty in initiating or sustaining the necessary Why does this happen? The short daytime sleep, and as a result sleep answer is because man is designed to deprivation occurs with the symptoms function alertly during the day and of decreased alertness, loss of sleep at night. To do otherwise is to concentration, decreased motor skills, attempt to change or go against our and irritability as well as increased internal biologic clock or circadian sleepiness during the wake hours. rhythm. We tend to be overcome by the Complications of the disorder have drive to sleep when two different been described with increased mechanisms “kick in.” One, the gastrointestinal symptoms and circadian rhythm, has a daily cycling exacerbations of cardiovascular between sleep and wakefulness and is disorders. It is also recognized that largely set by the environmental cues there are frequent disruptions of the from light. We tend to get sleepy when social and family life that often can the nighttime falls and become alerted lead to fractures in relations and when the sun rises. This clock affects increased tensions within the family not only the drive to sleep but many of unit. All too often individuals who our body systems are tuned into it as suffer the most with well. The other drive to sleep this disorder find ...individuals who suffer is called the homeostatic drive. the most with this themselves at greater It is simply a buildup of the risk of accidents or disorder find themselves need to sleep that comes from at greater risk of injuries, and due to prolonged wakefulness. The their symptoms they accidents or injuries... longer one goes without sleep, bring both safety and the more difficult it is to avoid productivity issues to the workplace. the onset of sleep. Even minor loss of sleep will make this drive cause us to It is estimated that from 2 to 5 percent feel drowsy, even in the daytime. The of shift workers may suffer with this only “fix” for this drive is adequate sleep problem. However, this is a periods of sleep. A person working the difficult statistic to obtain and the night shift must go against his internal
◆ www.neahealth.com keyword: sleep disorder clock and attempt to be alert during the night, when his environmental cues are to sleep. Even worse, the worker many times has great difficulty getting sufficient amount of sleep during the daytime or early evening that is capable of suppressing the homeostatic sleep drive. Thus the worker is at risk of having to work in a sleep-deprived state and during a time interval that his body is telling him to sleep. As if this were not enough to deal with, there are more complicating factors that can affect the situation. Although the worker needs to sleep during the day, society doesn’t always respect this need. The necessity of getting things done often forces a worker to choose between sleep and not getting the task completed. Interruptions to sleep can come from the telephone, loud noises, door knocks, family members, and dozens of other examples. Light and potentially increased daytime temperatures can be problems for daytime sleepers. Family members and their needs, as well as the sense of obligation and desire on the part of the worker to be a part of the family life, further contributes to the likely loss of sleep. This may be from either the time spent in activities or the emotional stress of feeling guilty that then interferes with the attempts to sleep. Perhaps in an unknowing manner, many times the efforts to be fair with work schedules can further complicate the shift worker’s lot. Everyone has heard of “jet lag” and realizes that when one travels to a distant time zone your body has to adjust, and that there are functional issues that are very similar to what is described above. With jet lag our internal clock is aided in its time resetting by stimuli that come from a “new” light dark cycle, and from the social cues from the activities around us. These are lacking for the shift worker. His work cycle is the only change. Although there can be some adaptation to the new work time, it is rarely complete during the days allotted to working the shift. Workplace policies that vary the shifts among groups of workers can keep any complete adaptation from happening. This, in effect, causes the body to be in a constant need to adapt – a goal made more elusive by these very changes.
Rotating shifts, off times when workers rejoin their daytime oriented families, and extended overtime all further complicate the delicate processes attempting to adapt to the un-natural work periods.
that the workplace can be adapted to help the workers become more successful in their struggle to change. Things like bright lighting, and consideration of authorized power naps, timings of breaks and approving the use of alerting medications may Solutions to this problem, just like the help facilitate the internal clock shift. problem itself, are They can learn to listen to neither simple nor those workers who are Individuals can learn to within the control of having trouble adapting to make a self-assessment of any one particular the night shifts and adjust their own tolerance person or group of schedules where possible. for the shift work... people. They must They can look to the come as a result of research in work shift the cooperation among workplace scheduling and strive for the least managers, the family, and society and disruptive types of schedules that can from the individual. It is essential for still achieve the economic and everyone involved to be educated productivity goals. And perhaps most about the issues that bring about the importantly they can learn to watch sleep disorder and its real for the signs of workplace sleep consequences that threaten individual deprivation among their employees. and public safety, diminish They need to develop methods that productivity and work quality, and detect quality, safety, absenteeism and contribute to weakening marital and health issues that can stem from the family relationships. Education is failure to tolerate the many stresses needed in what the scientific and created by the work schedules. Doing medical communities know may be this may well uncover currently helpful in reducing the symptoms and unappreciated consequences already risks. present in the work place. Individuals can learn to make a selfassessment of their own tolerance for the shift work and make decisions on whether to continue or find ways to get to more tolerable shifts. They can learn how to better control the daytime sleep environment and their sleeping habits. They should talk with their physicians about medications that can both aid sleep during the day or increase alertness during the work shift. They can learn the importance of a regular sleep routine and how to best adapt to the changing work schedules. Families can be educated on the importance of helping to maintain and not interfere with the quality of the worker’s sleep environment and better understand the stresses that come from such work schedules. They can become more knowledgeable and accepting of the unwanted impact of shift work upon the ability of their worker to participate in family outings. Workplace managers can become educated in the same way as individuals about the sleep disorder but can also learn about ways
One reason for strong optimism may well be that timing may be on our side. The discipline of clinical sleep medicine is on the rise, and increasing numbers of trained sleep physicians are becoming available to help educate and treat these individuals. Due to the tireless work of many of the early pioneers in sleep medicine, there has been an ever-increasing awareness of the importance of good sleep and the consequences of too little or bad sleep among the public and practicing physicians. More funding for sleep research is there, and answers to the complex questions raised by this disorder are being sought. However, undoubtedly the first and most important step is awareness and understanding of this sleep disorder.
David R. Nichols, M.D. Sleep Medicine NEA Clinic – 870.935.4150 9. NEA HEALTH • Fall 2006
EXERCISE
in Older Adults...
WHAT’S IN IT FOR YOU?
Y
ou’re getting older – you’re mad – and you won’t put up with it anymore! Is that the way you feel? Don’t we all feel the creep of time in our daily lives? As the years pass, we sometimes have regrets about things we’ve said or didn’t say, as well as things we’ve done or wished we’d done. Does that mean it’s too late to make changes in our lives, to make better choices about the way we live? Not really. Research shows that when we reach our 50s, 60s and even 70s, altering our lifestyle can still improve our ability to manage stress, keep the weight off and improve our mental and physical health. Preservation of function is especially important in our senior years. We want to do many of the things we’d put off until retirement, or at least until the kids moved out of the house, such as travel, resume old hobbies, take an educational class, etc. Beyond that, many seniors are finding that they have to return to the workforce to supplement their income or obtain health insurance. We all know that the cost of healthcare is skyrocketing. It is also known that choosing healthier lifestyles can help to limit those costs through reduced need for medications,
lowered complication rates for surgery and shorter recovery times for most illnesses.
With Americans living longer, it is important to be able to continue to take care of our daily tasks of living such as: bathing, dressing, walking, driving, climbing ladders or stairs, playing sports or simply remembering where we put our keys. Exercise can positively impact all of these activities; however, many people have questions they need to consider prior to starting an exercise program. 1. Is it too late to begin an exercise program? 2. Am I too old to exercise? 3. Is it safe to begin exercising, even if I haven’t done so in years? 4. What are the risks of exercise? 5. What kinds of exercises are right for me? 6. How much exercise is enough? The answer to the first two questions is as follows: It is never too late and you are never too old to begin exercising, regardless of your health, once cleared by your doctor to be sure it is safe and you won’t aggravate an underlying heart, lung or orthopedic condition. Studies have shown that older adults accrue benefits, even in their 70s. So dash the thought you are too old to join in with the rest of the fitness crowd! The third question should be addressed in the context of communication with your primary care doctor. For most people, exercise is safe, even if they were not athletic in their younger years. It is just a matter of making good choices as to what kind of exercises to do and with what degree of intensity. In some cases, you need to start slowly, with non-impact activities such as water aerobics or stationary cycling. For some, a brisk walk or light jogging might be right. It depends upon your current level of fitness, as well as your underlying medical status.
10. NEA HEALTH • Fall 2006
In response to question four, you need to know that any physical activity poses risks, whether it is doing the laundry, painting a wall or walking the dog. The risks depend upon the frequency, intensity, type, time and progression of exercise. (I like the acronym FITT-PRO to help remember this.) For most senior adults, the main risk will be stiffness and soreness as they begin exercising. As fitness levels improve, the risks shift toward overuse types of problems, such as tendinitis or bursitis. With high intensity or prolonged exercise, the risks then shift toward hypoglycemia (low blood sugar) in diabetics, arthritis, stress or compression fractures, muscle or tendon ruptures, etc. With few exceptions, these can all be avoided with a properly structured and monitored program. In regard to question five, I am always asked what kinds of exercises are right for senior adults. This is a very loaded question because you need to take into account each person’s underlying health status. Considerations must include: • Current weight or body fat percentage • Current activity level • Underlying orthopedic problems – arthritis of the knees, bursitis of the shoulders, heel spurs, osteoporosis, etc. • Cardiac problems such as vessel blockages or abnormal heart rhythms • Lung problems such as emphysema or asthma After talking with your doctor you may want to consult with a personal trainer to help you get started with a new program. These fitness experts can help to select appropriate training exercises. These might include: swimming, walking, cycling or elliptical training to improve cardiac fitness, or Pilates, Yoga or Tai Chi to improve flexibility or working with weight machines to build strength and muscular endurance. Lastly, I hear the question, how much is enough? If you have the time, performing a rotating routine that includes strength
training two to three days per weeks, alternating with stretching and aerobic activities three days per week is ideal. Starting with a low to moderate intensity level for 10-15 minutes per day is a good start. Adding 4-5 minutes more aerobic exercise to your routine each week until you reach a 30-40 minute program is reasonable. Once you reach this point, if you feel up to it, you may want to increase the intensity until your heart rate is 60-70% of maximum heart rate. (There are tables to help estimate this based on age.) For resistance training, you probably want to start at low intensity, with a weight that you can comfortably lift 10-15 times per set.
Your trainer or doctor can give you an idea about which exercises to do and how much weight is appropriate. Don’t forget to stretch! As we get older, our flexibility is one of the first things we lose. This leads to back pain, shoulder problems and muscle injuries. Therefore, it is imperative to include this as a regular part of your regimen.
to design a personal fitness program that will fit your needs and help you stay trim, strong and healthy. Today is the time to make that commitment to improve your life. As I tell my patients, it’s better to wear out than rust out! Don’t hesitate to say hello if you see me at the Wellness Center.
At the NEA Clinic Wellness Center, there are experts available to help you change your life through exercise. They are ready
◆ www.neahealth.com keyword: exercise
Richard A. Covert, M.D., M.P.H. Occupational Medicine NEA Clinic – 870.910.6040
Thank You, Northeast Arkansas for your outstanding community support! YOU make these programs possible with supporting community fundraising events such as
A FREE after-school program to teach, motivate and guide overweight children and their families to build a solid foundation of proper nutrition and regular exercise for a healthy lifestyle.
Duck Classic Woman to Woman Luncheon
Laura Taylor, Manager 870.336.1760
Dare To Ride Biker Classic Ar t Slam
Provides a community of hope, support and
Fall Ball
families living with a catastrophic illness.
educational programs FREE of charge for
Brenda Wiseman, Director June Morse, Volunteer Coordinator 870.934.5214
Phantom Affair Trash to Treasure
For more information about these events or volunteering call today! Holly Acebo, Executive Director 1835 Grant Ave. Jonesboro, AR 870.934.5101
In 2005, we assisted in filling over 25,000 FREE prescriptions, over 9 million dollars in free medicine to those who couldn’t afford it. Kim Provost, Director 870.934.5400
www.neacfoundation.org 11. NEA HEALTH • Fall 2006
Diabetic Retinopathy: What You Should Know
D
iabetes affects your whole body, from your head to your toes. The most common and most serious eye complication from diabetes is Diabetic Retinopathy. All people with diabetes are at risk for Diabetic Retinopathy including both type I and type II diabetics. That’s why everyone with diabetes should get a comprehensive eye exam including dilation at least once a year.
Normal Vision
The retina is like the “film” at the back of your eye that develops the picture. It absorbs the incoming light rays and sends a picture to your brain. Diabetes affects the small blood vessels that take oxygen and nutrients to the retina. These blood vessels are damaged by the high blood sugars and form aneurysms. The aneurysms leak blood and fluid into the retina, which causes damage. The retinal damage is mostly irreversible, so early detection and treatment is important to avoid vision loss. The longer you have diabetes the more likely you will have Diabetic Retinopathy. The damage that occurs is cumulative and increases with time. The higher your blood sugars run, along with blood pressure and cholesterol, the more damage they cause to the retina and blood vessels. Studies have shown that controlling these factors will lower your risk of vision loss. Don’t wait for symptoms! Often there are no symptoms in the early stages of the disease, nor is there any pain. Be sure to have a comprehensive eye exam at least once a year. Treatments can be performed with lasers, and, if caught early, the risk of blindness can be reduced by 90 percent. However, laser surgery often cannot restore vision that has already been lost. That is why early detection is the key to good outcomes. If you or a family member are diabetic and haven’t seen an Ophthalmologist for a comprehensive eye exam lately, then call NEA Clinic Ophthalmology. Our doctors are specialists in diagnosing and treating Diabetic Retinopathy. At NEA Clinic we take care of the whole patient, from your head to your toes.
Matthew Margolis, D.O. Ophthalmology NEA Clinic - 870.932.0485
◆ www.neahealth.com keyword: diabetic retinopathy 12. NEA HEALTH • Fall 2006
Vision with Diabetic Retinopathy
Finally … An Option – Freedom from Glasses
The AcrySof® ReSTOR® IOL is now available and delivers a high level of glasses-free vision for cataract patients. The AcrySof® ReSTOR® IOL allows you to read prescription bottles, magazines and newspapers, while also having the ability to drive or go on sightseeing tours, all without using your glasses! In fact, FDA clinical studies have demonstrated that 80 percent of patients never needed to wear glasses or bifocals again. Please schedule an appointment today! LASIK No Stitch, No Shot, No Patch Cataract Surgery AcrySof® ReSTOR® Lens Laser Eye Surgery Diabetic Eye Disease
No more reading glasses!
OPHTHALMOLOGY 416 E. Washington, Suite B Jonesboro, AR 72401
Dr. Joe George • Dr. Matthew Margolis • Dr. James Cullins
870-932-0485 www.neaclinic.com
Macular Degeneration Glaucoma Pediatric & Strabismus Surgery Designer & Safety Eyewear Contact Lenses, No Line Bifocals Medicare & Medicaid Accepted
13. NEA HEALTH • Fall 2006
g n i n e 7 p O 00 2
an affiliate of CARTI
F
or more than 25 years, NEA Clinic has been the leader in providing comprehensive, personalized, quality, specialty care for patients throughout the Northeast Arkansas region.
“This cancer center, appropriately named the NEA Cancer Institute and Research Center, will truly be unlike any other in the state. In order to better serve our patients, the center will house under ‘one roof’ all specialists and technical services needed to conveniently care for the cancer patient,” said Jim Boswell, CEO of NEA Clinic.
Over the past several years the clinic has experienced significant growth in its Medical Oncology practice as a result of the growth of the region and the continued confidence of the patients that “state-of-the-art” specialty care is available in Northeast Arkansas.
Specifically, medical oncology physicians, radiation oncology physicians, the chemotherapy treatment center, radiation treatment center, cancer research center, advanced imaging center, patient education services, and supportive care services such as NEA Clinic Charitable Foundation’s HopeCircle will be within the center. “This ‘one-stop or ‘integrated’ approach to providing comprehensive medical care is the foundation of NEA’s multi-specialty group practice,” stated Boswell.
In order to continue to meet the demands of patients in the region and further our commitment to providing the full range of cancer care right here at home, NEA Health System has announced plans to expand its services by building a state-of-the-art cancer treatment center to serve patients in our region.
As stated above, the NEA Cancer Institute and Research Center will include both radiation oncology and medical oncology facilities. Instead of visiting different facilities and medical offices, patients will receive both medical therapy (such as chemotherapy) and radiation therapy in one convenient location.
14. NEA HEALTH • Fall 2006
Treatment for cancer has advanced significantly in recent years, and has become more complex due to different modalities of therapy that are often required. Multiple specialists are often consulted to coordinate the treatment plan, which will now occur on-site in one location. With the new cancer center, complicated treatment plans will be better coordinated since the specialists will be practicing under the same roof. Also, consultations with both radiation and medical oncologists can be done in one visit, which will make it convenient for all patients. We are proud to announce a partnership and affiliation with Central Arkansas Radiation Therapy Institute (CARTI), which has been leading the way in radiation oncology in Arkansas over the past 30 years. CARTI operates seven facilities across the state including those on the campuses of UAMS, Baptist Health and St. Vincent Infirmary Medical Center in Little Rock, and facilities in North Little Rock, Mountain Home, Searcy and Conway. CARTI is dedicated to providing the most advanced forms of radiation therapy as well as outreach and educational programs to patients. Through our affiliation with CARTI we will be able to utilize their expertise and resources to make available immediately for our patients the latest and most advanced forms of radiation therapy such as IMRT (intensity-modulated radiation therapy). IMRT is an advanced mode of high-precision radiotherapy that utilizes computer-controlled X-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. This method conforms the radiation dose to the tumor while minimizing radiation exposure to surrounding normal tissues. The range of services provided by CARTI is far greater than just leading-edge radiation therapy. In fact, CARTI provides a number of patient assistance and outreach services outside the lines of actual treatment, which enables them to assist patients and their families in the fight against the disease. CARTI and NEA believe very strongly in caring for the patient as a whole, including a devoted concern for each patient’s physical, emotional and financial wellbeing. These include patient services, support services, prevention materials, education, and follow-up. The medical oncology unit will have a spacious, relaxing chemotherapy suite overlooking a meditation garden. More exam rooms and an onsite laboratory will make visits more efficient and timely. The goal and mission of all the doctors, nurses and support
staff is to provide individualized care to every patient in a compassionate and personal manner. The NEA Cancer Institute and Research Center will be home for NEA Clinic Charitable Foundation’s (NEACCF) HopeCircle. HopeCircle provides various services to the community at-large, free of charge, including education programs and support groups for patients and their families who are living with a catastrophic illness. HopeCircle volunteers will continue to provide their gifts of laughter, sharing and listening to patients in the new cancer center. Education and research will be cornerstones of the NEA Cancer Institute and Research Center. A quiet library and conference room will be available for patients and their families to help them understand their disease and treatment options. Access to computer searches, web sites, as well as educational video and audio materials will be made available. Taking the time to educate patients and families regarding their diagnosis and treatment options has always been an important goal for the medical oncology department at NEA Clinic, as well as CARTI and NEACCF HopeCircle. Patients who understand the natural history of their disease, the prognosis, as well as benefits and side effects of therapy, are often able to cope with their disease in a healthier manner. Scientific medical research in the pursuit of new and better treatments for cancer will be an important service offered at the NEA Cancer Institute and Research Center. The NEA Clinic medical oncology department and CARTI have a long history of providing clinical trial treatment options for cancer patients. Clinical research also involves supportive care studies such as evaluating promising drugs for the treatment of pain, nausea, anemia or fatigue. Two full-time nurses in our clinical trials department will provide counseling and support to all of the patients on studies. As the state’s second-largest clinical study provider (second only to UAMS in Little Rock), these research studies are a critical part of the new facility. The NEA Cancer Institute and Research Center will provide highquality cancer treatment in a single convenient location where a team approach will be offered to patients. Medical and radiation oncologists and nurses can work together and communicate in the most efficient manner to provide compassionate care. Our goal is to provide the most effective cancer treatment using the newest technologies in regard to patient care. We are committed to improving the quality of care with the use of education and research options. In the process, we will do everything within our power to make patients and their loved ones feel as comfortable and secure as possible. We feel it is our duty to not only provide the treatment necessary to win the battle, but to help remove the fear and uncertainty that can accompany a cancer diagnosis by replacing them with knowledge, compassion and hope. 15. NEA HEALTH • Fall 2006
Spreading the Seeds of Hope! Many community organizations and businesses recently came together to celebrate the first annual Week of Hope in Jonesboro. Organized by NEA Clinic Charitable Foundation's HopeCircle, the Week of Hope was a celebration of hope that highlighted the importance of hope in all our lives and in the community. The event kicked off September 25 at the Court House in Downtown Jonesboro and included a dove release, an official proclamation by city officials, and a 21-gun salute. Loretta Bookout, wife of the late state Sen. Jerry Bookout, spoke on the importance of hope in her life. In addition, a children's choir comprised largely of HopeCircle's "Victory Volunteers" performed a beautiful rendition of "I Believe I Can Fly." Throughout the week, a wide variety of businesses, charitable organizations, and individuals celebrated hope in their own way. Many local churches took on the message of hope for their Sunday sermons, and countless businesses supported the theme in their own way through banners and other advertisements. Thank you to all who spread the message of HOPE throughout our region.
Solutions
A Physician Directed Wellness Center
to Top Fitness Excuses Indoor Heated Pool Cardio Equipment
Excuse : “I have no time.”
Free Weights
Solution: Who does have the time? We all lack time in certain areas; but if getting healthy and in shape is important to someone, they will make time for it. Wake up 30 minutes early and walk, lift hand weights while watching television, stretch while you are in front of the computer, take the stairs instead of the elevator, carry your own groceries to the car, or simply practice perfect posture. There are easy ways to avoid a completely sedentary lifestyle.
Selectorized Machines Group Exercise Classes Weight Loss Program Arthritis Management Heart Risk Factor Reduction Corporate Health Program Nutritional Counseling Health Risk Assessments City Blends Juice Bar
Excuse : “I have too many other obligations.”
Solution: In order to be of service to others, you must first be of service to yourself. You must be true to your own purpose in life. Your obligation to yourself is what will enable you to fulfill your obligations to others!
Excuse: “I don’t know where to begin, what machines to use, or even how to use them.”
Solution:
If you simply have no desire, motivation, or education on beginning a fitness regime, contact a personal trainer. Personal trainers guide and motivate clients to reach their peak fitness potential by assessing their individual needs. They have a strong understanding of exercise equipment and the human body. They can design and distribute physical fitness training programs and personal nutrition to meet any fitness goal.
Excuse : “I have tried to lose weight before and it just didn’t work. I worked out for three weeks and never saw results.”
Solution: Don’t give up! And three weeks is not near long enough to see noticeable results. It is common for a good program to take six to seven weeks of dedication before seeing any noticeable results. Try again, stick with it, and don’t give up – especially before you even begin! Happy Training!
Your Hour of Power! This 60 minute barbell program strengthens all your major muscles in an inspiring, motivating group environment with fantastic music and awesome instructors. With simple, athletic movements such as squats, lunges, presses and curls, Group Power is for all ages and fitness levels. Discover results, discover Group Power! Limited Class Size Call to Reserve Your Spot!
Kara Fowler, Personal Trainer NEA Clinic Wellness Center 870.932.1898
◆ www.neaclinicwellness.com
2617 Phillips Drive Jonesboro, AR 72401 870-932-1898 www.neaclinicwellness.com
17. NEA HEALTH • Fall 2006
M
ore than 100 types of Human Papillomavirus (HPV) have been identified. HPVs are clearly associated with cervical cancer, especially HPV 16 and 18. HPV 6 and 11 are found in 90 percent of genital warts. A new recombinant vaccine to these four HPV types has recently been approved by the FDA.
Here is a what, who, when, where and why of simple questions and answers to help understand this new vaccine.
Q: What is HPV? A: HPV is a virus that can cause cervical cancer. In technical terms, Human Papillomavirus is a nonenveloped, double-stranded DNA virus that infects basal epithelium through microabrasions (tissue disruptions). Q: Is the vaccine a live virus? A: No, it is created from noninfection virus-like particles of the major capoid protein.
Q: Is anyone eligible for this vaccine?
Q: Can the vaccine be taken orally, like Polio?
A: No. The vaccine should only be given to young females ages 9 to 26 years of age.
A: No, it is given as an intramuscular injection over a 6-month period: the first dose, a second dose 2 months later, and a third dose 6 months after the original dose.
Q: Why is it limited to females? A: At this time, the vaccine is aimed at helping control cervical cancer and, of course, men do not have a uterine cervix. Q: Why only young women?
Q: What is the most common side effect reported from the vaccine? A: Injection site pain of mild to moderate intensity was found in 94 percent of patients. Only 48 percent of patients who received placebo (injection without active agent) reported mild to moderate site pain.
18. NEA HEALTH • Fall 2006
A: The vaccine is not effective after a human papillomavirus (HPV) infection. It is estimated one act of intercourse yields an average infection rate of 21 percent. One can become HPV infected only with intimate contact.
Q: Will my private insurance pay for the vaccine at my doctor’s office? A: Ask your insurance provider.
W H AT
IS A
VIRUS?
a : the causative agent of an infectious disease b : any of a large group of submicroscopic infective agents that are regarded either as extremely simple microorganisms or as extremely complex molecules, that typically contain a protein coat surrounding an RNA or DNA core of genetic material but no semipermeable membrane, that are capable of growth and multiplication only in living cells, and that cause various important diseases in humans, animals, or plants.
W H AT
IS A
VA C C I N E ?
Vaccines help prevent people from getting sick. There are many kinds of vaccines. Each vaccine is made up of parts of weakened or killed bacteria or viruses of a specific disease. After you have a vaccine, your body's immune system makes antibodies to fight the disease. If you are exposed to the same disease in the future, the antibodies kill the bacteria or viruses before they have a chance to make you sick. Q: Can the vaccine be taken during pregnancy? A: The vaccine is not recommended for use during pregnancy. It is a pregnancy category B drug, having not shown any impairment to fertility or fetal development in rats that were studied with the drug. Therefore, no human pregnancy studies. Q: Can the vaccine be taken before 9 years of age? A: The safety and value in children younger than 9 has not been studied.
Q: How common an infection is HPV? A: An estimated 75 percent of the U.S. population is affected by this sexually transmitted disease (STD). It is the most common STD in America. Q: Will the HPV vaccine eliminate cervical cancer? A: The potential to eliminate nearly 70 percent of HPV-related malignancies worldwide exists with the current vaccine. Q: Is this vaccine right for my daughter? A: Completed clinical trials of the HPV vaccine show great promise in eliminating genital warts, cervical dysplasia, and cervical cancer when given to females before they become sexually active. Discuss this series of injections with your doctor at your child’s next visit.
◆ www.neahealth.com keywords: HPV, cervical cancer, vaccine Charles Barker, M.D., PH.D., F.A.C.O.G. Women’s Clinic NEA Clinic – 870.972.8788 19. NEA HEALTH • Fall 2006
BREAST CA
Preven M
ost of us are aware of the screening tests for breast cancer. Monthly self breast exams and yearly mammograms are done to detect the disease at an early stage to help optimize the chance for a cure. Screening mammograms have been shown to improve the survival rate for women with breast cancer because of this early detection. But what can be done to prevent breast cancer from developing in the first place? There are several treatments and actions one can do to help decrease the chance of getting this cancer. These interventions are usually discussed with women who have been determined to be at a higher risk of developing breast cancer compared to those who are at low risk. There are computer programs your primary care physician or
Cover Story by Carroll Scroggin, Jr., M.D.
20. NEA HEALTH • Fall 2006
BREAST CANCER
ANCER
ntion gynecologist can use to determine your lifetime risk of getting breast cancer. If the risk is high, then options are discussed to help decrease the risk.
Risk Factors aAge. The breast cancer incidence increases as one gets older. aFamily history of breast cancer, especially if it occurs in a close relative (mother or sister). The risk gets higher with 2 or more close relatives with the disease. aSpecific inherited gene mutations that can lead to breast cancer. Examples are the breast cancer 1 or 2 (BRCA 1, BRCA 2) mutations. These are often tested when there is a strong family history of breast cancer (3 or more relatives) or if the disease occurs in a very young female relative. aObesity. Weight gain is associated with an increased risk of breast cancer, and the highest risk is seen in women who gain a significant amount of weight after menopause. aAlcohol. There is a higher risk of breast cancer in those who drink a moderate amount of alcohol on a regular basis. aRadiation exposure. There is an increased risk of developing breast cancer after radiation therapy is given to the chest or thorax. This risk is highest when treatment is given at an early age. An example is an adolescent or young adult who receives chest radiation therapy for Hodgkin’s disease. Radiation therapy given to women who have had a breast lumpectomy for cancer does not increase the risk of developing cancer in the other breast.
Treatment Intervention
aProlonged exposure to estrogen, which is the female hormone produced by the ovaries.
If one is deemed to be at increased risk for developing breast cancer in the future, there are things that can be considered to decrease the risk.
aEarly Menstruation in women at an early age (11 or those younger) or who begin menopause at a later age have longer estrogen exposure.
1. Treatments that block estrogen production: Anti-estrogen agents Tamoxifen lowers the risk of developing breast cancer in women who are at increased risk. This medication taken by mouth selectively blocks the estrogen effect on breast cancer cells
aWomen who never have been pregnant or who become pregnant at an older age (above 40) are at increased risk of breast cancer. Estrogen levels are lower during the time of pregnancy and during breast feeding. aWomen who take estrogen medication are at increased risk of developing breast cancer. This includes hormone replacement therapy (such as estrogen-progestin drugs). Oral contraceptives (such as “the pill”) have not been shown in a consistent manner to increase the risk of breast cancer. Some studies have shown a slight increase in risk but other studies have not. aA previous breast biopsy showing certain abnormal (yet benign) changes increases the risk of breast cancer. aA personal history of breast cancer increases the risk of getting a second, unrelated breast cancer in the future.
21. NEA HEALTH • Fall 2006
and breast tissue (but doesn’t block estrogen’s effect on other organs). Side effects include hot flashes, an increased risk of developing cancer of the uterus, and an increased risk of developing a stroke or a blood clot involving legs or lungs. Raloxifene is similar to tamoxifen but has a lower risk of developing blood clots and cancer of the uterus. Earlier this year, a large nationwide study showed that this agent can significantly decrease the risk of breast cancer occuring in postmenopausal women who are deemed to be at high risk. Aromatase inhibitors. These newer drugs (Arimidex, Femara, Aromasin) are effective in curing postmenopausal women who have early stage breast cancer. These drugs block estrogen production from tissues in the body other than the ovaries. They are promising drugs for the prevention of breast cancer. Clinical trials are ongoing now, and hopefully in the futurethese agents will be used in high-risk postmenopausal women. Removal of the ovaries (prophylactic oopherectomy) Removing the ovaries will obviously decrease the estrogen production in premenopausal women and decrease the risk of getting breast cancer. This surgical option is usually recommended for women who have a very high risk of developing both breast cancer and ovarian cancer (such as those who have inherited the BCRA 1 or 2 genes). 2.
Removal of the breasts. Surgical removal of both breasts (prophylactic mastectomies) obviously decreases the risk of developing breast cancer. Because of the psychological issues of removing normal breasts to prevent breast cancer, most women undergo counseling prior to the procedure. This treatment is usually considered in women who have several high risk factors for the development of breast cancer.
3.
Stop or decrease the use of alcoholic beverages. There is a higher risk of breast cancer in those who drink a moderate amount of alcohol on a regular basis.
4.
Exercise. Regular exercise (3 to 4 hours per week) can decrease estrogen production and lower the risk of developing breast cancer in the future. Also, exercising regularly can help with weight reduction and can help prevent weight gain, which is a risk factor for developing the disease.
It is controversial whether diet can reduce the risk of breast cancer. A diet containing large amounts of vitamins A, C, and beta-carotenes may decrease the risk somewhat but has not been clearly proven to prevent breast cancer. Populations who have a large amount of fat in the diet tend to have more cases of breast cancer. It is not clearly known, however, if a low-fat diet can really prevent the development of this disease. Women should be aware of the risk factors for developing breast cancer. Obviously, genetic factors such as a strong family history for the disease or the presence of the BRCA 1 or 2 genes in the family cannot be altered. But other risk factors can be influenced and women should discuss the benefits and side effects of treatment intervention with their doctor. Estrogen hormone replacement therapy is very effective in preventing menopausal symptoms and osteoporosis. Such therapy may be a reasonable option in a woman with a low risk of getting breast cancer. If a woman has an increased risk of developing breast cancer, then avoidance of hormone replacement therapy and consideration of using anti-estrogens should be discussed. Also, a dedicated goal of regular exercise and avoidance of alcoholic beverages can help. Women should consider undergoing a risk assessment by their primary care physician or gynecologist. If the risk is high, further counseling can be obtained regarding what treatment interventions and lifestyle changes can be done to prevent this disease. No matter what the risk, remember to get your yearly mammograms and perform your monthly self exams.
◆ www.neahealth.com keyword: breast cancer Carroll Scroggin, Jr., M.D. Hematology/Oncology NEA Clinic – 870.935.4150 22. NEA HEALTH • Fall 2006
DOC+FINDER 870.935.NEAC ANESTHESIOLOGY Alfonso Aquino, M.D. Sheila Stinson, M.D. Oksana Redko, M.D. 3024 Stadium, Jonesoro, AR 72401 (870) 972-7390
CARDIOLOGY
FAMILY PRACTICE Jonesboro J. Timothy Dow, M.D. Douglas L. Maglothin, M.D. Joe McGrath, M.D. James Murrey, M.D. Carrie Hunter, M.D. Windover Clinic / Urgent Care 1111 Windover, Jonesboro, AR 72401 (870) 935-5432 Michael E. Crawley, M.D. Michael E. Tedder, M.D. Arnold E. Gilliam, M.D. Stadium Clinic / Urgent Care 3003 Apache, Jonesboro, AR 72401 (870) 931-8800 Craig A. McDaniel, M.D. Troy A. Vines, M.D. W. Scott Hoke, M.D. Randy Carlton, M.D. Nathan Turney, M.D. Woodsprings Clinic / Urgent Care 2205 W. Parker, Jonesboro, AR 72401 (870) 933-9250 Tim Shown, D.O. Melissa Yawn, M.D. Jeffery Barber, D.O. Hilltop Clinic / Urgent Care 4901 E. Johnson, Jonesboro, AR 72401 (870) 932-8222
Osceola Jerry R. Biggerstaff, M.D. Debbie Wilhite, A.P.N. 616 W. Keiser, Osceola, AR 72370 (870) 563-5888
Anthony T. White, M.D. Michael L. Isaacson, M.D. Robert D. Taylor, M.D. Eumar T. Tagupa, M.D. D.V. Patel, M.D. Margaret Cooper, A.P.N. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
Alison Richardson, M.D. Trumann Clinic 305 W. Main, Trumann, AR 72472 (870) 483-6131
Lake City Kristi Statler, M.D. 208 Cobean, Lake City, AR 72437 (870) 237-4100
Cherokee Village
Ronald J. Blachly, M.D. D. Allen Nixon, Jr., M.D. Carroll D. Scroggin, Jr., M.D. Stacia Gallion, A.P.N. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
HOSPITALIST Robert B. White, M.D. Kim Davis, M.D. Brock F. Harris, M.D. 3024 Stadium, Jonesboro, AR 72401 (870) 897-8462
INTERNAL MEDICINE
CARDIOVASCULAR & THORACIC SURGERY James A. Ameika, M.D. Deborah Fairchild, A.P.N 3100 Apache, Suite B4 Jonesboro, AR 72401 (870) 972-8030
Ray H. Hall, Jr., M.D. Stephen O. Woodruff, M.D. Ryszarda Hejmej, M.D. Kristy Wilson, A.P.N. Linda Farris, A.P.N. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
Michael Raborn, M.D. Reginald Barnes, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
Windover (Jonesboro) Alex Kosloff, M.D. 1111 Windover, Jonesboro, AR 72401 (870) 935-5432
DERMATOLOGY
Osceola Holli Banks-GIles, M.D. 616 W. Keiser, Osceola, AR 72370 (870) 563-5888
James Towry, D.O. 3100 Apache, Suite B3 Jonesboro, AR 72401 (870) 934-3530
ELECTROPHYSIOLOGY Ben Naidoo, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
EMERGENCY MEDICINE Brewer Rhodes, M.D. Michael Tomlinson, M.D. 3024 Stadium, Jonesboro, AR 72401 (870) 972-7251 Kevin D. Ganong, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150 Diabetes Center Bilinda Norman, R.N.P. 311 E. Matthews. Jonesboro, AR 72401 (870) 935-4150 Michael D. Hightower, M.D. Brad Moore, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
GENERAL SURGERY Gastric Bypass & Bariatric Surgery K. Bruce Jones, M.D. Russell D. Degges, M.D. John A. Johnson, III, M.D. James Cunningham, M.D. 800 S. Church, Suite 104 Jonesboro, AR 72401 (870) 932-4875
Brad Bibb, M.D. 3 Iroquois Dr., Cherokee Village, AR 72525 (870) 856-2862
Blytheville Joseph Kulpeksa, M.D. 526 Chickasawba, Blytheville, AR 72315 (870) 762-3331
NEPHROLOGY Michael G. Mackey, M.D. Angie Fowler, A.P.N. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
NEUROLOGY
ENDOCRINOLOGY
GASTROENTEROLOGY
Trumann
HEMATOLOGY ONCOLOGY
OPHTHALMOLOGY LASIK, No Stitch, No Shot, No Patch Cataract Surgery F. Joseph George, M.D. Matthew Margolis, D.O. James Cullins, O.D. 416 E. Washington, Suite B Jonesboro, AR 72401 (870) 932-0485
ORTHOPEDIC SURGERY Henry Stroope, M.D. Jason Brandt, M.D. 3100 Apache, Suite A2 Jonesboro, AR 72401 (870) 935-8388
OTOLARYNGOLOGY (ENT) Bryan Lansford, M.D. Bart Patenaude, M.D. 3100 Apache, Suite B2 Jonesboro, AR 72401 (870) 934-5500 Hearing Center Amy Stein, Au.D., CCC-A 3100 Apache, Suite B2 Jonesboro, AR 72401 (870) 934-5500
PHYSICAL THERAPY Jeff Ramsey, P.T. Terry R. Womble, M.P.T. 1007 Windover, Suite B Jonesboro, AR 72401 (870) 336-1530
PLASTIC & RECONSTRUCTIVE SURGERY W. Tomasz Majewski, M.D. Melanie Greeno, ICT Skin Care / Aesthetician 3100 Apache, Suite B3 Jonesboro, AR 72401 (870) 934-5600
Kenneth Chan, D.O. Bing Behrens, M.D. Yuanyuan Long, Ph.D., M.D. 3100 Apache, Suite A Jonesboro, AR 72401 (870) 935-8388
PULMONOLOGY
NEUROSURGERY
RADIOLOGY
Robert Abraham, M.D. Melinda Hulett, A.P.N. 3100 Apache, Suite A Jonesboro, AR 72401 (870) 935-8388
Jeffrey S. Mullen, M.D. John K. Phillips, M.D. Gregory Lewis, M.D. 3100 Apache, Jonesboro, AR 72401 (870) 934-3533
OBSTETRICS & GYNECOLOGY
RHEUMATOLOGY
Real Time 4D Ultrasound Charles L. Barker, M.D., Ph.D., F.A.C.O.G. Mark C. Stripling, M.D., F.A.C.O.G. Charles C. Dunn, M.D., F.A.C.O.G. Norbert Delacey, M.D., F.A.C.O.G. Michael Hong, M.D., F.A.C.O.G. Lorna Layton, M.D., F.A.C.O.G. 3104 Apache, Jonesboro, AR 72401 (870) 972-8788
William Hubbard, M.D. Meredith Walker, M.D. Patrick Savage, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
Beata Majewski, M.D. Leslie McCasland, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
SLEEP MEDICINE David Nichols, M.D. 311 E. Matthews, Jonesboro, AR 72401 (870) 935-4150
OCCUPATIONAL MEDICINE Richard A. Covert, M.D., M.P.H. 3005 Apache, Jonesboro, AR 72401 (870) 910-6024
OPEN 7 DAYS A WEEK
Stadium Clinic (870) 931-8800
Hilltop Clinic (870) 934-3539
Woodsprings Clinic (870) 910-0012
Windover Clinic (870) 935-9585
Visit our web site at: www.neaclinic.com
Late Night Clinic (870) 910-6040
Preventing
“Boomeritis”
W
hile there may be no single fountain of youth, you can slow down the aging process by staying physically active. Regular exercise enhances muscle and joint function, keeps bones strong and decreases your risk of heart attack and stroke. Osteoporosis is a condition that results in “softened” bones. A weakened skeleton results in an increased risk of a fractured or broken bone. Cardiovascular disease is the leading cause of death in the United States, and
strokes are an increasingly common cause of permanent mental and physical impairment. Exercise has been shown to be an extremely effective way to fight osteoporosis, cardiovascular disease, and to preserve mental capacity. However, as we age, our bodies may not allow us to participate in exactly the same way we did in our younger years. The American Academy of Orthopaedic Surgeons has coined the term “Boomeritis” to describe some of the aches and pains boomers feel in the quest for a healthy body.
Here are some tips developed by the American Or thopaedic Society for Spor ts Medicine and American Academy of Or thopaedic Surgeons that can help you exercise safely. Always take time to warm up and stretch before physical activity. Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, stationary cycling or running or walking in place for 3 to 5 minutes. Then slowly and gently stretch, holding each stretch for 30 seconds.
Don’t succumb to the “weekend warrior” syndrome. Compressing your physical activity into two days sets you up for trouble and doesn’t increase your fitness level. Try to get at least 30 minutes of moderate physical activity every day. If you’re truly pressed for time, you can break it up into 10minute chunks. Remember that moderate physical activity can include walking the dog, working in the garden, playing with the kids and taking the stairs instead of an elevator.
Take lessons and invest in good equipment. Whether you are a beginner or have been playing a sport for a long time, lessons are a worthwhile investment. Proper form and
24. NEA HEALTH • Fall 2006
instruction reduce the chance of developing an “overuse” injury like tendinitis or stress fractures. Lessons at varying levels of play for many sports are offered by local park districts and athletic clubs. Select the proper shoes for your sport and use them only for that sport. When the treads start to look worn or the shoes are no longer as supportive, it is time to replace them.
Listen to your body. As you age, you may find that you are not as flexible as you once were or that you cannot tolerate the same types of activities that you did years ago. While no one is happy about getting older, you will be able to prevent injury by modifying your activity to accommodate your body’s needs. Develop a balanced fitness program that incorporates cardiovascular exercise, strength training and flexibility. In addition to providing a total body workout, a balanced program will keep you from getting bored and lessen your chances of injury.
www.neaclinicwellness.com www.neaclinic.com www.neahealth.com www.orthoinfo.aaos.org
Use the 10 percent rule. When changing your activity level, increase it in increments of no more than 10 percent per week. If you normally walk 2 miles a day and want to increase your fitness level, don’t try to suddenly walk 4 miles. Slowly build up to more miles each week until you reach your higher goal. Also use the 10 percent rule as your guide for strength training and increase your weights gradually.
Add activities and new exercises cautiously. No matter if you’ve been sedentary or are in good physical shape, don’t try to take on too many activities at one time. It’s best to add no more than one or two new activities per workout.
If you have or have had a sports or orthopaedic injury like tendinitis, arthritis, stress fracture or low back pain, consult an orthopaedic surgeon who can help design a fitness routine to promote wellness and minimize the chance of injury.
◆ www.neahealth.com keyword: exercise
If you are new to exercise or unsure of where to start, you should seek the advice of a wellness counselor, personal trainer, or teaching professional. Proper technique and appropriate intensity are good ways to prevent injury. Exercise is appropriate for all ages and fitness levels, but it should not cause persistent discomfort or pain. If this is the case then medical attention should be sought. My approach to sports injuries is to first make an accurate diagnosis and then prescribe a treatment regimen that will return you to activity as quickly as possible. My goal as a sports medicine physician and orthopaedic surgeon is to keep you active and healthy.
Jason Brandt, M.D. Orthopedic Surgery NEA Clinic – 870.935.8388 25. NEA HEALTH • Fall 2006
Sunshine Skin and the
I
the most abundant form of UV light at the Earth’s surface. The levels of UVA during the daylight hours do not fluctuate very much. UVC is filtered out by the Earth’s ozone layer and does not make it to the surface of the planet in any significant amounts. UVB has a shorter wavelength than UVA and is much more “energetic.” Because of the shorter wavelength, it does not penetrate into our skin as deeply as UVA, but it is capable of more damage. Its levels do fluctuate significantly during daylight hours and is at its greatest concentrations during the midday. Skin colors vary, and the color of our skin is very important as it relates to sun exposure. The fairer the skin color, the more damaging the sun’s ray can be to the skin. The darker the skin color, the more protected the skin is from UV light.
think that to a certain extent we are all dermatologists. Everyone looks at their own skin as well as the skin of others around them. I have had many patients tell me that they have been told by someone else, “You should have a doctor take a look at that spot on your skin.” It is my hope that this article will help further educate all of my fellow budding dermatologists.
What are the effects of UV light on our skin? UV light is what is responsible for changing our skin color after exposure to the sun or in tanning beds. When the skin tans, it is in fact a tell-tale sign that the skin has been damaged by UV light. Because UV light is a form of radiation, the skin will try to protect itself and us from the damaging assault by Why does our skin look the way it does? Well, of course a lot producing pigment. This pigment production is called a tan. of our skin’s appearance has to do with the genes we A tan does not form until the skin has been exposed to inherited from our forbearers. Those genes make us black or radiation from UV light. The tan develops because of the white, brown or yellow and all of the colors of skin in injury to the skin cells that occurs during the UV light between. Fortunately or unfortunately, our skin type is not exposure. The more pigment the skin can produce, the more something we can choose. What else makes our skin look the protected it will be. Unfortunately, people with naturally dark way it does? skin generally don’t worry too much about getting a tan. It is the fair-skinned folk who desire to look darker Other than our genes, the environment in which we live than God made them. It is these same fairprobably has the greatest impact on our skin’s appearance. skinned people who have the greatest Probably the most important factor in our environment The tan risk of developing skin cancer precisely affecting the skin is the SUN! The sun is what helps us because they will intentionally expose develops because grow crops; it drives the weather and keeps us warm in themselves to UV light to get a tan. In the cold void of space. But the sun also damages our of the injury to addition to these effects, exposure to skin on a daily basis. The sunlight that reaches our Earth the sun has other unpleasant results. the skin cells... is a form of electromagnetic energy. It is not a single They include wrinkling, crow’s feet, loss entity, but rather it is made up of three main components. of skin elasticity, liver spots, skin thinning The infrared spectrum of energy gives the sun’s rays the (think about your grandmother’s hands), warming sensation we enjoy on a cool crisp autumn day. The dilated blood vessels, and blotchiness and, generally visible spectrum of the sun gives us the light we see by to go speaking, most of the things we associate with aging skin. about our daily business. Beyond the visible range of light, which ends with the violet range, is the Ultraviolet (UV) There are three common forms of skin cancer. The most spectrum. This is a type of radiation that also has 3 common is Basal Cell carcinoma, the second most common components: Ultraviolet A (UVA), Ultraviolet B (UVB) and is Squamous Cell carcinoma and the third type and probably Ultraviolet C (UVC). better known is Malignant Melanoma. These cancers arise from specific cell types in the epidermis or outermost portion UVA has the longest wavelength of these three and is the of our skin. The bottom layer of epidermal cells is called least “energetic.” This means that it is the least damaging to basal cells. Basal Cell cancer is the most common of all skin the skin. This lower energy level has led to claims that it is cancers in North America and Europe. It is usually found in harmless and safe to use. This is simply not true. UVA is also 26. NEA HEALTH • Fall 2006
There are three common forms of skin cancer.
areas of the skin exposed to sunlight, but sometimes it occurs in other areas of the skin as well. This type of skin cancer appears as a raised, hard, red or red-grey pearly wound often found on the forehead, eyelids, cheeks, nose and lips. Although there is always a chance it could become serious, basal cell cancer usually does not spread to other areas of the body like the lymph nodes or other body organs. Most cases are easily treated and cured.
damage that is essentially irreversible. This ongoing cellular injury, whether it is to basal cells, squamous cells or melanocytes, is what leads to the development of skin cancer.
How do these changes happen? First, UV light directly damages the genetic material (DNA) of our cells leading to mutations; second, it produces activated oxygen molecules that in turn damage DNA and other cellular structures; and third, it leads to a localized immunosuppression, thus blocking the body’s natural antiThe Squamous cells are the most numerous types cancer defensive abilities. The more There are many websites of cells in the epidermis. Squamous cell skin exposure to UV light we receive the with information about skin cancer occurs most frequently on the skin greater the risk of skin cancer. cancer and exposure to UV light. exposed to sunlight over long periods of For example, people who live time. As such, this type of skin cancer in Arizona have twice the risk The National Institute of Health: tends to develop where maximum of skin cancer than people www.nci.nih.gov/cancertopics/types/skin exposure to radiation occurs. This is who live in Minnesota The National Cancer Institute: www.cancer.gov usually the forehead, cheeks, nose, because they live in a lower lip, and tops of the ears. It also sunnier environment. And The American Cancer Society: www.cancer.org usually develops in areas where the this is a cumulative skin has been damaged by the sun, process that means it is the The Skin Cancer Foundation: www.skincancer.org areas where you find freckles and other sun/UV light exposure you types of pigmented and non-pigmented collect over your whole The American Academy of Dermatology: blemishes. The blemishes can develop lifetime, not just the sun you www.aad.org into rough, scaly patches with small areas got this summer at the lake. The American Osteopathic College of of open wound that do not heal. They So every type exposure you get Dermatology: www.aocd.org eventually grow into larger wounds with contributes to your lifetime total crusts. This type of cancer can be removed with accumulation. Lying on a tanning www.neahealth.com a good chance of cure … if it is caught in time. It bed is important in this process as is most dangerous if it occurs on mucous membranes well. Not only can people get sun exposure such as on the lip. every day, now they can continue to expose themselves to UV light when the sun goes down, thus adding Malignant Melanoma arises from the pigment producing to their lifetime radiation exposure with a tanning bed. cells in the epidermis known as melanocytes. Although it is rarer than the two previously discussed cancers, melanoma is What can be done to protect our skin from this ever-present the most serious type of skin malignancy. It often first shows danger? Our bodies are wonderfully made and have built-in itself as a mole or pigmented spot that begins to grow, bleed, systems that try to correct the damage we allow to occur to or change its color, shape or texture. It usually spreads if not ourselves. Our immune system is constantly at work trying treated in the early stages of its development. While to repair the damage that has already taken place. It is easier ongoing exposure to UV light is important for the for these defenses to keep up with this injury early in our development of the two previous cancers, Melanoma seems lives, but with the ongoing damage from UV light exposure to be more related to intense, intermittent, strong exposures the systems can’t keep up. This results in the aforementioned to sun light, especially in those individuals who are not skin changes of blotchy pigmentation and liver spots, accustomed to intense sun exposure. An example of this wrinkles, freckles, skin laxity and loss of tone, which are the would be getting a bad sunburn at the beach as a child but tell-tale signs of ongoing injury to the skin. not going to the beach very often. If caught early, malignant melanoma can be treated and cured. If diagnosis and What steps can be taken to prevent treatment are delayed it can be fatal. The melanocytes are the this from happening? The good same cells in our skin that produce pigment; in other words news about all of this is it is they are the cells responsible for the tan skin develops after never too late to make UV light exposure. In order to create a tan it is required that changes. You can improve the melanocytes be given UV radiation exposure. Only after the health of your skin by the radiation of the skin by UV light will these cells be wearing sunscreen that stimulated to produce the pigment that results in tanning. In blocks both the UVA and other words, the tan is produced because the skin has been UVB spectrums. You damaged and as a result of trying to protect itself from more should always use radiation damage the melanocytes produce pigment to try to sunscreens and lip prevent more damage from occurring. Ultimately, it balms with a sun is this ongoing radiation exposure, whether in tanning protection factor (SPF) salons or just everyday sun exposure, that results in cellular of at least 15, and the 27. NEA HEALTH • Fall 2006
higher the better. These quickly. Particularly bad are the new rapid tanning machines should be applied to all the that are proclaimed to give a darker, richer tan in less time areas of skin exposed to the than conventional beds. These beds work by either having a sun, especially during the larger number of bulbs or bulbs with higher wattage or both. peak sun hours between 10 They do not expose an individual to less UV light. a.m. and 4 p.m. Always follow directions when In summary, it should come as no surprise to you that in applying sunscreen. For it order to have beautiful, youthful looking skin you have to to work best, sunscreen take care of the skin you have. All the should be applied at least 15 creams, lotions and potions in the to 20 minutes before you go world will not and cannot take the outside; use it generously on place of good skin protection. So all sun-exposed skin and reapply starting today, take care of your skin it every 2 hours. A 1-ounce and you’ll always be glad you did. application (about a palm full of sunscreen) is recommended. Many sunscreens wash off when you sweat or swim and must be reapplied more frequently for James B. Towry, D.O. maximum effectiveness. Don’t be fooled by a cloudy day – Dermatology UV light penetrates through cloud cover and will give you a burn even on a cloudy day. UVA easily penetrates through NEA Clinic – 870.934.3530 glass windows such as in cars or homes as well. You can protect most of your skin with clothing, too. This includes wearing long-sleeved shirts and a hat with a broad brim. Baseball style caps give some limited protection to the top of the head and forehead but too little else. Fabric with a tight BEBE FLEXON GIORGIO ARMANI LAURA ASHLEY NIKE RALPH LAUREN OAKLEY SILHOUETTE weave generally provides the best sun protection. And many companies now make and sell sun protective clothing with the SPF woven into the fabric. Much of this is common sense, and many of us can remember our grandparents and even our parents telling us to cover up while in the sun. The good news is that exposure to UV light can be avoided or at least greatly reduced. One of the best ways to avoid UV light is to avoid tanning in the sun, and by all means stay away from tanning beds. By far the worst thing you can do is voluntarily expose yourself to the radiation of the sun and UV light in tanning beds. I am sure that if they called You can improve tanning beds “radiation the health beds” – when in fact this is exactly what a tanning bed of your skin... is, an artificial source of radiation in the UV range – they would not be quite so popular. UVA has been touted as the “safe” UV light; but many scientific studies have shown it to be quite damaging to the skin, albeit not as bad as UVB, but bad nonetheless. Tanning beds do not produce pure UVA either. When turned on the beds have a blue glow from producing light in the visible violet spectrum. The bulbs that produce the UVA also produce some UVB – how much varies from manufacturer to manufacturer. How much UV light you are exposed to varies from bed to bed as well. Older bulbs produce less energy while newer bulbs are more “energetic” and can cause injury much more 28. NEA HEALTH • Fall 2006
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Walking and running is one of the least expensive ways to stay in shape. All you need is a good pair of shoes … right? So, what determines a “good” pair of shoes: Brand name? Price? In-Style magazine? A good pair of walking/running shoes should fit your specific needs. Ask yourself the following questions: Do you have high or low arches? Will you walk/run on the trail, road, or a treadmill? How many miles will you exercise each week? Are you a pronator (moderate to severe rolling to inside of foot)? Specialty running stores usually have staffs that are knowledgeable and helpful in finding shoes that fit your needs. Once you have answered these questions, you are ready to shop! If you wear orthotics, take them with you. Try the shoes on with the socks you will be wearing when exercising. Try on a variety of styles, colors, and brand names. The width of the shoe should fit snug but not tight. You want to go up a full to half size from your everyday shoes because your feet will swell when exercising. Measure at least a thumbnail’s width between the end of your toe and the tip of the shoe. Make sure your arch matches the shoe’s arch pad.
Two locations: DOWNTOWN JONESBORO 230 South Main Street Jonesboro, AR 72401 870.910.5569 THE MALL AT TURTLE CREEK 3000 East Highland Drive Jonesboro, AR 72401 870.336.2453 www.gearheadoutfitters.com
Once you make your purchase, the shoes should last between 300-500 miles before they lose support. If you average 12 miles a week, change your shoes every six months. It is best to wear your athletic shoes only when exercising. After you have reached the mileage limit, you can wear them to work or around town. “The better the shoe, the farther they will take you.” Gearhead Customer Amanda Herget Owner, Gearhead Outfitters Runner
29. NEA HEALTH • Fall 2006
Rehabilitation & PARKINSON’S P arkinson’s disease affects many people here in the Northeast Arkansas region. It is one of the many chronic, progressive diseases that typically affect adults 65 years or older. The first symptom is having a tremor on one side of the body when the arm or the hand is at rest. Other common features include tightness of the limbs with movement, slowness of thought, and decrease in balance when up and walking.
an inherited disposition, toxins in the environment (cyanide, manganese, carbon disulfide, pesticides, well water, methanol, organic solvents) as well as what we refer to as oxidative stress. The oxidative stress theory is very complex and is felt to involve the dying off of the cells that produce the Dopamine from a substance that we are either exposed to or placed in our own bodies.
Parkinson’s disease is a disorder of cells in the brain which produce a substance called Dopamine. These cells begin to deteriorate and the effects of the decrease in Dopamine cause the symptoms that we see outwardly in Parkinson’s disease.
Overall the amount of new cases that would be diagnosed is about 20 cases per every 100,000 people per year. In the United States there are approximately 200 people for every 100,000 that are living today with Parkinson’s disease.
The exact cause of these changes in the Dopamine producing cells is unknown. There are many theories which include rapid aging,
The initial signs and symptoms of Parkinson’s disease usually begin in one extremity or side, but may involve both limbs or even
A patient with Parkinson’s disease can experience one or more of the following signs and symptoms: • Stiffness and slowed movements • Tremor or shaking at rest • Frequent falls or tripping • Difficulty walking • Memory loss • Slowness in performing • Difficulty getting out of a chair or rolling over in bed • Regular daily living skills • Decreased sense of smell • Difficulty with swallowing
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DISEASE the trunk of the body. The appropriate diagnosis can be made with the input of your physician and usually a neurologist. There are multiple medications that are available that aid with the symptoms of Parkinson’s disease. When these are combined with an aggressive and appropriate therapy approach, they can help with decreasing some of the symptoms and improving the function of the individual. Patients who receive physical therapy, occupational therapy and speech therapy along with medication have a better outcome and improve their performance in all areas versus those who received only medication. Rehabilitation for patients with Parkinson’s disease emphasizes trunk extension, as well as mobility and weight shifting and balance training. The rehabilitation team works on environmental adaptations for the home so that the home is safe and can be appropriately used by the individual with Parkinson’s disease. A home visit by a therapist is often helpful. Speech therapy is used to aid with swallowing as well as speaking problems and improving the quality of the voice in patients who have Parkinson’s disease.
Often people with Parkinson’s disease experience difficulty with bowel and bladder issues. This compounds the difficulties that they have with their overall function. Our specialized rehabilitation nursing staff at HealthSouth Rehabilitation Hospital takes into consideration all of these issues and implements the most appropriate treatment approach in the hospital setting to aid with coordination of these issues. At HealthSouth we have multiple interventions that can aid people with Parkinson’s disease including VitalStim to aid with swallowing, interactive metronome to aid with movement, and power plate technology to aid with balance. HealthSouth Rehabilitation Hospital of Jonesboro is a Parkinson’s Proficient Accredited treatment center from a rehabilitative standpoint. If you, or someone you know, has Parkinson’s disease and think that they would benefit from an evaluation by one of our highly trained physical medicine and rehabilitation physicians or a specialty trained therapy staff, please call HealthSouth Rehabilitation Hospital at 870-932-0440, or Dr. Terence Braden and Dr. Kristin Jarrard at 870-934-1099.
◆ www.neahealth.com keyword: Parkinson’s disease
31. NEA HEALTH • Fall 2006
APN?
WHAT IS AN
T
his is a question that those of us who work as APNs often hear from our patients. Everyone knows the terms “doctor” and “nurse,” but some explanation may be required to fully express the importance of an APN.
Advanced Practice Nurses (APNs) are registered professional nurses who have completed a Master of Science in Nursing degree including clinical practice requirements. There are four categories of APNs: Clinical Nurse Specialist (CNS), Advanced Nurse Practitioner (ANP), Certified Nurse Anesthetist (CRNA) and Certified Nurse Mid-wife (CNM). They must be board certified by a nationally recognized certifying body approved by the state board of nursing. There are more than 240,000 APNs practicing in the United States. They deliver quality, safe, cost-effective care in a timely manner in a variety of settings in the healthcare community. APNs are prepared to practice in an expanded role in homes, schools, public and private clinics, hospitals, industry, nursing homes and hospice. They perform comprehensive health assessments aimed at health promotion and disease prevention. They diagnose, manage, and treat acute and chronic illnesses. Additionally, they can prescribe medications, and may obtain their own DEA number. They are required to maintain a collaborative practice agreement with a licensed physician(s) and do not require direct supervision. NEA Clinic has several well-qualified APNs practicing in various specialty clinics. Cardiology, Cardio-Thoracic Surgery, Family Practice, Hematology/Oncology, Internal Medicine, Pulmonology, Nephrology and Neurosurgery. Margaret Cooper, APN, has over 14 years of experience in the cardiac field and has worked with Dr. Michael Isaacson in the Cardiology clinic for the past three years. Ms. Cooper sees follow-up returns from Pictured top row: Margaret Cooper, APN Linda Farris, APN Kristy Wilson, APN Debbie Wilhite, APN Second row: Deborah Fairchild, APN Melinda Hulett, APN Stacia Gallion, APN Angie Fowler, APN 32. NEA HEALTH • Fall 2006
recent hospitalizations as well as established patients with various cardiac conditions. She has special training in performing a test called the Ankle Brachial Index (ABI) in the office that detects peripheral arterial disease. Dr. Isaacson is available to Ms. Cooper immediately for consultation when necessary and he works closely with her throughout the week. Stacia Gallion, APN, has been employed with NEA Clinic’s Hematology/Oncology department since March 2005. During initial consults, patients see the physician and a treatment plan is formulated. Mrs. Gallion manages patients undergoing chemotherapy by monitoring for side effects and disease response. She evaluates with follow-up visits with patients who have completed chemotherapy, assessing for evidence of recurrent disease. By the addition of the APN role, the physicians in the Hematology/Oncology department are able to be more efficient and provide comprehensive care for their patients.
Kristy Wilson, APN, and Linda Farris, APN, are located in the Internal Medicine department. Both are seasoned Family Nurse Practitioners and enjoy the specialty of Internal Medicine. They assist with providing comprehensive care to the clients of Dr. Ray Hall and Dr. Stephen Woodruff, and are available in the clinic five days a week. Preventive health maintenance is emphasized by both advanced practice nurses. Physicians are always available to assist the nurse practitioners if needed. The Internal Medicine department strives to function as a team providing the best care in a timely manner. Melinda Hulett, APN, works with Dr. Robert Abraham in the Neurosurgery department. Ms. Hulett performs a detailed history and physical examination on new patients prior to Dr. Abraham’s evaluation, which allows both of them to meet the new patients. They feel the team approach helps their patients receive exceptional personalized care. She sees patients in the office for follow-up visits. She makes daily rounds on their patients who have had surgery and are hospitalized and makes arrangements for their discharge home. Angie Fowler, APN, sees patients of Dr. Michael G. Mackey in Nephrology department, but also assists with consults in the hospital. Her primary role is to visit our dialysis patients in the dialysis units. Ms. Fowler makes weekly visits to four different dialysis centers, monitoring their progress and addressing other primary care issues that arise. Deborah Fairchild, APN, has worked with Dr. James Ameika for 10 years in the Cardiovascular and Thoracic Surgery department. In the office setting she manages the vascular clinic, which includes seeing new patients, follow-up office visits and performing resting segmental arterial Doppler examinations. Ms. Fairchild sees follow-up surgical patients in the office for wound checks, routine post-operative visits and for newly developed problems. In the hospital setting she completes the history, physicals and pre-op teaching for newly admitted patients, and assists with complicated cardiovascular surgeries. She makes morning rounds on hospitalized patients and rounds with Dr. Ameika in the afternoons. She provides discharge instructions and teaching for all of their patients. Debbie Wilhite, APN, works in the Osceola Family Practice clinic seeing office patients five days a week. She has a large number of pediatric patients but manages patients from birth through the elderly. Ms. Wilhite is able to do minor surgical procedures in the office, including suturing and lesion removal and also performs joint injections. She is able to admit patients to the hospital in Osceola and follows them throughout their hospital stay. She enjoys teaching diabetics how to manage their disease and medications. Dr. Jerry Biggerstaff is her collaborating physician and is always available to her if needed. NEA Clinic is an exceptional multi-specialty group that works together as a team to provide quality, proficient healthcare to our patients. Our APNs offer their expertise in a variety of settings, partnering with physicians to meet our patients’ healthcare expectations.
33. NEA HEALTH • Fall 2006
34. NEA HEALTH • Fall 2006
GROWING with the COMMUNITY
I
n October, NEA Clinic announced its plans for the largest medical office building in Northeast Arkansas. Conveniently located on Stadium Boulevard near NEA Medical Center, the new construction project will consolidate over 50 NEA Clinic physicians practicing in more than 20 specialties into a state-of-the-art Medical Complex. Construction of the 120,000-square-foot building will begin late 2006 or early 2007. The new medical office building will provide a convenient, easily accessible, state-of-the-art environment for NEA patients, physicians and staff. The facility will house leading-edge diagnostic treatment services in a wide range of specialties and subspecialties. Located at this site, you will find specialists, surgeons, internists, and a whole host of technical support staff, that are all integrated under a single electronic medical record. This one-stop or “integrated� approach to providing comprehensive medical care is the foundation of NEA’s multi-specialty group practice. “Doctors from every medical specialty working together to care for patients, joined by common systems and a shared philosophy of ‘above all excellence in patient care’ is what makes NEA Clinic and this new medical complex truly unique,� says Jim Boswell, CEO. NEA Clinic’s capital projects, such as the construction of this medical plaza, are an integral part of our mission and
commitment to improve the healthcare services available within the region. Developing improved medical facilities furthers our commitment to outstanding patient care through integrated programs in patient care, research, education and prevention. “This comprehensive medical complex will provide the space for the clinic to continue its long-standing commitment to grow by adding new specialists and services in order to meet the community’s need� states Ray Hall, M.D. founder of the clinic.
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COUNSELING SERVICES
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Holiday Turkey When baking your turkey, do so in a roasting pan that allows the fat and drippings to gather at the bottom without the turkey resting in them. Basting with butter or oil is absolutely not necessary; you can use wine or apple juice or broth instead if you would like. Do NOT purchase a self basting bird as they are higher in fat and calories because of the addition of butter or coconut or corn oil.
Holiday Gravy Pour the drippings from your turkey into a large glass measuring cup. After the fat rises to the top, skim it off and discard it, reserving the broth. Mix one tablespoon of cornstarch with one tablespoon of broth (making a slurry), then stir this mixture into the rest of the broth and simmer in a small pan until thickened. Add more cornstarch in slurry form if needed for thickening.
Creamy Mashed Potatoes Instead of using cream and butter to moisten and flavor your mashed potatoes, use evaporated skim milk. It adds a thick texture and a rich taste without any fat. If you really want to spice things up, roast heads of garlic in foil for 45 minutes at 325 until soft, and then squeeze the meat of the garlic into your potatoes.
Low-fat stuffing Traditional dressing/stuffing uses lots of butter. This healthier version is packed with flavor but leaves out most of the fat. INGREDIENTS: • 1 pound whole grain bread, cubed • 1 pound mushrooms, sliced • 1 large onion, sliced • 1 head celery, sliced • 5-10 cloves garlic, minced • 1 teaspoon dried sage • 2 teaspoons dried thyme • Black pepper to taste • 1/2 cup white wine • Non-fat chicken broth or vegetable broth • 1 egg or egg substitute • Salt to taste PREPARATION: 1. Sauté mushrooms, onion, celery, and garlic in the white wine. 2. Add the sage, thyme, and pepper to the vegetables as you cook. 3. Cook until tender – don't overcook the mushrooms. 4. In a large bowl, mix the cooked vegetables with the bread cubes. 5. Add the egg and broth until it is moist. 6. Use to stuff poultry or cook separately. 7. To cook separately: Bake covered for 30 minutes at 350F, uncover and bake 15 minutes more.
36. NEA HEALTH • Fall 2006
Non-fat stuffed baked apple Makes 1 serving. 110 calories, 0.1g protein, 0 fat, 29 g carbohydrate. INGREDIENTS: • 1 small apple (cored, and peeled 1/3 of the way down) • 1 tablespoon raisins • 1 teaspoon lemon juice • 1/2 teaspoon honey • A couple drops of rum flavoring • A dash of cinnamon • 1 teaspoon water PREPARATION: 1. Heat oven to 350 degrees F. 2. Combine all of the ingredients except the water and apple. 3. Stuff this into the apple. 4. Place the water in the bottom of an ovenproof custard cup, put the apple in the cup. 5. Cover the apple with foil and bake for 3545 minutes. Microwave method: Cover with plastic wrap and cook for 2 minutes on high, check to see if it is done, turn and continue to heat in 1 minute increments, turning each minute, until the apple soft and cooked.
The American Heart Association offers several healthy cooking tips in the New American Heart Association Cookbook, 7th Edition, which will be available at booksellers everywhere in November. • Cut down on saturated fat in creamy dressings by mixing in some nonfat or low-fat plain yogurt. • Use non-stick cookware so you can cook with a minimum of oil or vegetable oil spray. • For a wonderful flavor enhancer, sprinkle food with vinegar or citrus juice. Add it at the last minute so the flavor is at its strongest. • Substitute chopped vegetables for some of the bread in your stuffing recipe.
The family that eats together, eats better. A University of Minnesota study found that children who ate family meals consumed more fruits, vegetables and fewer snack foods than kids who ate separately from their parents.
The Family Dinner
It’s a concept that often gets cast aside in favor of meals on the run. After all, what parent has time to cook a meal in between a full day of work and an evening filled with chores, kids’ homework and after-school activities? All too often, we get caught up in the busy-ness of life and forget to savor the moments (and the foods) that make the term “home-cooked meal” so appealing. Perhaps these ideas will persuade you to try having meals together more often. According to the U.S. Department of Health and Human Services – Substance Abuse and Mental Health Services Administration, it is more likely that children will eat healthier and more well-balanced meals if they eat with their parents. And because eating together means spending time together and talking to each other, it also decreases their chances for using alcohol, tobacco or illegal drugs. Sitting around the dinner table together instead of the television promotes interaction rather than the couch potato syndrome. There’s no getting around the fact that some kids just don’t like broccoli, or asparagus, or whatever the case may be. Try to have a variety of vegetables so that there is at least one vegetable on the menu that your child will enjoy. Even if you don’t have the time to cook a meal yourself, you can instill healthy eating habits in your children when you eat out together. You can determine, at least in part, what they eat when you help them order off the menu.
Remember that eating together is healthier for everyone – both nutritionally and emotionally. 37. NEA HEALTH • Fall 2006
What is Family Medicine? Sometimes as a Family Medicine physician I am asked about who I see as patients and what I do in my practice. People are often surprised that we, as Family Medicine physicians, treat children of all ages, from newborns to teenagers, and that we see children for both acute illnesses and wellness examinations, or check-ups.
complete four years of medical school. There are two types of medical schools: allopathic medical schools (M.D.) and osteopathic medical schools (D.O.). Upon completion of medical school, three years of additional training specifically in Family Medicine is required. This additional training in a specific specialty is called residency.
Family Medicine physicians are concerned with the total healthcare of the individual and the entire family. We are trained to diagnose and treat a wide spectrum of ailments and illnesses in patients of all ages. The Family Medicine physician receives a broad range of training that includes Internal Medicine, Pediatrics, Obstetrics & Gynecology, Psychiatry, and Geriatrics. Special emphasis is placed on prevention on the primary care of entire families utilizing consultations and community resources when appropriate.
Family Medicine physicians in your community are available to provide comprehensive primary healthcare to your entire family, including children of all ages and the elderly.
Growing up in rural Southeast Missouri, my Family Medicine physician was my living definition of what a doctor should be. Dr. Cash delivered me and treated me during my childhood years until his retirement. In addition to providing my and my siblings’ healthcare, Dr. Cash also took care of my parents and grandparents, both in the clinic and hospital setting. As a child, I decided that I wanted to be a doctor, and a Family Medicine physician is what I envisioned I would be.
NEA Clinic offers four Family Practice clinics in Jonesboro: Windover, Woodsprings, Hilltop and Stadium. There is also one in Trumann, one in Lake City, one in Osceola and a brand-new Family Practice clinic in Cherokee Village. In addition, our four Family Practice clinics in Jonesboro also offer Urgent Care services. Urgent Care is very similar to the Family Practice, but it is offered on a walk-in basis rather than by appointment. It is intended to be available for minor medical emergencies, and is also available after normal business hours and on weekends. For example, if someone in your family suddenly comes down with an illness that needs medical attention fairly urgently but not serious enough for the emergency room, an Urgent Care clinic will likely meet your needs. To find a Family Practice physician near you, call (870) 935-NEAC.
Like all other medical specialties, Family Medicine physicians are required to complete college requirements for admission to medical school and then they must successfully
◆ www.neahealth.com keyword: family medicine 38. NEA HEALTH • Fall 2006
Tim Shown, D.O. Family Practice NEA Clinic – Hilltop 870.932.8222
ADVERTISERS Families, Inc.......................................................pg 35 1.877.595.8869
NEA Clinic......................................pg 23, back cover 870.935.NEAC, www.neaclinic.com
Gearhead Outfitters ..........................................pg 29 870.910.5569, 870.336.2453, www.gearheadoutfitters.com
NEA Clinic Charitable Foundation ................pg 11 870.935.5101, www.neacfoundation.org
HealthSouth ......................................................pg 31 870.932.0440
NEA Clinic Ophthalmology ............................pg 13 870.932.0485, www.neaclinic.com
Heritage Bank....................................................pg 13 870.802.2344, www.heritagebankark.com
NEA Clinic Wellness Center ............................pg 17 870.932.1898, www.neaclinicwellness.com
JETS ..................................................................pg 30 870.935.JETS
NEA Medical Center ........................................pg 41 870.972.7000, www.neamedicalcenter.com
JP&O • Jonesboro Prosthetic & Orthotic Laboratory ..........................................pg 3 870.932.6436, 1.800.232.6436
NEA PremierCare ..............................................pg 5 870.932.0023, www.neamedicalcenter.com The Podiatry Group..........................................pg 39 870.931.FEET, 1.800.737.3668
LensMasters ......................................................pg 28 870.972.1818, www.rxlensmasters.com
Research Solutions ............................................pg 33 870.268.8431, www.neaclinic.com
Medic One ............................................................pg 7 870.972.0708
Surgical Hospital of Jonesboro ..........................pg 3 870.336.1100, www.tshj.com
Medical Necessities............................................pg 34 870.935.4825, 1.800.920.4242
Diabetic Foot Care
•
Bunion Pain
If you have foot pain ... Planter Warts Ankle Pain ... You ou need a Wound Care foot doctor
Diabetic Custom Shoes Hammertoes Children’s Foot Care Ingrown Toenails Corns/ Calluses
931-FEET 1-800-737-3668 Dr. Coates
Dr. Reiner
Dr. Haughey
Offices Located In: Jonesboro, Walnut Ridge, Pocahontas, Newport, Cherokee Village
637 E. Matthews, Jonesboro Jonesbo 39. NEA HEALTH • Fall 2006
Commit to be
Fit
Commit
- M A R AT H O N S -
FREE fitness activities for all youth and seniors throughout Northeast Arkansas. These programs will encourage youth and seniors to run or walk 25.2 miles over the course of several weeks, then get together to complete the final mile of the marathon. Commit To Be Fit Marathon Goals: 1. Encourage youth and seniors to be more active
Registration required! Final Mile: April 14, 2007
to be
JUNIOR
Fit
M A R AT H
ON
Children of all ages can run or walk their miles anywhere they want; home, during recess, soccer practice, or wherever and whenever they can. Everyone will keep track of their mileage based on the honor system and supervision from a parent, teacher or coach. FINAL MILE: ASU on Saturday, April 14, 2007. Participants will be encouraged by cheers from the crowd and awarded with a Marathon Certificate, Commit to be Fit T-shirt, and be entered to win several prizes including an MP3 player and a laptop computer. For more information contact: Laura Taylor l_taylor@neaclinic.com (870) 336-1760
2. Establish consistent exercise habits 3. Increase community support and awareness of fitness All participants must register! Participants will track their progress on a Mileage Log. You may register online at www.neacfoundation.org, or pick up a registration form from the NEA Clinic Wellness Center. Children can pick up registrations for the Junior Marathon at local schools. When the registration form is received, a Mileage Log will be sent to your home. *You must turn in your completed Mileage Log in order to receive your certificate and FREE T-shirt and enter to win prizes.
40. NEA HEALTH • Fall 2006
Registration required! Final Mile: April 21, 2007
Seniors throughout Northeast Arkansas will strive to complete this running/walking activity by accumulating the 25.2 miles by April 2007. You may run or walk the miles anywhere. Everyone will keep track of their mileage based on the honor system. FINAL MILE: NEA Clinic Wellness Center on Saturday, April 21, 2007. Everyone will be awarded with a Marathon Certificate, Commit to be Fit T-shirt, and be entered to win great prizes. There will also be FREE health screenings. For more information contact: Danielle Pittman d_pittman@neaclinic.com (870) 932-1898
Commit to be Fit marathons are brought to you by NEA Clinic Charitable Foundation. Let’s get healthy together! www.neacfoundation.org for registration forms
WE’RE CHANGING HEALTHCARE IN NORTHEAST ARKANSAS ONE PRIVATE ROOM AT A TIME. The last thing you want to share your hospital experience with is a stranger, so we’ve eliminated all shared rooms at NEA Medical Center—And we guarantee it. In fact, it’s just the beginning of changes big and small that you’ll begin to notice as we continue our effort to make your stay—or your loved one’s—convenient, comprehensive and comfortable in the privacy and security of a private room. The latest in medical technology and services—coupled with our personal attention to care tailored to your individual need and concern—is our continuing commitment to
LEADING EDGE HEALTH CARE
@ Now available in many areas
870-972-7000 www.neamedicalcenter.com 41. NEA HEALTH • Fall 2006
ONE CHILD. ONE CLINIC.
Jason Brandt, M.D.
Tim Shown, D.O.
Carrie Hunter, M.D.
Jeffery Barber, D.O.
ORTHOPEDIC SURGERY
FAMILY PRACTICE
FAMILY PRACTICE
FAMILY PRACTICE
Broken leg set. Here’s hopping to Cole’s complete recovery.
Anna’s sprained elbow had taken her out of the sling of things. Now she’s back to hanging around.
Isabella’s ear infection gone – we’re hearing the smiles have returned.
Annika’s sore throat soothed. Giggles back in full force.
When it comes to taking care of your family, we’re all about kids! So not only are our family practice doctors the best choice for your healthcare, we’re the best choice for your children’s as well. With convenient clinic hours and locations, we’re partners for your health—for life. And our advanced medical records technology will grow with your child, building a comprehensive, single-source medical history file, right from the start. One family. One clinic. It’s not just our promise, it’s our practice.
870-935-NEAC www.neaclinic.com