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PROVIDING NORTHEAST ARKANSAS AND THE SURROUNDING AREA WITH HEALTHFUL INFORMATION
ISSUE 8
Spring/Summer 2008
Cervical Arthroplasty: Total Disc Replacement Artificial Lumber Disc Replacement Low Back Pain Carpal Tunnel Syndrome Strange Events During Sleep Age-Related Macular Degeneration No More Bladder Leakage Getting in Shape Effective Parenting Strategies Healthy Choices Health & Hair
Neurosurgeons in Northeast Arkansas
Robert Abraham, MD
Gregory Ricca, MD FACS
Rebecca Barrett-Tuck, MD Kenneth Tonymon, MD
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On The Cover
Page 1
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.
Thanks to all of our advertisers! PUBLICATION OFFICE
1835 Grant Ave., Jonesboro, AR 72401 h_acebo@neaclinic.com www.neaclinic.com Holly Acebo, Editor/Executive Director NEA Clinic Charitable Foundation Director of Marketing NEA Clinic, NEA Baptist Christy Appleton, Director NEA Clinic Charitable Foundation Nicole Frakes, Graphic Design Melissa Tubbs Kim Provost NEA Health is published bi-annually for the purpose of conveying health-related information for the wellbeing 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© 2008 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.
“Why I Became A Doctor”
M
y decision to become a doctor was made when I was a junior in high school. I had an aptitude for the sciences and in the 60's and 70's a profession in medicine was both honorable and respected (it still is so now but somewhat different than then).The actual process was a formidiable task and the financial aspects of going to medical school was a "leap of faith". The decision has worked out very well for me and one that I have never regretted in that I love what I do on a daily basis. Robert Abraham, MD
M
y decision to become a physician was more the result of a process than of an isolated event.To understand the process, you will have to travel back with me to the 1960’s to a small town in southeast Arkansas – Marvell.
My father, Daniel, was the original Dr. Tonymon. Easily one of the most intelligent people that I know, he, nonetheless, put a great deal of effort into studying and learning and received his MD from the University ofTennessee in 1959. After completing an internship in Nashville ,TN, he returned to Marvell to enter general practice. About a quarter mile from our house, he built his clinic (which would serve as the birthplace of approximately 2000 infants over a 16 year period). It was not uncommon for my father to see and treat forty to fifty patients each day. After the last clinic patient had been seen, my father would make house calls on those patients who could not come to the clinic. On these rural gravel roads of Phillips, Lee, and Monroe counties I learned the art of medicine (and driving on gravel roads). His interest in and knowledge of each patient as a person impressed me in those early teenage years and served as the model by which I have practiced as a physician since 1979 and as a neurosurgeon since 1986. Compassion, empathy, service, responsibility, and the desire (as well as the ability) to educate the patient were some of the things that I observed in my father which created the strong relationship between his patients and him. It was that relationship which made medicine special for me. My father’s best friend, Edmund Hirsch, Jr., also played an influential role in the process of my decision to become a physician. He ran one of the two department stores, served as the Chief of Marvell’s volunteer Fire Department (for decades) and as my Boy Scout troop master, and conducted the operations of his family’s agricultural business. Essentially, a “multi-tasker”, Mr. Hirsch nonetheless made time to oversee my Scouting activities. As a matter of fact, I eventually became Mr. Hirsch’s first Eagle Scout in Troop 12. Like my father, service and responsibility were the hallmarks of how he led his life. Sadly for me, Mr. Hirsch passed away recently and may not have known how his life influenced mine. My father has retired from medical practice now. What amazes me these days is his ability to remember his patients from the 1960’s and 1970’s. In other matters he seems like the absent minded professor! What continues to impress me is how his patients from rural Phillips, Lee and Monroe counties remember and miss him when they or their families venture to Jonesboro for neurosurgical care. Thanks, Dad, for teaching me the art of medicine. I made the right decision.
Kenneth Tonymon, MD
F
rom a very early age, science was always my favorite subject. I loved anatomy and neurophysiology! Working in a hospital when I was going through college helped me discover my true passion. I started out as a lab tech, but my hunger for more control over the patients and the need to play a role in the patient's health lead me to become a physician. I love helping people and making a difference in their lives. Rebecca Barrett -Tuck, MD
www.neacfoundation.org
1. NEA HEALTH • Spring/Summer 2008
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from the editor
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20+
H
ave you ever wondered what it would be like to participate in research and help advance medicine in the world? Right here at NEA Clinic, we have over 50 clinical trials taking place each month.
I find this so intriguing – to be able to test new medicines and help find things that help patients live longer, healthier lives. How exciting! Since NEA Clinic brought these clinical trials “in-house”, I have had the pleasure of working closely to recruit patients. It’s amazing how many people you talk to that have truly benefitted from these studies! How great is it that we can do that right here in Northeast Arkansas. This NEA Health issue features incredible articles from our neurosurgeons. It reinforces our world-class health care right here at home. Thank you for picking up a copy of NEA Health, enjoy! See you soon at NEA Clinic Wellness Center! We recently launched a new weight loss program called The Real Weigh. I have been drinking the shakes and they are very good and very healthy as a meal replacement. Stop by and see our friendly staff for a free consultation, we have seen great results with lots of weight lost within the first month of the program.... Just in time for swim suit season! We also are about to launch a new Body Pump class, visit our website for updates and details, www.neaclinic.com. Have a Healthy and Blessed Day!
Page 2
CONTENTS
pages of advice from doctors and health professionals you know and trust. 4 The Team Approach to Internal Medicine
- Dr. Ray Hall & Dr. Stephen Woodruff
6 Strange Events During Sleep
- Dr. David R. Nichols
8 Health & Hair
- Jeannie Bonds
9 Dr. Woodruff Relieves Abernathy Award
- LeAnn Askins
10 Age-Related Macular Degeneration
- Dr. F. Joseph George
12 The Need To Give Back
- Paul Betz
13 Carotid Artery Disease
- Dr. D.V. Patel and Dr. Anthony White
14 Getting in Shape
- Dr. Jason Brandt
16 No More Bladder Leakage
- Dr. Michael Hong
18 Cervical Arthroplasty:
Total Disk Replacement - Dr. Robert Abraham
18 Low Back Pain
- Dr. Gregory Ricca
19 Artificial Lumbar Disk Replacement
- Dr. Kenneth Tonymon
19 Carpel Tunnel Syndrome
- Dr. Rebecca Barret-Tuck
23 Snacking Can Be Healthy!
24 Effective Parental Strategies for
Improving Child Behavior - Dr. Kenneth Dill
27
In Review
NEA Clinic Charitable Foundation
34 Healthy Eating
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The benefit of targeted treatments and dedicated friends.
neabaptist.org | 870.972.7000 3. NEA HEALTH â&#x20AC;˘ Spring/Summer 2008
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THE TEAM APPROACH TO INTERNAL MEDICINE Dr. Ray Hall Dr. Stephen Woodruff
atients who receive care from internists at NEA Clinic are now getting the expertise of not just one doctor, but an entire team of medical professionals.
P
However, these patients also need a physician who knows their medical history and can still treat them for more simple conditions such as a sinus infection.
At the 311 East Matthews location, an internal medicine care team approach to treatment started several months ago to give patients more access to medical care.
Woodruff explained that the way the system works with the NEA Clinic Internal Medicine Care Team is that the entire team establishes contact with a patient so that each member of the team is familiar with the needs of each patient. This also allows patients to become comfortable with the entire team. In addition to regularly-scheduled appointments, patients are able to receive same-day treatment, often from an advanced practice nurse, if they become sick.
The approach started gaining momentum in the United States because of a shortage of internists in the country, explained NEA Clinic internist Dr. Ray Hall. As the senior population in the country continues to increase, so will the need for internists.
“We’re improving access to care,” Hall noted.
Patients who turn to internists usually have chronic illnesses, explained Dr. Stephen Woodruff, an internist and medical director of NEA Clinic.
The current internal medicine care team at NEA Clinic is made up of three physicians and two APNs, but Woodruff said plans are to continue to expand the program in the coming years. No matter why the patient visits the clinic, or which physician or APN the patient sees, the entire team is able to discuss the patient’s situation and offer the best medical care available. “It really helps to make the patient more in charge of their healthcare,” Woodruff explained. Traditionally, a patient might see a primary care physician when sick, and specialists for specific, chronic medical conditions. This would mean seeing many physicians, while a patient with an internist can receive care from one physician who has extensive knowledge of the patient’s medical history. Woodruff said the internal medicine care team approach also means less visits to the emergency room and allows patients to be more on top of their own health care issues. “We’ve seen a real benefit since we went to this in 2007,” the NEA Clinic medical director said. Hall said the approach is being proposed on a national level.
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Ray Hall, MD Stephen Woodruff, MD Brannon Treece, MD Kristy Wilson, APN 311 E. Matthews, Jonesboro 870.935.4150
Internal Medicine Care Team
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Downtown Festival - May 16 Historic Downtown Jonesboro, AR Live Music - Vendors - Kid Zone Bike Show - Food
to ride
BIKER CLASSIC ‘08 benefits the programs below.
JPD D.A.R.E.
A police officer led series of classroom lessons that teach children how to resist peer pressure and live productive, drug-free, and violence free lives.
Charity Bike Run - May 17 NEA Clinic - Woodsprings Clinic 2205 W. Parker Road, Jonesboro, AR
Registration 8 to 10 am First Bike Out 9:00 am -Last Bike Out 10:30 am
Bike Parade 3:00 pm
Historic Downtown Jonesboro
Bike Giveaway & Awards 4:00 pm Historic Downtown Jonesboro
• HopeCircle • Center For Healthy Children • Medicine Assistance Program • Wellness Works!
For more Biker Classic information/registration forms
Greg 870-930-8076 • Kevin 870-930-8052 Event Hotline: 870-934-5131
www.bikerclassic.com
Win a Harley-Davidson V-ROD!
Thanks Harley-Davidson of Jonesboro, Inc.
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5.
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I
t was a typical night; John and Mary, a married couple in their 60’s, had been peacefully sleeping when Mary is awakened by a disturbance next to her. John is actively engaged in a loud conversation, and he is not calling out to her! He is warning someone to “look out…take cover now!”
John’s arms begin to swing like a boxer, at first swinging out into the darkness, and then he lands a hard blow to her cheek. Mary, at first stunned, soon feels the intense pain in her face. John continues his active assault, but now he has jumped from the bed in a mad dash to somewhere, all the while yelling, “quick get down, into the foxhole.” Then he runs into the bedroom wall and falls backward hitting his head on the dresser’s edge. Mary screams “what are you doing?” There is no answer, and she tries several more times before John finally hears his wife’s voice. Mary repeats, “What are you doing?” John, becoming more aware of his real surroundings, slowly responds, “I was back in Vietnam, I was taking cover and warning my buddies to do the same. I guess it was just a bad dream.”
So, what’s up with that? This event is something that many people are unfortunate enough to endure on an almost nightly basis. John has just suffered from an episode of what is called REM behavior disorder (RBD). John, experiencing a very unpleasant dream about his Vietnam combat experience, begins to “act out” the scenes as they unfold in his dream by swinging out in defense and running for cover, calling to his comrades on the way. To his shock and amazement he finds he has injured his wife and suffered personal injury when falling against the bedroom furniture. This episode is not what happens to a normal person. When we enter rapid eye movement sleep and experience a dream, the brain, in effect, turns off our body muscles with the exception of those for breathing and eye movements. What happens to John and other patients like
him is that their muscles are not “turned off” and they are able to act out their dreams unaware of any effect on the real environment or its inhabitants. RBD has an estimated occurrence in the general population of 0.5%. The first reports of acting out dreams appeared in the 1970’s and the description of the clinical disorder followed in 1986. The overwhelming numbers of patients with this disorder are older men who either have or will develop degenerative disorders of the brain. Perhaps the most common such disorder is Parkinson’s disease, in which up to 25 % of patients may exhibit the behavior. RBD has also been associated with narcolepsy, autism, multiple sclerosis, stroke patients, brain tumors and other neurological conditions. These conditions produce a chronic form of RBD but an acute type has been associated with alcohol withdrawal and with the use of prescription medications used to treat depression, dementia, anxiety, and Parkinson’s disease to name a few. It has also been implemented in the excessive consumption of caffeine and chocolate. When the cause is related to the medications, women and younger patients have been seen with the disorder. The chronic form can also occur as an idiopathic (unknown cause) disorder. The cases will present with either the complaints of violent sleep behavior or with the resulting injuries to self or bed partner. Diagnosis of RBD is in large part made from the history of the clinical behavior occurring after about 90 minutes of sleep or in pre-dawn hours. Both are typical times for the appearance of REM sleep. Confirmation of the disorder can be achieved with the use of the polysomnogram (sleep study). During this study limb movements are found to occur during periods of REM sleep which would usually show no motor activity at all. Fortunately, treatment can be highly successful with the use of the drug clonazepam. Response is seen in over 90 % of the patients and they maintain a lasting benefit over years of therapy. Another experience out of REM sleep that virtually all of us have experienced is a nightmare. We all know that a typical
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◆ www.neahealth.com keyword: Sleep Problems nightmare consists of an emotion charged dream (typically anxiety, fear or terror but also anger, rage, embarrassment or disgust). It usually portrays experiences that focus on imminent danger or threat to the individual but may be other distressing themes. Occurrence of nightmares is highest among children and declines with age. Percentages will vary depending on the reported frequency in all age groups. If one considers the frequency of “at least sometimes” then reports are: 30-90% among children; 40-60% in young adults; and 60-68% in older adults. There has been some suggestion of a familial or genetic predisposition to nightmares. When the occurrence of nightmares takes on a recurrent theme with increased severity, and there is associated sleep disturbance with a delay in return to sleep it begins to satisfy the diagnostic criteria of nightmare sleep disorder. Some medications have been reported to be associated with increased nightmares. Some examples include the beta-blockers, Calan, Aricept, Halcion, and Prozac. Treatment is not typically required but a variety of treatments are available when it has reached highly disturbing status. Most of the successful therapy modes involve some form of behavioral therapy.
muscles, or speak. Breathing and eye movements are retained. This can be a normal finding or may be part of the symptoms of narcolepsy. This disorder like the one above occurs because of the residual effects of REM sleep that have not gone away with the onset of wake state. It is estimated that the occurrence of this event is low. It occurs “often or always” in 0%-1% of young adults and “at least sometimes” in 78%. If one looks at the frequency of at least once in a lifetime, it goes up to as high as 40-50% of the population. I would like to mention one last sleep disorder that occurs as an event during sleep. It is called sleep bruxism. It is characterized as a grinding or clenching of the teeth during sleep. It can cause noise sufficient to disturb the bed partner, but can also be destructive to the teeth and jaws, and be a cause of headache and orofacial pain. It is estimated that 8% of the general population are conscious of teeth grinding sounds during their sleep. Clinical recognition is based upon the history of the grinding, a morning jaw pain or stiffness, or worn teeth on inspection. Confirmation of the disorder can be seen during a polysomnogram with the increased motor activity of the jaw muscles seen during the sleep period. Causes may relate to increased stresses and anxiety or to increased sleep arousal responses. Treatment may consist of relaxation therapy, improved sleep hygiene, muscle relaxants, or oral appliances to protect the teeth. Many dentists are very familiar with this disorder and check for it during routine dental exams.
There are several disorders that occur during the transition into and out of our sleep. Some of these can be frightening until we understand more about them. One is called the sleeps starts or jerks. It is a sudden jerking of the arms, legs, face or neck that is often associated with the sensation of falling and occurs with The above descriptions of the sleep disorders occurring Occurrence of nightmares...the onset of sleep. It may be out of sleep along with those described in the last issue the frequency of “at least accompanied with a vivid, of this magazine (sleep terrors, sleep walking etc) are sometimes” reports are: 30-90% impactful and brief dream some but certainly not all of the disorders arising among children; 40-60% in young event. This is a normal from sleep. As I have said previously, the study of phenomenon, and may sleep disorders is fascinating. As suggested by adults; and 60-68% in older adults. occur with a frequency as Murphy’s Law “anything that can go high as 60-70 %. At times wrong…will go wrong”. It is very likely many there may be a loud auditory more disorders of sleep are yet to be discovered component of an explosion, thunder clap, cymbal clashes sound and understood. The process of waking and or other similar sound. The emotions of fear or terror associated with sleeping is a highly complex series of biologic events that involve one a racing pulse or cessation of breathing have also been reported. A of the most complex organs in our body, terrifying hallucination that occurs with the onset of sleep or the human brain. I continue to be amazed wakefulness is another example of a transition disorder. It is called by the complex interaction of emotional, either a hypnagogic (at sleep onset) or hypnopomic (upon awakening) physical, environmental, and and consists of the immediate recall of a dream content that is typically developmental factors that have the ability threatening in nature. It has a very real feeling like the events are to affect the quality of our sleep and actually occurring in the bedroom. It is thought that these represent a therefore the quality of our life. delay in the cessation of a REM sleep dream during the immediate period of waking. These can be a normal finding or may occur with David R. Nichols, MD the increase in REM sleep associated with the removal of medications FAASM and Diplomat of the known to suppress REM sleep. They are also a feature of narcolepsy. American Board of Sleep Medicine One last example of a transition disorder is called sleep paralysis. This Sleep Medicine is the brief experience of awakening and being unable to move your NEA Clinic – 870.935.4150 7. NEA HEALTH • Spring/Summer 2008
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Health & Hair
Healthy Hair Tips:
Jeannie Bonds, High Maintenance Salon
I
s dry or limp hair weighing you down? Did you know that what you eat is reflected in the health of your hair? All of the hair revitalizing shampoos in the world will not help if you do not nourish your body!
Just like your body, your hair needs a nutritiously balanced diet to stay healthy-a food plan containing a rainbow of fruits and vegetables that are loaded with vitamins, antioxidants, whole grains, minerals, nuts & seeds, and lean protein for iron play an important role in how healthy your hair looks and feels. Water is also important, not only to hydrate your body, but it keeps your hair silky and shiny. You should drink 8-10 glasses of water a day for maximum hydration. The fiber from fruits, vegetables and grains are good for your body and for your hair. For stronger and growing hair, you need protein for a building block such as meat, fish and eggs. To prevent hair loss and to support hair growth, you need B12 which is also found in meat and eggs as well as yogurt, iron and calcium.
Do You Have Trouble Sleeping Through The Night? Insomnia is a condition where you might: • Wake up frequently during the night • Awaken during the night but usually fall back to sleep • Wake up too early in the morning without being able to fall back to sleep • Experience distress as a result of their nighttime symptoms, or report problems with daytime fatigue or impairment
Those who have trouble sleeping through the night may qualify to participate in an insomnia research study of an investigational drug to see if it may improve your quality of sleep. You must be 18 years of age or older to participate. People who qualify to participate in this study will receive at no cost: • Investigational medication and • Medical care associated with the study, including lab work, ECG and physical exams. Type II Diabetics suffering from insomnia are also encouraged to call.
If you are interested call Dr. Nichols at
870.268.8431 to schedule a screening visit.
Clinical Research Center www.neaclinic.com 8. NEA HEALTH • Spring/Summer 2008
• Stay hydrated • Choose natural fresh foods • Get 5 or more servings of fruits and veggies per day • Get a balance of protein complex, carbs, healthy fats, vitamins and minerals • Take a multi-vitamin with an Omega 3 supplement • Get plenty of sleep and exercise • Don’t stress!
As we get older, we have problems with graying hair and hair loss. To help prevent this you need Biotin which will help produce Keratin. Biotin can be found in wheat germ, certain meats, oatmeal, egg yolks, soy, mushrooms, bananas and peanuts. Another helpful mineral is B5 which can be found in eggs, liver, milk, sunflower seeds, peas and peanuts. B6 is also important because it creates melamine which gives you your color. B6 can be found in wheat germ, potatoes, garbanzo beans, chicken, spinach and red meats. Some habits that can damage your hair are too much caffeine, a low protein diet, vitamin and mineral deficiency, a high salt diet, eating processed foods, and having excess amounts of trans fats and saturated fats. The overuse of vitamins and supplements can also contribute to unhealthy hair. Overall, healthy hair can be achieved by following recommended diet guidelines and by keeping it simple. An organic diet with lots of water and a few vitamins and supplements can give you the hair you’ve been dreaming of!
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Dr. Woodruff receives Abernathy Award
NEA Clinic’s
By LeAnn Askins
A
n NEA Clinic physician is being recognized throughout the state as a leader in the medical field after recently receiving a prestigious award for his work.
Dr. Stephen Woodruff, medical director and internist with NEA Clinic, was presented with the Robert Shields Abernathy Award for Excellence during the state American College of Physicians conference. The award is named after the former University of Arkansas for Medical Sciences Department of Medicine chairman. Abernathy was also a professor in the Department of Internal Medicine and Infectious Disease. Woodruff describes Abernathy as “a legend in Arkansas,” noting that receiving the award baring his name made the recognition even more special
“I couldn’t ask for more of an honor,” - Stephen Woodruff, MD
Physicians in internal medicine nominate their peers from throughout the state for the award each year. “Usually it’s someone who has made a contribution to medicine in Arkansas over a long period of time,” Woodruff explained. Many of those nominated also have close ties to UAMS. Woodruff is a graduate of the university and has served as an associate professor of internal medicine since 1984. Woodruff is the second NEA Clinic physician to receive the honor. Dr. Ray Hall was awarded the recognition in 2001.
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Hall said having two NEA Clinic doctors recognized is a mark of distinction for Northeast Arkansas. “It’s really the pinnacle of your career,” Hall said. He noted that a lifetime of work of physicians is examined after nominations are made, and the award is a reflection of the dedication to the field during a physician’s entire career. A Jonesboro High School graduate and Arkansas State University, Woodruff joined the staff of NEA Clinic in 1982. Before that he served as an internal medicine staff physician with the Naval Aerospace Regional Medical Center in Pensacola, Florida. He is currently a member of the Southern Medical Association, American College of Physicians and the Chief Medical Officer Council of the American Medical Group Association. Serving as Medical Director of NEA Clinic since 1997, Woodruff is also on the board of directors of the NEA Clinic Charitable Foundation and the joint venture board of NEA Baptist Memorial Hospital.
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“I couldn’t ask for more of an honor,” he said.
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◆ www.neahealth.com keyword: Macular Degeneration
Age-Related Macular Degeneration
A
ge-related macular degeneration (AMD) is a disease associated with aging and is the #1 leading cause of severe visual loss in persons 60 years of age and older. It affects at least 15 million people in the U.S. AMD damages the macula of the retina, the light-sensitive tissue at the back of the eye. The macula is located in the center of the retina and allows one to see fine details. When the macula is damaged, there is loss of central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD never affects peripheral vision (side vision), so that even with advanced macular degeneration, one is able to function fairly well in one’s normal surroundings. It is important to note that AMD never progresses to complete blindness (total darkness). This is because of the nonaffected peripheral vision. Macular degeneration is categorized as “Dry” and “Wet”. AMD always begins with the “dry” variety, with 10% eventually becoming “wet”. There is no pain with either form. Dry AMD: Early Dry AMD usually has no symptoms or visual loss and no treatment is needed. Intermediate Dry AMD is associated with a central “blurred spot”. Blurred vision is the most common early sign. As the light-sensitive cells in the macula slowly become damaged, central vision, especially near reading vision, becomes more and more difficult. More light may be needed for reading and other tasks. The National Eye Institute’s Age Related Eye Disease Study (AREDS) found that taking a specific high dose formulation of antioxidants and zinc (Ocuvite, VisiVite, ICaps) reduced the risk of progression to Advanced Dry AMD. The AREDS formulation (eye vitamins) will not restore the vision already lost from the disease. Also recommended is a diet high in green leafy vegetables and fish. Advanced Dry AMD occurs when the central “blurred spot” becomes bigger and darker. Reading vision is significantly compromised and some type of magnifying device will be needed. In general, Dry AMD progresses very slowly and, in 10. NEA HEALTH • Spring/Summer 2008
many instances, remains stable for several years without progression. However, 10% of Dry AMD becomes "wet." Wet AMD: This form occurs when abnormal blood vessels leak blood and fluid under the light-sensitive macula. Damage to the macula occurs rapidly, resulting in loss of central vision quickly. An early symptom of Wet AMD is “wavy lines” that are normally seen as straight. Any sudden change in central vision should be evaluated by your eye care professional at once. An Amsler Grid test may detect early leakage. The pattern of the grid resembles a checkerboard. Each eye is checked separately. While staring at a black dot in the center of the grid, you may notice that the normally straight lines appear wavy or missing. This would indicate possible leakage. A fluorescein angiogram can be performed. A special dye is injected into your arm. As the dye passes through the retinal blood vessels, digital pictures are taken. The location and degree of leakage will dictate what treatment options would be of most benefit. Laser Surgery A laser is used to destroy the abnormal leaking blood vessels. However the Laser may also destroy some surrounding healthy tissue. Only a small percentage of people can be treated with laser, mainly determined by the location of the leaking blood vessels. Photodynamic Therapy (PDT) A drug- VERTEPORFIN (trade name Visudyne) is injected into your arm. It “sticks” to the surface of the abnormal leaking blood vessels in the eye. A light is shined into the eye for approximately
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AMSLER RECORDING CHART • • • • • •
Use with reading light, reading distance, and reading glasses Cover one eye Look at center dot Note irregularities (wavy, size, grey, fuzzy) Test other eye Contact ophthalmologist (if necessary)
vitamins) provided a benefit to those with Early Stage Dry AMD. The AREDS formulation is of most benefit to those with Intermediate Stage Dry AMD.
90 seconds. The light activates the drug which in turn destroys the leaking blood vessels. Unlike laser surgery, PDT does not destroy surrounding healthy tissue. Several treatments may be required. Intraocular Injections New drugs (Macugen, Avastin, Lucentis) can be injected into the eye. High levels of a specific “growth factor” occur in eyes with Wet AMD, promoting the growth of abnormal leaking new blood vessels. This drug treatment blocks the effects of the “growth factor’. Several injections may be required.
Frequently Asked Questions Who is at risk for AMD? The greatest risk factor is age. People over age 60 are at greater risk. Other risk factors are family history, smoking, obesity, race, and gender. Whites are more likely to lose vision than African Americans. Women appear to be at greater risk than men. Can people with Early Dry AMD take the AREDS formulation to prevent the disease from progressing? Early Dry AMD has no symptoms or visual loss. The study did not find that the AREDS formulation (eye
How can I care for my vision now that I have AMD? If you have Dry AMD, you should have a comprehensive dilated eye exam at least once a year. If there is progression of the disease, your eye care professional may recommend that you take the AREDS formulation (eye vitamins). Also, eat a diet high in green leafy vegetables and fish. Because Dry AMD can become Wet AMD at any time you should check your vision with the Amsler Grid every day at home. If you detect any changes (wavy or missing lines), contact your eye care professional immediately. If you have known Wet AMD and treatment is recommended, have the treatment as soon as possible. The faster the leaking blood vessels are destroyed, the better for long term vision. What activities can I do if I have already lost some vision from AMD? Don’t be afraid to use your eyes for reading, watching TV, and other activities. Normal use of your eyes will not cause further damage. If there is considerable visual loss, ask your eye care professional about low visual aids, such as magnifiers. Specialists in low vision services are available. Above All, Remember – No matter how far advanced the Macular Degeneration, you will never, ever become completely blind (total darkness). Macular Degeneration affects central vision, never peripheral vision (side vision). F. Joseph George, MD NEA Clinic Eye Center 870. 932.0485 11. NEA HEALTH • Spring/Summer 2008
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Getting in Shape -
The Doctor’s Prescription absorption is lost after 250-300 miles so if you run 10 miles per week, you may need new shoes every 9-12 months. It is not often that you get a doctor’s order to buy shoes!
W
ith warmer weather approaching, many people start the annual quest of making themselves “swim suit” ready. Sometimes that noble pursuit leads to physically injuring ourselves. I had the recent pleasure of speaking with about 300 women who attended the “Women Can Run” seminar sponsored by NEA Clinic Wellness Center and Gearhead Outfitters. I shared with them some tips on how to achieve their fitness goals and minimize their chance for injury.
Start
Slowly.
With running or any physical activity, make sure your first sessions are fun and not tiring. Give your body a chance to get used to it. Do not stop exercising if you get muscle soreness in the beginning. It will disappear as you exercise regularly. Use the 10 percent rule when increasing your running. That means you don’t increase mileage or duration more than 10% a week. Do stop if you experience severe pain or swelling.
Seeking out experienced runners or using a knowledgeable personal trainer for advice will help prepare you for a successful and enjoyable experience. Unfortunately, injuries can occur when exercising, but many injuries are preventable or reduced through proper conditioning, footwear selection, and awareness of environment. If pain limits your activity despite a period of rest and a trial of over the counter medication, medical evaluation should be sought. If continuing with an exercise program is your goal, then select a provider that will help you identify the problem and work with you to return to your activity as quickly and safely as possible.
wly o l S t
Star
Protect your skin. Remember broad spectrum sunscreen of at least SPF 15. Sunglasses and a hat also protect you. Skin cancer is quite prevalent, but fortunately your risks can be minimized with protection. For running and walking, shoe wear is the most important piece of equipment. When trying on shoes, do it at the end of the day or after a workout. Your feet will be largest then. There should be a thumbnails width between the end of the longest toe and the end of the shoe. Sixty percent of a shoe’s shock
mes
tre d Ex
Avoi
Avoiding extremes in climate can minimize heat related injuries. You can lose 6-12 ounces of fluid for every 20 minutes of running, so drink 10-15 oz of fluid prior to activity and every 20-30 minutes. One pound of weight lost after a run equals one pint of fluid lost.
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Planning where you run and what you wear is also important for your safety and health. Wear reflective clothing when running in low light conditions. Look for smooth, soft surfaces to run on. Running with a partner can be enjoyable and provide an element of security. If alone, carry an I.D. or write your personal info (name and emergency contact) on the inside sole of your shoe. Let others know your route and carry a cellular phone if able.
in
Sk r u o ct Y
e
Prot
Jason Brandt, MD Orthopedic Surgery & Sports Medicine NEA Clinic – 870.932.6637
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CAROTID ARTERY DISEASE
-the leading cause of strokehe medical term is atherosclerosis. But you probably recognize its more familiar term: hardening of the arteries. It's caused by plaque, fatty deposits that build up inside an artery and prevent blood from flowing normally.
T
procedure called carotid artery stenting (CAS) with embolic protection at NEA Baptist Memorial Hospital.
Sometimes plaque accumulates in the neck’s largest artery — the carotid — which carries blood to the brain. The result is carotid artery disease (CAD). The danger is that pieces of the plaque will flake off and travel into the brain. Or, a blood clot could get stuck in the artery and cut off blood to the brain. Either situation can cause a stroke.
The procedure involves an interventionalist inserting and steering a system of low-profile catheters and guidewires to the carotid’s lesion location. Deploying a filter to help prevent plaque debris from entering the blood stream toward the brain, the doctor prepares the site for stenting. A stent is a small, metal mesh tube that props open a diseased artery and restores normal blood flow.
Carotid artery disease is more common among the elderly. There are ways to know you might be at risk: a family history of stroke, atherosclerosis in another area of the body, high blood pressure, diabetes, smoking, irregular heartbeat and a history of coronary bypass surgery. The symptoms of carotid artery disease include weakness, tingling or paralysis in the limbs or face, difficulty swallowing, eyesight problems, dizziness, confusion or fainting. But all too often, the first symptom is stroke itself.
D.V. Patel, MD, Anthony White, MD
NEA Clinic Cardiology is excited about the improved quality of life this new procedure can offer their patients. A vascular team that is fully trained in diagnosis, treatment and management administers it, as well as follow-up services for patients with carotid artery disease. You can learn more about carotid artery disease and the new stenting procedures by calling NEA Clinic Cardiology at (870) 935-4150.
A stroke happens when the flow of oxygen and nutrients to the brain is cut off. Tissue swells and the brain cells begin to die quickly. Identified as the nation’s third leading cause of death, strokes affect nearly 700,000 people every year. A quarter of them die. People who survive strokes often have speech problems, difficulty thinking clearly, emotional problems and pain. Severe strokes can also cause paralysis. While there are several ways to treat carotid artery disease, the goal is always the same: get blood flowing to the brain as quickly as possible. Anti-stroke drugs can prevent certain kinds of clots beforehand. During an actual stroke, drugs called thrombolytics can help open the carotid artery and keep the damage to a minimum. A severe blockage usually requires a procedure called a carotid endarterectomy. A surgeon cuts into the diseased carotid artery, located in the neck, and scrapes away the obstructing plaque. More recently, however, interventionalists doctors who perform procedures that don’t require open surgery - are looking at other alternatives. Dr. D.V. Patel and Dr. Anthony White now offer one of these new alternatives, a painless 13. NEA HEALTH • Spring/Summer 2008
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The Need to
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Give Back! T
he complexity and sophistication of hospitals has always intrigued me. The dynamics of the physicians, equipment, patients and technology were amazing, but over time I realized there was much more to a hospital. I realized people who work in a hospital have a need to give back regardless of their day-to-day job; they are working to provide patients with the best care possible. I began my career as an administrative intern. During one of my visits with the hospital administrator, I Paul Betz, CEO NEA Baptist and commented about a picture on Dr. Brock Harris, Hospitalist his office wall. The picture was of a young patient shooting a basketball. The child had no hair, was dressed in a patient gown and had an IV pole in tow. The administrator was obviously motivated by it and said that no matter how sick they are, children will always be children. This solidified my interest in hospital administration and reinforced my personal need to give back. Baptist Memorial Health Care also has a need to give back. A not-forprofit organization and community partner, Baptist spends millions each year ministering in and caring for the community. In 2007, Baptist provided more than $428 million in community benefit, which includes charity care, patient accounts that werenâ&#x20AC;&#x2122;t paid, free community health fairs and educational events, community contributions and other activities. The mission of Baptist is based on the three-fold ministry of Christ â&#x20AC;&#x201C; preaching, teaching and healing. Following this same mission since 1912, Baptist has grown into one of the largest private not-for-profit health care systems in the country. With 15 hospitals in West Tennessee, North Mississippi and East Arkansas, Baptist admitted approximately 85,000 I am proud to patients, treated more than 283,000 ER patients, performed nearly 23,500 be a small part surgeries and delivered almost 10,900 of this difference. babies last year. The Baptist system has more than 3,100 affiliated physicians and is proud to partner with the physicians of NEA Clinic. The partnership is based on the desire of both organizations to provide a stable opportunity to give back to the community for many years to come. Together NEA Clinic and Baptist will are committed to making a difference in the delivery of health care throughout the region. Paul Betz, CEO NEA Baptist Memorial Hospital
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June 6, 2008 • 6:30 pm • Holiday Inn How can we help insure that the future will be bright? One way is by meeting the needs of children, youth and families today. This is the mission of Junior Auxiliary of Jonesboro, AR, Inc., a non-profit women’s volunteer service organization founded in 1950. We look for ways to improve the lives of Craighead county children by developing and implementing programs that instill self-esteem and challenge minds. Members of Junior Auxiliary of Jonesboro, AR work community service projects in the health, welfare, civic, cultural and educational fields. We also work closely with the staff of local school districts and other organizations to identify children with unmet special needs such as clothing, school supplies and medical/dental care.
Join us for our 2nd Annual NEACCF Gala as we honor
Loretta Bookout Dinner and Dancing with music by
“The Bouffants”. Black Tie Optional.
Call 934.5101 for tickets or sponsorship opportunities.
One of the service projects of Junior Auxiliary of Jonesboro helps local elementary schools with the Berkley Health program. Members lead the pig lung dissections and teach about the risks associated with smoking. The committee members also coordinate a pig heart dissection at the Sixth Grade Academic Center. This includes a pre-teaching day on heart anatomy and physiology, diseases of the heart, risks of heart disease and the importance of good nutrition and exercise. For more information on JA or how you can help, log onto
jajonesboro.org 15. NEA HEALTH • Spring/Summer 2008
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◆ www.neahealth.com keyword: Urinary Incontinence in Women
No More Bladder Leakage W hen a toddler wets her pants, it is somewhat funny and understandable; but when an adult woman wets her pants, it is no laughing matter. Television commercials and magazine ads often present incomplete or misleading information about adult incontinence, resulting in misunderstanding of this common diagnosis.
There are three common mechanisms that lead to urinary incontinence. The first mechanism is stress incontinence. It is caused by pelvic relaxation and loss of bladder anatomical support. Urinary leakage occurs when one exerts increased abdominal pressure. Activities such as coughing, laughing and running can cause such urinary leakage. The second cause is intrinsic sphincter deficiency. This is caused by an abnormally low pressure of the urethra sphincter (the valve that release the urine). As the result, one would experience frequent leakage of urine with minimal activities. This condition occurs more often in the elderly population. Finally, the third cause of incontinence is overactive bladder. It is caused by spontaneous bladder spasms that lead to urinary urgency and frequency. If the spasm is strong enough, it can cause a gush of large urine loss. Treatment plan for urinary incontinence is dependent on the underlying etiology. For patients with mild and infrequent stress incontinence, Kegal exercise, the tightening of the pelvic floor muscles, is often helpful. However, daily aggressive exercise is needed to achieve positive outcome. Professional training with a physical therapist could isolate the target muscles and further improve the results. In more severe scenarios of stress incontinence and cases of sphincter deficiency, several surgical treatments are available. Oftentimes these procedures are performed in conjunction with hysterectomy or pelvic reconstructive surgery. One of the exciting developments in the surgical treatment is the tension free tape sling procedure. It is an outpatient procedure that is minimally invasive and has excellent outcome. It involves the placement of a synthetic mesh under the bladder neck through three small incisions. This mesh provides a structural support for the bladder to correct the anatomical dysfunction associated with stress incontinence and sphincter deficiency. Because this procedure is minimally invasive, the patient could potentially return to work the following day with some lifting restrictions. Overactive bladder is treated by medication. The medication is designed to control urinary urgency and urge-related incontinence. It generally takes 2 to 3 weeks before one can experience relief of symptoms. However, these medications will only control the symptoms but not eradicate the condition. Daily therapy is needed to control the bladder spasms. Common side effects included dry mouth, constipation and worsening of glaucoma. I often tell the patients that incontinence is not a life-threatening disease, but it could be an embarrassing chronic condition. If you suffer from urinary incontinence, discuss this issue with your physician. Several treatments are available.
Don’t be afraid to have a good laugh! We’ve got you covered! Michael Hong, MD, FACOG Obstetrics and Gynecology NEA Clinic Women’s Clinic – 870.972.8788 16. NEA HEALTH • Spring/Summer 2008
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Danny Guffey – Healthsouth Jonesboro Patient At age 60, Danny Guffey never imagined that a massive stroke was in his future. Guffey underwent knee surgery on a Wednesday and the following Friday, he suffered a massive stroke. Guffey was discharged to HealthSouth Rehabilitation Hospital of Jonesboro where he spent two full weeks undergoing extensive rehabilitation. There, his rehab team designed a comprehensive program designed especially for his needs. The team’s dedication and expert care proved to be greatly beneficial in his recovery. Mr. Guffey is currently participating in outpatient therapy at HealthSouth with continued postive results. When asked about his therapy at HealthSouth Jonesboro, he says, “It was absolutely great.” For more information on rehabilitation at HealthSouth Rehabilitation Hospital of Jonesboro, call 870 932-0440.
1201 Fleming Avenue • Jonesboro, AR 72401 870 932-0440 ©2008:HealthSouth:702416
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Cover Story
NEUROSURGERY is the surgery involving any part of the nervous system, including the brain, spinal cord, nerves, spine and their supporting structures and vasculature. Neurosurgeons treat patients who require operation procedures or consultation for neurological abnormalities.
CERVICAL ARTHROPLASTY:
TOTAL DISC REPLACEMENT
Figure 1
C
ervical spine pain (neck pain) is a very common condition with varied causes. Most episodes of neck pain can be resolved with conservative measures only, however, a small percentage of patients may require operative treatment. Surgical procedures for cervical spine disorders have been performed for over fifty years. There has been a steady progression in the way we treat cervical disc disease. Posterior procedures for symptomatic cervical disc disease was the favored approach forty to fifty years ago. With the advent of better diagnostic methods the pathology of the cervical spine was more clearly defined. On many occasions the offending lesions were located anterior to the spinal cord making them inaccessible from a posterior approach. The anterior approach has been the dominant approach for the past 25 years.
within six weeks will need further evaluation. The symptoms of neck, shoulder and arm pain, muscle spasms, neck stiffness, weakness and numbness in the arms/hands are indicative of cervical disc disease. An examination may reveal tenderness, muscle tightness, limited mobility and neurologic dysfunction with sensory loss, weakness and loss of reflexes. Diagnostic studies to include x-rays, MRI scans, CT scans and myelograms will reveal the problems. The treatment options for symptomatic cervical disc disease are continuing to evolve. Anterior cervical diskectomy with fusion has been an excellent operation with good results in over 85 90 % of the patients.
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continued page 20
Patients with symptomatic cervical disc disease which does not respond to conservative measures (rest, medications, physical therapy and pain management)
Robert Abraham, MD Neurosurgery â&#x20AC;&#x201C; NEA Clinic
Low Back Pain
A
lmost everyone has experienced or will experience spine related pain. In this article, I will touch upon some of the causes, associated symptoms and treatment options for this common malady. I will also provide a framework to use on making decisions on a course of treatment. The most common cause of back pain is muscle strain. This happens when your back muscles are asked to do more than they can. The muscles, joints and ligaments are injured either by one wrong move or multiple repetitive moves. The muscles spasm and can cause incapacitating back pain and the inability to move. Other common problems include disc ruptures, spinal stenosis, facet joint pain, bone spurs, and degenerative disc disease. A disc rupture occurs when the central cushion Gregory Ricca, MD FACS of the disc herniates (squishes) out of its 18. NEA HEALTH â&#x20AC;˘ Spring/Summer 2008
normal central location within the disc. This is akin to stepping on a jelly donut. The disc fragment can compress nerves causing pain, numbness, tingling and/or weakness in one or both of the lower extremities. Rarely, a disc rupture can interfere with bowel and bladder function. This latter problem is often an emergency. Many ask what causes a disc to rupture. The simple answer is that the forces on the disc were more than the disc could handle. Occasionally one major trauma rips the disc capsule and causes the central cushion to herniate. More commonly, it is the repetitive stresses of life that weakens the disc. This process is similar to breaking a credit card. Spinal stenosis is a slow progressive narrowing of the spinal canal (the space within the spine where the nerves live). This narrowing compresses nerves. Frequently the sufferer experiences pain into the back of the lower extremities
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continued page 21
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Artificial Lumbar Disc Replacement: New Technology for an Old Problem
T
wo issues previously, Dr. Rebecca Barrett-Tuck reviewed some ways to manage an aching back in an article directed towards nonsurgical methods. In this article, I would like to present the Synthes ProDisc-L Total Disc Replacement implant as new surgical technology now available and FDA approved for treatment of lumbar degenerative disc disease (DDD). Lumbar degenerative disc disease (DDD), in general, isn't really a disease—it's the normal wear and tear process of aging on the spine. Unfortunately, as we age, the intervertebral discs (pillow-like pads between the bones in the spine) lose their flexibility, elasticity, and shock-absorbing characteristics. When this happens, the discs change from a supple, flexible state that allows fluid movement, to a stiff and rigid state that restricts movement. Gradually, the collagen (protein) structure of the outer portion of the disc—the annulus fibrosus— weakens. The degenerative process also affects the water content in the discs with loss of the water-attracting molecules in the discs. Because water content is crucial to maintaining movement, the discs become more stiff and rigid with DDD. Although more commonly seen in patients in their 40’s, 50’s, and above, younger people can develop DDD as well. Episodic injuries as well as repetitive activity related trauma represent some of the causes which can start the degenerative process in the intervertebral discs.
Regardless of the cause, lumbar DDD is a slowly progressive process which will eventually affect the quality of a patient’s life with LOW BACK PAIN. If nonsurgical management is ineffective for relief of that pain, select patients can now consider the Synthes ProDisc-L as an alternative to lumbar fusion, which has been the traditional surgical treatment of lumbar DDD. The ProDisc-L implant is composed of three components: two cobalt chromium alloy endplates and an ultra-highmolecular weight polyethylene dome inlay. The endplates are inserted into position and the polyethylene inlay is locked into the inferior endplate, creating a ball and socket joint. Motion is controlled and predictable along the surface of the polyethylene dome. In fact, ninety-four percent (94%) of all Kenneth Tonymon, MD ProDisc-L patients in the FDA Neurosurgery – NEA Clinic approval study demonstrated normal range of motion at 24 months postop.
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CARPAL TUNNEL SYNDROME
C
arpal tunnel syndrome is a relatively common affliction, which has been described back as early as the beginning of the 20th century. Carpal tunnel syndrome often times is a result of excessive use of the hands, particularly involving computer work and keyboarding as well as factory work and sometimes simply activities typical of a homemaker such as cooking, sewing, and cleaning. The carpal tunnel is a narrow passageway bounded by ligaments and bones through which passes the median nerve. This nerve supplies most of the sensation to the palm side of the hand as well as innervation to the muscles of the thumb and a few other muscles. Pressure placed on this nerve produces numbness, tingling, pain, and eventually weakness of the hand. Fortunately, treatment for carpal tunnel syndrome is quite effective in relieving the pain and numbness and allowing the patient to return to normal activities.
SIGNS AND SYMPTOMS: Carpal tunnel syndrome usually begins gradually with a vague aching pain in the wrist and hand in association with numbness and tingling that often times begins during the night. • TINGLING AND NUMBNESS Numbness and tingling in the fingers and the hands particularly involve the thumb, index, middle fingers and a portion of the ring finger; however, most people perceive that the numbness and tingling involve their entire hand. This sensation commonly begins at night and often times a person simply thinks that the sensation is because they have slept in an uncomfortable position. As the syndrome advances, however, the numb sensation or tingling sensation also occurs while driving, holding the phone, or first thing in the morning. Many people are able to shake or rub their hand to relieve the symptoms. continued page 22
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Rebecca Barrett-Tuck, MD Neurosurgery – NEA Clinic
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Cervical Arthroplasty... Ccontinued Several factors, however, can lead to problems: 1) failure to fuse 2) hardware or graft failure 3) progressive degeneration at adjacent levels and 4) loss of mobility. Over the past 20 years cervical disc arthroplasty has been available in other countries and recently FDA approval has been granted for arthroplasty devices in the United States. Arthroplasty has several advantages over a fusion: 1) motion preservation
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Artificial Lumber Disc Replacement... Ccontinued The ProDisc-L implant is inserted from the front of the spine. In order to accomplish this approach, the neurosurgeon teams up with an “approach or access surgeon” who is usually either a general surgeon or vascular surgeon possessing extensive experience with blood vessel surgery in the region just in front of the spine. The approach surgeon makes the abdominal incision where it will provide the best access to the disc to be replaced. He then gently displaces the sac which contains the intestines to one side of the spine and carefully moves the iliac arteries and veins to reveal the disc space for the neurosurgeon.
2) prevention of adjacent level disease and 3) no need to wait for the fusion to occur. (See Figure 1 for examples of an ACDF and cervical arthroplasty) Indications for cervical arthroplasty in the investigational studies included: 1) symptomatic cervical disc disease in only one vertebral level between C 3 - 7 2) symptoms to include neck or arm pain and neurological deficit and radiographically confirmed herniated disc, spondylosis (bone spurs) and loss of disc height, 3) age between 18 and 60 years and 4) failure of conservative therapy for 6 weeks or progressive neurologic symptoms and signs while on conservative treatment. The contraindications to cervical arthroplasty are even more extensive: 1) involvement in more than one vertebral level 2) marked cervical instability 3) fused level adjacent to the level to be treated 4) allergy to materials in the artificial disc and 5) severe facet joint disease to name a few. Cervical arthroplasty has been shown in clinical trials to provide the same level of pain relief and high patient satisfaction, with fewer reoperations when compared to the standard of care, ACDF. This treatment option will hopefully provide a more natural level of function for patients who will need operative repair for symptomatic cervical disc disease. Robert Abraham, MD Neurosurgery NEA Clinic – 870.935.8388 20. NEA HEALTH • Spring/Summer 2008
At this point in the surgery the neurosurgeon totally removes the degenerated disc and implants the Synthes ProDisc-L Total Disc Replacement. The approach surgeon then checks the abdominal contents and the iliac arteries and veins before closing the incision. In the postoperative recovery period, the patient gets out of bed the same day and is expected to walk in the hallway. In our experience, patients have stayed in the hospital anywhere from 23 hours to 96 hours, with most leaving in 48 to 72 hrs. Patients are expected to begin walking with a target distance of two miles per day as well as to demonstrate consistency with lower back and abdominal strengthening exercises. Although traditional lumbar fusion and the Synthes ProDisc-L Total Disc Replacement implant both reduce the pain of lumbar DDD, it is hoped (but yet to be proven in statistical study) that the occurrence rate of DDD will be lessened in those intervertebral discs above and below the ProDisc-L implant because of its motion preservation ability. Some articles in the spine literature cite the occurrence rate of development of “adjacent segment” DDD with lumbar fusion as high as 30%. This “adjacent segment“ DDD probably has multiple causes; however, stiffness and lack of motion in a fused segment of spine is thought to be a prime contributor. With a life expectancy of at least 75 years, young adults may want to give careful consideration of what is implanted in their intervertebral disc spaces to treat DDD. At least now in the 21st century they have a choice.
Kenneth Tonymon, MD Neurosurgery NEA Clinic – 870.935.8388
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Ccontinued
whenever he/she attempts to stand or walk. For some, the legs feel weak and heavy and they have to sit down frequently to get relief. It is common for patients with spinal stenosis to sit while others shop. If they shop, they are the ones who push the grocery cart allowing them to lean forward. Leaning forward opens the canal and helps un-pinch the nerves a little. Spinal stenosis generally becomes symptomatic in individuals older than 60. Facet joints are paired supports attached to the back of each vertebral body. Arthritis of these joints can cause back pain just like arthritis of other joints can cause pain elsewhere. Repetitive trauma causes these joints to enlarge which can then compresses nerve roots. Bone spurs develop when the edges of the bones thicken and protrude. These protrusions (spurs) are a sign of degeneration of the spine. They are often associated with arthritic changes of the spine, back pain and occasionally pain into the lower extremities. Discs can degenerate and allow nerve fibers from the edges of the disc to grow into the center of the disc. This occasionally causes significant low back pain whenever the disc is loaded with weight, as in sitting or standing. The pain eases when the disc is unloaded, as in lying down.
Good nutrition will help maintain good tissue strength. Sleeping on a firm mattress is important for good spine hygiene. During dream state most of the muscles in the body become paralyzed. If the mattress is soft or worn out, the body will sag causing damage to the joints and ligaments of the spine. A soft pillow top on the mattress is fine as this prevents pressure points on the skin and makes for a more comfortable sleep. The mattress itself however should be firm and provide excellent support. Quality, well-padded walking shoes are also important. If you develop a spinal problem, it is best to see your primary care physician (PCP). If you do not have a PCP, get one. Your PCP is best able to understand your needs and start basic treatment. Your PCP can also help you understand your problem and arrange a consultation with a specialist when needed. Treatment for the above problems includes rest, heat/cold packs, massage, anti-inflammatory medications such as Ibuprofen and Naproxen, muscle relaxers, pain medications, physical therapy, treatment at a pain clinic, and occasionally surgery. Dr. Greaser is our pain specialist and he has numerous treatments that often can help a person with spinal pain. If surgery is needed, it is most commonly done to decompress one or more nerves. Sometimes it is done to correct improper alignment and stabilize the spine. This usually requires fusing bones and placing metal to help hold two or more vertebra together. Now Dr. Tonymon and Dr. Abraham are able reasons to have to replace the damaged disc with a new artificial disc.
A combination of genetics and lifestyle causes the spine to degenerate. If you genetically have a spine like a bulldozer, it can handle ...there are only two just about anything. If your spine is spine surgery: more like balsawood, just normal life will easily wear it out. This is why 1) Progressive loss of neurologic function people who have spine surgery tend to When should one decide to have 2) Intolerable & intractable symptoms have repeat spine surgery. Generally, surgery? In general, there are only two it is not the first operation that leads reasons to have spine surgery: 1) to the second operation. Usually Progressive loss of neurologic function whatever caused the patient to have one spine surgery causes the and 2) Intolerable and intractable symptoms. The first reason is the person to have additional spine surgeries. Saying ‘do not have back most important. Ignoring a progressive loss of nerve function has the surgery because that will make you have additional back surgery,’ very high risk of permanent nerve damage. An example of this is like saying ‘do not repair that part of the fence because that will would be a pinched nerve causing a progressive foot drop. The make you have to repair other parts of the fence.’ second reason (intolerable symptoms and inability to get better any other way) is very personal, and only the person affected can answer We cannot control our genetics but we can control our lifestyle. this question. Some people are in such severe pain that they cannot Factors that weaken the spine include smoking, obesity, poor body tolerate even a couple of weeks of nonsurgical treatments. Others mechanics, repetitive pulling or tugging, bending, straining or have tried to live with their symptoms for years before they finally twisting, poor muscle tone, poor nutrition, sitting with poor decide to have surgery. posture and sleeping on a soft mattress. Smoking weakens the connective tissues that hold us together thus weakening the spine If a person does not have progressive nerve damage and can live as well as all other tissues in our bodies. Cross-country truck with his or her symptoms, then they should not have surgery. If a drivers tend to have a higher incidence of spinal problems because person has progressive loss of nerve function or they sit for long periods of time in a bouncing vehicle with poor if symptoms significantly interfere with their posture (lack of lumbar support). Standing and walking on life, then surgery should be considered. concrete is also very hard on the low back. In summary, the better you take care of your What can be done to prevent spine disease? If one is a smoker, the back, the better your back will take care of you. first and most important thing to do is to quit smoking. If one were If you should need our help, we will be happy to obese, weight reduction would unload the spine. The low back can do all we can. be protected by using good body mechanics including proper posture and employing good lifting techniques. Exercises to strengthen the muscles around the spine (abdomen, sides and back) will protect our Gregory F. Ricca, MD FACS spine during daily life. Sitting with good posture (including using Ricca Neurosurgical Clinic lumbar support) helps prevent straining the joints and ligaments.
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Carpal Tunnel Syndrome Ccontinued • PAIN Pain occurs in the wrist and the hand often times radiating up the forearm even occasionally as far as the shoulder. • WEAKNESS As the syndrome becomes more severe, weakness in the hands occurs as well as a tendency to drop objects. A common complaint is inability to open jars. CAUSE: The cause of carpal tunnel syndrome is pressure placed on the median nerve. The median nerve does indeed supply sensory and motor function. The sensation to the small finger is supplied by the ulnar nerve; therefore, the small finger is usually not involved with the numbness. Carpal tunnel syndrome results when the size of the carpal tunnel is narrowed. Usually, this is caused by thickening of the ligament overlying the median nerve, therefore, placing pressure upon the nerve. Other causes may include thickening of bones surrounding the carpal tunnel or swelling or thickening of the tissues surrounding the median nerve within the carpal tunnel. • LIGAMENTOUS THICKENING Most common cause of carpal tunnel syndrome is excessive use of the hands, which leads to thickening of the ligaments and resulting in pressure upon the median nerve. • OTHER CONDITIONS Rheumatoid arthritis, diabetes, and thyroid disorders can result in swelling and thickening of surrounding tissues. These conditions are commonly associated with carpal tunnel syndrome. Fluid retention during pregnancy can also result in carpal tunnel syndrome; however, often times symptoms resolve after completion of the pregnancy.
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WHO IS AT RISK: Studies show that carpal tunnel syndrome is most common in persons who consistently use repetitive and forceful motions of the hands and wrists. Carpal tunnel syndrome is frequently seen in factory workers who do heavy assembly line work or persons who use power tools. Carpal tunnel is also commonly seen in keypunch operators, typists, and persons who use a computer frequently. In this age of video games, carpal tunnel syndrome can also be seen as a result of excessive video game usage. It has also been shown that women are three times more likely as men to develop carpal tunnel syndrome. The incidence increases after menopause. In addition, some persons simply due to heredity have a smaller carpal tunnel than the average and, therefore, are more likely to develop carpal tunnel syndrome. Any condition that results in fluid retention or swelling of tissues including thyroid disease, diabetes, obesity, rheumatoid arthritis, pregnancy, oral contraceptives and other hormonal changes may place a person at greater risk. DIAGNOSIS: In most cases, the diagnosis is made from the person’s history and physical findings. Suspicions thereafter will be confirmed by the use of electrodiagnostic testing. A small shock is used and the speed of nerve conductance is measured to determine if indeed carpal tunnel syndrome is present. TREATMENT: Mild symptoms of carpal tunnel syndrome can be relieved by the utilization of wrist splints and anti-inflammatory medications in addition to taking more frequent breaks or stop some of the activities that may have caused the pain. If the symptoms are unresponsive to these measures and have become significant, then surgical treatment is the very best option. The surgical procedure involves cutting the ligament that is placing pressure upon the nerve, therefore, allowing the nerve to recover from the damage that is occurring due to the compression. Surgery is usually very effective resulting in almost immediate relief of pain and tingling. Numbness and weakness also will respond to surgical intervention. Recovery is most complete if the carpal tunnel release is completed before the nerve has been significantly damaged. Limited use of the hand and wrist is possible within only a few days after surgery. Use of heavy tools in the hand is usually restricted for several weeks to a couple of months. Once recovery is complete, the patient may resume all of their normal activities both at home and at work. Rebecca Barrett-Tuck, MD Neurosurgery NEA Clinic – 870.935.8388
22. NEA HEALTH • Spring/Summer 2008
n a C g n i k Snac ! y h t l a e Be H
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N
eed a snack? No problem, say the folks at the AARP (www.aarp.org), just keep it healthy. If you watch what you’re doing, you can get some of the fiber and nutrients your body needs through your snacking. You can also stave off some of those between meal hunger pangs that can cause you to overeat if you let them go too long. Smart snacking could help your reduce your calorie intake if you eat smaller meals and use your snacks to keep you going in between. Keep in mind that as you age your body needs fewer calories.
Here are some suggestions for healthy snacks: • Fruit: fresh, frozen or dried. • Raw vegetables, cut and portioned in bags. Try carrots, celery, red and green pepper. You can dip them in low-fat dressing for a little extra zing. • Whole-wheat English muffin with apple butter with a cup of herb tea. • Slices of angel food cake with nonfat whipped topping. • Whole grain crackers with reduced-fat cheese or peanut butter. • Nonfat cottage cheese or yogurt with honey.
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• A handful of nuts or trail mix. • Hummus with whole-wheat pita bread. • A smoothie (nonfat milk or yogurt blended with fruit).
© 2007 Regions Morgan Keegan Trust. Investment services are provided through Morgan Keegan & Company, Inc., a subsidiary of Regions Financial Corporation and a member NYSE and SIPC. Trust services are provided through Regions Morgan Keegan Trust, a trade name for the Trust Division of Regions Bank. Securities sold through Morgan Keegan and Regions Morgan Keegan Trust are not FDIC–insured, not guaranteed by Regions Bank and may lose value.
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Effective Parental Strategies for Improving Child Behavior
A
n effective parent and child interaction is a very important part of a child’s behavioral development. This is accomplished through the use of effective strategies by the parent to guide the child towards healthy behaviors that will ultimately stay with them into adulthood. All behavior is learned and is shaped by the consequences whether positive or negative. The consistency and swiftness of the parent in providing either positive or negative consequences for the child usually over time leads to increasing the desirable behavior or decreasing the undesirable behavior. These parental strategies are specific to the child’s age so they must adapt as the child develops. Examples of positive reinforcement include parental praise of completion of an assignment or task, appropriate manners or etiquette in a certain situation, or any positive performance of the child. Inadvertent rewards could include a smile, a pat on the back, or overhearing the parent praise the child about school accomplishment. However, sometimes-inadvertent rewards can lead to undesirable behavior. Examples of this include giving a treat to a child to head off a temper tantrum or feeding a child each time he or she awakens during the night. A common habit is for parents to provide attention to a child who is acting badly despite this being reinforcing of the undesirable behavior. If a parent does not give adequate attention to a child even when exhibiting good behavior, a child will act out and behave poorly in order to get any attention despite the parents’ efforts to be providing negative reinforcement. In general, the best use of attention is to provide it when the child is behaving well and withhold it when a child is behaving poorly. 24. NEA HEALTH • Spring/Summer 2008
Most children learn better and faster by being rewarded for good behavior than being punished for bad behavior. Negative reinforcement, however, is necessary at certain times because all children act in inappropriate ways at times whether unintentionally or on purpose for a gain. The two ways to inflict punishment effectively are by denying certain privileges or by imposing uncomfortable circumstances or activities. Examples of restricting privileges include not allowing a child to play video games or watch TV for a length of time. Examples of imposing undesirable circumstances involve requiring certain chores to be done or using a separation method called “time out”. The most important negative reinforcement arises sometimes naturally as a result of the bad behavior. For example, a child refuses to eat a healthy meal and becomes hungry by the time it is bedtime or spends money early that was designated for a class field trip and does not get to go once the time arrives for it. There are also some consequences that follow logically such as a parent taking the colors away for a week for a child who has been coloring on a wall or desk. Some of the most common mistakes parents make that can lead to ineffective discipline are accidentally rewarding an undesirable behavior, having too many punishable behaviors, failing to reward or notice desirable behaviors, paying attention to the child only when they exhibit bad behaviors, and having inconsistent rules that vary a lot over time or by situation. Certain parental characteristics are also important to recognize that they may make effective discipline difficult as they place restraints on time and resources. For example, individual parental illness such as chronic diseases, personality disorders, or
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The American Academy of Pediatrics does not recommend spanking a child for the following reasons:
1. It provides a condescending message to children that parents are allowed to hit despite punishing the child for the same act.
2. It undermines the nurturing and cooperative relationship parents try to have with their children and teaches them to use more aggressive and violent forms of conflict resolution as adults. It has been shown that adults spanked, as children are more likely to be depressed, use alcohol, have more anger issues, and be more physically violent towards their children and spouses. 3. Spanking lessens the effectiveness of other better means of discipline over time.
4. As parents usually are reluctant to spank, its effectiveness is lost because it is dependent on the promptness after the bad behavior. This can lead a parent to develop feelings of ineffectiveness and develop frustration.
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alcoholism and drug abuse put children at significant risk. Lack of social/economic support systems with poverty, hostile marriages, and limited childcare resources are factors that can put excessive stress on a parent and affect his or her ability to parent. Having excessive child rearing responsibilities with large families, multiple births, or children with chronic illnesses or difficult temperaments can threaten the stable environment needed for an effective parental relationship with a child. When the family system becomes stressed, it is important to seek help. Your family physician or pediatrician can help to develop intervention efforts to stabilize the family environment, as there are many resources in the community devoted to this cause. Remember that punishment is not ever going to be enough to effectively teach children. They also have to learn which behaviors are acceptable and desirable. Effective discipline allows this learning through a safe and loving environment developed by predictable consequences that are consistent over time and in different situations and by providing adequate attention and praise of desirable behaviors that allow that child to learn the ability to be more responsible and make better decisions. Kenneth Dill, MD Family Medicine - Osceola NEA Clinic – 870.563.5888 Chief of Medical Staff SMC Regional Medical Center
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HOSPITALIST
OTOLARYNGOLOGY (ENT)
Alfonso Aquino, M.D. Oksana Redko, M.D. 3024 Stadium, Jonesboro (870) 972-7390
Robert B. White, M.D. Brock F. Harris, M.D. Brian McGee, M.D. Kara Cooper, M.D. 3024 Stadium, Jonesboro (870) 897-8462
Bryan Lansford, M.D. Linda Farris, A.P.N. 3100 Apache, Suite B2, Jonesboro (870) 934-3484
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. Suresh Patel, M.D. Margaret Cooper, A.P.N. 311 E. Matthews, Jonesboro (870) 935-4150
Jonesboro J. Timothy Dow, M.D. Douglas L. Maglothin, M.D. Joe McGrath, M.D. James Murrey, M.D. Kristi Statler, M.D. Windover Clinic & Urgent Care 1111 Windover, Jonesboro (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 (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 (870) 933-9250 Tim Shown, D.O. Melissa Yawn, M.D. Jeffery Barber, D.O. Hilltop Clinic & Urgent Care 4901 E. Johnson, Jonesboro (870) 932-8222 Osceola Kenneth Dill, M.D. Debbie Wilhite, A.P.N. 616 W. Keiser, Osceola (870) 563-5888 Trumann Alison Richardson, M.D. Nathan Turney, M.D. Brannon Treece, M.D. 305 W. Main, Trumann (870) 483-6131 Lake City Kristi Statler, M.D. Sarah Hogan, A.P.N. 208 Cobean, Lake City (870) 237-4100 Cherokee Village Brad Bibb, M.D. 51 Choctaw Trace, Cherokee Village (870) 856-2862 Paragould Wade Falwell, Jr., M.D. Kasey Holder, M.D. Paragould Clinic & Urgent Care 4700 West Kingshighway, Paragould (870) 240-8402
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ANESTHESIOLOGY
CARDIOLOGY
FAMILY PRACTICE
11:21 AM
CARDIOVASCULAR & THORACIC SURGERY James A. Ameika, M.D. Deborah Fairchild, A.P.N 3100 Apache, Suite B4, Jonesboro (870) 972-8030 Michael Raborn, M.D. 3100 Apache, Suite B3, Jonesboro (870) 219-7685
CLINICAL RESEARCH 416 E. Washington Ave, Suite C Jonesboro (870) 934-1007
DERMATOLOGY James Towry, D.O. 3100 Apache, Suite B3, Jonesboro (870) 934-3530
EMERGENCY MEDICINE Brewer Rhodes, M.D. Michael Tomlinson, M.D. Jerry R. Biggerstaff, M.D. 3024 Stadium, Jonesboro (870) 972-7251
ENDOCRINOLOGY Kevin D. Ganong, M.D. 311 E. Matthews, Jonesboro (870) 935-4150 Diabetes Center Bilinda Norman, R.N.P. 311 E. Matthews, Jonesboro (870) 935-4150
GASTROENTEROLOGY Michael D. Hightower, M.D. 311 E. Matthews, Jonesboro (870) 935-4150
GENERAL SURGERY
INTERNAL MEDICINE Ray H. Hall, Jr., M.D. Stephen O. Woodruff, M.D. Brannon Treece, M.D. Kristy Wilson, A.P.N. 311 E. Matthews, Jonesboro (870) 935-4150
NEPHROLOGY Michael G. Mackey, M.D. Amy Ferguson, A.P.N. 311 E. Matthews, Jonesboro (870) 935-4150 Dialysis Center 3005 Middlefield, Jonesboro (870) 934-5705
NEUROLOGY Kenneth Chan, D.O. Bing Behrens, M.D. Yuanyuan Long, M.D., Ph.D. 3100 Apache, Suite A, Jonesboro (870) 935-8388
NEUROSURGERY Robert Abraham, M.D. Kenneth Tonymon, M.D. Rebecca Barrett-Tuck, M.D. Jeffrey Kornblum, M.D. 3100 Apache, Suite A Jonesboro (870) 935-8388
OBSTETRICS & GYNECOLOGY 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 (870) 972-8788
OCCUPATIONAL MEDICINE Melissa Yawn, M.D. Jeffery Barber, D.O. 4901 E. Johnson, Jonesboro (870) 910-6024
Hearing Center Amy Stein, Au.D., CCC-A 3100 Apache, Suite B2, Jonesboro (870) 934-3484
PAIN MANAGEMENT Raymond Greaser, M.D. 3005 Apache, Jonesboro (870) 933-7471
PEDIATRICS Brannon Treece, M.D. 311 E. Matthews, Jonesboro (870) 935-4150 *All NEA Clinic Family Practice physicians see children as well.
PHYSICAL THERAPY Jeff Ramsey, P.T. Terry Womble, P.T. 1007 Windover, Jonesboro (870) 336-1530
PLASTIC & RECONSTRUCTIVE SURGERY W. Tomasz Majewski, M.D. 3100 Apache, Suite B3, Jonesboro (870) 934-5600
PODIATRY Chris Rowlett, D.P.M. 1007 Windover, Jonesboro (870) 932-6637
PULMONOLOGY William Hubbard, M.D. Meredith Walker, M.D. 311 E. Matthews, Jonesboro (870) 935-4150
RADIOLOGY Jeffrey S. Mullen, M.D. 3100 Apache, Jonesboro (870) 934-3533 John K. Phillips, M.D. Gregory Lewis, M.D. 3024 Stadium, Jonesboro (870) 972-7000
RHEUMATOLOGY Beata Majewski, M.D. Leslie McCasland, M.D. 311 E. Matthews, Jonesboro (870) 935-4150
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 (870) 932-4875
OPHTHALMOLOGY Joseph George, M.D. James Cullins, O.D. 416 E. Washington, Suite B Jonesboro (870) 932-0485
SLEEP MEDICINE
HEMATOLOGY ONCOLOGY
ORTHOPEDIC SURGERY
SPECIALTY CLINIC
Jason Brandt, M.D. Henry Stroope, M.D. Thomas Day, M.D. 1007 Windover, Jonesboro (870) 932-6637
Pocahontas (870) 892-9541
Ronald J. Blachly, M.D. D. Allen Nixon, Jr., M.D. Carroll D. Scroggin, Jr., M.D. 311 E. Matthews, Jonesboro (870) 935-4150
David Nichols, M.D. 311 E. Matthews, Jonesboro (870) 935-4150
WELLNESS CENTER 2617 Phillips, Jonesboro (870) 932-1898
A location near you • open 7 days a week No Appointment Necessary HILLTOP STADIUM 4901 E. Johnson 3003 Apache Drive (870) 934-3539 (870) 931-8800 WINDOVER WOODSPRINGS PARAGOULD 1111 Windover 2205 W. Parker Rd. 4700 W. Kingshighway (870) 935-9585 (870) 240-8402 (870) 910-0012
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
IN
REVIEW
g people and gr n i p l e owi h ng
. a st y t i ronger commun
www.neacfoundation.org • 870-934-5101 27. NEA HEALTH • Spring/Summer 2008
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
Letter from the Director
I
am extremely pleased to tell you, our friends, that the NEA Clinic Charitable Foundation is having a great impact in the community. The current sessions for Center for Healthy Children and Wellness Works! are filled to capacity. HopeCircle continues to see approximately 40 patients and family members each day, and the Medicine Assistance Program is striving daily to keep up with the needs of these patients. We are pleased because this is the mission of our Foundation – to meet the healthcare needs of our community. We have begun our annual campaign to raise funds for these programs. Our goal this year is to raise $550,000 for their support. Recently, we began our internal campaign, NEA Foundation Club. This group is composed of physicians and employees who work at the NEA Clinic, and want to help others through the Foundation programs. They pledge to give monthly (or an annual one-time donation) to the Foundation. They can designate a specific program, or to “where needed most.” We are very grateful for this support and dedication. These physicians and employees give of themselves every day - helping others is what they do – it’s who they are. They are some of the most caring, compassionate people you will ever meet. When we witness these donations being made, we vow once again to be good stewards of these precious funds we are acquiring. You will see in this issue many events we are planning, and some that have already occurred this Winter. The Triumph of the Human Spirit Awards were outstanding as we honored those wonderful recipients this year. We hope you will join us for the fun times, and hope you will take advantage of the educational opportunities to learn about topics such as grief, fitness and nutrition. The grief seminar on April 24 promises to be outstanding! I’m looking forward to the annual rebirth of nature – our Arkansas Springs are just beautiful to behold!
Wishing you all much joy!
Christy Appleton Director NEA Clinic Charitable Foundation
Be sure to see
“The Bouffants” at the 2nd annual
June 6, 2008 • 6:30 pm Holiday Inn 28. NEA HEALTH • Spring/Summer 2008
In 2006, the NEA Clinic Charitable Foundation developed a program entitled Wellness Works! The mission is to educate, support and motivate patients with specific illnesses on how to improve their quality of life through nutrition and exercise. The program is designed to empower the participants to make healthy lifestyle choices throughout their active lives. Furthermore, the program is designed for three modules of special populations including diabetic, cancer, and cardiac patients. These programs are available to anyone who meets the disease criteria. All participants are medically cleared and referred by their physician before beginning the program. It is important to implement good health practices as a part of the treatment process. This can decrease complications as a result of diabetes, heart disease and cancer. Wellness Works! consists of guided exercise at the NEA Clinic Wellness Center, weekly nutrition classes and emotional support. All participants have free access to the NEA Clinic Wellness Center during the duration of the program. During the past two years, Wellness Works! has grown tremendously. There are currently approximately 50 participants between the cardiac, diabetic and cancer programs. Participants who complete this program have seen great results. These patients have experienced weight loss, improved strength and endurance, range of motion/flexibility, nutritional status, emotional wellbeing, and the ability to perform activities of daily living at a much higher level. The summer session will begin in June, 2008. Referral forms can be printed from our website at www.neacfoundation.org or picked up at the NEA Clinic Wellness Center at 2617 Phillips Drive, Jonesboro.
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
2007 Memorials Kenneth Agin Bob & Christy Appleton Jennifer Bingham Addison Chetister Sara Howell Ginger Johnson Laura Shelton Shari Webbe Dr. James Bassinger Dr. & Mrs. Ray Hall Ms. Carolyn Bell Dr. Michael Isaacson Mr. Carl Bennett Dr. Michael Isaacson Margaret Birmingham Sarah Johnston Mary Bishop Bob & Doris Bishop Frances Bond Dr. DV Patel Franka James Bowen Jarrod & Peyton Bowen Mr. Norman Brewer Dr. Michael Isaacson Leonle Bufkin Dr. Bryan Lansford Robert Caneer Dr. Ray Hall Dr. Rodney Carlton Dr. & Mrs. Ray Hall NEA Clinic Administration & Physicians Dr. Ken Carpenter Dr. Bruce Jones Ray Casey Dr. & Mrs. Mark Stripling Mr. Danny Castle Dr. Michael Isaacson OV Chamberlain Sherril Chamberlain Kenneth & Marlene Jones Billy & Margaret Timmons Tommy & Nema Wileman Ms. Audie Cissell Dr. Michael Isaacson Mr. George Cooksey Dr. Michael Isaacson Ms. Maguerite Culver Dr. Michael Isaacson
Ester Cupp Dr. Ray Hall Luke Decker Dr. DV Patel Judy DeRoeck Dr. Ray & Barbara Hall Mr. CC Dulaney Dr. Michael Isaacson Joe Emerson Dr. & Mrs. Mark Stripling Eddie Emison Leslie & Joe Grabowski Dr. Ray Hall Mr & Mrs Allen Nixon Mary Presgrove Tom & Valerie Rainwater Betty Fielder Dr. Ray Hall Nyal Fitzgerald Dr. Michael P. Berry WR & Evelyn Kendrick Nona Ford Brad & Dawn Schulz Herman Edward Gairhan Dr. Mark & Peggy Stripling Betty Gambill Robert Robinson Mildred Gaskin Dr. DV Patel Terry George Dr. DV Patel Marion Gerdes Dr. Michael Isaacson Thelma Ruth Gibson Dr. & Mrs. Mark Stripling Kathy Gott Dr. DV Patel Howard Gray Dr. Ray Hall Kelsey Hall Bob & Christy Appleton Bland Harper Dr. DV Patel Dr. Mark & Peggy Stripling Calvin Hesse Martha Stafford Mr. Michael Hoffmann Dr. Michael Isaacson Nadine Hopper Dr. DV Patel
Jimmy Hoy Dr. DV Patel Marzee Ann Hyneman Sara Howell Martha Stafford Mrs. Jean Funk Vernon & Janice Mather Kenneth Jones NEA Clinic Administration & Physicians Julia Kieffer's Birthday Russell Patton Family Donna King Robert Robinson Mrs. Jan Kirkindall Dr. & Mrs. Ray Hall Dr. Michael Isaacson Jessie Koury Dr. DV Patel Mr. Leslie Larkin Dr. Michael Isaacson Ms. Carolyn Lloyd Dr. Michael Isaacson Mr. Donald Maple Dr. Michael Isaacson Dale & Delora May Steve May Ms. Helen McDonald Dr. Michael Isaacson Kim McNabb The Staff of the NEA Clinic Charitable Foundation Holly & Rusty Acebo Christy & Bob Appleton Kim & Brett Provost Dr. Mark & Peggy Stripling Mr. Billy Medley Dr. Michael Isaacson Chuck Meredith Dr. Ray Hall Phillip Meurer Dr. DV Patel Virgil "Buddy" Miller Tony & Joyce Files Ms. Elizabeth Modesitt Dr. Michael Isaacson Dr. Brad Moore NEA Clinic Administration & Physicians Dr. Robert Taylor
Ms. Laveda Myatt Dr. Michael Isaacson Aletha Nibert Dr. DV Patel Ms. Margarette Noell Dr. Michael Isaacson Martha Stafford Ms. Virginia Owens Dr. Michael Isaacson Mr. John Pohlner Dr. Michael Isaacson Ms. Opal Poteet Dr. Michael Isaacson Mary Puryear June Morse Pat Watson Ms. Gerlean Rahm Dr. Michael Isaacson Ms. Corinne Rhodes Dr. Michael Isaacson Mr. Bryan Riley Dr. Michael Isaacson Mrs. Joanne Rose Dr. Michael Isaacson Rory Scroggin The Staff & Board of the NEA Clinic Charitable Foundation Bob & Christy Appleton Debbie Prevost Floyd Selby, Jr. Dr. Robert Taylor Mrs. Senteny Sara Howell Carletta F. Settlemoir Carolyn Haynes Rev. Roy Shelton, Jr. NEA Health System Mr. Guy Shempart Dr. Michael Isaacson Debbie Sibert Russell & Donna Phillips Jerry & Linda Pillow Brenda Richey Jacqueline Sowerby Ms. Dianne Sloan Dr. Michael Isaacson Floyd Smith, Jr. Nancy & Bryan Walters
Mr. Dewey Snider Dr. Michael Isaacson Ms. Joan Stanford Dr. Michael Isaacson Ramona Sweet Dr. Bruce Jones Leonard "Buster" Tankersley Dr. & Mrs. Mark Stripling Tony Tapper Lisa McCar Dee Roddy Dee Mae Roddy Jerry Taylor Rod & Charlotte Faulkner Howard Templeton Dr. & Mrs. Robert Taylor Mrs. Maranda Terrell Dr. Ray Hall Mr. Gene Tisdale Dr. Michael Isaacson Mr. Herman Toombs Dr. Michael Isaacson Carmaleda Tyler Dr. DV Patel Ms. Marjorie Tyner Dr. Michael Isaacson Mary Ussery Dr. DV Patel Brian Wadley Dr. Mark & Peggy Stripling Mr. Charles Welch Dr. Ray Hall Zach Whited The Sellmeyer Family Ted & Lyn Hubbard Dr. Michael Isaacson Roy Whited Dr. Ray Hall The Sellmeyer Family Ted & Lyn Hubbard Dr. Michael Isaacson Sandra Qualls Seth Whited James & Karen Skinner Mr. Donald Williams Dr. Michael Isaacson Gayle Wood Dr. Mark & Peggy Stripling Larry Yandell Dr. DV Patel
2007 Honorariums To Contribute Dr. & Mrs. Lou Adams - Louis Schaaf Christy Appleton - David & Faye Cox Dr. Ronald Blachly - Scott & Lori Mixon Susie Farley - David & Faye Cox Charlotte Faulkner - Carolyn Haynes Mr. & Mrs. Neal Graham - Louis Schaaf Mr. & Mrs. Dan Hesse - Martha Stafford
Mr. David Hogan - Louis Schaaf Dr. & Mrs. Allen Hughs - Louis Schaaf Dr. Michael Isaacson - Dr. DV Patel - Dr. Eumar Tagupa Dr. Bryan Lansford - David & Faye Cox Dr. & Mrs. George Lipsey - Louis Schaaf Mr. & Mrs. Reggie Miles - Martha Stafford
June Morse - David & Faye Cox Linda Muzinich - Dr. & Mrs. Charles Dunn Susan Naretto - Dr. & Mrs. Charles Dunn Dr. Allen Nixon - Scott & Lori Mixon Dr. DV Patel - Dr. Eumar Tagupa Mr. & Mrs. Gary Prosterman - Louis Schaaf Mr. Stephen C. Reynolds - Louis Schaaf
Dr. Carroll Scroggin - Scott & Lori Mixon Dr. & Mrs. M. Coyle Shea, Jr - Louis Schaaf Dr. Eumar Tagupa - Dr. DV Patel Dr. Robert Taylor - Dr. DV Patel - Dr. Eumar Tagupa Dr. Anthony White - Dr. DV Patel - Dr. Eumar Tagupa
a Memorial or Honorarium - send information to NEA Clinic Charitable Foundation PO Box 1960 Jonesboro, AR 72403
or visit our website for an online donation. www.neacfoundation.org
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
Thank you to our Board of Directors! We are pleased to announce the NEA Clinic Charitable Foundation Board of Directors for 2008. These leaders are vital to the mission, and lend guidance and support throughout the year.
Holly Acebo, Executive Director Christy Appleton, Director Carroll Scroggin, M.D., President Janice Cranford, Vice-President Steve May, Treasurer
Loretta Bookout Woody Freeman Joseph George, M.D. Susan Hanrahan, Ph.D. Bobby Hogue Mary Hyneman* Lorna Layton, M.D.*
Ronnie Norman John Phillips, M.D.* Susan Tonymon* Brannon Treece, M.D.* Barbara Weinstock Anthony White, M.D. Melissa Yawn, M.D.
Ex Officio Jim Boswell, CEO, NEA Clinic Edward Pruett, Chaplain, NEA Baptist Memorial Hospital Robert Taylor, M.D. Steve Woodruff, M.D.
* We welcome our newest members who have joined in 2008.
2 0 0 8
It has often been said that NEA Clinic's greatest asset is its people. Those who work at NEA Clinic are more than just physicians & employees. They are family. Each day NEA Clinic physicians and employees give of their time and talent to improve the health of the Northeast Arkansas community. Those listed in this tree represent the physicians and employees who have given generously to the NEA Clinic Charitable Foundation through the Foundation Club.
Robert E. Abraham, MD• Holly Acebo • Christina P. Appleton • Janet Alexander • Cathy Baltz • Terry Bankston • Charles L. Barker MD, PhD • Megan Barnes • Annette E Bednar • Bing Xie Behrens, MD • Judy A Bennett • Elisha Ann Berry • Jerry R. Biggerstaff, MD • Carolyn Biggs • Ronald J. Blachly, MD • Beth Block • Denise Boles • James W. Boswell • Angela Jeanette Brewington • Erika L. Brodell • Letha S. Brown • Nikki S. Brown • Melissa Bruno • Karen Denise Bryant • Rebecca Campbell • Michelle Marie Canizales • Patty Caples • Laura Carlisle • Anginetta J Carlton • Heidi Carnathan • Sheryna A. Chadwick • Kenneth Chan, DO • Joyce C. Chastain • Phyllis Cheshier • Margaret Leigh Cooper • Brittney Correa • James D. Cullins, OD • Joyce L. Darling • E. Scot Davis • Sheila Davison • Kim Leslie Day • Thomas E. Day, MD • Rhynea Debow • Rusell D. Degges, MD • Norbert Delacey, MD • Stephanie Denise Devries • Jill Ditto • Debbie Doty • Mary E. Dover • John Timothy Dow, MD • Charles C. Dunn, MD • Paula Ann Earnhart • Irma Margaret Easley • Kristina R. Ebbert • Virginia S. Edwards • Susan E. Erwin • Regina S. Escue • Ashli Finley • Judy A. Fletcher • Brenda J. Flippo • Charlene E. Flowers • Bo Fowler • Kara Fowler • Jeremy W. Frakes • Nicole A. Frakes • Stacia Lynne Gallion • Kevin D. Ganong, MD • Ashley Goad • Bonnie B. Goodman • Jennifer L. Gramling • Tracy Lanay Griggs • Peggy J. Grimes • Gwenda L. Gschwend • B. Josiephene Gulley • Juanita C Hackman • Ray H. Hall Jr., MD • Cynthia W. Hannah • Jillian Racheal Harris • Lena Harrison • Tina Hawkins • Holly Henderson • Cheryl A. Hensley • Kathy Herring • Brenda Sue Hillyer • Mary A. Hines • Kerry Michelle Hogland • Wallace Scott Hoke, MD • Ruth H. Holden • Jeff L. Holder • Mary Elizabeth Holland • Michael Tzuoh-Liang Hong, MD • Don Hubbard • Chela Hutson • Michael L. Isaacson, MD • Lola E. Jackson • Leena James • Rosa Jennings • Phyllis K. Jones • Lisa Kellett • Sandy Kirksey • Holly Leann Kiech • Donna Ann Kilburn • Penny King • D PF Laumer • Kinya Louise Lacy • Lisa M. Lane • Bryan K. Lansford, MD • Judy D. Lenderman • Kim Lochner • Deborah J. Lochridge • Mary J. Loucks • William Leonard Loucks • Jane Lynch • Michael Mackey, MD • Douglas L. Maglothin, MD • Brenda P. May • Tammy R. Mays • Rosetta McCann • Brandy McDaniel • Joseph McGrath, MD • Patti Wray McQueen • Leona R. Miller • Shirley A. Millsap • Lois A. Montgomery • N. Genevieve Moore • June C. Morse • Lisa Nicole Neff • Lori Nelson • Bilinda Lane Norman • Tyler W. Parnell • Dharmendra V. Patel, MD • Karen Elaine Pope • Kim Provost • Billie F Pruitt • Jeff & Danna Ramsey • Terina L. Reeks • Joseph Brewer Rhodes, MD • Wilma L. Rice • Kristen Richmond • Melissa F. Roberts • Vickie J. Robinson • Judy Karen Rogers • Rita L. Rogers • Carroll D. Scroggin Jr., MD • Angela Scott • Michelle Shannon • Teresa A Shempert • Shonna Slater • Marcy Smith • Melanie D. Smith • Tammy Smithee • Tina Smithee • Lane Speakman • Amy L. Stein • Mark C. Stripling, MD • Laura Rhea Sullivan • Carolyn Lynn Tacker • Eumar T. Tagupa, MD • Candace Taylor • Robert D. Taylor, MD • Sharon Kay Townsend • Melissa Tubbs • Laura Tribble • Deanna Turner • Wendey Tyler • Troy A. Vines, MD • Ashlee Waleszonia • Meredith M Walker Jr., MD • Ehrline Walter • Nancy Arminda Walters • Melissa Diane Ward • Velta J. Waters • Patty Lee Watts • Cheryl Diann West • Erica Renee West • Leah D. West • Regina K. West • Janet Weston • Anthony T. White, MD • Marcia A Whitehurst • Jennifer Willis • Kristy L. Wilson • Stephen O. Woodruff, MD • Shelley R. Woods • Tina Woodward • Crystal Louann Young
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
“The Triumph of the Human Spirit” Triumph of the Human Spirit was an evening of celebration that recognized ten outstanding individuals who have dealt with adversity and made a positive impact on the lives of others. The fifth annual event recognized past honorees and thanked them for their inspiration. Diana Davis, K8 anchor, then told each 2008 honorees’ story and NEACCF president, Dr. Carroll Scroggin presented them with a framed print. The art for the honorees was created by Gima Jansen, a well-known Paragould artist. The title of the piece was “Awakening Heart: Level 2. Following the presentations the audience was entertained and inspired by the First Baptist Men’s Trio, Harold Copenhaver, David Hurley and Mark Groves. A slide presentation of pictures from the honorees lives was presented during the music. Recipients of the 2008 Triumph of the Human Spirit were: Carla Cate, Paragould; Tammie Clausen, Tuckerman; Dora Edings, Jonesboro; Thyda Lee Fryer, Jonesboro; Billie Jean Hill, Jonesboro; Matt Hubbard, Jonesboro/Florida; Jimmy, James & Barbara Lewis, Jonesboro; Ted Pylant, Jonesboro; Perry Wood, Monette; Kristen Worthington, Jonesboro
The Center for Healthy Children has entered its fifth session since it opened in 2005. This session, the participants have found an extra bout of drive, in the form of good ‘old healthy competition. The group of kids, ages 8-12, has been divided into two teams: the kids enrolled on Mondays and Wednesdays are now the Green Team and the kids on Tuesdays and Thursdays are now the Blue Team. The battle between Green and Blue is fought through different exercises. Each team earns points for reaching specific goals. These goals include everything from the number of laps around the indoor track to push-ups and sit-ups. Points are even awarded to each team for attendance and dressing for exercise in the appropriate ‘gear’. The kids enrolled in the Center for Healthy Children meet after school at NEA Clinic Wellness Center, where they have the opportunity to improve their health through exercise, play and learn proper nutrition. Some of the activities include running and walking, sports specific drills, swimming and various games. The staff strives to balance fun with hard work and great efforts. The winners of the team competition will not only be awarded bragging rights, but the promise of an unknown prize. Of course, this free program would not be possible without the valiant efforts of the community of Northeast Arkansas. NEA Clinic Charitable Foundation has pulled together great resources to form this free after school program. For more information on the Center for Healthy Children and to find out if your child qualifies, visit our website at www.neacfoundation.org. 31. NEA HEALTH • Spring/Summer 2008
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
NEA Clinic Charitable Foundation Wins Loveland Award! By LeAnn Askins Since it’s inception in 2001, the NEA Clinic Charitable Foundation has meant so much to so many. From the elderly woman who couldn’t afford all the medications she needed and the loved ones who sought a kind smile as their grandfather went through cancer treatment to the young boy who learned how to make healthy eating choices and the cardiac patient looking for ways to have a better recovery, the Foundation has played a major role in Northeast Arkansas. Through it’s Medicine Assistance Program, HopeCircle, Center for Healthy Children and Wellness Works!, NEA Clinic Charitable Foundation has assisted thousands of households locally. It’s no wonder that word of the help offered through the Foundation would spread throughout the state and the country – garnering a national recognition. Those involved with the Foundation recently received word that it has been honored with the Loveland Memorial Award. The award, through the American College of Physicians, was established in 1961 to honor Edward R. Loveland, who served 33 years as the first Executive Staff Officer of the College. According to information on the award, it is “bestowed to a layperson or lay organization for a distinguished contribution in the health field.” By receiving the recognition, NEA Clinic Charitable Foundation joined many notable organizations that have taken the extra step in 32. NEA HEALTH • Spring/Summer 2008
making a difference in the health of others. Past recipients of the award have included the W.K. Kellogg Foundation, the American Cancer Society, the American Heart Association and the American National Red Cross. In being nominated for the Loveland Award, NEA Clinic Charitable Foundation received letters of recommendation from throughout Northeast Arkansas and the state. Both individuals and families who have utilized the Foundation’s programs as well as those in politics and the medical field showed their support. Dr. Joe Thompson, Surgeon General of Arkansas, commended the NEA Clinic physicians for seeing the need for programs that would help the community. “NEA Clinic Charitable Foundation illustrates the best in what philanthropy can build in a community,” he noted. “… the Foundation has fostered programs that respond to critical needs, provide innovative solutions and ultimately make a difference in the health of the citizens.” Also the director of the Arkansas Center for Health Improvement, which supports publicand private-sector efforts to improve health, Thompson focused on the success of Center for Healthy Children. “By using physical activities and educational lessons to teach overweight children about proper exercise and nutrition, the Center demonstrates the linkage of resources and intellectual capital to raise awareness, offer support, and
increase the likelihood of success within the lives of the children they touch.” State Senator Paul Bookout also offered his support of the Foundation, noting the importance it has played in the lives of those in Northeast Arkansas, including his own family. “In today’s society, we underestimate the power of a smile, a kind word or a listening ear,” his letter said. “These gestures coupled with the supreme medical expertise of the physicians and staff, lives are instantaneously and positively impacted.” Bookout noted the obvious love of helping others and the sincerity and compassion that are shown through the programs of NEA Clinic Charitable Foundation as reasons the Foundation is making a difference in the area. “I can personally attest to the HopeCircle program as it was instrumental in caring for my father, Senator Jerry Bookout, in his battle with cancer.” Dr. James W. Farris, associate professor of physical therapy and director of the physical therapy programs at Arkansas State University, noted the importance of all four programs offered through the Foundation. “Through its programs and community outreach events, NEA Clinic Charitable Foundation is committed to improving health of individuals of all ages beginning with the prevention of illness through coping with endof-life issues. The Foundation is a regional leader in addressing some of the many health needs of the people in the communities it serves and would be an outstanding choice for the Loveland Award.”
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NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
Join the
NEA LEGACY SOCIETY Giving Now = Giving Forever The NEA Legacy Society is for the perpetual benefit of the NEA Clinic Charitable Foundation. As a non-profit, 501(c) 3 entity, our Foundation exists to improve the health of our community every day. We currently provide to the community – free of charge – four programs: HopeCircle, Center for Healthy Children, Medicine Assistance Program, Wellness Works!, as well as sponsoring several scholarships. Even though the community is very generous in supporting our fundraising
Ways to Participate You may make tax-advantaged donations to The Legacy Society in several ways. Donors will be recognized at a yearly recognition event in the following ways: ❑ Immediate Contribution $1,000 to $4,999 Circle of Love $5,000 to $9,999 Circle of Health $10,000 to $24,999 Circle of Wellness $25,000 to $49,999 Circle of Hope $50,000 and above Circle of Charity ❑ Endowments Establish an endowment (minimum $10,000) designating the NEACCF as beneficiary. You may take up to three years to fully fund the endowment; additional contributions may be made at any time. Once the endowment is fully funded, the NEACCF will receive yearly contributions
events which support these programs, the challenges constantly increase as we continue to touch more lives. We invite you to become a member of the NEA Legacy Society by making a donation of at least $1,000 per year to the Foundation. This society will ensure that these programs provided by the NEA Clinic Charitable Foundation, have the funds they need to continue year after year. in perpetuity. Charitable endowments benefiting the NEA Clinic Charitable Foundation will be held by and invested through the Arkansas Community Foundation, of which the Craighead County Community Foundation is an affiliate. ❑ Estate Planning You may establish a Lifetime Annuity that would provide you and/or your spouse guaranteed, tax-advantaged income for the rest of your lives, as well as other tax benefits. At your death(s), the remainder of the annuity would be added to the NEACCF’s endowment Fund. ❑ Planned Giving You may make a Planned Gift by naming The NEA Legacy Society as a beneficiary in your will, living trust, other estateplanning documents and/or life insurance contracts.
Start Today
LEGACY SOCIETY DONATIONS
❑
January 1 – March 15, 2008
❑
❑
I would like to make a donation to the NEACCF for: $ ____________________ My check is enclosed. I will commit to establishing an endowment for the NEA Legacy Society. Please contact me at the number listed below. I have included the NEACCF in my will or estate-planning documents. Please keep me informed about the on-going programs of the Foundation.
Bartels’ Law Firm Mr. and Mrs. John Allen Mrs. M.G. Spurlock In Memory of Mabe Spurlock
Name: Address:
________________________________________________________________________ ____________________________________________ Phone:____________________
Signature ______________________________________________________ Date:____________
MAIL THIS TO US AT PO BOX 1960, JONESBORO, AR 72403 33. NEA HEALTH • Spring/Summer 2008
08- Spring NEA Health - 3-30:NEA Health -Spring-Summer 07
Peanut Butter Granola Balls
• 2 tablespoons honey • 4 tablespoons peanut butter • 2 cups granola • 2 to 4 tablespoons milk, or as needed In a large bowl, mix together the honey and peanut butter. Stir in the granola. Add enough milk to just moisten--you want it to stick together. Form into balls. Chill until ready to serve.
4/1/08
Bring the salmon to room temperature 20 minutes before grilling. Preheat the oven to 450º. Set a large cast-iron grill pan over low heat and pre-heat for 1 minute. Brush the salmon lightly with the oil and season with salt and pepper.
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Fresh Fruit Smoothie • 1/2 cup soy milk • 1/2 cup white grape juice • 1 cup strawberries, stemmed • 1/2 cup pineapple chunks • 1/2 lemon, squeezed • 1/4 teaspoon Vitamin C powder • Small handful fresh seedless grapes Put all ingredients in blender. Blend until smooth. Add ice for a shake like smoothie.
Indoor Grilled Salmon
• Four 5-ounce (1-inch-thick) center-cut salmon fillets, skin-on • 2 tablespoons olive oil • Salt and black pepper
3:09 PM
Raise the heat under the grill pan to medium-high. Place the salmon, skin-side up on the grill. Cook 3 - 5 minutes - the salmon will have distinctive grill marks. Turn salmon midway if you want hatched grill marks) Flip salmon over, and move the grill pan to the oven.
Cook the salmon in the oven for 2 to 3 minutes more for pink inside. (5 - medium, and 7 - well done) Remove from the pan, and let rest for 2 minutes.
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Austin Is Making Healthy Choices! From the beginning of the 2007-2008 school year Debbie Gairhan has helped her first graders make healthy choices, from the healthy snacks in the afternoon to even birthday parties. The emphasis on living healthy, responsible lives has made an impact on first grader Austin Shipman. When planning for his birthday, he told his mom that since he goes to the Health and Wellness Magnet school, he didn’t feel cupcakes were a healthy choice for a birthday treat to share with his classmates. He asked if he could bring fruit instead. His mother agreed, and contacted his teacher to ask about bringing the healthy snack to celebrate with. When she arrived at school with 3 large containers of bananas, oranges and apples cut up, the class was very excited. They ate every morsel, and were in agreement that Austin had chosen a wonderful AND healthy birthday treat. Austin is a top student who leads by example every day.
Debbie Gairhan’s 1st Grade Class Health/Wellness & Environmental Studies Magnet School Jonesboro School District 35. NEA HEALTH • Spring/Summer 2008
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Clinical Research Center
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The leader in medical research, NEA Clinic brings more new and important clinical trial opportunities to Northeast Arkansas than any other healthcare provider. A clinical trial is a research study conducted with volunteers to answer specific health questions. Carefully conducted clinical trials are the fastest and safest way to find treatments that work and improve patient care.
Benefits of Clinical Trials: •New and improved treatment options for patients •Fewer side effects •Latest treatment options close to home •New standards of care •Free medical care •Reimbursement for time and travel may also be provided.
Current Clinical Trials:
Current Oncology Trials:
870.268.8431
870.934.5343
Cardiac Stent Diabetes Diabetes (not taking medication) Diabetic Painful Neuropathy Hypertension Insomnia Pediatric Allergy Pink Eye Rheumatoid Arthritis Sinusitis Coming soon: Bacterial Vaginosis Dual Coagulation Therapy Acute Coronary Syndrome Type I Diabetes (newly diagnosed) HPV Female Hyposexual Desire Disorder
Breast Cancer Esophageal Cancer Lung Cancer Colon Cancer Rectal Cancer Lymphoma We also have registry studies open for colon, lung, lymphoma and myelodysplatic syndrome. If you would like to become part of an exclusive group of people benefiting from and helping clinical research, please contact us.
www.neaclinic.com M
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1711 EAST PARKER RD, JONESBORO AR. (870)972-5827 36. NEA HEALTH • Spring/Summer 2008
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Food For Proper Nutrition, Regular Exercise & Routine Doctor Visits
Begin your Weight Loss Journey T he Real Weigh! Contact NEA Clinic Wellness Center to sign up for a free, no obligation orientation and start your 12 week journey of losing weight
The Real Weigh with Real Results!
Call Today! 870-932-1898 www.neaclinicwellness.com
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Thereâ&#x20AC;&#x2122;s Nothing Quite Like A Day At The Mall The Mall at Turtle Creek is a great pl ace to check out the l atest fashions, hang out with friends and fa mily, and just enjoy shopping at itâ&#x20AC;&#x2122;s finest.
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