PROVIDING NORTHEAST ARKANSAS AND THE SURROUNDING AREA WITH HEALTHFUL INFORMATION
ISSUE 11
Fall/Winter 2009
A Good Night’s Sleep David R. Nichols, MD
H1N1 Flu:
10
Ways You Can Stay Healthy at Work
What is Bioidentical Hormone?
Primary Spine Tumors
Personal Trainer Benefits Chonic Low Back Pain
Facial Aging & Rejuvenation
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On The Cover
NEA Health magazine benefits the programs of
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PUBLICATION OFFICE
1835 Grant Ave., Jonesboro, AR 72401 h_acebo@neaclinic.com www.neaclinic.com Holly Acebo, Editor Director of Marketing NEA Clinic, NEA Baptist Kim Provost, Director of Fundraising and Events NEA Clinic Charitable Foundation Cheryl Goad, Director of Programs and Grant Development NEA Clinic Charitable Foundation Nicole Frakes, Graphic Design 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© 2009 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.
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Why did I become a doctor?
T
he answer is corny but here is the truth. I decided to become a physician when I was in the 7th grade. I reasoned that I really enjoyed the biologic sciences and the idea of helping people with health problems really attracted me. I never varied my thoughts about this career and then one day I was a doctor. Education - BA in Zoology from University of Wisconsin - Milwaukee Internship - University of Missouri - Columbia Residency - University of Missouri - Columbia Fellowship - Pulmonary Medicine, University of Wisconsin - Madison Certifications - American Board Internal Medicine American Board Medical Specialties Pulmonary Disease American Board Sleep Medicine Organizations - American Academy of Sleep Medicine American College Chest Physicians American College Physicians American Sleep Disorders Association American Thoracic Society Arkansas Medical Society Arkansas Thoracic Society
David R. Nichols, MD Sleep Medicine NEA Clinic – 870.336.4144 1. NEA HEALTH • Fall/Winter 2009
from the editor
20+
CONTENTS
pages of advice from doctors and health professionals you know and trust.
A
s fall is quickly upon us, we start thinking about long sleeves, warm coats, hot chocolate, football, and tailgating. What we don't like to think about is illness brought on by the change in seasons, strep throat, the flu, and around our house mono. There have been several area schools effected severely with students absent due to illnesses. Classrooms are smaller, football teams are smaller, and our industry work force is crippled at times.
Here at NEA Clinic we strive in educating our employees and our patients in preventative measures to help reduce the spread of germs. You will see many businesses taking proactive steps in providing hand sanitizer and tissues to employees and customers. People are encouraged to stay home who are running fever and feeling ill. See steps in preventing the flu on page 15 of this issue of NEA Health. These steps are not only beneficial in keeping the flu away, but many other illnesses as well. Rest is an important part of staying healthy and we hope our readers enjoy a good night’s sleep every night. Please read the very informative article written by Dr. David Nichols, Sleep Medicine Specialist with NEA Clinic. It is amazing how many people suffer from sleeplessness, you are not alone. It’s a very common problem as there are many things that prevent people from enjoying a restful night. Call for an evaluation with Dr. Nichols and he can get you on the right track. We hope you enjoy this issue of NEA Health. Have a healthy & blessed day!
4 What is Bioidentical Hormone?
- Dr. Michael Hong, FACOG
6 Good Night’s Sleep
- Dr. David R. Nichols
8 Facial Aging & Rejuvenation
- Dr. Anthony Bentley
10 Primary Spine Tumors
- Dr. Robert Abraham
12 From the Garden to the Kitchen
- Health, Wellness & Environmental Studies Magnet School
14 Locks of Love!
- Pam Collins, LPN
15 H1N1 FLU: 10 Ways You Can Stay
Healthy At Work - CDC
16 Benefits of a Personal Trainer
- Kara Fowler Cato
18 NEA Clinic Sleep Center
- Dr. David R. Nichols
22 Maudie Rogers - 862 Summer Miles!
- Kara Fowler Cato
24 Chronic Low Back Pain
- Dr. Kenneth Dill
26 Ultrasounds - An Effective Tool in
Medical Diagnosis - Lisa, Lane, BSRS, RVT, LPN
27 Holly Acebo, Editor Join TEAMNEA next year for the Susan G. Komen Race for the Cure®
In Review
NEA Clinic Charitable Foundation
- Program Updates - Event Updates: ShareHope Walk, Hope Week, Duck Classic - Memorials/Honorariums
34 Healthy Eating TEAMNEA at Race for the Cure®, October 2009
2. NEA HEALTH • Fall/Winter 2009
NEA Clinic’s
Dr. Robert Taylor receives Abernathy Award
T
he Robert Shields Abernathy Award for Excellence is an award given annually to an Internist who has trained, practiced, and/or taught in Arkansas, has been active in the American College of Physicians and has made a significant impact in Internal Medicine in Arkansas. Dr. Robert D. Taylor, who has practiced internal medicine and noninvasive cardiology at NEA Clinic for 30 years is the 2009 recipient of this prestigious award.
“Dr. Taylor’s contribution to the success of NEA Clinic and the health care of patients in our area is inestimable, Bob is one of the finest physicians UAMS has produced.” says Dr. Ray Hall, Founder of NEA Clinic. Serving as President of NEA Clinic is another role Dr. Taylor takes much pride in. “I have had the pleasure of working along side Dr. Taylor as president of the NEA Clinic for over 10 years and quite frankly his contribution to the strategic direction and success of NEA Clinic has been immeasurable.” adds Jim Boswell, NEA Clinic CEO. Dr. Taylor is the third NEA Clinic physician to receive the honor. Dr. Ray Hall was recognized in 2001 and Dr. Stephen Woodruff in 2007. No other clinic in Arkansas has been honored three times with this award. “I consider this the greatest professional honor I could receive as an “... having been trained in part internist in the state of Arkansas. Knowing and by Dr. Abernathy makes the having been trained in part by Dr. Abernathy award even more special to me. ” makes the award even more special to me.” says - Robert Taylor, MD, FACP Dr. Robert Taylor.
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What is Bioidentical Hormone?
B
ioidentical hormones are hormones extracted from plant sources. They share similar structures produced by human beings. The goal of bioidentical hormone therapy is to restore the normal physiologic female hormone levels produced by premenopausal women. Each therapy is individualized to adjust her hormone imbalance. It allows dosing flexibility in order to manage various symptoms and complaints.
Common symptoms of menopause include hot flashes, night sweats, mood swing, vaginal dryness, and decrease sex drive. Other associate symptoms include fatigue, increased facial hair, sleep disturbance, and frequent urinary track infections. The major ingredient in the bioidentical hormone is estrogen. The major naturally produced estrogens are estradiol and estriol. Together, they reduce hot flashes, improve cholesterol levels, and help restore bone health. The second ingredient is progesterone. Symptoms of progesterone loss include anxiety, mood swing, and decrease libido. Unlike much traditional hormone therapy, progesterone is administered to all women undergoing bioidentical hormone therapy. Estrogen and progesterone are known to balance each other in their physiological functions. The final ingredient is testosterone. Symptoms of testosterone loss include muscle wasting, fatigue, and loss of sexual interest. Not every woman will require testosterone supplement. Individualized balanced therapy is the key to a successful treatment. A comprehensive evaluation is needed before initiation of any hormone replacement therapy. The evaluation includes examination of her medical history, current medications, physical findings, and lifestyle factors. Hormones levels are measured by blood and salvia tests. A prescription would be filled at a pharmacy that specialized in compounding medications. Once a proposed dosage is constituted, the hormone can be administered orally or topically. The goal of bioidentical hormone therapy is to restore the physiological hormone balance that is altered by the aging process. The final success is the improvement of her overall well beings. This could be the solution to your postmenopausal complaints. Ask your gynecologist.
Michael Hong MD, FACOG Obstetrics and Gynecology NEA Clinic – 870.972.8788
4. NEA HEALTH • Fall/Winter 2009
For many of our patients, like the Carson family, the NEA Women’s Clinic is a family affair. From first visits as teenagers, to births and everything after, we’re proud to be trusted with your family and its health. With our Electronic Medical Records, your complete—and unique—medical history follows you throughout your patient history with us. And that information is instantly available at check-in at NEA Baptist Memorial Hospital should hospital admittance ever become necessary. Conveniently located just off the Highway 63 Bypass at the Stadium Drive exit next to NEA Baptist Memorial Hospital (and just up the street from Turtle Creek Mall), we’re available—and will be available for your family and it’s future—no matter how many generations.
Charles L. Barker, M.D. Ph.D., FACOG
Mark C. Stripling, M.D. FACOG
3104 Apache Dr. Jonesboro, AR 72401
Charles Dunn, M.D. FACOG
Norbert Delacey, M.D. FACOG
Michael Hong, M.D. FACOG FACO OG
Lorna M. Layton, M.D. FACOG FACO FA COG G
(870) 972-8788 neaclinic.com 5. NEA HEALTH • Fall/Winter 2009
A Good Night’s
Sleep S
lowly your eyes open, and for a moment you are still on that sunset sail on the calm still waters of the Caribbean, but then it hits, you’re not there, this is your own bed and another night of sleep is over. A quick check of the time confirms you’ve been asleep 7 ½ hrs. Further assessment finds that you feel pleasantly refreshed with a renewed sense of alertness, energy, and vitality making you eager to meet the challenges of the new day. You recall hardly anything from your sleep except those last memories of your sailing experience, but know you’re ready for the new day.
That is a good night’s sleep! Have you ever wondered about: What is sleep? What is good sleep? Why do we sleep? What or who controls when I sleep? How do you know when you had enough sleep, or when you haven’t? Why can we fail to get it? These are all important questions that many of us never stop long enough to ponder. If you want to know more, then read on.
What is Sleep? If you turn to the dictionary you find that sleep is “a state of partial or full unconsciousness in people and animals, during which voluntary functions are suspended and the body rests and restores itself.” Not bad, but not a fully complete answer. Sleep is essential for survival. Animal models have shown prolonged deprivation causes death (rare in humans), and sleep loss in humans causes many fatal vehicle crashes annually. Although we don’t fully understand sleep we do know that it is a period when the body is in a state of reduced environmental awareness but the brain is actively processing information and regulating critical body functions. The brain actively and cyclically moves through multiple stages of sleep throughout the night. These stages are divided into rapid eye movement sleep (REM) and 3 stages of non-rapid eye movement sleep (N1, N2, and N3). The stages each have distinctive findings that identify them during sleep studies. Body and brain activities like dreaming, hormone regulation, storing recently learned information into the brain circuits, and regulating of blood pressure and breathing are but a few examples. Sleep stage shifting and process regulation is achieved through neuro-transmitters (chemicals) and nerve pathways in the brain.
What is “good” sleep? Good sleep is perhaps best described by thinking about the sequence. As night falls you develop an increasing sense of sleepiness, the feeling of heavy eyes, a mind that is not focusing and a desire to lie down. In the comfort of your bed you drift into sleep within 15-20 minutes and have very little remembered disturbance during the night. Then you awaken without the use of an alarm and feel as I described above. You are restored, recharged and refreshed. The day-time finds you sharp and alert 6. NEA HEALTH • Fall/Winter 2009
functioning well until the night begins to fall again. This should be the same day after day with only rare exceptions. The one exception is a normal brief dip in alertness during the “siesta time” occurring in the early afternoon. The amount of sleep to achieve this, like every human process follows a bell shaped distribution, and ranges from short sleepers of 5-6 hrs, average at 7-8 hrs and long sleepers 8-10 hrs. If you sleep in on weekends one should suspect that your choice of sleep length is less than your need.
How do you know if you sleep enough or too little? Having the good sleep pattern described above is a good indication that the sleep duration has been sufficient. Coming from the opposite view, perhaps the very best way to know if you have gotten adequate sleep is to be very aware of the signs of sleep deficit. In our high tech, 24 hour society, sleep has a low priority for many. I have had numerous patients seen in the sleep center tell be that they see sleep as lost opportunity to get things done, a waste of time. While expressing this belief, they are usually totally unconscious of the signs of sleep loss. A brain that has been unable to get enough sleep will usually show symptoms in three distinct areas. First and the most obvious is the pressure to sleep that has not been dissipated. This symptom is sometimes difficult to appreciate because we can overcome it with stimulation from activity, complex tasking, or the use of caffeine. But let there be a lull in activity, and the sleep will come on. The second area is mood stability. A sleepy person can be irritable and hard to deal with, depressed or even excessively anxious. Cognition or the ability of the brain to be alert, exercise good judgment and perform tasks with skill and accuracy can be affected. Sleep loss is typically associated with loss of motor skills, reflex response and coordination. Many of these things are not apparent to the sufferer.
Why do we sleep? Although we may not know exactly, it is clear that almost all living animals do sleep. It is an essential process to life and is determined in our genes. The arguments over this question have spanned several decades and have spawned several theories. The adaptive theory proposes sleep increases the chances of survival. Support for this theory comes from the observations that animals adjust their sleep/wake cycles to take advantage of their unique biologic capabilities and expose themselves only when things like their vision and other senses and other physical capabilities promote their survival in the harshness of nature. The energy conservation theory suggests that sleep is a mechanism of conserving energy in animals. The support comes from the observation that animals with high metabolic rates sleep longer. The last theory that has perhaps the best support is the restorative theory of sleep. This places emphasis on the restorative role of sleep. It further suggests that there is a neurotoxin (sleep promoting) that builds up in the brain and that during sleep the levels decrease thus creating the restoration in vitality and alertness. In addition other chemical changes promoting the sleep-wake cycle take place.
What regulates human sleep? The sleep-wake cycle is one of many bio-rhythms in animals. We have cells in our brain that serve us like an internal clock or timer. They have a genetically determined ability to create repeating cycles over periods of time in a very accurate and reproducible manner. These rhythms can occur in less than, greater than or about equal to a 24 hrs period. Therefore a process may cycle in periods of a month or longer like the female menstrual cycle, in a 24 hour day cycle like sleep, or less than a day like periods of REM sleep every 90 minutes within the sleep period. The sleep-wake rhythm occurs within the 24 hour period and is set to our environment by the light dark cycle of the 24 hour day. If left unaffected by our behavioral changes the human body wants to wake to light and sleep with darkness in a consistent pattern (or times). The main clock effect is an alerting stimulus to our brain. A second influence on our times to sleep or wake is what is called the homeostatic mechanism of sleep. Put simply the longer we are awake the more the “pressure” on the brain to want to return to sleep. This “pressure” is believed to be caused by a building of the sleep promoting neurotransmitters in the brain mentioned previously. Sleep at any time of the day or night has the ability to reduce this pressure to sleep. The internal
clock drive for alertness is working against the building pressure to sleep throughout the day and we usually succeed in being alert until this stimulus is gradually reduced as night time arrives. Then the pressure to sleep dominants and sleep onset normally occurs.
What can interfere with sleep? It pretty much follows Murphy’s Law: “Anything that can go wrong will go wrong”. There are countless ways that normal sleep can be disrupted. Primary sleep disorders (e.g. sleep apnea, insomnia, restless legs, parasomnias, and periodic limb movement disorder), psychiatric conditions (e.g. hyperactivity, depression, generalized anxiety, bereavement, and psychosis), medical conditions (e.g. asthma, congestive heart failure, reflux esophagitis, urinary symptoms, pain conditions of arthritis, neuropathy, leg cramps, fibromyalgia, and many others) or just everyday life stresses or changes. Perhaps the least obvious factor can be our own behavioral choices. We can, unwittingly, be very destructive to the maintenance of good sleep, all the while complaining that we have poor sleep and don’t understand why.
What is sleep hygiene & why is it important? The rules of good sleep hygiene are just another list of good suggestions (e.g. personal hygiene, oral hygiene), that are known to make our health and in this case our sleep better. They are all focusing on strengthening the regulation of the sleep wake cycle and to reduce unwanted interference with that process. 1. Maintain a regular bedtime and wake time schedule for all days of the week. - This means know your real sleep need and plan to get it. It is most important to get up at the same time each day and get light exposure. It is also what helps set the internal clock. If you find it difficult to wake in the morning you may be getting too little sleep and need an earlier bedtime. 2. Utilize a “wind-down” time prior to sleep onset. - Everyday stresses can create anxiety and the inability to allow the sleep pressure to “take over” at bedtime. Plan to solve your issues early in the evening and find relaxing, enjoyable things to do the hour or two prior to bedtime. - It is important that this is not done in the bedroom. It is a place that is not for anything except sleeping and sex. No work, arguments, problem solving sessions or brain storming, TV or computers. Take it to the study, living room or home office. 3. Never attempt to make yourself go to sleep based on the clock time. If not falling asleep within 20-30 minutes consider that you are not ready to sleep and resume your “wind down” activity until you are. But remember to still get up at the same time in the morning. It may be just one of those nights, bedtime the next night will come easier. 4. Avoid alcohol, nicotine, and caffeine prior to bedtime or if awakening during the night. - Each of these chemicals can interfere with sleep. Alcohol although it can put you to sleep often as it is metabolized causes later awakening. Nicotine can interfere with sleep onset and when levels decrease during
the night may cause awakenings. Caffeine is a direct sleep antagonist. It keeps one awake. People vary greatly in how fast the body eliminates it. Good practice would be no caffeine within 6 hours of bedtime. (coffee, soft drinks, power drinks, tea, chocolate and some over the counter pain medications are common sources). 5. Avoid exercise or hot baths or showers with in two hours of bedtime. - This increases the body core temperature and can delay sleep onset. 6. Bedtime Snacks can be okay if you are hungry, but avoid foods that promote gas, indigestion and reflux. 7. Provide a proper bedroom environment that is promoting of sleep for both bed partners. - These are very common issues. Environmental factors can be pets, children sharing the bed, mattress or pillow comfort, snoring, temperature, noise (TV, music, outside noises, etc), light, safety concerns, and a number of other things that make it hard to sleep. These affect everyone in different ways. To deal with these when there are two people in the same bed or room takes an open discussion but is essential to getting all concerned a good night’s sleep. Sometimes the best solution is to choose different rooms for sleeping. Keep in mind that what may be one sleepers comfort may be the others deterrent to sleep. 8. Avoid any naps during the wake period if at all possible. They will only decrease the sleep pressure to sleep at bedtime. - If you have that over whelming need to sleep at “siesta time”, nap no latter than 2:00 PM and limit it to no longer than thirty minutes.
What to do if you fail to achieve good sleep? What I hope you will do is recognize that there may be an issue with your sleeping that is causing you some daytime functional or mood issues and potentially health and safety issues. The causes for this are numerous and varied and often times multiple. The best solution if the problems persist past the resolution of contributing stresses or life changes for more than a week to a month would be to seek help. This should involve a good assessment of your health (mental and physical) as well as your David R. Nichols, MD sleep habits and quality. The best therapies are those that are directed to the Sleep Medicine root cause of the problem. NEA Clinic – 870.336.4144 7. NEA HEALTH • Fall/Winter 2009
Facial Aging & Rejuvenation W
e can all recognize the facial differences between a young person and an older person and many can guess a person's age within a few years based on their appearance. However, most would find it difficult to list the complex changes in facial structure that occur with aging and contribute to our apparent age. Altering these structures is the basis for facial rejuvenation, and the approach taken differs, based on individual needs. In general, the less aggressive approaches yield more subtle results, whereas more aggressive procedures produce more dramatic changes, but increase the risk of complications. Therefore, earlier, milder interventions allow the maintenance of a youthful appearance with the least amount of effort and risk. The appearance of the skin plays an important role in defining our apparent age as it is the first thing we see when we look at a face. With aging, the skin tends to become thinner as it loses collagen and as the number of supporting cells within the skin decrease. Loss of elastic fibers within the skin makes the skin less resilient and can contribute to fine wrinkles. All of these changes are greatly exacerbated by sun damage. Sun exposed skin shows apparent accelerated aging, accented by pigmentary (color) irregularities and deeper wrinkles than in non-exposed skin. Therefore, the best way to keep your skin looking young is to limit your sun exposure, and that includes avoiding tanning beds. Fortunately, the skin is easily accessible and irregularities can be treated by a number of modalities. The most common
treatments are over-the-counter moisturizers and skin tightening agents, which can help to address very minor wrinkles, at least temporarily. But, again, conservative treatments are going to yield limited results. And, a recent study of several popular over-the-counter skin treatments found that more expensive creams were no more effective than many of the cheaper brands. So, don't spend a fortune on these treatments hoping to dramatically turn back the hands of time. Prescription skin treatments are the next step in the quest for more youthful skin. Tretinoin, commonly known as Retin-A, has been shown to improve skin quality due to its effects on collagen and elastin, which are abundant in young, supple skin. Often used to treat acne, tretinoin is relatively safe and can be started as part of the skin maintenance regimen in the late teens to early twenties, but is even more useful for aged and sun-damaged skin. Hydroquinone, commonly referred to as “fading cream”, addresses another sign of aging skin, by helping to fade irregular pigments (sun spots, or age spots) on the face. Often, these chemicals are combined for improved results in skin appearance. For more dramatic results, the skin can be altered by means of minor mechanical, chemical, or thermal injury, resulting in the production of new collagen in the skin as part of the healing process. Dermabrasion is essentially the mechanical removal of skin cells by means of either excoriation by fine sanding wheels, sandblasting with fine crystals, or exfoliation by abrasive pastes. Old skin cells are removed and replaced by new, healthier skin cells. The skin cells can also be chemically damaged using various acids. The improvement in skin texture and color depends on the chemical used and the depth of the burn, with deeper burns producing more dramatic results, but with higher risks of complications, including scarring. The skin can similarly be ablated using lasers which can be custom fitted to each individual skin condition. Some lasers are better for creating skin tightening, while others address the pigmentary problems (age spots) or hypervascularity (superficial blood vessels) seen in sun damaged skin. Next, we must consider the underlying soft tissues of the face. As we age, we lose volume within our faces, resulting in deep wrinkles and sagging skin. Just as an inflated balloon will sag as air is let out, our faces sag as they lose fat. Loss of fat from the cheeks results in the appearance of circles around the lower eyelids and deepening of the nasolabial folds ( the wrinkles between our nose and corners of our lip), as well as the appearance of jowls as skin droops below the jawline. Loss of fat in the temples changes the aesthetically pleasing “upside down egg” or “heart-shaped” face into more of
8. NEA HEALTH • Fall/Winter 2009
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an oval or rectangular appearance, giving away our true age. At the same time, changes in the underlying facial skeleton modify the youthful proportions of the face. The maxilla (the middle part of the face) decreases in size, making the eye complex larger, the lips thinner, and the chin more pronounced. In the past, these changes were addressed mainly by “lifting” the drooping tissues, often resulting in an unnatural appearance. Although facelifts, brow lifts, and other surgical procedures are still useful, the importance of addressing soft tissue and skeletal volume loss have become more widely recognized. The use of injectable facial fillers to replace the lost fat and to augment bone resorption, as well as to add thickness to the thinning skin, are now the mainstay of facial rejuvenation. In those with severe volume loss, facial implants are available to restore the natural contours to the face. If necessary, the skin and soft tissues can then be surgically resuspended with dramatic results. For a detailed evaluation, please call for an appointment at (870) 934-3484. Dr. Anthony Bentley is board certified in Otolaryngology and Facial Plastics and is a member of the American Academy of Facial Plastic and Reconstructive Surgeons.
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Anthony Bentley, DO Otolaryngology (ENT) NEA Clinic – 870.934.3484 9. NEA HEALTH • Fall/Winter 2009
Primary Spine S
pinal intradural extramedullary tumors account for two-thirds of all intraspinal lesions. Meningiomas, schwannomas and neurofibromas are the most common of these benign tumors. While most are benign a small percentage can be malignant. The three cases in this report are excellent representations of these tumors. Nerve sheath tumors (schwannomas and neurofibromas) and meningiomas will have a similar presenting picture with spinal cord and nerve root compression being the hallmark of these lesions. PRESENTATION The symptoms are usually insidious with a delay of 1 to 2 years between onset and diagnosis not being uncommon. Patients will present with pain, weakness, sensory deficits and sphincter disturbances typically in that order. The actual location of the lesion will determine what symptoms are present. Signs on examination can include hyperreflexia, paraparesis, paraplegia, paresthesia, sensory loss, gait instability and sphincter dysfunction. The size, location, duration of neural compromise will determine which symptoms and signs will be present. With the slow onset of symptoms some patients may actually be non-ambulatory at the time of presentation and many will be myelopathic on their initial examination. Extradural intraspinal lesions will present in a similar manner. Meningiomas are more common in women with a 3:1 to 4:1 female to male ratio. Nerve sheath tumors have no gender predominance. Most tumors are in the thoracic or lumbar region. DIAGNOSTIC STUDIES MRI is the primary diagnostic study. MRI clearly delineates the level of the tumor and the relation of the tumor to the spinal cord. Meningiomas are usually isointense on T1 and T2 weighted images, however, they display intense enhancement with gadolinium. Nerve sheath tumors are hyperintense on T2 weighted images. CT scans can also be helpful if lesions demonstrate evidence of bony erosion. TREATMENT The treatment for these lesions is surgical resection. The location of the tumor dictates the approach. Most tumors are dorsal or lateral and a standard laminectomy will provide adequate exposure. If the tumor has a ventral component the laminectomy can be extended laterally toward the articular process. The use of intra-operative ultrasound will allow the surgeon to localize the tumor prior to opening the dura. These tumors are usually encapsulated and can be debulked, if need prior to resection, so that there is no operative trauma to the spinal cord. Most tumors can be totally resected. Meningiomas have a point of origin from the dura that is either resected or extensively cauterized. Nerve sheath tumors arise from a nerve root and the majority of time cannot be separated from that structure. Resection of the tumor sacrifices a non-functioning nerve without any additional neurological deficit. Recurrences are rare in most cases and no adjuvant therapy is required.
10. NEA HEALTH • Fall/Winter 2009
CASE PRESENTATIONS Case I: This year 66 old female presented with pain in the left lower thoracic region. Pain was brought on by touch and was present approximately one week prior to seeing her primary care physician. She also had pain upon taking a deep breath, cough and sneeze. Numbness in her left hand and leg. No problems with ambulation and no sphincter dysfunction. Her physical examination revealed left lower thoracic area tenderness. Thoracic spine MRI revealed a T -9 intradural extramedullary mass on the right side of the canal causing gross cord compression (see Figure 1a). She underwent operative therapy with a gross total resection of an obvious dural based lesion consistent with a meningioma. On followup visits her pre-operative pain has resolved and she remains neurologically intact. Post-operative thoracic MRI showed no residual tumor (Figure 1b). Case II: A 75 year old female presented with progressive bilateral leg numbness for four months. She also had lower back pain, weakness in her legs, right side worse than left, gait instability and urinary frequency. Physical examination revealed gait instability with a cane being used to ambulate, weakness in the lower extremities with the right side weaker and hyperreflexia in the lower extremities. Thoracic MRI revealed a T 5-6 level intradural extramedullary lesion which was 1.3 x 2.2 cm in size (see Figure 2). Her operative therapy again revealed a dural based tumor that was totally resected. Diagnosis was a meningioma. Follow-up exams at one and five months showed resolution of her symptoms and abnormal findings on examination.
Figure 2 - MRI T2 weighted Sagittal shows a ventral and right 1.3 x 2.2 cm globular tumor. The spinal cord was displaced posteriorly and to the left.
Tumors Figure 3a - MRI T2 weighted Axial shows a 3.0 x 3.5 C1/2 dumbell shaped tumor which is extradural.
Figure 1a - MRI T2 weighted Sagittal shows a dorsally located 1.1 x 2.0 cm tumor on the right side displacing the spinal cord anteriorly.
Figure 1b - MRI T2 weighted Sagittal shows a total resection of the tumor
Case III: This 25 year old female was evaluated for complaints of right leg pain and falling. Duration of both symptoms was approximately one year. She also had problems with her balance, numbness in the right arm and leg. Positive findings on examination were spastic gait, weakness in the right arm and leg and abnormal cerebellar findings. MRI of the brain showed a large left C 1-2 extradural mass within the spinal canal. Mass effect was noted on the upper cervical spinal cord and an extra-spinal mass growing through the neuroforamen (see Figure 3a,b). This was consistent with a classic dumbell appearance that is seen frequently in nerve sheath tumors. Findings at surgery revealed a nerve sheath tumor which was extradural and enveloping the nerve root at this level. She had a total resection of her tumor. Follow-up visit revealed resolution of her symptoms and a normal physical examination. CONCLUSION Benign primary tumors of the spine can present with varied symptoms over a long span of time. Diagnostic studies primarily in the form of MRI scans clearly define the anatomy of the lesion and is useful in surgical planning. These lesions can usually be totally resected with excellent functional recovery.
Figure 3b - MRI T2 weighted Sagittal reveals the tumor in the spinal canal at C1/2. Robert Abraham, MD Neurosurgery NEA Clinic – 870.935.8388 11. NEA HEALTH • Fall/Winter 2009
to the
from the
Photography by Kendy Schimmel Photography
N
ot all classrooms at Jonesboro Health, Wellness and Environmental Studies Magnet School have desks…or chairs…or even ceilings. And they wouldn’t have it any other way.
Outdoor classrooms provide educational opportunities for the students, and provide the key that connects the health and wellness components with the environment to form the school’s theme of Health, Wellness and Environmental Studies. The “Rose Courtyard” showcases bird feeders and baths that are scattered throughout perennial and annual flowering plants. The “Vegetable Courtyard” has raised box gardens, each purposed for a specific crop. Each box holds a variety of pumpkins, gourds, squash, lettuce, spinach, beets, turnip greens and carrots for harvesting. As the gardens flourish, students take part in the process of planting, maintaining and harvesting. A “Sensory Garden Courtyard” (to open in 2010) will house an outdoor kitchen, rain barrels, and sensory garden beds. HWES sought training and curriculum guidance from California based LiFe Lab Science Program. Whitney Cohen, Life Lab Educator from Santa Cruz, California, trained the entire HWES staff this summer in how to incorporate garden and kitchen lessons that support the existing Arkansas State Frameworks. September 2009. A group of excited First graders enter. They find 8 stainless steel food prep tables, commercial double oven with 6 burners and a side grill. The pantry in the room is stocked with choppers, graters, numerous measuring devices, a wok, a juicer…all for student use. There is a wealth of cookbooks and curriculum books that show lessons in measurement and science concepts. Welcome to the HWES Nutrition Lab! Thanks to the 2009 Hidden Valley Ranch, Love Your Veggies grant, students embrace good eating choices by using what the students first grow in the gardens and then prepare in the Nutrition Lab. “It’s all about ownership. Lettuce, for example, isn’t something that most kids want to sit around and eat. But when they plant, harvest and wash it…they are going to try it. That is the beginning,” shares Melinda Smith, Magnet Curriculum Coordinator. This Fall, all first graders will be participating in a cucurbit study. In the student kitchen/ Nutrition Lab, students will take part in discovery lessons examining the different seed types, water content, texture, and function of cucumbers, melons, pumpkins, edible and nonedible gourds. The students will prepare a healthy snack of roasted pumpkin seeds. 12. NEA HEALTH • Fall/Winter 2009
The following is a lesson the Fourth graders enjoyed: Harvest lettuce from the garden using microscopes and hand lenses, view the fresh-cut lettuce Journal all findings. Be sure to include any insect activity, soil, appearance, etc.
After the investigating and journaling was completed, the students then harvested and washed a crop of lettuce to be placed on the free choice veggie buffet available at lunch each day to the students. Exploration is a weekly class for students to benefit from community experts sharing their talents, experiences and professional knowledge. Each week different speakers motivate students through demonstrations. Lessons include showing respect, developing healthy eating and exercising habits, and maintaining personal hygiene. Through the support of community partners, students are learning how to find their place in the community and environment, and how to make a difference in both.
Prosthetic & Orthotic Laboratory Upcoming presentations include: h magazine,“Healthy 1/3 page, twoforinsertions Snacks Runners” presented by Yolanda Young of KAIT8. “Fruit and Vegetable Juicing. How to get 100%” presented by Linda Wishart, 8 Certified Yoga Instructor. “Introduction to Martial Arts” presented by Joey Perry Martial Arts Academy . “Choosing Healthy Afterschool Snacks” presented by Laura Taylor, Program Manager NEA Clinic Center for Healthy Children
HWES relies on the expertise of community leaders in their field. Mr. David Hughey of Hughey’s Nursery is a constant friend who has assisted in outdoor classroom design, garden consultation and has supplied HWES most recent residents, two hens Minerva and Louise. These hens provide eggs for our Nutrition Lab and endless teaching opportunities for our staff. Keith and Jill Forester of Whitton Farms, provide year around vegetable garden consulting, and locally grown fresh fruits and vegetables that are used in Nutrition Lab lessons. Look for a Toasted Pumpkin Seeds recipe on page 34
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Giving of one’s self
www.locksoflove.org
Locks of Love!
Angel is a "true Angel" and is a fine Christian young lady who often puts others before herself.
Planning
Jennifer took some pictures at her salon on Saturday when Angel got her haircut and although it doesn't look like it was cut very short, Jennifer was able to obtain a 13 inch ponytail that we will be sending to the Locks of Love. Angel started her new school year with a cute haircut and "a good feeling in her heart!"
M
y daughter, Angel Collins, 14years-old, decided she wanted to have her hair cut this summer and my friend, Jennifer Brown one of the co-owners of "Three's Company Beauty Salon" in Walnut Ridge, AR is the ONLY person that she trusts to cut her hair! Although we live in Jonesboro, AR, I don't mind making the drive to Walnut Ridge since they have such a good relationship!
"Who knows, this might just become an annual tradition!" says Angel.
Well, one thing led to another and instead of getting a "summer cut" right after school was out, Angel decided that she wanted to grow her hair out all summer and then have Ms. Jennifer cut it off when it was long enough to qualify to donate her hair to the "Locks of Love" to help someone else benefit also. I don't mind bragging about my own daughter, because
Pam Collins, LPN NEA Clinic Woodsprings Urgent Care 870.910.0012
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14. NEA HEALTH • Fall/Winter 2009
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10
H1N1 Flu:
Ways You Can Stay Healthy at
Work
A
s we face this extraordinary flu season, consider these ten things you can do to protect yourself and others:
1 Wash your hands often with soap and water for 20 seconds, or use an alcohol-based hand sanitizer if soap and water are not available. Be sure to wash your hands after coughing, sneezing, or blowing your nose.
2 Avoid touching your nose, mouth, and eyes. Germs spread this way.
3 Cover your coughs and sneezes with a tissue, or cough and sneeze into your elbow. Dispose of tissues in no-touch trash receptacles.
4 Keep frequently touched common surfaces clean, such as telephones, computer keyboards, doorknobs, etc.
5 Do not use other workers’ phones, desks, offices, or other work tools and equipment. If you need to use a coworker’s phone, desk, or other equipment, clean it first.
6 Don’t spread the flu! If you are sick with flu-like illness, stay home. Symptoms of flu can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, tiredness, and sometimes vomiting and diarrhea. CDC recommends that people with flu-like illness stay home for at least 24 hours after they are free of fever without the use of fever-reducing medicines. If supervisors or employees
have questions about use of leave for illness or to care for an ill family member, please contact your local Human Resources office or your office’s leave administrator.
7 Get vaccinated against seasonal flu.
It can protect you against seasonal influenza viruses, but not against 2009 H1N1.
8 Ask your doctor if you should get the 2009 H1N1 flu vaccine. People recommended to receive the 2009 H1N1 flu vaccine as soon as it becomes available in October are health care workers, children, pregnant women, and people with chronic medical conditions (such as asthma, heart disease, or diabetes). People living with or caring for infants under 6 months old should also be vaccinated to protect these children who are too young to be vaccinated. For more information about who should get vaccinated, visit http://www.cdc.gov/h1n1flu/vaccination/acip.htm.
9 Maintain a healthy lifestyle through rest, diet, and exercise. 10 Learn more. Visit http://www.flu.gov or contact CDC 24 hours a day, 7 days a week: 1-800-CDC-INFO (232-4636), cdcinfo@cdc.gov adapted from http://PandemicFlu.gov/ Vans • Wheelchairs Home Modification Lifts • Ramps
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Benefits of a
Personal Trainer! E
veryone knows that exercise is extremely important when it comes to your health. Exercise helps lower cholesterol, helps lower blood pressure and the risk of heart disease, helps prevent diabetes or helps control diabetes without the use of medicine. Exercise obviously helps control body weight and body fat, helps maintain healthy muscles, bones, and joints. Exercise can help reduce depression and anxiety, and can also help improve psychological well-being. But when it comes to exercise, do you know exactly what it is that you are supposed to be doing? That is where a personal trainer comes in.
A personal trainer is someone who has a background in health and fitness, and who has been certified through a professional organization. Personal trainers will help get you started on an exercise program and help make sure that you are staying on track and getting the most out of your workouts. Most importantly, a personal trainer will help make sure that the exercises that you are performing are being done correctly and safely to prevent any injuries. In addition, there are several other benefits to working with a trainer. A personal trainer will help push you past giving up on your workout. A trainer knows just how far your body can be pushed without going over the limit. They will help push you in a way that will help improve your cardiovascular capacity and a way that will help build your muscle strength and tone your body.
16. NEA HEALTH • Fall/Winter 2009
A personal trainer will encourage you to continue exercising even when you want to give up and quit during an exercise. They won’t let you quit on yourself and that may be the hard part to take at times, but it is worth it. The payoff is worth it! There are so many clients that know exactly what to do and how to do it, but when it comes down to the wire, they would definitely quit if someone wasn’t standing there counting and encouraging them to finish. A personal trainer is also a great way to keep from getting bored while exercising. So many people want to only use the machines, or only want to repeat the same exercises over and over. Same exercises, same weight, same number of sets and repetitions. Over time, your muscles get used to those exercises. This causes your calorie burning metabolism to level off, which prevents weight loss and muscle gain. There are thousands of exercises that can be done using dumbbells, barbells, and even just your own body weight. Because your personal trainer is highly trained and knowledgeable about the body and the way it operates, they can constantly change up your workouts in a way that continues to challenge your body, and in a way that keeps you from getting bored with the same exercises. I know what you are thinking… How much does it cost? The average price of one personal training session runs approx. $25. Some clients choose to meet two to three times per week; others choose to meet once a week or even once a month. Just checking in with a personal trainer to check weight and measurements and to make sure exercises are
NEAHealth Tip! No more excuses! Get started with your exercise program being performed correctly can be just enough to make sure that you are staying on track to accomplish your fitness goals. Having a personal trainer also helps you form an exercise routine. It is much easier to show up to the gym knowing that there is someone waiting on you that will help motivate you and help you exercise. So many people don’t use their gym memberships simply because they don’t even know where to begin. Even just scheduling a few sessions to get you into the swing of things would be a great way to help you get started. In conclusion, when it comes to your personal health and fitness, hiring a personal trainer as your guide and mentor would be a wise investment. Helping you get started on a safe and efficient routine can save you time and the risk of injury in the long run. Not to mention the fact that proper exercise will help form a healthy lifestyle! Sound enticing? Great! Come check out the NEA Clinic Wellness Center. Not only is it a great place to work out, but there are certified personal trainers on staff that are ready to help you conquer your personal fitness goals. You can tour our facility, get a free 7-day pass, meet our trainers, etc. And when you join, you get a free session with a personal trainer just to help you get started!
you! I look forward to seeing Kara Fowler Cato SilverSneakers® Senior Advisor NEA Clinic Wellness Center 870.932.1898 www.neaclinicwellness.com
We all know we should exercise, and most of us have what seem like pretty good reasons to avoid it. Here are some of the most common, along with some common-sense responses: • “I don’t have any spare time.” The truth is that we make time for what’s important to us. Schedule exercise into your day like any other appointment. • “Exercise is boring.” The key is finding something you like. Look for team sports, group activities, or interesting surroundings to keep your mind as well as your body occupied. • “I’m too out of shape.” Just don’t overdo it at first. Check with your doctor for suggestions, and start with low-impact activities such as swimming or bike riding. • “I’m not fat.” Good, but exercise is about more than losing weight. You want to maintain your health, and also control cholesterol and prevent heart disease—both benefits of regular exercise.
17. NEA HEALTH • Fall/Winter 2009
Cover Story
Sleep Medicine Sleep Medicine deals with those conditions that result in sleep disturbances capable of creating sleep loss sufficient to interfere with the quality of life. Through accurate diagnosis and appropriate therapy addressing these disorders helps patients to improve the daily quality of life. Some of the common problems are sleep disordered breathing, insomnia, restless leg syndrome, and excessive daytime sleepiness.
Board Certified Physicians and Registered Sleep Technologists
M
y name is Dr. David R. Nichols, the medical director of the NEA Clinic Center for Sleep Disorders (NEAC-CSD), and I am extremely excited and proud to be writing this article for the fall issue of NEA Health. It is my pleasure to formally introduce the center to Jonesboro and North East Arkansas. The NEAC-CSD opened on November 3, 2008 and is located at 1118 Windover in Jonesboro. The center is an evolution of the Sleep Medicine Department of the NEA Clinic started with my joining the clinic medical staff in May of 2006. I am a former Fort Smith, AR physician trained and board certified in Internal Medicine with a Pulmonary Disease sub-specialty and a Diplomat of the American Board of Sleep Medicine. After an active career of 27 years in pulmonary and critical care in Fort Smith, with the last 10 of those years including Sleep Medicine, I decided to change the direction of my professional career and focus exclusively on Sleep Medicine. Discussions with the NEA Clinic administration and physician leadership in 2005 included not only opening the Sleep Medicine department but also plans for the future development of a sleep center to support the diagnostic needs of the practice. The clinic had the vision and commitment to add a rapidly growing new medical specialty capable of bringing state of the art treatment and diagnostics to patients suffering with sleep disorders. In this article I will describe our center facility, the technical and clinical staff on site as well as the extended clinical staff off site. I will discuss the scope of the practice as well as our commitment to our patients and the community.
David R. Nichols, MD
18. NEA HEALTH • Fall/Winter 2009
The NEA Clinic Center for Sleep Disorders is a multi-disciplinary center that meets the American Academy of Sleep Medicine’s (AASM) definition of a sleep disorder center because of its ability to evaluate, diagnose and treat all sleep disorders, and provide follow-up care for these patients. At this time the expertise of the center is focused at the age ranges of adult to age 13. The sleep disorder center definition stands in clear distinction to facilities that are focused on just performance of sleep diagnostic studies. The American Academy of Sleep Medicine has also established standards for centers in the performance of diagnostic studies, and treatment of patients. The AASM is the premier professional organization that accredits sleep centers to be in compliance with standards of excellence set by the professional sleep community. This center has been developed and staffed in a manner that is committed to meet all of the standards set by the AASM. The clinical staff is committed to perform the evaluations and diagnostic studies, and to develop treatment plans that follow the current published evidence based guidelines of care. The center accomplishes this mission by having dedicated physicians, technical and support staff. The physician staff for the center is the core of what makes it a multi-disciplinary organization. As the field of clinical sleep medicine evolved it was clear that many existing disciplines were involved in the treatment of sleep disorders. The specialties included psychiatry and psychology, pulmonary disease specialists, internal medicine specialists, pediatricians, neurologists, and ear nose and throat surgical specialists (otolaryngologists), dentists, orthodontists and oral surgeons. In recent years, as with all developing specialties board certification processes were developed that allowed a designation of added expertise in the field of sleep medicine for all of these existing specialties, and training programs have also been producing specialists in sleep medicine. The developmental concept of the NEAC-CSD was to become a focal point to bring the NEA Clinic physicians interested in treatment of sleep disorders together, and to seek interested community physicians. The goal was to promote an interactive environment which would allow for “learning from and with each other” and create an “audience” for inviting outside speakers. Although the participants become the immediate beneficiaries of their efforts the ultimate goal is to improve the care of patients treated through the center and within the community. The forum allows for the discussion of complicated patient treatment plans that could crossover all the disciplines. At this time I serve as the “resident” sleep specialist at the center. I am seeing patients referred by their physician or self-referred with sleep complaints. The process begins with an evaluation of these complaints with a comprehensive medical history and then adds findings from a physical examination. This process generally produces a suspected diagnosis which will either generate a decision to perform a diagnostic test to confirm or the initiation of an appropriate treatment plan. Dr. Bing Behrens, an NEA Clinic board certified neurologist and sleep medicine physician and her partner Dr. William Long, certified in Neurology and board eligible in sleep medicine, see their neurology patients with sleep complaints in the NEA Clinic Neurology Department and send patients to the center as needed for diagnostic testing. When any of the sleep specialty physicians feel a patient is in need of another medical specialty to treat the sleep disorder a referral is made to that specialist. Dr. Anthony Bentley (currently board eligible in Sleep Medicine) and Dr. Bryan Lansford of the NEA Clinic ENT Department provide expertise in the surgical management of obstructive sleep apnea (OSA), primary snoring, or nasal conditions that complicate medical management of OSA. They may in turn refer patients they see in their
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continued page 20
19. NEA HEALTH • Fall/Winter 2009
Sleep D
continued from page 19
office for either diagnosis or medical management of a sleep disorder. In some patients with obstructive sleep apnea, or snoring a treatment option includes the use of an oral appliance. This would result in the referring of the patient to their dentist. Dr. William Morgan has elected to join with us in the center for our educational meetings as well as to serve as a consultant. His practice as a dentist has focused on the areas of tempro-mandibular joint disease (TMJ) and sleep apnea. In a similar manner patients with underlying mental disorders may be jointly managed by a sleep specialist and a behavioral medicine specialist in the community. Every effort is made to keep everyone involved in the care aware of the treatment plans and progress. Equally important to the quality of services at the NEAC-CSD are the sleep technologists, nursing and the front office staff. In accordance with the standards set by the AASM, all of our sleep technologists have attained the standards of being a Registered Polysomnography Technologist (RPSGT). They are responsible for performing the sleep study, scoring the results for the sleep specialist to interpret, and in educating and training patients about aspects of treatment. This is a complex job and there are many ways of getting inaccurate data or making inaccurate scoring decisions. For this reason they receive comprehensive training before they are allowed to take the examination to become registered. At the center we have a chief technologist and manager, Rickey Lee, BS, RPSGT and four more technologists: Brock Smith, RPSGT, Coralyne Turner, CRT-SDS, RPSGT, Dalton G. Barber, RPSGT and Colleen Blanchard, RN, RPSGT. With these technicians the center provides studies 7 nights per week and when needed studies during the day. The center provides regular training opportunities to maintain the skills of the technicians and conducts quality assessments to assure consistency of scoring among the technologists and adherence to the scoring recommendations of the AASM. During the day, Stacey Hart, LPN serves as my clinic nurse and assists in the care of the patients being seen for evaluation and in follow-up, handles patient calls, data collection, quality assurance studies and helps with equipment ordering and patient problems. Our customer service representative, Mary Miles is in charge of center phone calls, patient scheduling for day and night evaluations, data processing, billing, quality assurance studies and insurance verification. Clinicians and staff are committed to doing our jobs well and are constantly looking for ways to measure how we are doing and how we can do even better to serve our patients. Our facility consists of about 3500 square feet, and is designed to meet the needs of both a daytime sleep medicine practice and the needs a diagnostic test site performing over night and daytime sleep testing operations. There are 4 private sleep rooms with private bathrooms. They were designed and furnished to simulate the comforts and privacy of a bedroom at home, but have the needed technical equipment to monitor a night of sleep remotely from the centers control room. Patients have the ability to communicate at all times with the clinic staff in the control room via a two-way intercom. In addition low light video cameras and microphones provide remote monitoring of body position and any movements or sounds associated with some of the common sleep disorders. The rooms are also equipped to provide remotely controlled Positive Airway Pressure (PAP) devices that are utilized along with a face mask to treat obstructive sleep apnea. Oxygen is available if needed during the sleep study. There is a showering facility provided for those patients wishing to shower prior to going home or to work the morning after the sleep study. There are 2 exam rooms that serve for daytime sleep evaluations and as hook-up rooms in preparing patients for studies. There are two physician offices and a conference room for staff meetings and education. The center is a fully integrated service of NEA Clinic and shares a common electronic medical record and uses additional software to manage the sleep practice that helps in scheduling and work flow of studies but also allows building a database of information used for
20. NEA HEALTH • Fall/Winter 2009
practice analysis and quality assurance studies. These systems facilitate good communication with referring providers, among our staff and with guiding our commitment for improving our practice. The sleep center is seeing and treating patients with obstructive sleep apnea, insomnia, restless leg syndrome, periodic limb movement disorder, narcolepsy and other causes of excessive daytime sleepiness, and a variety of parasomnias conditions such as sleep walking, talking, sleep movement disorders, or other strange activities occurring during or around the sleep period. Not all of these conditions require treatment but are worth evaluating to determine if treatment or reassurance is needed. Patients who are self or physician referred often complain of loud snoring, daytime fatigue or tiredness, excess sleepiness during the day, poor quality of sleep or strange behaviors during the night. The center can also offer help with conditions called circadian rhythm disorders. Examples are shift workers sleep disorder, Jet lag, or sleep phase disorders (delayed or advanced). These disorders often arise because of the conflict created when we attempt to sleep or remain awake at times that proves to be at odds with the way our internal body clock is set. Many times the most important aspect of the sleep evaluation is gaining an understanding of how to improve sleep habits to get better sleep and learning about some of the myths and misconceptions that can develop about sleep. One of the clear missions undertaken by the NEAC-CSD is sleep education. This may be directed at our patients, staff, or other healthcare providers. We firmly believe that patients do best with a deeper understanding of their sleep problem as well as its treatment. We in the center are willing to come out into the community to address groups or businesses interested in sleep issues related to most any topic. In the center we keep some education materials for distribution and have a resource center that provides access to recommended sleep education websites. The physicians and staff of the NEA Clinic Center for Sleep Disorders are excited to be a new addition to the healthcare resources of Jonesboro and the region and are already working hard to help improve the quality of sleep for our patients. We pledge to continue our efforts to bring state of the art sleep medicine technology and treatment to the citizens of North East Arkansas.
David R. Nichols, MD Sleep Medicine NEA Clinic – 870.336.4144
Having Trouble Sleeping...
We can help! Come tour our Sleep Center with comfortable, convenient sleep study rooms. 1118 Windover, Jonesboro, AR
870-336-4144 • www.neaclinic.com
- Board Certified Physicians & Registered Sleep Technologists David R. Nichols, MD Bing Behrens, MD William Long, MD/PHD
Maudie Rogers - 862 Summer Miles!
T
his past summer, NEA Clinic Wellness Center’s SilverSneakers® Fitness Program, as well as all SilverSneakers® facilities across the state, participated in the “100 miles in 100 Days” program. Members were asked to track their mileage for the summer months to see how many miles they could accumulate, but members weren’t to stop there, they were to get as many miles as possible. 89-year-old Maudie Rogers knew that she could easily complete the 100 miles, and set a personal goal to get as many miles as she possibly could. “I’m a big competitor, even if I am only competeing with myself ” Maudie says as she easily walks on the treadmill, “I just wanted to get as many miles as I could.” And that she did. Over the three month period, Maudie completed a total of 862 miles, walking on the treadmill, riding the bicycle, and participating in water aerobics classes and a SilverSneakers® Muscle Strength and Range of Motion (MSROM) aerobics class. To display her determination, Maudie would show up sometimes at 9:30 am to begin her exercise regimen. This being before she participated in an hour long class that began at 1pm. Maudie averaged around 18 miles per day, sometimes gaining up to 25 miles at a time. Something that makes Maudie’s story even more inspirational is the fact that she had some health problems over the summer. Though she has never been a smoker, Maudie was diagnosed with
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Mrs. Rogers was so proud to be able to visit with Dr. David Lipschitz of the University of Arkansas for Medical Sciences and discuss her experience with the SilverSneakers Fitness Program. Dr. David used her as a prime example of “passion” in his speaking event, which was centered around positive living and longevity through passion for living. lung cancer. She had to miss several classes due to doctor appointments and her biopsy, but she did not let that slow her down. She listened to her doctors recommendations, and returned to the gym as soon as she was able to. Members of the SilverSneakers® program can participate in their choice of activities at NEA Clinic Wellness Center. Members can use the indoor track, treadmills or bikes, or can take part in classes. The specially designed, low-impact class that Maudie participates in the most, MSROM, is intended to help with strength, flexibility, balance and coordination. She believes this class helps her maintain a healthy and independent lifestyle, as well as making new friends. Betty Foster, one of Maudie’s classmates, says that Maudie is pure inspiration. The two met in the MSROM class over two years ago and instantly hit it off. Betty claims that she has never met anyone quite like Maudie, and she is grateful for the friendship that they have embarked on. Maudie is also grateful for Betty’s friendship, and for the friendship and support of her classmates. “The class has been my support group, they’ve all been great.” Though Maudie has exercised her entire life, it is never too late to begin an exercise program. You can join Maudie at NEA Clinic Wellness Center, 2617 Phillips Drive. For information on the SilverSneakers® program call 932-1898 or visit www.neaclinicwellness.com. “People who don’t exercise don’t know what they’re missing.”
Kara Fowler Cato SilverSneakers® Senior Advisor NEA Clinic Wellness Center 870.932.1898 www.neaclinicwellness.com
23. NEA HEALTH • Fall/Winter 2009
Chronic Low Back Pain C
hronic low back pain is defined as pain in your lower back that occurs longer than 3 months. The rate of chronic low back pain has more than doubled since the early 1990’s and this trend has been linked to increases of depression and obesity in the population. It is important to discuss low back pain with your family physician to evaluate and manage this very common condition affecting many patients of Northeast AR. Evaluation of your low back pain by your doctor can be broken down into a few categories: 1) nonspecific low back pain 2) back pain associated with symptoms that radiate to other parts of your body or spinal stenosis, a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves 3) back pain coming from a source other than the spine 4) back pain associated from another specific spine cause such as a nonmechanical type
The most common cause of low back pain results from a lumbar sprain or strain and this represents 70% of all causes of low back pain. The mechanical causes of back pain that result in radiculopathy or spinal stenosis include degenerative disk disease and facet disease, osteoporotic fractures, traumatic fractures, herniated disks, congenital disease with curves in the spine such as severe kyphosis (also known as hunchback) or scoliosis (a side to side curvature of the spine) spondylosis (degenerative changes in the spine due to osteoarthritis), and internal disk disruption. These mechanical causes
24. NEA HEALTH • Fall/Winter 2009
of low back pain cause about 25% of cases of low back pain. About 2 % of the time the low back is a result of a source other than the spine such as from diseases of the pelvic organs such as prostatitis (inflammation of the prostate), endometriosis (cells that line the uterus are deposited in other areas of the body), chronic pelvic inflammatory disease, aneurysm of the aorta, GI disease such as pancreatitis (inflammation of the pancreas), cholecystitis (inflammation of the gall bladder), penetrating ulcer, or renal disease such as kidney stones or infection of the urinary tract. Other rarer types that are usually nonmechanical in nature include specific types of cancers and infections. Management of chronic low back pain is accomplished with both pharmacologic and non pharmacologic treatment options. Imaging such as XR of LS spine is usually delayed 1-2 months as initial treatment has been shown to be effective treatment for many patients. Pharmacologic starts with use of nonsteroidal anti-inflammatory drugs NSAIDS) or acetaminophen. Tramadol, opiods, and muscle relaxants may be used in those patients who do not respond to initial treatment with NSAIDS or acetaminophen. However, taking opiods can lead to the development of tolerance and hyperalgesia (enhanced pain response to stimuli). It can also lead to addiction, so is usually used with caution and frequent visits with your doctor to access pain and either wean down or titrate up depending on pain levels. A few herbals have been shown in some studies to be as effective as NSAIDs, namely Harpagophytum procumbens (devil’s claw) at 50 mg daily and Salix alba (white willow bark) at 240 mg daily.
Some nonpharmacologic treatment options include physical therapy which is focused on strengthening and stabilizing the core muscle groups of the abdomen and back, acupuncture, behavioral therapy involving progressive relaxation and cognitive behavioral therapy, and a style of yoga called Yinoyoga have all been shown to provide improvement in chronic low back. Lumbar back braces have been shown to be helpful as well as the TENS unit (transcutaneous electrical nerve stimulation) ultrasound, and prolotherapy (involves injecting an otherwise non pharmacological and non-active irritant solution into the region of tendons and ligaments for the purpose of strengthening weakened connective tissue) Other more invasive procedures for treating low back pain include epidural steroid injections and surgery. Patients with radicular symptoms may benefit from epidural steriod injections and can be found up to 3 months after those injections. In patients who have pain despite 12 months of nonsurgical treatment, surgery may be an option. Spinal fusion has been shown to be good for treating back pain caused by infections, fractures, progressive deformities and spondylolisthesis (slipped disk). Disk arthroplasty (replacing original intervertebral disk with an artificial one) has also been shown to be good treatment of chronic low back pain. Call your family doctor if : • You develop numbness of your leg, foot, groin, or rectal area • Pain radiates past your leg below your knee • You have fever, stomachache, nausea or vomiting, weakness, or sweating • You lose control over voiding or having a bowel movement • Your pain is so intense it affects your movement • Your pain is not improving after 2-3 weeks
Caring for your loved ones the way we care for ours!
CPAP All available hospital beds & accessories/gel overlays Wheelchairs (powered, lightweight manual)
Biliblankets Crutches & canes All diabetic supplies Neonatal/pediatric supplies Orthopedic products & braces/sprints Full-time Registered respiratory therapist and Knee CPM physical therapist on staff. We bill medicare/ Incontinent supplies medicaid & all other private insurance providers.
Kenneth Dill, MD Family Medicine - Osceola NEA Clinic – 870.563.5888
ACHC Accredited
2711 S. Caraway Rd. Suite B, Jonesboro • 870-933-1993 25. NEA HEALTH • Fall/Winter 2009
Ultrasounds - An Effective Tool in Medical Diagnosis
M
edical ultrasound awareness month occures every October. This a joint effort of several organizations including the American Institute for Ultrasound In Medicine, American Society of Echocardiography, Society of Diagnostic Medical Sonography, Society of Vascular Ultrasound and other organizations, to familiarize and educate the public about medical ultrasound and its importance in health care. Diagnostic medical ultrasound is a procedure using high frequency sound waves to produce images of organs, tissues, or blood flow inside the body. This procedure is often referred as an ultrasound scan or ultrasound examination. Although the general public is familiar with ultrasound and its use during pregnancy, many people are unaware of the many areas of the body that can be imaged by ultrasound such as the abdomen, breast, reproductive system, heart and blood vessels. Diagnostic medical ultrasound is increasingly being used in the detection of heart disease and vascular disease, as well as detection of injuries to muscles, tendons, and ligaments. Unlike
many other imaging modalities ultrasound does not use x-rays and does not expose the patient to any radiation. The safety of medical ultrasound has allowed this noninvasive imaging modality to become an increasingly effective tool in medical diagnoses.
A diagnostic medical sonographer is a highly skilled professional who performs ultrasound examinations using specialized equipment to produce images of structures inside the human body. The sonographer presents the images to a physician trained in interpretation of ultrasound. The sonographer and physician work as a There are several areas of specialization in the team to obtain the best possible images in the safest manner in order to arrive at a diagnosis. field of medical ultrasound, including
evaluations of:
Abdominal ultrasound – all the soft tissues, blood vessels, and organs of the abdominal cavity. Breast ultrasound – breast abnormalites often found by mammography. Echocardiography – anatomy and hemodynamics (blood flow) of the heart, its valves, and related blood vessels. Neurosonography – brain and spinal cord. Obstretic/gynecologic ultrasound – female reproductive system. Ophthalmic ultrasound – eye, including orbital structures and muscles. Vascular ultrasound – hemodynamics (blood flow) of peripheral and abdominal blood vessels.
NEA Clinic has an accredited cardiovascular ultrasound laboratory with Registered Sonographers, who have demonstrated specific training, ability, and experience to perform ultrasound exams accurately. Maintaining credentials requires on-going medical education by sonographers. An accredited ultrasound laboratory must demonstrate accuracy and a commitment to quality and safety. Lisa Lane, BSRS, RDCS, RVT, LPN NEA Clinic Cardiology Supervisor Cardiovascular Ultrasound
Hospice Care of NEA “Your first choice for quality hospice care”
870-932-7779 Criteria for Eligibility v Patient has been diagnosed with a progressive,
life-limiting illness or condition and has decided to stop all treatment v Patient and the family agree with the goals of hospice care and sign an agreement consenting to Hospice Care of NEA services Hospice Care of NEA service area: v Craighead v Greene v Poinsett v Mississippi v Clay v Crittenden
Susan Carter, President/CEO of Hospice Care of NEA, is a Registered Nurse with 25 years experience. She started her own company, Home Health Professionals Inc. in 1989, which is recognized as one of the top 150 experts in the United States by the National Association of Home Care and Hospice. She has served as President of the Home Care Association of Arkansas, was a delegate to the 2008 Home Care and Hospice Industry Strategic Planning Congress, and is currently appointed to the Arkansas Governor’s Healthcare Advisory Board.
Hospice Care of NEA is a subsidiary of Home Health Professionals Inc. 26. NEA HEALTH • Fall/Winter 2009
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
IN
REVIEW
g people and gr owi helpin ng
. a st ronger community
www.neacfoundation.org • 870-934-5101 27. NEA HEALTH • Fall/Winter 2009
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
Quality Driven... A
s the new Director of Programs and Grant Development for the NEA Clinic Charitable Foundation, I feel blessed to be a part of this progressive organization and among so many caring and compassionate professionals. After many years in the non-profit world, the Foundation is a perfect fit for me. I love Jonesboro. I grew up here, received my undergraduate and graduate degrees from Arkansas State University and, after living and working in the San Francisco Bay Area in the early 2000's, moved back home. Several years ago I found a quote that I immediately appreciated: “Quality doesn't just happen. It requires intention, effort, and skill.” I'm not sure who to attribute this quote, but I like how it simply states what is easily forgotten: Quality, simply defined as a “grade of excellence”, does not magically appear. Since 2001, the NEA Clinic Charitable Foundation has grown to support five quality-driven programs: Medicine Assistance Program, HopeCircle, Center for Healthy Children, Wellness Works! and ShareHope. The quality of our programs is derived from numerous sources that include – our professional and caring staff, dedicated volunteers, and a supportive community. I am proud of our foundation programs, each developed with the NEA Clinic Charitable Foundation’s mission in mind – to help change lives. Blessings, Cheryl Goad Director of Programs and Grant Development NEA Clinic Charitable Foundation
Grant Update! After-School Program Promotes Nutrition & Fitness Thanks to a grant from The Blue & You Foundation for a Healthier Arkansas the NEA Clinic Charitable Foundation’s Center for Healthy Children is expanding its program! Since January 2009, we have implemented nutrition and fitness after-school programs in seven schools, reaching hundreds of children and families. Thank you Blue & You! 28. NEA HEALTH • Fall/Winter 2009
Did you know an estimated 900,000 pregnancy losses occur each year in the United States? Often, there is no explanation as to why such a thing happens. For many families the loss of this much wanted new life leaves them in a state of shock and devastation. ShareHope is a program dedicated to helping families before, during, and after such a loss. ShareHope has trained volunteers who are also bereaved parents. If called, these volunteers will make hospital visits, phone calls, send emails, provide literature, and offer support through our monthly group meetings. ShareHope also offers a lending library with resources like books, DVD's/CD's, and articles pertaining to grief and the loss of a baby. To many of the families served by ShareHope, this program is the true essence of “quality” care. As one mom recently shared “I know I am surrounded by good people who really care about me and my family when my doctor tells me about ShareHope. I knew I was not alone in my grief. What a comfort it was to be given information about ShareHope.” Hearing this from families is what brings hope even in the midst of darkness. As we continue to work with families who have been touched by the tragic death of a baby through pregnancy loss, stillbirth, or in the first few months of life, one thing rings true with all of them, they are so thankful for the support that has been given to them through ShareHope. It is our hope that no family will suffer the loss of a baby alone. ShareHope and the physicians, nurses, and countless volunteers who support this program strive to reach out to others so that we can continue to Touch Lives, Heal Hearts, and Give Hope.
Children's Footprints by Doreen Sexton Some children come into our lives and go quickly. Some children come into our lives and stay awhile. All our children come into our lives and leave footprintsSome oh so small; Some a little larger; Some, larger still, But all have left their footprints on our lives; in our hearts, And we will never, never be the same. Stacey Orr ShareHope Program Coordinator pictured with her father Marc Higgins
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
A
spirit of love and hope permeated Craighead Forest as over 450 people gathered for the 1st Annual ShareHope Walk of Remembrance and Hope. Sixty eight babies were named, honored and remembered with love. Families and friends commemorated the lives of children who died too soon with music, balloons, laughter, tears and a walk around the lake on October 3. Comments by Stacey Orr and Diana Davis, combined with the voice of Dia Sawyer singing “Precious Child” set the stage for an event that reminded all in attendance of how precious and fragile life is and how Hope can surface in the most tragic circumstance. To view more pictures and a video of this beautiful event visit www.neacfoundation.org and look for us on facebook.
29. NEA HEALTH • Fall/Winter 2009
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
QUALITY
OF
GIVING...
As the parent of a young boy, I sometimes worry about teaching the art of giving to my child. As the holidays approach this becomes more evident as we make our Christmas lists and get wrapped up in the hustle and bustle of the season. Over the years I have found the true spirit of the season is in giving. I am fortunate that I work for an organization that allows me to give to others every day. It is such a blessing to receive a note of gratitude from a patient who received much needed medication, or a high five from a child who just ran a lap around the track. Recently, at our NEACCF ShareHope Walk of Rembrance, Madison McKinley an 11 year old from Jonesboro donated $50 to our foundation. This was money that she earned by creating and selling necklaces. The pride with which she gave of her money was humbling, and the look of admiration on her mothers face was heartwarming. Madison is truly learning the joy of giving.
QUALITY OF STAFF...
There are so many ways to give at this time of year. Listed below are several ways that you can give to NEA Clinic Charitable Foundation: • Bake Cookies to serve to Chemo patients through HopeCircle • Volunteer to assist with paperwork in our Medicine Assistance Program • Give a donation in honor of your loved ones, co-workers, or friends • Purchase a book for one of our lending libraries The gift of your time and talents, as well as monetary donations, enable us to continue giving to others throughout the year. May you have a blessed and happy holiday season! Kim Provost Director of Fundraising & Events NEA Clinic Charitable Foundation
front desk, where they always have her favorite candy, to the nurses who regularly give her medicine intravenously and cheer her up, all of the staff have made her feel like she is special. She knows that she is not a number to them, but someone they genuinely care about. A family no longer receiving active treatment talks about the years they have spent coming to the clinic. Their love for the staff and their recognition of the care they received has validated the fact that they matter to those who treat them. That care has made a difficult journey much more bearable.
orking in HopeCircle, we are blessed to see our NEA Clinic patients and staff in a unique way. Because of our relationships we often hear what others don’t. Recently we have repeatedly heard how much our families appreciate the staff and the quality of service they receive here.
W
A widow, at her husband’s funeral, instead of lamenting her own loss, reminisces about how good the staff was to her and her husband. How they laughed and visited and became friends as they battled the disease – together.
Quality is defined as a degree of excellence; a distinguishing attribute. That definition certainly fits the employees of the NEA Clinic at 311. E. Matthews.
Quality is a degree of excellence that shows in the interaction the employees at 311 have with patients and their families – from the voice on the telephone, through all the people who do the probing, sticking, questioning and answering, to the person checking them out. Our staff is dedicated to putting our patients first, and we all benefit from that commitment, especially our patients.
Gratitude is often expressed to and for the staff. Three times in one recent week patients and family members expressed their appreciation, gratitude – and love – for what they call their “extended family”. A long time patient who has gone through multiple diagnoses and extensive treatments for almost 20 years raves about “her” team. From the 30. NEA HEALTH • Fall/Winter 2009
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
all is such a heart warming time of year. Leaves falling, football, duck hunting…We are aiming high for our 7th annual Duck Classic - December 10 & 11. This year’s event promises to be a quality dinner & hunt. Duck Classic, one of the largest hunting fundraisers in the nation, attracts names such as: Underarmour, Xpress Boats, Avery, ESPN & The Outdoor Channel to Jonesboro. To learn more or participate visit www.duckclassic.com or call 870.934.5101.
F 7
th
n An
ua
l
Dec. 10 -11, 2009 Enjoy awesome barbeque, silent & live auction. Then hunt one of Northeast Arkansas’ Favorite Blinds
T
he NEACCF Center for Healthy Children is branching out and reaching more children throughout Northeast Arkansas than ever before. Since inception in February 2006, the CHC has welcomed hundreds of overweight children and their families to join an exercise program and participate in nutrition education to improve their quality of life.
Jim Boswell’s UH HRCH “Cutter”
Entry Fees: $1,500 per team tax-deductible donation (max. (max. 44 members members per per team) team)
The CHC continues to engage children and families for that same guidance and support. In addition thanks to a grant from the Blue & You Foundation, the program has been taken on the road to local elementary and middle schools. Free after school exercise and in school nutrition education has been provided for hundreds of children. Activities are led by health and exercise professionals including doctors, personal trainers, health educators and even an executive chef! The most recent contribution is a free physical education class for home schooled children. The Center for Healthy Children prides itself on offering exciting and innovative approaches to improving physical fitness and nutritional knowledge for families of Northeast Arkansas.
Includes dinner, auction & opportunity to hunt one of Northeast Arkansas’ Blinds
870-934-5101 www.duckclassic.com 31. NEA HEALTH • Fall/Winter 2009
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
MANY FACETS OF GIVING
G
iving to the NEA Clinic Charitable Foundations can take many forms. Money is always needed, but is not the only way to support our programs.
W
hat a wonderful opportunity Hope Week presents each year. We spend time spreading the message of Hope and encouraging others to concentrate on Hope and think about what brings Hope to life. This year we joined with the City of Jonesboro as they celebrated “A Hope Filled Community for 150 Years”, and ASU as they celebrated “Powering Minds and Fostering Hope for 100 Years”; two very important Hope filled occasions. The part Hope plays in the lives of individuals, organizations, universities and cities can’t be overemphasized. Hope is the spark that fires the imagination and keeps us going when the darkness starts closing in. It keeps us moving forward and prods us to share that spark with others, spreading the light and the power of Hope. Melissa Coles, Hope Week chairperson, shepherded volunteers and the community through the process of deciding what inspires Hope and how to share that Hope with others. Food and clothes collection, parties for special needs students, making & delivering book marks for patients, creating handmade items for patients, free eye exams and glasses - the projects varied as greatly as the individuals and organizations involved. The common thread was highlighting and sharing Hope and the result was a week filled with service, joy, laughter – and Hope. The culmination of the week was the wonderful ShareHope Walk of Remembrance and Hope. The event honored the lives of babies who died too soon. Diana Davis emceed the walk and read the names of all the babies being remembered. The beautiful voice of Dia Sawyer enhanced the occasion as hundreds of family members and friends released balloons and walked in remembrance and love. Hope Week and its many activities and events demonstrated the impact Hope can have on each of you.
“Hope brings purpose to the day and light to the night”. Thank you! June Morse HopeCircle Program Manager NEA Clinic Charitable Foundation
32. NEA HEALTH • Fall/Winter 2009
Handmade afghans, beautiful handcrafted jewelry, baked goods, books, gas cards, crocheted & knitted booties & caps, lace trimmed baby dresses; even a prize winning hand painted plate can all be given to the foundation and be used by our families. Because our programs touch the hearts of so many, the gifts that are given back often come from the heart. When people ask how they can help, we encourage them to give what and how they can – it may be fresh baked bread, yarn for our knitters, bottled water for our groups, snacks for patients – or it may be money. Whatever the gift, we are grateful to the giver for sharing. Our patients are always humbled and appreciative that someone cares enough to give something to make their day brighter. And, we are thankful for the many facets of giving.
NEA Clinic Charitable Foundation ... Giving back to the community of Northeast Arkansas
Memorials 2009 Spring/Summer * Edith Allen Dr. DV Patel Roy Anderson Ms. Gladys Anderson Mr. & Mrs. Bruce Barnes Mr. & Mrs. Paul Black Mr. & Mrs. Jake Morse Ms. Amy Privett Ms. Mary Wegert Mrs. Shari Wilson NEA SHRM Walter Anger Dr. & Mrs. Ray Hall Dr. Michael Isaacson John Barber Dr. & Mrs. Ray Hall Esther Bayless Dr. Michael Isaacson Opal Bone Dr. & Mrs. Mark Stripling Ralph Brasher NEA Clinic Administration & Foundation Staff
*Donations given from January - July 2009
Edna Burton Dr. Michael Isaacson Conley Caroline Mr. & Mrs. Derek Falls Sadie Carter Dr. DV Patel Willa Creecy Dr. DV Patel Rosemary Barone Davis Mr. & Mrs. Rusty Acebo Dr. & Mrs. Brad Bibb Mr. & Mrs. Jim Boswell Mrs. Donna Bowren Mr. & Mrs. Barry Carlton Mr. & Mrs. Rusty Chambers Dr. & Mrs. Ray Greaser Dr. & Mrs. Ray Hall Mr. Michael Hallmark Mr. & Mrs. Larry Holden Mr. & Mrs. Doug Imrie Dr. & Mrs. Bruce Jones Dr. & Mrs. David & Betty Nichols Dr. & Mrs. Mark Stripling Dr. & Mrs. Brannon Treece Dr. & Mrs. Stephen Woodruff NEA Clinic Physicians & Admin Lipscomb & Pitts Pulaski Bank Jonesboro Regional Chamber of Commerce Mary Elizabeth Dement Mr. & Mrs. Chris & Darlene Rogers Mr. & Mrs Lonnie & Brenda Vester
Charles Dent Dr. Michael Isaacson Dwight Dunkerson Dr. Michael Isaacson Bruce Dunlap Mr. & Mrs. Phil Bridger Ms. Ruby F. Ford Dr. Michael Isaacson Sidney Gansz Dr. Michael Isaacson Jay Goodman Ms. Martha Caldwell Dr. & Mrs. Ray Hall Ann Gookin Loyd & Johnnie Wood Lottie Greer Dr. Michael Isaacson Mr. Melvin Griffin Dr. Michael Isaacson Bobbie Guntharp Dr. Michael Isaacson Allen Hardin Dr. Michael Isaacson Kay Harrison Dr. Michael Isaacson Doris Hicks Dr. DV Patel Edith Lalman Dr. Michael Isaacson Freda Lentz Dr. Michael Isaacson Ronnie Loven Dr. DV Patel Ricarda Marshall Dr. Michael Isaacson Norma Martin Mr. & Mrs. Ernest Chittick
Honorariums - 2009 Spring/Summer * Mr. & Mrs. Jerry Blanton Ms. Charlotte Faulkner Cardio Partners Dr. Michael Isaacson
Community Advisory Committee NEA Baptist Memorial Hospital NEA Clinic Central Billing Office Professional Credit Management
Jack McCann Dr. & Mrs. Ray Hall Ray McClintock Dr. Michael Isaacson Deborah McGue Mr. & Mrs. Leonard Lamberth Tammy Parker Dr. DV Patel Ruth Puryear Dr. & Mrs. Ray Hall Robert Robinson Dr. & Mrs. Mark Stripling Jimmy Simino Dr. Michael Isaacson Thomas Snell Dr. Michael Isaacson John South Dr. DV Patel Glenda Stayton Mr. & Mrs. Rusty Acebo Mr. & Mrs. Scot Davis NEA Clinic Physicians & Employees Isabel Grace Stonecipher Mr. & Mrs. Kevin Orr Parker Gavin Taylor Mr. & Mrs Gary & Dean Austin Ms. Donna Kay Austin Mr. Cliff Hufstedler Ms. Dina Hufstedler Mr. & Mrs. Al & June Kerley Ms. Martha Nemwan Mr. Harold Rose AC & Willa Dean Shaver Maynard Church of Christ Mr. Eugene Young Dr. Michael Isaacson
Stacey Orr Mr. & Mrs. Derek Falls
The perfect gift for any occasion!
Contribute a Memorial or Honorarium mail it to NEA Clinic Charitable Foundation PO Box 1960, Jonesboro, AR 72403 or make online donations at www.neacfoundation.org
33. NEA HEALTH • Fall/Winter 2009
Toasted Pumpkin Seeds Seeds of one pumpkin 2 Tbsp olive oil (or oil of choice) Salt DIRECTIONS 1. Preheat oven to 350 F. 2. Line a cookie sheet, large enough to accommodate all pumpkin seeds in one layer, with aluminum foil or parchment paper. 3. Toss pumpkin seeds and olive oil in a bowl until seeds are thoroughly covered. Spread seeds on prepared cookie sheet. Salt seeds generously. 4. Roast seeds for 15 to 20 minutes, or until the edges of the seeds are just starting to get brown and seeds are crunchy. Taste and salt again, if desired. Serve immediately, or store at room temperature in an airtight container. They should keep for a week or more, though they'll likely be gone much sooner. Variations: Looking for a twist on traditional pumpkin seeds? Sprinkle pumpkin seeds with a little curry powder, brown sugar, or powdered ginger along with salt before you put them in the oven.
Banana Chocolate Chip Muffins (Serves 12 - Calories per serving: 200 )
1 cup all-purpose flour 1 cup whole-wheat flour 1/2 cup rolled oats 2 teaspoon ground cinnamon 2 teaspoon baking powder 1 teaspoon baking soda 1/2 teaspoon salt 1 ripe banana, mashed 1/4 cup chopped walnuts 1/2 cup light brown sugar 2 tablespoons vegetable oil 2 large eggs 1 1/4 cups reduced-fat buttermilk 1 teaspoon pure vanilla extract 2 tablespoons chocolate chips 34. NEA HEALTH • Fall/Winter 2009
Seared Plums
4 plums, cut into ½-inch wedges 6 springs of thyme 2 tablespoons balsamic vinegar 1 ½ teaspoons honey ½ teaspoon kosher salt 1 teaspoon freshly ground black pepper
DIRECTIONS 1. Preheat the oven to 400 F. 2. In a bowl, combine all of the ingredients and set aside for 10 minutes. 3. Heat a nonstick ovenproof skillet over medium heat, add the plum mixture, and cook 30 seconds to 1 minute, until the surface of the plums are seared and caramel-colored. 4. Transfer the plums to the oven and bake for about 10 minutes, or until the plum skins are just beginning to break and the color is vibrant.
DIRECTIONS1. Preheat the oven to 400 degrees. Line a 12-muffin tray with paper liners. Set aside. 2. In a standing mixer, combine the all-purpose flour, whole-wheat flour, rolled oats, ground cinnamon, baking powder, baking soda, salt and mashed banana, and blend on low speed for 2 minutes. Add the walnuts, brown sugar, vegetable oil, eggs and reduced-fat buttermilk, and blend for 2 minutes on medium speed. Add the vanilla extract and mix until well combined. 3. Using an ice cream scoop, portion the batter evenly into the muffin tin, and top each muffin with 3 to 4 chocolate chips. Bake at 400 degrees for 15 minutes. Once muffins are baked through, remove them from the oven and let cool. Serve.
Vegetables in Disguise The idea of hiding healthy foods inside kidfriendly, delicious treats may seem like a miracle for anyone whose children turn up their noses when its time to eat their veggies. There are recipes by the dozens of this so-called sneak attack that hides healthy vegetables in common kid food. If you still haven’t heard of this phenomenon, thumb through Jessica Seinfeld’s book, Deceptively Delicious or a similar read, The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids' Favorite Meals by Missy Chase Lapine. You’ll find recipes that call for common vegetables to be blended in a food processor and baked right into kids’ favorite munchies. This is one sure way to guarantee your child is soaking up all the nutrients they need for their growing bodies. Before you know it, you’ll be serving up brownies with spinach, macaroni and cheese with cauliflower or even chicken nuggets with broccoli or beets! – Laura Taylor, NEACCF Center For Healthy Children Manager
Survive the Holiday Candy Craze:
1. Ask your kids to sort out their favorite treats and donate the rest to their classroom or a local church or daycare. 2. Keep their tasty treats in the kitchen and instruct them to always ask before eating any. This way, you can monitor the amount of candy they consume in a day.
3. Take some of their treats to your coworkers, customers, patients, etc. for gifts. 35. NEA HEALTH • Fall/Winter 2009
EXERCI FLU FRUITS FUN GRAINS ABITS HEALTHYHAR Historic Downtown Jonesboro, AL HOSP- IT Live Music - Vendors — Kid Zone Bike Show - Food HYDRATED HYGIENE TIONS IMMUNIZA NEA Clinic - Woodsprings MEDICINEClinic K 2205 W. Parker Rd., AR MILJonesboro, K MIL MUSCLE NEACLINIC Win This NURSE Harley-Davidson SAFETY SANITIZE FLSTC Heritage ES SUNGLASS Softail Classic! SH TOOTHBRU Don’t have to be present to win TE TOOTHPAS VACCINE www.bikerclassic.com ES VEGETABL VITAMINS for Fundraiser R WATED.A.R.E. JPD XRAY
Downtown Festival - June 4
to ride
0 1 ‘ C I S S A BIKER CL
Charity Bike Run - June 5
Thanks Harley-Davidson of Jonesboro, Inc.
NEAHealth Tip - Provided by CDC Medical employees mention this ad to receive your discount!
Traveling During the Flu Season http://PandemicFlu.gov/ Know when you should avoid travel. If you are sick with symptoms of influenza-like illness, you should not travel. Be prepared for health screenings at airports. Airport staff in some countries may check the health of arriving passengers. You can prepare for travel by educating yourself about the outbreak situation and screening procedures in your destination country or countries. Know what to do during and after your trip. During your trip, follow local guidelines and practice healthy habits. Read more about traveling during flu season on
http://PandemicFlu.gov/
36. NEA HEALTH • Fall/Winter 2009
ANESTHESIOLOGY
HOSPITALIST
OTOLARYNGOLOGY (ENT)
Alfonso Aquino, MD Oksana Redko, MD Ross D. Andreasson, MD Larry L. Patrick, MD 3024 Stadium (870) 972-7390
William Hubbard, MD Robert B. White, MD Brock F. Harris, MD Kara Cooper, MD Matt Quick, MD 3024 Stadium (870) 275-2916
Bryan Lansford, MD Anthony Bentley, DO 3100 Apache, Suite B2 (870) 934-3484
CARDIOLOGY
FAMILY PRACTICE Jonesboro J. Timothy Dow, MD Douglas L. Maglothin, MD Joe McGrath, MD James Murrey, MD Windover Clinic & Urgent Care 1111 Windover, Jonesboro (870) 935-5432 Michael E. Crawley, MD Michael E. Tedder, MD Arnold E. Gilliam, MD Stadium Clinic & Urgent Care 3003 Apache, Jonesboro (870) 931-8800 Craig A. McDaniel, MD Troy A. Vines, MD W. Scott Hoke, MD Randy Carlton, MD Nathan Turney, MD Woodsprings Clinic & Urgent Care 2205 W. Parker, Jonesboro (870) 933-9250 Tim Shown, DO Melissa Yawn, MD, MRO Jeffery Barber, DO, MRO Hilltop Clinic & Urgent Care 4901 E. Johnson, Jonesboro (870) 932-8222
INTERNAL MEDICINE
Anthony T. White, MD Michael L. Isaacson, MD Robert D. Taylor, MD, FACP Eumar T. Tagupa, MD D.V. Patel, MD Suresh Patel, MD, FACP Margaret Cooper, APN Jennifer Jarrett, APN 311 E. Matthews (870) 935-4150
Ray H. Hall, Jr., MD, FACP Stephen O. Woodruff, MD, FACP Brannon Treece, MD Carla Nix, PA Kristy Wilson, APN 311 E. Matthews (870) 935-4150
Raymond Greaser, MD Donna Bowren, PhD, APN CNS 3005 Apache (870) 933-7471
NEPHROLOGY
CARDIOVASCULAR & THORACIC SURGERY
Michael G. Mackey, MD Sara Lamberson, APN 311 E. Matthews (870) 935-4150
Brannon Treece, MD 311 E. Matthews (870) 935-4150 *All NEA Clinic Family Practice physicians see children as well.
James A. Ameika, MD Deborah Fairchild, APN 3100 Apache, Suite B4 (870) 972-8030 Michael Raborn, MD 3100 Apache, Suite B1 (870) 219-7685
Dialysis Center 3005 Middlefield (870) 934-5705
CLINICAL RESEARCH 416 E. Washington Ave, Suite C (870) 934-1006
CLINICAL ONCOLOGY RESEARCH 311 E. Matthews (870) 934-5343
EMERGENCY MEDICINE Brewer Rhodes, MD Jerry R. Biggerstaff, MD JT DeWitt, DO 3024 Stadium (870) 972-7251
ENDOCRINOLOGY Kevin D. Ganong, MD 311 E. Matthews (870) 935-4150 Diabetes Center Bilinda Norman, APN 311 E. Matthews (870) 935-4150
Osceola Kenneth Dill, MD Debbie Wilhite, APN 616 W. Keiser, Osceola (870) 563-5888
GASTROENTEROLOGY
Trumann Alison Richardson, MD Brannon Treece, MD 305 W. Main, Trumann (870) 483-6131
K. Bruce Jones, MD Russell D. Degges, MD David L Phillips, MD 800 S. Church, Suite 104 (870) 932-4875
Lake City Kristi Statler, MD 208 Cobean, Lake City (870) 237-4100 Cherokee Village Brad Bibb, MD 51 Choctaw Trace, Cherokee Village (870) 856-2862
Hearing Center Amy Stein, AuD, CCC-A 3100 Apache, Suite B2 (870) 934-3484
Michael D. Hightower, MD 311 E. Matthews (870) 935-4150
GENERAL SURGERY
HEMATOLOGY ONCOLOGY
NEUROLOGY Kenneth Chan, DO Bing Behrens, MD William Long, MD/PhD 3100 Apache, Suite A (870) 935-8388
NEUROSURGERY Robert Abraham, MD Kenneth Tonymon, MD Rebecca Barrett-Tuck, MD 3100 Apache, Suite A (870) 935-8388
PAIN MANAGEMENT
PEDIATRICS
PHYSICAL THERAPY Jeff Ramsey, PT 1007 Windover (870) 336-1530
PLASTIC & RECONSTRUCTIVE SURGERY W. Tomasz Majewski, MD Melanie Greeno, ICT 3100 Apache, Suite B3 (870) 934-5600
PODIATRY Chris Rowlett, DPM 1007 Windover (870) 932-6637
OBSTETRICS & GYNECOLOGY
PULMONOLOGY
Charles L. Barker, MD, PhD, FACOG Mark C. Stripling, MD, FACOG Charles C. Dunn, MD, FACOG Norbert Delacey, MD, FACOG Michael Hong, MD, FACOG Lorna Layton, MD, FACOG 3104 Apache (870) 972-8788
RADIOLOGY
OCCUPATIONAL MEDICINE Melissa Yawn, MD, MRO Jeffery Barber, DO, MRO 4901 E. Johnson (870) 910-6024
OPHTHALMOLOGY
William Hubbard, MD Meredith Walker, MD 311 E. Matthews (870) 935-4150
Jeffrey S. Mullen, MD 3100 Apache (870) 934-3533 John K. Phillips, MD Gregory Lewis, MD 3024 Stadium (870) 972-7000
RHEUMATOLOGY Beata Majewski, MD Leslie McCasland, MD 311 E. Matthews (870) 935-4150
Joseph George, MD James Cullins, OD 416 E. Washington, Suite B (870) 932-0485
David Nichols, MD 1118 Windover (870) 336-4145
ORTHOPEDIC SURGERY
VEIN CENTER
Jason Brandt, MD Henry Stroope, MD 1007 Windover (870) 932-6637
WELLNESS CENTER
Ronald J. Blachly, MD D. Allen Nixon, Jr., MD Carroll D. Scroggin, Jr., MD Stacia Gallion, APN 311 E. Matthews (870) 935-4150
SLEEP MEDICINE
Michael Raborn, MD 3100 Apache, Suite B1 (870) 219-7685 2617 Phillips (870) 932-1898
WOUND CARE CENTER James Fletcher, MD NEA Clinic - Windover Clinic (870) 935-543
A location near you open 7 days a week
Paragould Chris McGrath, MD Kenneth Tonymon, MD (Neurosurgery) David L Phillips, MD (General Surgery) Sarah Hogan, APN Paragould Clinic & Urgent Care 4700 West Kingshighway, Paragould (870) 240-8402
No Appointment Necessary
WOODSPRINGS 2205 W. Parker Rd. (870) 910-0012
Call 870-935-NEAC
WINDOVER 1111 Windover (870) 935-9585
STADIUM 3003 Apache Drive (870) 931-8800
HILLTOP 4901 E. Johnson (870) 934-3539
PARAGOULD 4700 W. Kingshighway (870) 240-8402
DOC+FINDER
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LATE NIGHT URGENT CARE 1111 Windover (870) 910-6040 open late Mon - Fri
w w w. n e a c l i n i c . c o m
Jake - born August 2009 at NEA Baptist
Delivering an exceptional experience.
NEA BAPTIST WOMEN’S CENTER — NEA Baptist is dedicated to making sure every birth is a beautiful beginning. That means a compassionate, highly trained maternity staff that’s with you throughout labor and delivery. And technology like Safe Place®, a computerized infant security system in the nursery that tells us where your child is at all times. But our care doesn’t begin and end in the delivery room. Our breastfeeding and lactation consultants will help make sure you and your baby get off to a good start together. And if you want guidance during your pregnancy, log into www.HerBaptist.org and subscribe to the My Baby Expectations e-newsletter. You’ll get free month-by-month information about the changes you’ll experience, delivered right www.neabaptist.com
to your inbox — all the way through your baby’s first year. It’s all part of the benefit of NEA Baptist.