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CONTENTS APRIL 2017 1 0 Stem Cell Therapy lor COPD
22
Carpal Tunnel Syndrome
12
23
Raise Oral Cancer Awareness
24
Breakthrough l aser Neuropathy Treatment
25
The juice Revolution in Nashville
Pelvic Physical Therapy and Rehabilitation
1 3 Can Yoga Help Those Undergoing Chemotherapy?
14
16 18
Early Detection of All Cancers is Vital
am both proud and excited to be the new owner of this well known, popular and long established magazine. For nearly seven years, Health and Wellness has kept the people of Nashville and surrounding areas informed of the latest health· care developments in the region.
I
26 Women with Chronic 28
'I Can't Focus ... What's Wrong with Me?'
Choosing an Oral Surgeon The Causes of Miscarriage
Need to Improve Your Sex life? Read These Books!
30
Relating to a Ch ild with Asperger's Syndrome
31
Spiritual Well ness: Mission in My Words: Chris Tomlin
CONTACT US Middle Tennessee Health & Wellness Magazine can be found in over 1,000 Middle Tennessee medical facilities, including: hospio:als, doaor. chiropractor and dental offices. Find a oopy of your FREE Health & Wellness Magazine in Davidson, Rutherford, Sumner and Williamson Counties. To get your arricle published and for ad rates, call 615·714-3051 MillieStubblefield@gmail.com ~Millll£ TENESSUHEAI.TH &W!WESS Magal.nt 2017. All'lgtQ ~ iltiOn
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To achieve this, we will be increasing the size of the magazine and creating more educational, enter· taining and informative anicles. In due course, our website will reflect these changes as well as being updated on a daily basis. I hope you enjoy the new look and
It is a legacy that I hope, no intend, to build upon as I take over the reigns as Publisher. There is so much happening in the health, wellness and fimess sector at the moment, it is our job as magazine and website owners to keep you, our valued readers, abreast of these changes.
Pelvic Pain
Nashville: A City Working Hard to Improve Itself
20 What to Know Before 21
Welcome from the new owner of Middle Tennessee Health & Well ness
Paul Rowney Publisher paui Ophrmedia.com 615-457·2816 Millie). Stubblefield Account Executive milliestubblefieldOgmail.com 615-714-3051 Christiana Muir Reporter, Reviewer christianaC!'phrmedia.com Scoll Stubblefield D•stribution Manager ssstubbOgmail.com Lorrie Ritchie Editor lorricritchieOgmail.com Sonny Grensing Graphic Design sonnygrensing®yahoo.com 5
new content as we develop the magazine for your greater reading pleasure. Paul Rowney Publisher
Local and National Health and Wellness News
A good sex life could increase work productivity
RESTAURANT REVIEW: CHRISTIANA MUIR
and joy
The Margot Cafe, Nashville While the restaurant used to be a filling station, it certainly doesn't look like it. Upon entering Margot Cafe, you will find a two story dining area with a bar in the center, a covered patio and garden outside, soft music, and a friendly staff. The potS and china hanging on the exposed brick walls combined with the open lighting help make the restaurant feel welcoming and intimate. The menu is specially created for that day. Owner and Chef Margot McCormack is passionate about creating dishes that are fresh and locally sourced . Bold and interest¡ ing flavors such as pizza with leeks and goat cheese or golden beetS with avocado mousse and grapefruit can be found on the menu. The menu offers appetizers to share ($3-$12), first course options ($6-$12), and second course optio ns ($18-$26). There are also dessert and drink menus. On my visit, my partner and I started off the night by ordering a glass of LaTour red wine ($12.50) and a peach bellini ($8). We shared an appetizer of "Herb Infused Olive Oil with Balsamic Vinegar and Parmesan" ($3). This was a plate of flavorful olive oil with spices and onion slices alongside fresh bread from the bakery. The focaccia bread was freshly baked and addictive.
Healthy sex life increases productivity at work, study finds A good sex life could increase productivity and joy in the workplace, acoording to a new study by The Cable Lifestyle. The study carried out at Oregon State University's College of Business says that maintaining a healthy sex life will help employees stay happy and engaged in their work. The study observed 159 married employees daily for two weeks. Those who had sex were found to be in a better mood at work the next day; which led to higher levels of work engagement and job satisfaction.
For dinner, we ordered two items off of the second course section: "Southern Natural Farms Flatiron Steak with Escarole, Crispy Red PotatOes & Parmesan Anchovy Dressings" ($25) and "Grilled Cobia with Wilted Romaine, Bacon Vinaigrette & Garlic Breadcrumbs" ($26). The steak was cooked as ordered and presemed beautifully. The grilled cobia was famastic. For dessert, we shared "Pomegranate Sorbet with a Pecan Lace Cookie" ($5) and a small french press coffee ($3). Our coffee was french pressed and poured at our table. Our gourmet meal for two including drinks, an appetizer, two main course dishes, a dessert, and coffee cost $88.24.
"We make jokes about people having a 'spring in their step,' but it rums out this is actually a real thing and we should pay attention to it," said study author Keith Leavitt, an associate professor ar Oregon State University's College of Business. He noted that sex triggers the release of hormones involved in feelings of reward, social bonding and attachment. For a full review of the study, go to www.lifestyle.thecable .ng.
20 micro homes for homeless
planned in south Nashville A community of 20 micro homes that will provide bridge housing for homeless people is planned on the campus of Glencliff United Methodist Church in south Nashville, write Getahn Ward and Holly Meyer, USA TODAY NE1WORK - Tennessee. Open Table Nashville, a nonprofit group that advocates for low-income, affordable housing, is leading the effort "Too many of our friends have died on the StreetS," said Open Table Nashville Executive DirectOr Rev. Ingrid Mdntyre.
Margot Cafe is open for dinner Thesday-Saturday (5:30-IOpm) and Sunday Brunch (Jiam-2pm). Margot Caft is closed on Sundays after brunch and Mondays. Margot Cafl. & Bar is IOC<Jted at 1017 Woodland Street Nashville, TN 37206 www.margotcafe.com Tel: 615 227 4668 6
"Hopefully; this place will help by providing community and programs that will get the most vulnerable into permanent housing." A full-time care coordinator will be onsite at the Village at Glencliff working to provide residentS with mental and physical health care and to help them with eventually securing permanent housing. To learn more about this project or to become a home sponsor, visit www.tenncsscan.com.
Local and National Health and Wellness News
Real dark chocolate offers incredible health benefits
NUTRITION FOR A HEALTHY LIFE
A beginner's guide to the
most important vitamins
14 incredible health benefits of eating dark chocolate Dark chocolate is not a guilty pleasure; it actually comes with many health benefits, writes Jacky MiUer with EcoWatch.com. Real dark chocolatenot processed and sweetened milk chocolate-is chock-full of incredible health benefits. Some nutrients are destroyed in the process of making chocolate available for the general marker. Check the label: Chocolate with a 60 percent or higher cocoa content is packed full of
By Karina Hammer, Certified Holistic Wellness Coach
Vitamins are essential nutrients that are required by the body to perform hundreds of functions, such as immunity, metabolism and digestion. Let's go over these micronutrients, where you can find them in nature and what you will experience if you are deficient.
nutrients and antioxidants. Often called bittersweet, it has minimal sugar. The best way ro get all the nutrients from chocolate is simply to use unsweetened cocoa nibs. The bitter, crunchy; seed-like snack isn't the best-tasting treat, but its nutritional profile makes it worthwhile. For derails about how dark chocolate helps in each of these 14 ways and to try three delicious dark chocolate recipes, visit www.ecowatch.com.
• Vitamin A: essential for eye and reproductive health · Sources: orange vegetables and leafy greens • Deficiency: leads to impaired
vision and reproductive problems
• 8 Vitamins: energy metabolism and the breakdown of glucose Vitamin B is actually a collection of 8 separate
vitamins. Some examples: · Vitamin 89: also known as folate, required for proper cellular function and growth -deficiency can lead to digestive dysfunction, depression, fatigue, and failure to thrive - Vitamin 812: vital for nervous system and brain function - deficiency leads to fatigue. depression, shon-tenn memory. Pernicious anemia, an autoimmune illness, can cause chronic shortage of B12
Why men should go for therapy and why they don't Why do men give therapy the cold shoulder? Probably for the same reasons that most men won't see doctors or other health specialists, writes Sean Swaby for the Goodmen Project. According to the American Psychological Association, men are 25% less likely to see their health professional and almost 4QOA> less likely to get their cholesterol checked . When it comes to their psychological needs, men seek out therapy half as
• Vitamin C: needed for healthy iron levels, proper immunity, and circulation - Sources: leafy greens, fruits (especially citrus), berries
- Deficiency: bleeding from mucus mem· branes, anemia, depleted immunity, scurvy
often as most women, said Ronald Levant, EdD, Professor of Psychology at the University of Akron. "Being a man can stack the odds against good health because many men have poor overall health behaviors and th en we prefer to see our local bartender rather than our local doctor," says Swaby. For a list of ways men can improve their mental health, read the full article a t www.goodmenproject.com.
• Vitamin D: an integral nutrient for improving a bsorption of calcium, and thus affects bone growth; also boosts inununity and liver function - Sources: mostly sunlight exposure to skin; red meat, seafood, fortified foods, and some edible mushrooms - Deficiency: muscle, joint, and bone weakness, pain, or fatigue
• Vitamin E: an antioxidant vitamin necessary for hair, skin, and nail development - Sources: healthy nuts and vegetable oils - Deficiency: impaired immunity. anemia. neurological and neuromuscular problems 7
• Vitamin K: needed to work with protein for best development and strength of blood vessels · Sources: leafy green vegetables: kale, lettuce, dandelions · Deficiency: anemia, heavy menstrual bleeding, inability for blood to clot, bleeding from mucus membranes
• Iron: necessary for proper transport of oxygen through blood vessels, and to ramp up healthy immunity · Sources: red meat, dark leafy greens, mushrooms, black scrap molasses · Deficiency: anemia, low energy. fatigue, pallor
• Zinc: modulates inflammation in many organs all throughout body; also helps strengthen immunity . Sources: meat, shellfish, vegetables and legumes . Deficiency: decreased immunity, low fertility, weight and hair loss • Iodi.ne: necessary for thyroid health and function · Sources: ocean seafood, seaweed and kelp · Deficiency: decreased thyroid function, hyper/hypothyroidism Vitamins are essential for our growth and function. The best way to ensure that you are getting all the vitamins that your body needs is by eating a variety of real, whole foods. Karina Hammer is a Nashville based IAWP Certified Holi$1ic Wellness Coach,
Co-Host of the Magnetic Heart Radio Show, Wellness Expert, Writer, Speaker and Educator. She can be contacted at : ~Vlvw.facebook.conJ/karin ahamm er
health@karinahammer.com.
or
Local and National Health and Wellness News
Juicing: a growing trend
John and Vui Hunt have built a thriving healthy food empire with 40 1 Love Juice Bar locations, successful Viet· namese restaurant Vui's Kitchen in Nashville and the newly opened City Silo Table & Restaurant in Memphis, writes Lizzy Alfs with USA TODAY.
PERSONAL ADVICE: ASK LISA
The first I Love Juice Bar debuted in Brentwood in 2013. The juice bar serves juices and smoothies packed with vegetables, fruit and super· foods. A food menu includes grab· and-go items such as overnight oats, almond butter sandwiches, spring rolls, hummus and veggies and kale quinoa salads. I Love Juice Bar's success renects a national rrend as consumers, espe· cially millennials, demand to know what's in their meals and where their food was grown. Read about their journey at www.tennessean.com. And for a great article on juicing, check out page 25 in this issue.
Are you listening to me? Practical advice for everyday problems from top local Psychologist, Or. Lisa Webb
Q: My husband never listens to what I have to
say. He says he "hears me" but then he does whatever he wants anyway. How can I get him to pay attention? Although my answer may seem con· tradictory to what you are asking, I would say the first thing to do is to check your own listening skills. Communication between couples is a delicate thing. We each have our own way of communicating. We expect our significant other to pick up on all of our cues, both verbal and non-verbal, and know exactly what we are saying. This is the fll'St step in communication breakdown: we do not come with the power of mind reading. Men and women have very specific communication sryles. Rather than building a marriage on mind reading and the guessing game, rrue communication can lead to knowing each other's needs and happily working tOgether to fulfill them.
Eating more - or less - of 10 foods may cut risk of early death, report claims About half of all U.S. deaths from heart disease, stroke and lYpe 2 diabetes are linked to poor diets, according to a new srudy published in the Journal of the American Medical Association, writes Allison Aubrey. And eating more - or less - ofjust 10 types of food can help raise or lower the risk of death from these causes. Scientists at Thfts University identi· fled the foods that seem to contribute the most to the risk. At the top of the list? Salt. Consuming too much salt was associated with 9.5 percent of the deaths.
Next: high intake of red meat and processed meats such as bacon was linked to eight percent of the deaths. And sugary drinks were a factor in 7.4 percent of the deaths. The srudy also found that low con· sumption of nuts and seeds was linked to about nine percent of deaths. In addition, diets low in seafood, whole grains and fruits and vegetables were found to contribute to about 6-8 percent of the deaths. You can read the full article at www.npr.org.
Here a re some thoughts to consider: Never say, •rm fine," unless you mean it: when your mate takes the time to ask if you are ok, they are showing love and concern for you. Make sure to give an honest and heartfelt answer when asked. Some· times we think that if we say, "I'm fine," in a not so nice way, they will read between the lines and figure out whatever has hurt us. It will 9
stick-it to our mate and make them "suffer'' just a little lo11ger for whatever it is we feel has hurt us. Listen first, fiX later: Before you start offering all of your "fix it'' ideas, ask your mate the question, "How can I help you?" They may not want anything more from you than just your listening ear. Don't feel that you have to make every· thing better. Sometimes, you can make things better just by sho,ving that you care enough to take the time to listen. Acknowledge: Within a commit· ted partnership, it is often obvious if there is conflict or if one of you is upser. Rather than ignoring the obvious, hoping to avoid confronta· tion, lovingly ask your partner what their frustrations are and be ready to listen and take responsibility in your part of the misunderstanding. The simple words "I'm sorry" have the power to save marriages.
Lisa Webb is at the Body & Mind Consulting Associates Group: www.bodymindtn.com. Her latest book: •Boardroom to Bedroom, Using your Executive Success for your Marriage" is available at www.a.mazoTLcom.
Stem Cell Therapy for COPD
The Very Greatest: The Final Fight of Muhammed Ali and the Future of Stem Cell Therapy for COPD There isn't much debate when it comes to the legacy of Muhammed Ali . He was, as he often claimed, "the greatest" boxer of his era, winning his first Olympic Gold medal at the age of 18. And, he was a rebel too. s a civil rights vanguard, he blatantly refused the draft leading tO his arrest and the stripping of his boxing titles at the age of 24. He would go on to spend five years of his fighting prime behind bars until1971. And what did he do when he got out?
A
He fought for ten more years. Despite showing signs of Parkinson's disease as early as 1979, he kept fighting until 1981. He wouldn't be officially diagnosed until 1984.
process. As these stem cells are pulled from a patient's blood or bone marrow, they can then be reintroduced into the body intravenously where they come to rest within the lungs, potentially reducing local inflammation, symptom expression and promoting healing from within. In 1996, Muhammad Ali lit the torch for the Atlanta Olympics. His arm shook throughout the entire procession. He never even tried to hide it. He didn't care. Ali was a strong advocate for
Parkinson's is a degenerative cogmtJVe disorder
stem cell therapy and its potential to treat his
brought about by the progressive loss of dopamine,
Parkinson's, but more than anything he believed
affecting the brain's motor skills and causing
in leading the path for others by championing
muscle rigidiry, slowness of movement, tremors and problems with gait and posture. Having a
his disease. He was a fighter and a consummate showman who never backed down from a
dramatic effect on the quality of life of those who
challenge. Diagnosed at the age of 42, he would live nearly
live with Parkinson's, 60,000 Americans are diagnosed with the disease every year. Although
half of his life with Parkinson's, lending his name
currently there is no known cure, stem cell therapy
and wealth to the development of a treatment that
and its ability to replicate needed cells (in this case dopamine cells) have shown great promise in
would allow those who suffered from the disease a chance to reclaim their lives.
treating Parkinson's and other quality of life
As stem cell therapy continues to develop, it too,
related conditions, such as chronic obstructive
has shown the propensity to restore hope to those
pulmonary disease (COPD). In similarity to Parkinson's, COPD is a degenera-
with few options. It has given inspiration back to those who may have otherwise given up.
tive lung disease that can have a significant effect
Despite his tough talking and raucous nature,
on quality of life, ultimately inhibiting an
Ali held a soft heart for the potentia l of every
individual's energy, mobility and ability to breathe unobstructed. Across the U.S., COPD is the 3rd
individual, once stating:
leading cause of death, affecting more than 15
will accomplish nothing in life." Regardless of the obstacles that stand before
million Americans. Fortunately, however, clinics like the Lung Institute (lunginstitute.com) are
"He who is not courageous enough to take risks
you, keep swinging.
working on it. As the field of stem cell therapy has continued to advance, our understanding of how the duplication of vital cells within the body can treat disease has increased exponentially. The key distinction of stem cell therapy compared
In the fight against COPD, stem cell therapy may just be the ace in your corner.
to other forms of treatment rests in the fact that stem cells emphasize the body's natural healing 10
If you or a loved one suffer from a chronic lung disease, the specialists at the Lung Institute may be able to help. You can contact the Lung Institute at 855-914-3212 or visit lunginstitute.conVwellness to find out ifyou qualify for these new treatments.
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Pelvic Physical Therapy
...
Pelvic Physical Therapy and Rehabilitation By Dawn Kuiper Duck, PT, OPT, Cert MOT, WHCC STAR Physical Therapy- Frankl in, TN
Pelvic physical therapy is a nonsurgical and nonpharmacological approach to the rehabilitation of pelvic problems including urinary incontinence, urinary frequency and urgency, pelvic pain (pain in the lower abdomen, peri neum, vulva/vagina), painful menstruation or cyclical pelvic pain and painful sex. This sub-specialty of physical therapy is now available at our Franklin, TN clinic ave you ever heard of pelvic physical therapy before? Generally the answer to this question is "no," but this sub-specialty of physical therapy practice can assist women with problems "down there" and is now available at our Franklin, TN clinic.
H
So what exactly is pelvic physical therapy? Pelvic physical therapy is a nonsurgical and nonpharmacological approach co the rehabilitation of pelvic problems including urinary incontinence, urinary frequency and urgency, pelvic pain (pain in the lower abdomen, perineum, vulva/vagina), painful menstruation or cyclical pelvic pain and painful sex. Pelvic physical therapy involves assessment and treatment of the musculoskeletal system of the pelvic region including the lumbar spine, hips, SI joints and pelvic girdle including the pelvic floor musculature. The pelvic floor is a muscular sling that extends from front to back and side to side of the bony pelvis. This muscular sling encircles the urethra, vagina (in women) and rectum, thereby supporting urinary continence, the pelvic organs that sit above, and sexual function and pleasure. The pelvic floor further contributes to stability of the trunk during daily activity, as well as breath and postural control through myofascial attachments. Statistics regarding pelvic dysfunction are staggering; it is estimated that 25 million American adults suffer from incontinence (National Association for Continence) and 1 in 7 women suffer from pelvic pain conditions (Herman and Wallace). Pelvic dysfunctions are commonly accepted as a normal part of the aging process, being female, or are not discussed as a result of the sensitive nature of this region and this leads to unnecessary suffering and lost quality of life.
So what goes wrong? As a parr of the aging process, disuse, pregnancy/childbirth, trauma, obesity, chronic constipation, chronic straining, lifesryle stressors and/or surgical interventions, and changes in the pelvic floor musculature can occur. These changes can result in long and weak, short and tight, poorly coordinating, painful pelvic floor muscles which can translate into the pelvic floor dysfunctions j ust mentioned.
What can you expect during pelvic physical therapy? Initial visits include a conversation regarding your signs and symptoms followed by a physical exam which may include an internal exam of the pelvic floor musculature. While most individuals understand and accept assessment of the musculoskeletal system of the low back and hip regions, musculoskeletal assessment of the pelvic floor is still a largely taboo subject and many people question if an internal exam of the pelvic floor muscles is truly a necessary part of pelvic physical therapy practice. The answer to this question is a resounding yes! How can we prescribe interventions if we do not know how the muscles are functioning? Do we need to strengthen or lengthen? Do we need better muscular coordination? Are the muscles spastic requiring release and relaxation? We must determine actual function before implementing a strategy. The position statement from the American Physical Therapy Association on Women's Health stares, "Internal vaginal and rectal assessment and treatment of pelvic floor dysfunction is within the scope of practice of the licensed physical therapist" (www.womenshealthapta.org). Once examination of the peripheral joints and pelvic floor muscle function has occurred, a treatment plan will be outlined and discussed. 12
Treatment options Treatment approaches in pelvic rehabilitation may include education, therapeutic exercise, behavioral strategies, modalities such as biofeedback or electrical stimulation, functional re-training, external and internal manual therapies and lifestyle factor modification . Patient participation in pelvic physical therapy is crucial to success. Are you one of the millions of Americans suffering from a pelvic floor dysfunction? Don't you owe it to yourself to explore interventions that can improve your pelvic region difficulties and thereby improve your quality of life? Take action now and seek a pelvic physical therapy referral from your healthcare provider and begin your journey to optimal pelvic health and wellness. The Women's Health Pelvic Physical Therapy program is currently available exclusively at our Franklin, TN clinic. Call today to schedule an appointment or to learn more, 615-591-8480. Dawn is a caring and compassionate physical therapist committed to assisting patients in addressing their pain problems, thereby improving their health, wellness and quality of life. Dawn graduated with an undergraduate degree in Exercise Science in I 996 from The University of
Toledo and a Doctor of Physical Therapy degree from The Arizona School of Health Sciences in 2002. Secondary to personal drive for ongoing professional growth and development, Dawn pursued certification in Mechanical Diagnosi$ and Therapy (MDT) through The McKenzie Institute for greater understanding of mechanical or movement based pain assessment and treatment. She earned her certification in MDT in 2015. In an effort to provide more patient centered and integrative physical therapy services, Dawn received a health coaching certification through The Integrative Women~ Health Institute in 2017. Dawn is an avid Ieamer and is currently pursuing the pelvic rehabilitation provider certification through Herman and Wallace Pelvic Rehabilitation Institute. Dawn may be reached at our Franklin clinic at (615) 591-8480. STAR Physical Therapy - Franklin 211 Bedford Way, Franklin, TN 37064 615-591-8480
Formerly
Ctlm~rlanc/Broin
and Spine
PINNACLE Surg i ca l Par t ners
Chris Taleghani, M.D., M.B.A.
LJ Chronic Bronchitis
D COPD
D Pulmonary Fibrosis
n Emphysema
n Interstitial Lung Disease
Your stem cells may enhance your quality of life.
New Name. Some ConlfKIS.\it»wte, Comprelwm·iw, Com xmient Care.'
Our growing practice allows us to offer our patients enhanced services and additional resources. It is our goal to understand what is happening, educate our patients, and offer the best treatment options-all while providing a positive experience for patients during a stressful time. Our multidisciplinary approach will exhaust all possible operative, non-operative, and alternative treatment options.
FOR PATIENTS WITH:
Stem cell therapy is a minimally invasive, outpatient option that may restore lung function and improve quality of life.
I
AREVOUACANDIDATEFORTREATMENT? TAKE THE FIRST STEP AND CALL!
(855) 914-3212 Lunglnstitute.com/Wellness
....
~
~
ill
Lung Institute
NATIONAL LOCATIONS I TE NN ESSEE LOCATION::
2001 Mallory Lane, Suite 302, Franklin, TN 37067
BreW~e~.
Michelle Michael
John Ray Clemmons
John Hudy
Ryan Fann
Charlotte Pikkert
I enjoy the options Nashville has to offer. There is always something to do or somewhere new to eat. I love to support local restaurants, and I especially enjoy shopping at the Farmer's Markets. We have professional sports and college sports. My family frequently visits the parks: Radnor Lake, Percy Warner, and Crockett Park in Williamson Co. Nashville is diverse, it has a lot to offer it's community. What could be done to make it even better? I don't have a solution for this, but maybe we need better public rransportation.
Our town is a proudly diverse and progressive city that welcomes all families and businesses with open arms and respects the respective contributions that each and every one can make to our community. We have the educational institutions, ans, and cultural amenities of a big city while maintaining a relatively small town atmosphere, making Nashville unique. We must constantly strive to improve the quality of life for every Nashville family. because our city will never reach its full potential until and unless every resident in our town has an equal opportunity to reach his or her full potential . We must also continue to develop and provide better public transportation options for our working families.
Mayor Barry's doing a lot of work on infrastructure with bike paths, parks, and green space. I think there's a lot of green space and bike paths already around the city that people don't realize we have out there and don't take advantage of. Being a sports town, we have a lot of ways for people to be active in some kind of sport. We have a wide opportunity of places you can go to work out. A smaller town might not have as many opportunities for group fitness. I think we need more sidewalks to get people running. Concrete may not be the best surface to run on, but we need to get people out and walking. More people need to know about the greenways and the opportunities they have to get outside.
Just like Amputee Blade Runners, there are a lot of other organizations that promote healthy lifestyles, and I think tha~s important to have different avenues to educate people on the importance of living a healthy lifestyle because there are so many people who are just unaware of what different diseases can do to your body. I think the presence of organizations that promote a healthy lifestyle is a great benefit of Nashville. I think Nashville could be more aggressive about educating the parents of children. If you educate them, then hopefully the knowledge will transcend down to children creating a posmve domino effect. We've got to figure out how to attack that and make that a little better.
Nashville is very much up to date with health. I think Nashville stands out because it is an artisan city, with a variety of food and not just traditional southern food. There's Thai, Lebanese and Indian food to name a few places that show how Nashville has a wide range of healthy options, but the artisan parr is what I think makes Nashville stand out the most. I have never been in another city that has been so creative with food. I think Nashville does a good job in terms of health except maybe we could work on programs for health in low income areas, not just the Brentwood and Green Hills areas.
John Hudy is a Lipscomb professor and the strength and conditioning coach for men's and women's basketball.
Eo/an Fann is a co-founder of local charity Amputee Blade Runners and a former Paralympic athlete.
Michelle
Michae~
Lipscomb
University Nutrition associate
professor, Assistant Director of the Dietetic Internship Program, and Tennessee Outstanding Dietetics Educator of the year.
John Ray Clemmons is the Democratic Representative for District 55, Davidson County.
17
Charlotte Pikkert is a student at Lipscomb University, a dietetics major and blogger. Comments and quotes
sourced by: Whitney Smith
Treating Adult ADHD
'I Can't Focus ... What's Wrong with Me?' By Heather Horton, MD, Neurologist
ADHD - attention deficit hyperactivity disorder - is the official, medical term for what was once called ADD. The condition affects approximately 10 million adults. In this article, we'll look at how the condition is diagnosed and the options for treatment.
'I
have difficulty focusing, but I am too old to have attention deficit hyperactivity disorder ... that only affects children ... PLUS, I am NOT hyper.' This is a misconception of the past. People with ADHD do not have to be outspoken, boisterous or physically active. They certainly do not all have 10 be children. ADHD affects approximately 10 million adults. Most of these adults suffer with the symptoms of this condition and are unidentified; therefore, they are untreated and are attributing their symptoms to another source lead ing to a diminished quality of li fe.
How do I know if my patient has ADHD? There are screening tools to help hone in on these patients. The World Health Organization Adult Self-Report Scale (ASRS) screener can be completed in office. If a patient endorses 4 of the 6 symptoms significantly, then formal diagnosis should be sought from a physician, trained in ADHD, that can perform a thorough evaluation.
What are my treatment options? Medication alone is not sufficient to help a person improve his or her problems with organization, time management, prioritizing and using cognitive aids, but it does improve attention and reduce impulsivity in adults who have been correctly diagnosed with the condition. Medication comes in the form of stimulant and non-stimulant. Both classes are used to enha nce brain activity.
Stimulams/psychostimulants are the most widely used medication for the management of ADHD symptoms in adults and children. The two most commonly used are methylphenidate and amphetamines. ADHD medications approved for adults include: methylphenidate; Focalin, Focalin XR; Concerta; Daytrana; Metadate Cf; a nd the a mphetamines, Adderall XR and Vyvanse. Short acting formula tions last approximately 4 hours, necessitating multiple doses throughout the day; whereas, long· acting preparations last up to 10-12 hours and are associated with fewer 'ups and downs,' meaning you can take the medications one to two times daily. Your physician can tailor a regimen best suited for your needs depending upon your daily routine and schedule. The most common side effects are loss of appetite, weight loss, sleep problems, headaches and jitteriness. They are known to potentially worsen psychiatric conditions like depression, anxiety and psychosis. Non-stimulant options also exist, but are consid· ered second-line (people with incomplete or failed response to stimulant agents), except for atomoxetine (Strattera). Whereas the effecrs of the stimulant are almost immediate, atomoxetine takes a longer time to produce a response, on occasion up to 6 weeks. Side effects include, but are not limited to, increased heart rate, increased blood pressure, dry mouth, difficulty sleeping and decreased appetite. Other options, a lthough not as widely used in adults, include Clonidine and guanfacine. Side effects of th ese medications include sedation 18
and potential for rebound hypenension (elevated blood pressure). Some physicians will also prescribe antidepressants to treat the symptoms if other psychiatric illnesses affect the patient (depression, anxiety).
Better equipped to treat adults withADHD The belief that ADHD/ADD only affects children is a thing of the past. Clinicians now know better and are better equipped with resources to treat their adult patients that present with complaints of difficulty with concentration, restlessness, poor memory, difficulty completing tasks, etc. Do not be ashamed to d iscuss these symptoms with your provider because we arc here to help. It is important to find a provider that is trained and experienced with the diagnosis and management of adult onset ADHD to set yourself on the path to improvement. Our neurologists here at KCA Neurology are rrained in the diagnosis, treatment and management of not only attention deficit hyperactivity disorder, but adult attention deficit hyperactivity disorder. We can assisl you and your primary care physician through the process and put you on a plan to improvement so that your life is yours again. To learn more or to schedule an appointment in our Franklin or ClarksviUe office, please call 615-550-1800, or visit us online at www.kcaneurology.eom.
Heather D. Horton, MD, Nl!urologist Dr. Horton joined KO\ in September of 2016. Her areas of expertise include migraines, seizures, neu· ropathy, multiple sclerosis and oorpal tunnel syndrome. Dr. /lorton can be seen in the Clarksville and Franklin locations.
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Choosing an Oral Surgeon
Trying to decide on an oral surgeon can be daunting. However, there are several resources available that can make the task much easier. Understanding your needs as a patient, along with the help and advice of your dentist, will go a long way in helping you find the right oral surgeon.
What to Know Before Choosing an Oral Surgeon By Jaime A. Romero, Jr., D.D.S.
T
o fmd an oral surgeon who best meets your needs, consider the following:
• Length of time the oral surgeon has been in practice
• Hours the oral surgeon has logged in training and clinical experience performing the procedure you need to have done • Estimated costs for the procedure and any preand post-op tream1ent plans • Diagnosis and treatment plan proposed by the surgeon Your personal dentist is a great resource in your search for an oral surgeon. Your dentist understands your situation, your history, and your surgical needs and is equipped to provide references that will best suit your needs.
There are several types of oral surgeons and practices, and each is equipped to handle specific oral care needs. Be sure you select an oral surgeon who specializes in your procedure or condition. Before settling on an oral surgeon, read your insurance policy. Depending on the type of coverage, your insurance might dictate which oral surgeon you can use. Your insurance provider should have a list of available surgeons and practices that you can choose from. Research those surgeons and facilities to find one that best suits your needs. Be proactive and thorough by researching education and experience of any potential candidates. Websites dedicated to specific practitioners and facilities can provide a wealth of information. You can find information concerning location, prices, 20
insurance qualifications, types of procedures, and specialties online. Reputable sites usually showcase customer reviews, which can be a great way to get informed feedback from other patient experiences. Look for an oral surgeon that has the right training and experience. Also, spend a little time getting to know your potential surgeon and the people who work in the office. It's crucial that you feel comfortable during these delicate procedures. Make some phone calls, do some research, even visit the facility. Find a practitioner you feel comfortable with and can trust with your oral health. If you are in the Nashville area, Solace Oral Surgery is here to help. Please call us at 615-320-1392 with any questions about our practice, and we would be happy to assist you.
Treating Carpal Tunnel Syndrome
What can I do?
Carpal Tunnel Syndrome By Christopher K. Taleghani, M.D.
Swell ing or other irritation of the carpal tunnel causes compression of the median nerve, w hich is what we refer to speci fically as Carpal Tunnel Syndrome. The most common culprit is overuse and repetition. Those w ho use their wrists and hands for repetitive work are likely to cause swelling and stress on the carpel tunnel. If preventative measures do not work, a Carpal Tunnel Release surgery is one of the most common surgical procedures performed by a neurosurgeon.
What is it? What causes it?
C
arpal 1\mnel Syndrome rakes place in the wrist. The s mall space between the wrist bone and the muscle tissue is called The Carpal Thnnel. The main nerve that passes through this small canal is called the median nerve, which conrrols feeling and sensation in the hand. The median nerve runs the length of the forearm into the hand and controls sensation in the palm, thumb and forefinger side of the hand. Swelling or other irritation of the carpal runnel causes compression of the median nerve, which is what we re fer to specifically as Carpal Thnnel Syndrome. There are various things that can cause inflammation in the carpal tunnel and lead to greater issues. Preexisting injuries or fractures may be a contributing faetor as excess swelling in the area may affect the wrist. Ufestyle or other health conditions may also be the perpetrator. Individuals with diabetes, arthritis, hyperthyroid ism as well as those who are
pregnant or obese may experience a higher chance of developing Carpal 1\mnel Syndrome. The most common culprit, however, is overuse a nd repetition . Those who use their wrists a nd hands for repetitive work such as carpenters, assembly line workers, musicians and those who work long hours at computers are likely ro cause swelling and stress on the carpel tunnel.
At the first s ign of any symptoms, it is important to see your neurosurgeon and try a few preventa¡ tive measures. U your job is repetitive, plan several work breaks during the day in which you can rest your wrist in a neutral position. lf there is any indication of swelling, icing the wrist during these breaks is also a great idea. If time limits hourly breaks, o ne could try a temporary splint or brace to wear in order to relieve stress on the fibrous tissue around the carpal runnel. Your neurosurgeon can also provide you with suggestions for Strengthening exercises and stretches to alleviate pain. If these treatment options do not work, surgery may be the next step. This surgery is called a Carpal Thnnel Release and is one of the most common surgical proced ures performed by a neurosurgeon. While there a few different techniques, this surgery involves cutting of one or more of the liga me nts ro relieve pressure a round the carpal tunnel ro decompress the median nerve. It is a fairly quick surgery and in normal cases, patients experience a full recovery within several weeks. During those weeks, it is important to continue to limit use and do the strength¡ ening exercises provided. Carpal ltmnel Syndrome can be a pain bur with the training and expertise of a neurosurgeon can be a quick and easy recovery! Dr. Ta legha ni and his knowledgeable staff at Pinnacle Surgical Partners will be happy ro share your options and walk you through the process of deciding what's best for your specific concern: 615-885¡2778.
How do I know if I have it? Compression in the median nerve may affect the palm, thumb, middle and index fingers. Any sort of prolonged tingling or numbness in this area can be the first indication that there is a n issue. Often burning or itching in the palm can accompany these symptoms, and weakness can also occur as Carpal Thnnel Syndrome digresses. Many people lose a great deal of grip Strength and are unable to carry out every day functions such as gripping a door handle or typing on a computer.
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Chris 1bleghani, M.D., M.B.A. Dr. Taleghani is a board certified neurosurgeon who specializes in minimally invasive surgery and complex spine and brain conditions. He reuived his Medical Degree at Georgetown University School of Medicine and completed his Neurosurgery Residency training at Pennsylvania State Milton S. Hershey Medical Center.
Oral Cancer Awareness Month
Alcohol Use - About 70% of people diagnosed with oral cancer are heavy drinkers. This risk is higher for people who use both alcohol and tobacco. For people who smoke and drink heavily, the risk of oral cancer may be as high as 1000h more than the risk for people who do not smoke or drink.
Raise Oral Cancer Awareness By Jean-Max Jean-Pierre, D.D.S., M.D.S., Diplomate, American Board of Periodontology
Most people don't realize that anyone can get oral cancer. Although most mouth and throat cancers have been associated with smoking and chewing tobacco, more than 25 percent of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.
A
pril is Oral Cancer Awareness Month, and in conjunction with doctors across the nation, you can share information and encourage your friends and family to have regular oral cancer screenings. Most people don't realize that anyone can get oral cancer. Although most mouth and throat cancers have been associated with smoking and chewing cobacco, more than 25 percent of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally. The fastest growing segment of oral cancer patients is young, other.vise healthy, nonsmoking individuals due to the connection berween oral cancer and the HPV virus. The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The earlier any form of pathology is found and treated, the better will be the outcome. Regular periodontal exams and cancer screenings in the office of a dentist or periodontist enable early detection. Depending on fmdings, you will be appropriately referred to a specialist for biopsy and treatment that minimizes the impact of the cancer on your life. Your dentist or periodontist should be doing an oral cancer exam at every checkup. Many clinicians offer an enhanced assessment once per year by scanning the mouth with a fluorescent light. You can also do self-examinations monthly, berween clinical exams and report suspicious changes.
Signs of Oral Cancer Because any of the following can be signs at the beginning of a cancerous growth, you should feel empowered to call your dentist or periodontist if you observe any of the following changes: • Reddish patches or whitish patches in the mouth
Sun Exposure - Cancer on the lips and face is also commonly associated with sun exposure. Applying sunscreen lotion or SPF lip balm will lower the risk. HPV - The HPV virus and other immunological disorders have been associated with increased risk. Although the incidence of HPV related oral cancer is increasing, individuals with oral cancers linked to HPV usually have a good prognosis. Periodontal Disease - Several srudies indicate an increased risk of oral tumors or precancerous lesions in the presence of gum disease, likely due to chronic irritation of periodontal gum and bone tissues. Regular dental cleanings and prompt clinical treatment of gum inflammation will eliminate this risk factor.
• A sore that fails to heal and bleeds easily
Save a life by sharing this information
• A rough spot, lump or thickening on the skin lining the inside of the mouth
Although the Oral Cancer Foundation (www.oralcancerfoundation.org) reports that 132 people in the United States are newly diagnosed with oral cancer every day and that one person dies every hour due to oral cancer, awareness in our nation is low. By sharing this article, you may save a life. Oral cancer can be detected early with regular annual or biannual screening, and even earlier with self-examination berween screenings. Lower your risk factors, support regular screenings, and don't delay in having an annual oral cancer assessment. Despite your best oral hygiene efforts, you should have your teeth professionally cleaned to remove plaque and your teeth and gum tissue examined every six months. Some individuals are at higher risk for oral health problems and are advised to visit their dentist or periodontist more frequently. For more information or to come visit us for an examination, please contact us at 615-264-6404 or visit us at www.periocarecenter.com.
• Chronic sore throat or hoarseness • Difficulty in chewing or swallowing • Numbness in the tongue or other part of the mouth • Swelling of the jaw • Unexplained pain facial or oral pain, although pain is not often associated with oral cancer
Self-examination Use a hand mirror to examine the insides of your mouth each month and feel abnormalities inside with your tongue. By using a mirror, you may detect changes on the lips, cheeks, tongue, palate, and gum tissue around the teeth. If you have a heightened risk of oral cancer, this is highly recommended.
Risk factors Tobacco Use- Up to 75% of mouth and throat canoers have been associated with smoking and chewing tobacco. The direct cause has been demonstrated to be carcinogens in the tobacco, and risk is directly correlated with the amount of tobacco used and for how long. If you smoke and are also a heavy drinker of alcohol, the risk of cancer increases more.
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Jean-Max Jean-Pierre, D.D.S., M.D.S.
Ncuhville area periodontal specialist, Dr. Jean-Max Jean-Pierre, is the author of the new book YOUR MOUTH-YOUR LIFE. He is on a mission to educate his patients and the public about the connection between oral health and systemic health. He practices periodontics in Hendersonville, TN.
Neuropathy
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Breakthrough Laser Neuropathy Treatment By Or. Sharon Roth, Roth Wellness & Chiropractic
Dr. Sharon Roth DC at Roth Wellness and Chiropractic w ill do a neuropathy severity examination to determine the extent of the nerve damage for only $45. This neuropathy severi ty examination w ill consist of a detailed sensory evaluation, extensive peripheral vascular testing, and a detailed analysis of the findings of your neuropathy. he most common method your doctor will recommend to treat your neuropathy is with prescription drugs that may temporarily reduce your symptoms. These drugs have names such as Gabapentin, Lyrica, Cymbalta, and Neurontin, and are primarily anti-depressant or anti·sei4ure drugs. These drugs may cause you to feel uncomfonable and have a variety of harmful side effects.
-· Flcure 2: The blood vessels will grow back a round the nerves much like a plant's roots grow whe n watered.
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Peripheral neuropathy is a result of damage to the nerves often causing weakness, pain, numbness, tingling, and the most debilitating balance problems. This damage is commonly caused by a lack of blood flow to the nerves in the hands and feet which causes the nerves to begin to degenerate due to lack of nutrient flow. can see in Figure 1, as the blood vessels that surround the nerves become diseased, they shrivel up which causes the nerves to nor ger the nutrientS to continue to survive. When these nerves begin to "die" they cause you to have balance problems, pain, numbness, tingling, burning, and many additional symptoms. As you
The main problem is that your dOctor has told you to just live with the problem or try the drugs which you don't like taking because they make you feel uncomfonable. There is now a facility right here in Nashville that offers you hope without taking those endless drugs with serious side effectS. In orde r to effectively treat your neuropa thy,
three factors must be de te rmined. 1) What is the underlying cause?
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Nerves Shrivel when Blood Vessels Disappear
I Flcure 1: When these very small blood vessels become diseased, they becin to shrivel up a nd t he nerves becln t o dece nerat e.
2) How much nerve damage has been sustained? NOTE: Once you have sustained 85% nerve loss,
there is likely nothing that we can do for you. 3) How much treatment will your condition require?
Th e treatment that is provided at Roth Wellness has three main goals: 1) Increase blood flow 2) Stimulate small fiber nerves 3) Decrease brain-based pain The treatment to increase blood flow utilizes a specialized infrared light therapy using light emitting diode technology. This technology was originally developed by NASA to assist in increasing blood flow. 24
The amount of treatment needed to allow the nerves to fully recover varies from person to person and can only be determined after a detailed neurological a nd vascular evaluation. As long as you have not sustained at least 85% nerve damage, there is hopei
Juicing
The growing trend for healthy drinks is sweeping over Nashville. Now many neighborhoods are featuring fresh, raw, organic, cold pressed juice. They're called 'juice bars', and they're becoming very popular. Christiana Muir (left) investigates.
Find your local Juicer: Urban Juicer:
The juice revolution in Nashville hroughout time, cultures have always found ways to use ingredientS from the earth to benefit their wellness. Many fruits and vegetables naturally contain medicinal properties that can treat a host of issues including organ function (heart, lungs, liver, and kidney), skin health, weight loss, cold/flu treatment, general wellness, and more. While there are a variety of juices available in your local grocery store, most of these drinks have been pasteurized and contain preservatives so they can have an extended shelf life. Any drink being bottled for more than 3·4 days has to go through a high heat pasteuriza. rion process, kiUing potential harmful bacteria and often many healthy pans of juice including antioxidants, protein, and fiber. However, as the methods of juicing have advanced, people are now able to access an excellent source of vitamins and nutrients in the form of a fresh, tasty, and healthy drink. You simply go to a juice bar, order your drink, and watch as it's made in front of you. No pas· teurization. No preservatives. Simply fruits and vegetables in their healthiest liquid form. Juice bars offer beverages that are not only delicious but are also tailored to fit your health needs. The Urban Juicer, a popular juice bar with five locations in the Nashville area, has named many of the items on its
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menu based on how each juice can help you. For example, The Cold Buster is a drink full of vitamin C with its apple, grapefruit, ginger, and lemon blend designed to combat a cold with the freshest ingredients. The Well Being is a mixture of kale, spinach, cucumber, apple, ginger, and lemon. They also feature juices on their menu named The Liver Lover, The Brave Heart, The Miracle Worker, and more, starting at $6.00 for 16oz. Many items on juice bar menus contain superfoods such as beetS, carrotS, spinach, and kale, along with fruitS such as apples, grapefruit, pineapple, and lemon. Some drinks also include some unexpected ingredientS such as jalapeno, garlic, coffee, cayenne pepper, cacao, cilantro, bee pollen, cashews, and mint. At most juice bars, you are able to choose what ingredientS you like and custom build your own drink. There are savory and sweet options to help satisfy your craving and most juices already are or can be modified to be vegan and gluten free. In addition to buying juices, most juice bars also provide smoothies, healthy food options, juice cleanse packages, and even "shots" - a small concentrated blend of cirrus, spices, and essential oils to boost your health. If you're interested in giving juicing a tty, here are some local juice bars that may be in your neighborhood: 25
• Melrose: 2206 8th Ave. South Nashville, TN 37204 • East Nashville: 1009 Gallatin Ave. Nashville, TN 37206 • Downtown: 21 Arcade Alley Nashville, TN 37219 • Charlotte: 4021 Charlotte Ave Nashville, TN 37209 • Franklin: 158 Front St. Suite 100 Franklin, TN 37064 Juice Bar:
• Green Hills: 2120 Green Hills Village Dr. Nashville, TN 37215 • Berry Hill: 522 Heather PI. Nashville, TN 37204 • Hillsboro Village: 2005 Belcourt Ave Nashville TN 37212 • The Gulch: 222 11th Ave. South Nashville TN 37203 • Germantown: 1120 4th Ave. North Nashville TN 37208 • Belle Meade: 6000 Highway 100 Suite 101 Nashville, TN 37205 • Mt. Juliet: 2726 N. Mt. Juliet Rd. Mt. Juliet, TN 37122 Lynne Lorraine's:
• East Nashville: 1100 Fatherland St. Suite 102 Nashville, TN 37206 Daily Juice:
• Downtown: 211 3rd Ave. South
Nashville, TN 37201 • Brentwood: 700 Old Hickory Blvd. Suite 203 Brentwood, TN 37027 Source: www.lifewithgreens.com
Women with Chronic Pelvic Pain
Are you suffering from "Undiagnosed Groin, Abdominal and Pelvic11 (UGAP) pain?
• A rather interesting situation is when patients have vaginal or deep pelvic pai n causing painful intercourse and pain when using tampons. There is a srigma about this condirion and patie nts rarely complain, even to their gynecologist.
Musculoskeletal pain is present in 22% to 80% of all patients with CPP.
By Pramod Wasudev, M.D.
I
t is estimated that in the USA a lone, literally millions of patients are reported as having chronic groin, abdominal and pelvic pain. Nearly 15 million women have chronic pelvic pain (CPP) and in this subset 46% have dyspareunia (painful intercourse). The annual medical cost of diagnosis and treatment is almost $1.2 billion. And the cost of loss of productivity is estimated to be $15 billion annually.
Chronic pelvic pain in women may have mu ltifactorial etiology and 22% have pain associated with musculoskeletal causes. Some of the causes of pelvic pain are as follows:
• Urology condition affecting urinary bladder like Interstitial Cystitis O.C.). Some of the patients with musculo· skeletal pelvic pain are mistaken for I. C.
• Bony Pelvis/Joint$/Spine
• Pelvic bone itself with all the joint, attached ligaments and more importantly the lining of the bones called periosteum which can get inflamed and is very painful.
• Weakness of pelvic floor: decondirioning!disuse
• Musculoskeletal. In this article we will be primarily addressing this condition. • Idiopathic - unknown etiology.
About the Pelvis The pelvis is a compact space packed with several structures: 45 muscles, ligaments, fascia, nerves and blood vessels. Amongst all these structures, important viscera (organs), urinary bladder, vagina, uterus tubes/ovaries and rectum are packed like a cocoon. There are numerous causes for having pelvic pain, depending on the condition (disease) affecting each organ. As expected, if disease starts in one struCture, several other adjoining structures are affected, such as:
Causes of Musculoskeletal Pain:
• Gynecological diseases affecting vagina, uterus, ovaries and tubes. Some of these conditions coexist with musculoskeletal.
It is very confusing for the patients to understand and express the symptoms associated with pelvic pain and very few come to our office stating they have "Pelvic Pain." Pain usually rad iates to the surrounding structures where pain is noticed, for example: • Lower abdomen and groin • Perineum, sitting bones (ischial tuberosities) and tail bone (coccyx) and they have a hard time sitting for a long rime • Lower back • Hip bones 26
• Muscles/Ugaments • Myofascial pain of pelvic floor muscles • Myofascial pain of back or hip muscles
• Tightness of pelvic floor and sphinCters • Tendinopathy, ligament sprain, adducrors, hip flexors and piriformis muscle • Damage to pelvic floor muscles from trauma or radiation: childbirth, prior surgeries, sexual abuse, sports/dance, repetirive minor trauma, for example, "Sportsman's hernia"
Study Results: Patients and Methods: Retrospective study of total of 203 parients seen between 1983 and 2006: 49 males (24%) and 154 females (76%). Precipitating factors were previous lower abdominal s urgeries in 46%, infections in 7.3%, sports activities in 3.9% and nonspecific in 33.4% of patients. Results: Out of 203 patients, 139 (68%) had exceUent results, 43 (21 %) had good results, 6 (3%) had satisfactory and 9 (4%) had partial to poor response. Six were lost to follow-up.
Chronic pain can be created by spasms of the muscles that line the pelvis, also known as the pelvic floor muscles. This "sling" of muscles, along with connective tissue called fascia, lift and support the pelvic organs including the bladder, uterus and rectum. Spasms in these muscles- known as pelvic floor tension myalgia or levator ani syndrome - may cause pain locally. Tight bands of muscle, known as trigger points, may be tender to the touch, and they may refer pain to other areas of the pelvis, abdomen and low back.
Musculoskeletal Dys function is Important to Evaluate Unfortunately, musculoskeletal dysfunction is not routinely evaluated as a cause of pelvic pain by gynecologists. A pelvic musculoskeletal examination is simple to perform, is not time-consuming, and is one of the most important components to investigate in all chronic pelvic pain patients. The muscles, joints and nerves in the pelvis can be injured just like any other part of your body. For instance, tissues can be overstretched, torn or cut in childbirth or surgery; muscles can weaken or tighten from disuse and injury; and poor postures and movements can slowly stretch or compress structures in the pelvis, leading to pain and dysfunction.
Many women with chronic pain suffer from anxiety, depression, or both, which worsens pain. Recurring or chronic pain can cause some women to feel depressed. These feelings are normal. In other cases, pelvic pain can be a symptom of depression or anxiery. It's essential to address depression or anxiery with therapy and medications as needed.
DON'T BE DISHEARTENED AND DISCOURAGED! Help is available. Don't be a Silent and Secret Suffe rer!
Diagnosis In the majoriry of patients, diagnosis includes a thorough clinical exam, taking a detailed history and conducting a detailed exam of the abdomen, including a pelvic and rectal exam. The following signs are suggested and practiced and are very helpful: • Rectus flexion sign • Adductor resistance sign • Vaginal hook sign • Trans vaginal sacroiliac sign Very few patients need cr scans, MRJ, GI endoscopy and laparoscopy. Diagnosis can be confirmed by a giving series of steroid injections.
Multidis ciplinary Appro ach to Treatment Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians, physical therapists and psychiatrists. n-eatment strategies include behavioral management, medications, physical therapy, trigger point injections and botulinum toxin injection. 27
Patie nt Tes timonial: I was experiencing some pain, so it was decided that I had to get a total hysterectomy. I went through my surgery and still noticed that I had a lot of the same pain. I let my OB/GYN know and he stated that it was past-op pain from the total hysterectomy. I figured that I would wait to see if it eased. I went back for a checkup from the surgery and when I was getting the examination, 1 noticed that the pain was almost unbearable. Then I knew that something was not right with my body. I would ask my doctOr'$ what was the matter with me and no one could give me an explanation as to why I was experiencing this pain, except that it was from adhesions (healing of the body). I gave it some rime to heal but it was getting unbearable. The pain was taking a toll on me, my personal life, my social life and my daily activities. Just when I began to get very aggravated with myself and the pain, I ran across Dr. Wasudev on a professional level. He told me what he could do and, just to reassure me, he spoke to a patient that had the same symptoms as I was experiencing and th~ patient told me about Dr. Wasudev and what he was doing to help people with the pain. I went to see him and he performed a full examination on me. He found every painful spot and came to the conclusion that I had tendonit~. I was experiencing pain in both lower quadrants, severe pain in my left groin, and dyspareunia for at least 6 to 8 months. He had asked me if the pain got worse with physical activities, and yes it did. Tdecided to go through with the injections that he had explained would help me. He informed me that I would have 3 sets of steroid injections also known as POPSS Injections. I proceeded with the first injections and the pain was not completely gone, butT did notice a difference like it had eased some. I went bock for my second set of injections, and during those injections I could feel that he was hitting the exact spots because I almost came off the table. I had realized that the pain was about 60 to 70% gone. I felt so relieved that some.t hing was finally going to he.lp me. When T had my 3rd set of injections, /was pain free and even the dyspareunia improved. /was so relieved that someone undel'$tOod me and what I was going through. Dr. Wasudev ~ a life saver and he has helped me in many ways. I respect him for being so compassionate and caring cowards his patients. I believe that if it was not for him, I would still be going through all of the pain. Dr. Wasudev is a very pei'$Onal man and he really undemands his patients. When I began seeing him, I felt like I was not just another patient, I was like his daughter. He showed me respect and reassurance that there is someone out there who cares and will not make you feel like you are cracy; like it's all in your head. I felt so imprisoned by the pain and I could not even get out and do yard work or even my activities of daily living. I would like co let Dr. Wasudev know chat he has changed my life and I respect him for that. If I ever have pain, I will not think twice about going to Dr. Wasudev. Thank you so very much! -- Cindy B.
Improving Your Sex Life
Need to improve your sex life? Read these books! A recent report claims that Americans have less active sex lives than in the past. Annabel Hollister looks at some of the current, and past, best-selling fiction titles that m ight reignite America's flagging lib ido.
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espite their re-knowned reserve, the Victorians were probably the first purveyors of mass produced Erotic Fiction (though the Greeks and Romans were not averse to the odd risque literary outing as well). Some of the most famous examples include: The Romance of Lust published in the mid 1860's by an anonymous writer, the delightfully named The Autobiography of a Flea (I 887) by another unnamed author, to the Lustful Turk published in 1828. And, of course, the most notorious of them all: Rmny Hill published in 1749 by John Clelandthat was banned from publication in America until 1966! (For a fuller list go to www.listverse.com).
There are no such inhibitions now. Amazon has a complete section devoted to 'Erotic Fiction'. E.L James's 'Grey' series has sold over 125 million copies worldwide; intro¡ ducing a whole new readership to wonders of literary sex (and more). The public can't get enough of this titillation, it seems. The rise of the self-published e-book has also allowed a flood of 'indie' authors to produce a staggering number of low cost books, of which a large percentage fall into the Erotic Fiction category. Many, like the "Grey" books, are now published as a series.
Writing about sex and eroticism is not easy! It's easy to criticize the abilities of some of these authors, but the subject matter is not an easy one to write about. Even the most accomplished authors, when it comes to penning a titillating piece can, inexplicably; seem at a loss for words-or at least the right ones. To recognize these failings, every year in England there is an annual "Bad Sex in Fiction Awards." For the last 24 years, organizers of the Literary Review have highlighted some truly unsuccessful, embarrassing and downright dreadful attempts by authors to write erotically charged prose in their books. Delightfully tongue in cheek, the Awards have regularly deflated the egos of some well-known authors who should know better including: Sebastian Faulks (Charlotte Gray), A. A Gill (Starcrossed), Tom Wolfe (I am Charlotte Simmons) Norman Mailer (The Castle in the Forest) and the 2016 Winner Erri De Luca's squirmingly awkward effort in The Day before Happiness. For the complete run down on these inept attempts at eroticism, go to www.literaryreview.co.uk. 28
In fact, every one of the top 50 books on the Goodreads.com list of top Erotic Fiction are now published in this way. So from this abundance of choice, how do you select the ones which might, 'do the trick'?
In compiling this list, the author makes no claim to their literary merit, or how 'erotic' they may be, that's in the eyes, or minds, of the reader. In an attempt to provide a broad choice, we have reviewed the countless lists out there and gone for a mixture of 'the classics' and the new.
1) The "Fifty Shades Trilogy," by E.L. James
2) Lady Chatterley's Lover, by D.H. Lawrence
Well, we had to get this one out of the way first. 125 million people can't be wrong, can they? And while it's no literary masterpiece, the story of the innocent Anastasia Steele embarking on a career of passion, sex and other adult activities with entrepreneur Christian Grey has clearly enlivened the lives of countless millions of couples. Why not find out for yourself what you're missing?
Now, this is a masterpiece. Written by D.H. Lawrence back in 1928 and banned for public consumption in many countries until the mid-1960s, the book was notorious for its story of the physical (and emotional) relationship between a working class man and an upper class woman. Its explicit descriptions of sex, and its use of thenunprintable words, shocked the censors for decades.
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........................ -¡ 3) The Deep End, by Kristen Ashley This is curre ntly at the top of Amazon's Erotica Cham. Its readers, though, seem to have fairly mixed reviews about it, but not bad enough that the author has already churned out a second book in the series that "once again delivers a smoldering hot story that is achingly romantic and populated with inte nsely raw cha racters that will stay with you long after you rum the final page." That's their claim, anyway.
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7) A Kingdom of Dreams, by Judith McNaught
5) Dark Lover, by J.R. Ward. If you like a bit of '1\vilight'' in your erotic reading, then this book, and the series that follows it, may be for you. Published at the height of the 'varnp~te' genre back in 2007, it's highly rated on Goodreads.com. And if you get hooked, or dare one say, binen, you've eight more to keep you going.
If you like a little historical fiction with your sexy reading, this may be for you: "a medieval tale of passion: Jennifer Merrick is taken from her convent school and held captive by an aggressive and arrogant Duke, only to find that their clashing egos give way to uninhibited desire." Maybe a bit on the romantic side, but hey what's wrong with that?
9) Dirty, by Megan Hart Another serial erotic writer, so if you like her style, you'll have plenry more to keep you amused. Familiar stuff, man meets woman, both looking for something they haven't found, until NOW! With a 4.5 star reader rating on Amazon, and apparently several rungs up the erotic ladder from the 'Grey' series, get ready to join the Megan Hart club.
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6) Bared to You, by Sylvia Day 4) Tropic of Cancer, by Henry Miller Described as "notorious for its candid sexuality" and responsible for the "free speech that we now take for granted in literature," this was first published in 1934 in France, but was banned in the United States until its publication in 1961. Largely autobiographical, it relates the author's life-and escapades-during the 1920's in Paris.
10) Forever, by Judy Blume
From # 1 New York Times bestselling a uthor comes "the provocative masterstroke of abandon and obsession that redefined the meaning of desire and became a global phenomenon," so gushes the publisher's blurb. But its appeal is borne out by the fact it is also in Goodreads.com Top 10.
8) The MacGregor Brides, by Nora Roberts Set in Scotland, it tells the story of a powerful patriarch of the MacGregor clan who schemes to see his three eldest granddaughters happily married. So Daniel MacGregor handpicks three unsuspecting candidates he believes would make perfect husbands. One of many from Nora Robert's vast library of Erotic Fiction.
All of these books are available at www.amason.com or any good online book retaller. For reviews and recommendations, go to www.goodreads.com. 29
"Blume catapults you back to that first time you fell in love, and the sexual curiosity that comes with it." Apparently, it's a book guaranteed to 'awaken your libido'. Published over 30 years ago, while it didn't get banned, it was pretry controversial at the time. "Modem readers may giggle at the lack of cell phones and other modem accoutrements, but they are sure to be drawn into this time-tested tale of first love," said one reviewer.
National Autism Awareness Month
Relating to a child with Asperger•s Syndrome April is National Autism Awareness Month. Autism, or Asperger's Syndrome, is on the increase. Here's some advice on how to recognize and relate to someone w1th the condition. ndividuals who have been diagnosed with Asperger's Syndrome are unique in that they usually demonstrate average or above-average intelligence, but !hey often have problems interact· ing with others. They tend to have difficulry relating to others, holding conversations, and understanding social cues. However, !hey want what every olher person wilh a disabiliry desires: to be accepted just as they are. It can be overwhelming whenever you first meet someone who has Asperger's Syndrome, but wilh some basic knowledge and techniques, you can learn how to engage wilh him or her.
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What does Asperger's Syndrome look like? Asperger's Syndrome does not have any physical characteristics, so it is strictly a person's behavior that indicates whelher !hey have an ASD (Autism Spectrum Disorder) such as Asperger's Syndrome. According to WebMD, there are a few common behaviors that may point to an Asperger's diagnosis.
1. Difficulty or inability to read others' emotions. Someone's tone of voice, facial expressions, and body language help most people distinguish how that person is feeling. An individual who has Asperger's Syndrome may not understand basic social vocabulary. He or she may not be able ro tell when anolher person is upset and might have diffi· culry detecting sarcastic tones.
3. Reliance on a schedule or particular habits. For children with an ASD such as Asperger's Syndrome, habits and schedules are key. They lhrive on the consistency offered by a strict routine and can become unsettled whenever there is a deviation from a plan. In some situations, this can be a source of major stress.
Relatin g to a child who has Asperger's Syndrome If you're trying to team how to relate to a child who has Asperger's Syndrome, remember that he or she wants to be accepted and valued just like you do. Children who have ASD are no different than anyone else. Their behaviors may make them seem like they are uninte rested or even rude at times, but this is just how their Asperger's Syndrome presents itself. With some patience and these tips, anyone can have a normal relationship with a child who has Asperger's Syndrome. • Set a schedule and stick to it. Children with Asperger's Syndrome thrive on consistency, so do your best to not interrupt this.
Autism: The figures behind the story About 1 percent of the world population has a utism spectrum disorder. Prevalence in the United States is estimated at 1 in 68 births. More than 3.5 million Americans live with an autism spectrum disorder. Prevalence of autism in U.S. children increased by 119.4 percent from 2000 (1 in 150) to 2010 (1 in 68). Autism is the fastest-growing developmental disability. Prevalence has increased by 6-15 percent each year from 2002 to 2010. Autism services cost U.S. citizens $236-262 billion annually. A majoriry of costs in the U.S. are in adult services - $175-196 billion, compared to $61-66 billion for children. Source: www.autism-sociery.org
• Give frequent reminders about any changes--"15 more minutes of TV time"
2. Fascination with a particular subj ect.
• Say exactly what you mean, without sarcasm or joking, until you know how he or she will respond. To a child with Asperger's Syndrome, "I'll be ready in a minute" means that you'll be ready in exactly 60 seconds. Not holding up to your promises could cause major anxiery.
• Have patience! Children with Asperger's Syndrome will likely talk about one subject repeatedly. Try to engage a t his or her level and to see eye-to-eye. If doing so is not appropriate for the situation, explain why it isn't and help to steer the child towards a better conversation topic.
A person who has Asperger's Syndrome will often have one particular subject that he or she becomes interested in, and !his area of fascination might dominate most conversations wilh others. This is especially true of children because !hey have not yet learned to incorporate other topics while socializing with others.
• Teach plenry of social cues, and give reminders when necessary. A child with Asperger's Syndrome or another ASD may not understand that whenever someone asks how he or she is doing, the polite response should be to also ask the same question in return. The child may need prompting during conversations on occasion.
A child or adult who has Asperger's Syndrome wants to be understood, and a little effort will go a long way. Remember to be patient and to show interest in him or her whenever you interact. Follow these tips, and you'll be able to have a healthy relationship with a child who has Asperger's Syndrome.
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Spiritual Wellness
MISSION IN MY WORDS: CHRIS TOMLIN Through the many d ifferent people I have met and cultures I have experienced, my eyes and heart have been opened to the beautiful diversity of God's creation and the w ideness of His mercy for us all. It is inspi ring to see th e work of Nashvi lle Rescue Mission connecting my fe llow Nashvill ians to the needs of our neighbors here at home. rowing up in the small town o f Grand Saline, Texas, I never would have imagined my love for music would one day take me around the world. Through the many different people I have met and cultures I have experienced, my eyes and heart have been opened to the beautiful diversity of God's creation a nd the wideness of His mercy for us all. Along the way, I have had the privilege of meeting wonderful people who are doing profound work through responsible organizations in every region across the globe. But in recent years, now living with my wife, Lauren, and our rwo girls here in Middle Tennessee, it is inspiring to see the work of Nashville Rescue Mission connecting my fellow Nashvillians to the needs of our neighbors here at home.
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About ten years ago, I learned that Bible srudy groups at the Mission had begun using my music as a soundtrack for their gatherings. 1 have always hoped that my platform might promote something more than j ust record sales, so to hear that some of my songs were helping framework the physical, emotio nal, and me ntal recovery of those whose journey had placed them under the care and tutelage of the Rescue Mission was deeply honoring. And then to think that this music might also aid the Mission in its Gospel-sensitive motive to spiritually restore those broken down by life right here in our zip code, I was so moved. 31
Some times it's easier to support someone across the world rathe r than help our neighbor next door. When we rema in on the outside of people's lives, it is easy to judge their circumstances, but when you really get to the bottom of someone's story, you realize there is so much involved in what brought them to the place of needing help-things in and out of their control. We have all needed a helping hand . So when we take the time to get to know the details of each other's stories, we reme mber that the grace God has extended to us is the same grace He extends to every single person. I love how Nashville Rescue Mission reflects this grace by becoming a lighthouse of refuge for the most vulnerable citizens of this city. Rescue is at the heart of the Gospel. And the Mission is simply inviting us to do our part in helping each othe r find home.
With ten albums, 15 No. 1 radio single$, a GRAM~ Award and eight additional nominations, three Billboard Music Awards, 21 Dove Awards, a platinum and four gold albums to his credit, Chris Tomlin is among the most well-known and influential artists in contemporary Christian music.