Health&Wellness September 2018

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Vol. 15 • Issue 12 • September 2018

PAIN

MANAGEMENT PATIENTS’ CHRONIC PAIN ALLEVIATED OR MANAGED AT THE PAIN TREATMENT CENTER OF THE BLUEGRASS

ALSO INSIDE Treating Jaw Pain

Coping with Arthritis Pain

Yoga for Pain Management

My hearing aids don’t define me — I do.

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GENERAL DENTISTRY Diagnosing and Treating Jaw Pain

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PAIN TREATMENT Alleviate Pain with MILD Treatment

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INTEGRATIVE MEDICINE Practice Mindful Breathing for Anxiety and Depression

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MASSAGE Helps Alleviate Chronic Pain

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FUNERAL Funerals, Memorials Services and Monuments Matter FAMILY DOC. Treating Stress Fractures

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FAMILY VISION Vision Problems can lead to Classroom Problems

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FITNESS TRAINING 4 Tips to Help Busy Parents Find Time for Fitness

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ORTHOPAEDICS Burning the Nerves

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YOGA For Pain Management

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What is Pain Management?

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Adapting Animal Toxins for Painkillers

Opioids: A Blessing and a Curse Opioids and Overdose

Coping with Arthritis Pain Naturally

Patients' Chronic Pain Alleviated or Managed at The Pain Treatment Center of the Bluegrass

Event Highlights GOLF: FITNESS & LIFESTYLE

FROM THE

EDITOR

Brian Lord | Publisher David Bryan Blondell | Golf & Special Sections Director Jennifer Lord | Customer Relations Specialist Barry Lord | Sales Representative Anastassia Zikkos | Sales Representative Kim Wade | Sales Representative Janet Roy | Graphic Designer Purple Patch Innovations | Web & Social Media

Health&Wellness Magazine can be found in 20 central Kentucky counties and is distributed to over 90% of medical facilities, including chiroprator’s, eye doctor’s and dentist’s offices. You can also pick up your FREE copy of Health&Wellness at most grocery and convenience stores as well as many restaurants throughout Central KY.

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SEPTEMBER 2018: PAIN MANAGEMENT

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Dear Friends, One of the Noble Truths in the Buddhist tradition affirms: “Pain is inevitable; suffering is optional.” The relatively new medical field of pain management is here to help people who suffer from chronic pain. According to the American Academy of Pain Medicine (www.painmed.org), common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain and neurogenic pain. September is Pain Awareness Month, a perfect time to learn about treatments and options. If you’re currently suffering from chronic pain, your first and best step should be to talk to your primary care physician. He or she may refer you to a pain treatment facility such as Ballard Wright Pain Treatment Center of the Bluegrass, whose work is profiled in this issue. Just know that you don’t have to continue suffering in silence. There is safe and effective help out there for you.

Here’s to your good health,

Tanya

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September 2018

What is Pain Management?

PAIN IS BOTH A SENSORY AND EMOTIONAL EXPERIENCE

By Harleena Singh, Staff Writer About 80 percent of Americans will suffer at least one episode of back pain in their lifetime. According to the International Association for the Study of Pain (www.iasp-pain. org), pain is an unpleasant sensory and emotional experience. Undergoing any kind of pain can seriously affect quality of life.

Pain management is the medical specialty born out of the need to treat all types of pain. Depending on the cause of the pain, pain management can be simple or complex.

Sensory pain can result from conditions such as arthritis, cancer treatment, fibromyalgia and old injuries. It is crucial to get this pain under control. This is the specialty of pain management.

Sometimes pain does not go away. Treating it can require a wide variety of skills and techniques, including: • interventional procedures; • medication management;

• physical or chiropractic therapy; • psychological counseling and support; • acupuncture & other alternative therapies; and • referrals to other medical specialists.

The pain treatment plan is guided by the history of the pain, its duration, intensity, aggravating conditions and structures involved in causing the pain.

Pain management identifies the precise source of the problem and prescribes optimal treatment.

There are many sources of pain, but it can be divided into two types: acute or chronic. Acute pain often happens right after an injury. Most of the time, it is quickly resolved. Patterns of recovery from acute pain are usually predictable and help in developing a treatment plan. Pain specialists realize it is important to control acute pain to prevent it from becoming chronic. Causes of acute pain include burns or cuts, certain diseases, dental work, broken bones, soft tissue injuries, labor and childbirth and surgery.

Chronic pain is defined as pain lasting longer than six months. It may be severe and is sometimes connected to a previous injury. Chronic pain affects people physically and emotionally. It is more difficult to treat. A multidisciplinary approach involving several specialists who offer treatment separately or simultaneously has become the standard of care for chronic pain. Physical symptoms of chronic pain include muscle tension, loss of mobility and lack of energy. The emotional effects can be similarly devastating. These include depression, anger and anxiety. Causes of chronic pain include cancer, nerve dysfunction, arthritis, unresolved disease or injury and degenerative disc disease.

Pain can come from many different sources. It can be categorized as: • Mechanical pain usually refers to back pain caused by injury, originating in the spine itself or in nearby muscle or nerve tissue.

• Inflammatory pain – When an injury occurs, the body’s natural immune response can cause pain and swelling at the site of the damage.

• Muscular pain can occur in any muscle in the body and is usually related to injuries. It can also happen when muscles are overused or you are under stress.

• Neuropathic pain – Sometimes, the nerves themselves may be the source of pain. This can be due to injury but it can happen without an injury or even after an injury has healed.

Pain management experts use measures such as analgesics, anticonvulsants, antidepressants, physical therapy and exercise and thermo therapies to treat pain symptoms. Physiatrists, also called physical medicine and rehabilitation physicians, are nerve, muscle and bone experts who treat injuries or illnesses that affect how you move.

Anesthesiologists are trained to help alleviate chronic pain through a range of interventional and minimally invasive procedures.

References:

• American Pain Experts (www.americanpainexperts.com) • Medicine Net (www.medicinenet.com) • Owensboro Health (www.owensborohealth.org) • Pain & Spine Specialist of Connecticut (www. treatingpain.com)

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September 2018

Opioids: A Blessing and a Curse BOTH OPIOIDS AND OPIOID ALTERNATIVES POSE PROBLEMS

By Angela S. Hoover, Staff Writer Pain takes complex pathways in the body, making it difficult to alleviate. The signals the brain interprets as pain sometimes come from the body’s surface, such as when you get a cut. Other times the source of the pain signals is deeper – from damage to nerves, which can happen with a bad wound. A third type of pain can come from a misfiring in the brain.

The main way to kill pain is to reduce the signals to the brain. This is the magic of opioids.

Opioids bind to mu receptors at the junctions where nerve cells meet. They essentially flip a switch that reduces the ability of these cells to fire. When nerve fibers send pain signals to the brain for processing, the neurons that normally make you feel pain don’t respond.

“Opioids don’t touch the pain source; they only turn off the appreciation of the pain in the brain,” said Lewis Nelson, a professor of emer-

gency medicine at New York University School of Medicine, who sat on a panel that recently recommended opioid guidelines for the Centers for Disease Control and Prevention (CDC). “A small dose of an opioid just changes the sensation from being something that is quite irritating to being something you don’t seem to care about as much.”

Opioids are highly addictive and pose a great risk for fatal overdose. About 21 percent to 29 percent of patients prescribed opioids for chronic pain misuse them. Between 8 percent to 12 percent of them develop an opioid addiction, according to the National Institute on Drug Abuse (NIDA). About 42,000 Americans died from prescription opioids and heroin in 2016, according to a CDC statement released in July.

Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states, says the NIDA. Ironically, opioids can sometimes make pain worse because of an effect called hyperalgesia.

Hyperalgesia occurs when opioids set off a chain of immune signals and the microglia cells in the spinal cord amplify pain rather than dulling it, even after the drug leaves the body. Separate from their pain-blocking interaction with receptors in the brain, opioids seem to reshape the nervous system to amplify pain signals, even after the original illness or injury subsides. Many researchers say hyperalgesia spurs increasing dosage, which can lead to overdose deaths.

Tramadol prescriptions have increased with the nationwide clampdown on more powerful

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opiates. Tramadol is a synthetic codeine analog that binds to the mu receptor and inhibits the re-uptake of serotonin and norepinephrine. It has a lower risk of addiction than other opioids but may cause seizure and serotonin syndrome.

Serotonin syndrome is characterized by neuromuscular and autonomic hypersensitivity as well as an altered mental state due to excess serotonin activity. It can also interact with antidepressants, as well as other analgesics, stimulants and certain antibiotics and herbs.

Another non-opioid drug that has been increasingly prescribed as an alternative pain treatment is gabapentin, a nerve pain medication generally used to treat seizures and shingles pain. While safe and effective for some patients, gabapentin can be deadly when combined with other drugs. This past spring, Kentucky classified the drug as a controlled substance after it was found in nearly a quarter of all overdose deaths in Louisville last year.

Fentanyl is a powerful synthetic opioid used for severe post-surgery pain. It rapidly gains access to the central nervous system because it efficiently crosses the blood-brain barrier. It is 100 times more potent than morphine.

New illicitly manufactured drugs include carfentanil, which is 100 times more potent than fentanyl, and 3-methylfentanyl, which is four times as powerful. Deaths from these drugs nearly doubled from 2016 to 2017, says the CDC.

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Opioids and Overdose CAREFUL USE MAKES PAIN MEDICATIONS SAFE

By Jean Jeffers, Staff Writer The overuse and misuse of opioids is a serious health problem. From 1999 to 2016, more than 630,000 people died from a drug overdose, according to the Centers for Disease Control and Prevention. Around 66 of those deaths involved an opioid. In 2016, the number of overdose deaths involving opioids increased by five times the number of deaths in 1999.

Over the years, overdoses have come in waves.

The third largest wave began in 2013 and has brought significant increases in overdose deaths involving synthetic opioids.

Opioids are a type of medicine sometimes used to relieve pain. They lower the number of pain signals your body sends to the brain.

Doctors prescribe these drugs most often to relieve pain from dental procedures, injuries, surgeries and chronic illnesses such as cancer. Some of the opioid drugs available include opium, codeine, fentanyl, heroin, hydrocodone, metha-

done, morphine and oxycodone. A time for safe use is one month.

Opioids are a safe choice for pain management — if taken properly. But people who misuse these drugs may become addicted. Misusing opioids means you don’t follow the doctor’s directions, and it could mean you take the drugs illegally. Drug tolerance means getting used to a drug over time and then needing more of it to achieve the same effects. Drug dependence occurs when you have withdrawal symptoms because you are not taking the opioid. Work with your doctor to prevent the occurrence of dependence and withdrawal symptoms.

Addiction is a disease that affects your brain and your behavior. It creates a desire to consume a drug on a regular basis. When you take a drug initially, particularly a controlled substance that has been known to cause addiction, you have control over your choice. When misused, the pleasure effect of the drug demands the person keep using it. Over a period of time, your brain changes and you develop a powerful urge to use the drug. Opioids create endorphins in the brain as brain structure is altered. Besides blocking pain, these endorphins make you feel good.

When you use too much of an opioid, you may shut down the body’s center for making endorphins and the body then must rely on what you give it. The longer you use opioids, the more likely this is to happen.

Knowing you are addicted is the first step to recovery. One obvious sign of addiction is being unable to curtail use of the drug. Symptoms of

substance abuse may be physical, behavioral or psychological. Some signs of opioid abuse include poor coordination, drowsiness, a shallow or slow breathing rate, nausea and vomiting, constipation, physical agitation and poor decision making. The addicted person may abandon responsibilities or have mood swings, depression, lowered motivation and anxiety attacks.

An overdose of opioids requires immediate medical attention. Call 911 if you suspect you or someone you know has had an overdose.

Symptoms of opioid overdose include unresponsiveness, slow or erratic breathing or no breathing at all, a slow or erratic pulse or no pulse, vomiting, loss of consciousness and constricted pupils. In some states, a nasal spray, Narcan, is available to keep on hand in case of an overdose.

Talk with your doctor about it.

Sources:

• Centers for Disease Control and Prevention (www.cdc.gov) • Family Doctor (www.familydoctor.org) • Substance Abuse and Mental Health Services Administration (www.samhsa.gov)

About the Author Jean is an RN and a writer for our Living Well 60+ and Health & Wellness Magazines. Her first novel, Journey Toward Healing, is due out later this year.

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D O N’ T G E T LO S T I N T H E CO N F U S I O N:

EXERCISE YOUR POWER OF CHOICE

emember when you went to see your physician and he or she decided you needed a diagnostic test? The office set up an appointment and your employer-paid insurance took care of most of the bill. Those were the good ol’ days! Well, maybe not so good if you’re at the doctor’s, but at least the financial aspect of your health wasn’t at the forefront of your mind.

How did this all get so complicated? For starters, doctor’s offices and hospitals are burdened with the laborious process of pre-certifying diagnostic tests through the insurance company to merely get permission to perform the test. A pre-certification is not a guarantee of payment, just a green light to move forward. Often, physicians ordering tests have no idea of their cost. After the test is performed, it is coded by a crazily complicated system, submitted, reviewed by the insurance company – which then rejects it at least once for resubmission – and at last an explanation of benefits (EOB) is issued to you, the policy holder, and some partial-to-no payment is sent to the medical provider. Any balance due is up to you to pay.

AT PCU, WE Another thing to be aware of is you can choose where to go for your diagnostic tests. In some BELIEVE IN cases, patients feel “bullied” into using the services preferred by their physicians. This could be EMPOWERING because of the physician’s comfort or convenience or corporate pressure to meet a quota. Sometimes, it makes sense to stay with a physician’s THE PATIENT. recommended provider or within the same corporate entity, depending on the procedure and the involvement the physician may have in treating any results from the test(s). For example, most obstetricians have an in-office ultrasound. Since the obstetrician will be monitoring the entire pregnancy, it makes sense to have ultrasounds performed there rather than elsewhere. But it’s not always necessary to undergo diagnostic tests at a recommended partner hospital or hospital-owned facility. Typically, tests at these places have higher fees than independently owned offices. It’s understandable these facilities charge higher rates, with their 24/7 overheads costs, numerous no-pay patients and extremely expensive emergency treatment costs. But unless you need to have tests done at such places, why should you be burdened with paying a higher cost?

Here’s the good news: There is a way to navigate this system by exercising your power of choice in your healthcare providers. This is especially easy to do with diagnostic tests. Whether you have insurance or not (although everyone should have at least a catastrophic insurance plan), you need to price check. Often outpatient diagnostic tests can be performed at a much lower cost with the same quality and expertise. Educating patients about how much power of choice they actually have has been our greatest obstacle at Patient Choice Ultrasound & Thermography (PCU). Ultimately it’s every patient’s choice because at the end of the day, it’s the patient who is responsible for the bill.

Having been in the mobile ultrasound business since 1982, I saw more and more physician clients either retire or become absorbed into a corporation. I became frustrated with doing business as usual and being unable to answer the question, “Will my insurance pay for this?” So this past January, I opened up a “storefront” diagnostic ultrasound office that is “cash based.” By eliminating the dependency on insurance reimbursement, we are able to reduce the price of all of our diagnostic testing to a fraction of the cost. Many people have very high deductibles, which means they

WHETHER YOU HAVE INSURANCE OR NOT, YOU NEED TO PRICE CHECK.

pay out of pocket for almost everything until that deductible is met. In most cases, the deductible isn’t met without a catastrophic event or serious illness. Our prices are affordable, transparent and all-inclusive, including the interpretation fee. PCU provides a receipt that may be used towards a patient’s deductible.

At PCU, we believe in empowering the patient. Somewhere along the line, the patient has gotten lost in the system. Our practice is designed for everyone, regardless of their insurance carrier, but especially for those with no insurance or those with high deductibles that make it a burden to go the traditional route. At PCU, we feel your only concern should be your health, not whether you should choose between your health and finances.

When scheduling, we have a moral obligation based on the company’s philosophy to inquire about your deductible. If you are close to meeting your deductible or anticipating an upcoming surgery, etc., we recommend you continue to shop around to do what is best for you in each particular circumstance. And whenever a patient chooses a different route, we appreciate any feedback so we can continually assess how to improve the care we are capable of providing.

We are currently open Monday through Friday with weekend appointments available. We accept Medicare as our only insurance. This decision was made solely to provide for the entire family. Health savings and Flex accounts are also welcome.

About the Author

With 40 years in the field of ultrasound, Kim Davis, RDMS, RDCS, RVS, is the founder and CEO of Patient Choice Ultrasound at 152 W. Tiverton Way in Lexington. PCU can be reached at (859) 554-7360 or by visiting its Web site at www. patientchoiceultrasound.com.

ABOUT PATIENT CHOICE ULTRASOUND & THERMOGRAPHY

PATIENT CHOICE

152 W. Tiverton Way, Lexington, KY • 859-554-7360 • www.patientchoiceultrasound.com Offering inclusive, transparent pricing for diagnostic imaging including Ultrasounds and Thermography. We strive to make healthcare less of a hassle and more about empowering patient choice.

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September 2018

COPING WITH ARTHRITIS PAIN NATURALLY

Regular massaging of arthritic joints can help reduce pain

HOT AND COLD THERAPY, OTHER TECHNIQUES MAY PROVIDE RELIEF

By Harleena Singh, Staff Writer For many people who are living with arthritis, managing pain is a part of daily life. Arthritis is a group of degenerative conditions marked by inflammation in the joints, which causes stiffness and pain.

Osteoarthritis, the most common type of arthritis, is caused by wear and tear over the years.

Rheumatoid arthritis occurs when the immune system attacks the joints as if they were foreign tissues. Because of this, rheumatoid arthritis is classified as an autoimmune disease.

Doctors usually treat arthritis with anti-inflammatory medications and painkillers. However, some medications cause side effects, so a natural approach to pain relief is becoming more popular. Here are a few suggestions: 1. Exercise more.

Regular movement helps maintain joint flexibility. Choose activities that build the muscles around your joints but don’t damage the joints themselves. Try low-impact exercises such as water aerobics or swimming to flex your joints without adding further stress rather than weight-bearing exercises such as running, which can be damaging.

2. Lose weight.

Extra weight puts more pressure on your joints, especially your knees, hips and feet. When you lose weight, you reduce the stress on your joints, which improves your mobility, decreases pain and prevents future damage to the joints.

3. Try acupuncture.

Acupuncture is an ancient Chinese medical treatment that involves inserting thin needles into specific points on your body, which supposedly reroute energies and restores balance in the body.

Acupuncture is recommended by

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and stiffness.

the World Health Organization for the treatment of over 100 different conditions, including arthritis.

4. Use hot and cold therapy.

Long, warm showers or baths help ease joint stiffness. Use an electric blanket or a moist heating pad at night (no more than 20 minutes at a time) to keep your joints loose. Cold treatments are best for relieving joint pain, swelling and inflammation. Wrap a gel ice pack or a bag of frozen vegetables in a towel and apply it to painful joints for quick relief.

5. Include the right fatty acids in your diet.

Omega-3 fatty acids help reduce arthritis pain. Fish oil supplements, which are high in omega-3s, also reduce joint stiffness and pain.

Another fatty acid that can help is gamma-linolenic acid or GLA, which is found in the seeds of certain plants such as evening primrose, borage, hemp and black currants.

6. Meditate.

Relaxation techniques and meditation can help reduce arthritis pain. According to the National Institutes of Health (NIH), practicing mindfulness meditation is helpful for some people with painful joints. Researchers also found people with depression and arthritis benefitted most from meditation.

7. Get a good massage.

According to the Arthritis Foundation (www.arthritis.org), regular massaging of arthritic joints can help reduce pain and stiffness and improve your range of motion.

8. Add turmeric to your dishes.

Turmeric contains a chemical called curcumin that may help reduce arthritis pain. The secret is turmeric’s anti-inflammatory properties. The NIH reports turmeric

given to lab rats reduced inflammation in their joints.

9. Try herbal supplements.

Many herbal supplements touted for arthritis pain include ginkgo, devil’s claw, thunder god vine, bromelain, boswellia and stinging nettle. Be sure to talk to your doctor before taking any of these supplements.

You should also talk to your doctor to formulate a medication plan for your specific pain symptoms. Over-the-counter pain medications, such as acetaminophen (Tylenol), ibuprofen (Advil,

Motrin IB, others) or naproxen sodium (Aleve) can help relieve occasional pain triggered by activity your muscles and joints aren’t used to. A cream containing capsaicin may be applied to the skin over an aching joint to relieve pain. Use it alone or with oral medication.

References

• Arthritis Care (www.arthritiscare.org.uk) • Arthritis Foundation (www. arthritis.org) • Health Line (www.healthline.com) • Mayo Clinic (www.mayoclinic.org) • WebMD (www.webmd.com)

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General Dentistry.

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September 2018

DIAGNOSING AND TREATING JAW PAIN A VA R I E T Y O F FAC TO R S C A N L E A D TO T M D I S S U E S

H

ave you ever experienced tenderness in your jaw area? Facial pain is a rather common issue in the general population, with 15 percent to 20 percent of people reporting symptoms. While some only suffer temporarily, others find their discomfort lingers for a longer period or reaches a level that significantly diminishes their quality of life. This type of pain can greatly affect chewing, biting and even speech. When the discomfort lingers or reaches severe levels, it will often prompt a doctor visit to address the issue.

You may hear people describing these types of pain using terms such as “TMJ” or “TMD.” TMJ stands for temporomandibular joint, which is the joint that connects the jaw to the temporal bones in the skull. TMD stands for temporomandibular joint disorder, a term used to describe problems involving the jaw area of the face. It is not uncommon for people to use both terms to describe this type of facial pain.

TMD symptoms can mimic other conditions, so a clinical examination by a dentist is necessary to make a proper diagnosis of the issue and pursue the best treatment plan to relieve any pain.

Should symptoms be the result of another type of condition, different treatments may be required to help alleviate the discomfort. Signs that are more common for TMD pain include: • pain in one or more areas, including the face, jaw and even the ear, similar to pain felt with an ear infection; • clicking sounds when chewing or just opening and closing the mouth; • popping in the jaw joint; • general trouble or pain when biting or chewing; • a jaw that feels stuck or locked or moves out of place; and • headaches that relate to jaw function.

A variety of factors can lead to TMD issues. While certain malocclusions, or bad bites, can lead to them, this is not the most common cause. Injury to the jaw is another factor that can prompt TMD issues. Frequently, however, the culprit is bruxism, or excessive clenching and/or grinding of the teeth. Often people are unaware they are clenching and/or grinding their teeth because this activity frequently takes place during sleep. That is why it is called nocturnal bruxism.

While doctors previously believed nocturnal bruxism was caused by a bad bite, now we generally believe the behavior is just a result of brain activity and is also possibly linked to stress, the use of certain medications and even genetic factors.

During an examination, in addition to asking a variety of questions about symptoms and where the pain seems to be located, a doctor will typically confirm how a person’s jaw works, test his or her bite and check the facial muscles. Doctors may also elect to take X-rays, a CT scan or an MRI or request other tests to help rule out potential problems.

Common conservative approaches to treating TMD pain generally include allowing the jaw to rest to reduce the pressure on it as well as the joint and muscles. Other recommendations include: • switching to soft foods and skipping hard, crunchy or overly chewy items; • chewing slower and taking smaller bites of food; • avoiding unnecessary biting or chewing (pencils, fingernails, etc.); and • not chewing gum.

Individuals may also be encouraged to take ibuprofen or aspirin to address pain. Applying moist heat or cold packs to the face can

FREQUENTLY, THE CULPRIT IS BRUXISM, OR EXCESSIVE CLENCHING AND/OR GRINDING OF THE TEETH.

help reduce pain. Additionally, a doctor may discuss wearing a dental appliance, similar to a retainer, during sleep to put the jaw in a more favorable position. Treatment plans depend on whether activity related to the pain is taking place during the daytime or during sleep, since the management of nighttime and daytime muscle activity differs. If stress is playing a role, techniques to recognize stress and reduce jaw muscle activity during stressful periods may be discussed.

If a patient does not find relief after implementing these approaches, additional measures, such as minor dental procedures or orthodontic treatment, can be discussed. Additionally, the use of physical therapy techniques or trigger-point injections can be reviewed. More severe cases may prompt a doctor to recommend one of several types of surgery should less conservative treatment options fail to provide adequate pain relief.

TMD symptoms can range from annoying to disabling, but help in determining the type and cause of pain is available. Resolving pain related to TMD generally takes patience and diligence as a person works with his or her doctor to find the best way to treat or manage the condition.

About the Author

Dr. Jeffrey Okeson is a professor at the University of Kentucky College of Dentistry, and also serves as chief of the college’s Division of Orofacial Pain and program director of the Orofacial Pain Clinic located in the Kentucky Clinic on UK’s campus. His interests include orofacial pain and temporomandibular joint disorders. More information on UK Dentistry is available at ukhealthcare.uky.edu/dentistry.

ABOUT UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY Clinic Info: 859-323-DENT (3368) • ukhealthcare.uky.edu/dentistry UK Dentistry offers expert, personalized care for the general and specialty dental and oral health needs of adults and children. We're committed to improving Kentucky, and beyond, one smile at a time.

Pain Treatment.

September 2018

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ALLEVIATE PAIN WITH MILD TREATMENT

issues,” said Dr. Ganzel. “Around 2016, it was given the full green light and is now picking up steam as a terrific procedure for pain relief.”

he Pain Treatment Center of the Bluegrass is the largest freestanding facility in Kentucky dedicated to the treatment of pain. It hosts 10 physicians of varying specialties and subspecialties, all who have the goal of pain alleviation and management.

Dr. Steven Ganzel, one of the doctors practicing at the Center, has recently added Minimally Invasive Lumbar Decompression (MILD) treatment to his list of services for those seeking relief from pain and suffering.

“Vertos Medical, Inc. is the company that developed the MILD Treatment,” Dr. Ganzel said. “They supply the necessary instrumentation to those doctors trained in the technique. I trained in this specifically because I saw the benefit it was giving many patients, and now I’ve been offering it to those who meet the criteria and seeing a great deal of success.”

What are the advantages of this procedure?

“The biggest advantage is that the convalescence is minimal,” Dr. Ganzel said. “Minimally invasive means just that. We go through two small holes to do the procedure, and it takes less than an hour to do both sides. By de-bulking the ligaments, the patient will find tremendous relief, and they are usually up and about within a few days versus up to six months for some spinal surgeries. Anesthesia is usually not necessary. Some patients do require ambulatory services, which are provided by the clinic since we are a full-service facility..”

How do people get a consultation to find out if they are candidates for MILD? “I have to have an MRI to know if there is thickening of the ligament,” Dr. Ganzel said. “If a patient has had an MRI elsewhere in the last year, that will work, but longer than that allows for too many changes in the body to develop, which might result in an improper clinical decision. Just contact us at The Pain Treatment Center and we will set up a consultation.”

Dr. Ganzel adds the procedure has worked wonderfully and with great success for many qualified candidates. “I wouldn’t spend time training on it and offering it to my patients if I didn’t believe in it 100 percent,” he said. Nor would the founder of The Pain Treatment Center, Dr. Ballard Wright, have undergone the procedure himself if he didn’t believe in it; and, in fact, he did, experiencing wonderful results and allowing him to once again walk without the use of a cane.

For more information on MILD and other services at The Pain Treatment Center of the Bluegrass, call (859)278-1316 ext. 258.

What are the criteria to receive the treatment?

“The person has to be 66 years of age and they have to have a thickening of the ligamentum flavum,” Dr. Ganzel explained. These ligaments that run along the lower spine tend to thicken with age and degeneration of the bone and discs. The ligaments start to take on more and more burden as those other structures are compromised. e spinal canal narrows and compresses This usually leads to weakness in the lower back and legs, which is e, the natural wear and tear on our spine called neurogenic claudication. The pathways through the back narrow ause the narrowing of the spinal canal – bone, or compression/bulging the discs. are constricted. This can also be hastened by arthritis and the ofnerves and other degenerative diseases. If the person has had a fusion or spinal surgery in the past 12 months, he or she is not a candidate for ber of symptoms such as pain, numbness MILD treatment. wer back. It may also limit the amount of Why is the procedure gaining momentum now?

“When Vertos first introduced the procedure, it did well for three to four years, then went into a bit of a lull due to clinical trials and other

symptoms increase when you walk or stand, ard, then you may have a certain type of sue that is causing the narrowing of the

about LSS

(Lumbar Spinal Stenosis)

about LSS

(Lumbar Spinal Stenosis)

Aging Spinal Canal with Stenosis

Disc Bulge Aging

Spinal Canal with Stenosis

Healthy, Open Spinal Canal Disc Bulge

Spinal Canal

Disc

Healthy, Open Spinal Canal Spinal Canal

Disc

Spinal Cord

Bony Overgrowth

Thick Ligament

Thick

Cross-section view of the spine

• Pain, numbness & tingling

• No pressure on spinal cord

• Weakness with activity

• Mobile/flexible

Spinal Cord

• No symptoms (pain,view numbness, Cross-section of the spine tingling) • No pressure on spinal cord • Mobile/flexible • No symptoms (pain, numbness, tingling)

Bony

Overgrowth Ligament Stenosis Creates Pressure, Causing:

• Pain Stenosis relieved by flexion (sitting, Creates Pressure, Causing: leaning, bending) • Pain, numbness & tingling • Weakness with activity

What is LSS?

Lumbar spinal stenosis (LSS) is a condition where the spinal canal the spinal cord nerves in your lower back. As we age, the natural I WOULDN’T SPEND can lead to a is number factors that cause the narro What LSS?of contributing thickening of TIME ligament tissue,(LSS) formation of excess bone,the orspinal comp Lumbar spinal stenosis is a condition TRAINING ON ITwhere the spinal cord nerves in your lower back. As we age, the na AND OFFERING IT TO can lead to a number of contributing factors that cause the Whatthickening are the Symptoms of LSS? MY PATIENTS IF I DIDN’T of ligament tissue, formation of excess bone, or The narrowing of the spinal canal can cause a number of symptom BELIEVE INbuttocks, IT 100legs and lower back. It m or a tingling sensation in your time/distance you are able to stand orof walk.

If your symptoms inc What are the Symptoms LSS? PERCENT. but you experience when you sit orcan bend forward, thenofyou The narrowingrelief of the spinal canal cause a number sym LSS that be treated by the of excess that isback cau or acan tingling sensation in removal your buttocks, legstissue and lower spinaltime/distance canal. you are able to stand or walk. If your symptom – DR. STEVEN GANZEL but you experience relief when you sit or bend forward, the LSS that can be treated by the removal of excess tissue that spinal canal.

• Pain relieved by flexion (sitting, leaning, bending)

ABOUT THE PAIN TREATMENT CENTER OF THE BLUEGRASS 280 Pasadena Dr. | 2416 Regency Rd., Lexington, KY • 859.278.1316 • www.pain-ptc.com The Pain Treatment Center of the Bluegrass is the largest freestanding facility in the Bluegrass Region dedicated to the treatment of pain. We specialize in treating patients for whom traditional medical/surgical methods have failed to alleviate their pain.

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Integrative Medicine.

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September 2018

PRACTICE MINDFUL BREATHING

FOR ANXIE T Y AND DEPRESSION

recent American Psychiatric Association poll found anxiety in Americans has increased sharply over the past year, up five points since 2017.1 Also in the past year, a Blue Cross Blue Shield report found major depression has risen by 33 percent since 2013. This rate is rising even faster among millennials (up 47 percent) and adolescents (up 47 percent for boys and 65 percent for girls).2 There are many ways to combat anxiety and depression, including prescribed drugs, physical activity, dietary changes, counseling, social support and contact with nature. There are several mind-body approaches also, including massage, emotional journaling, guided imagery, skilled relaxation, yoga, meditation and mindfulness. Mindfulnessbased cognitive therapy (MBCT) is an effective therapeutic approach designed to help people who suffer from repeated bouts of depression, chronic unhappiness and anxiety.3 MBCT combines cognitive therapy with mindfulness-based stress reduction (MBSR), a wellresearched educational set of meditative practices and mental attitudes that nurtures the cultivation of mindfulness.

Foundational practices in MBCT and MBSR include paying non-judgmental attention to your breathing – doing so with a clear intention – and bringing the qualities of curiosity, openness and acceptance to whatever you are experiencing. While this can certainly include pleasant experiences, the real therapeutic payoff is working with challenging, difficult and unpleasant experiences.

One of the basic practices in MBSR and MBCT is the ThreeMinute Breathing Space.4 This practice is short and simple but can be extremely helpful in learning to respond skillfully rather than react in unskillful, habitual ways that often make things worse.

The following guidelines and the

recording available at the link below do not take the place of professional counseling or medication. If you are suffering from anxiety or depression, ask your primary care provider for help and discuss this mindfulness practice with him or her.

Three-Minute Breathing Space This practice is best learned by daily repetition, at least once a day, during moments of relative calm and peacefulness. As you gain familiarity with the practice, you can use it as needed in moments of distress.

1. Becoming aware Bring yourself into the present moment by deliberately adopting an erect and dignified posture, whether you’re lying down, reclining, sitting or standing. If possible, close your eyes and bring simple awareness to your inner experience, scanning your body for physical sensations and observing your mind and emotions. Actually ask yourself “What is my experience right now … of physical sensations and sense perceptions in my body … of thoughts and images in my mind … of feelings and emotions?”

Notice the habitual labeling of some experiences as pleasant and others as unpleasant. Welcome whatever is arising, allowing yourself to simply have your experience without judging it. Can you actually turn toward both pleasant and unpleasant experiences rather than trying to push away or escape from the unpleasant and clinging to the pleasant?

2. Gathering Effortlessly and gently direct your attention to your breathing, feeling each in-breath and each out-breath. Allow the belly to be soft so the breath can deepen, fully expanding the lungs and sending relaxation impulses throughout the entire body and mind. Allow your breath to anchor you in the present and help you train your mind to pay attention, taming the chaotic “mon-

key mind” that is in such constant motion. Allow the breath to help you simply slow down, shifting from the “doing” mode and endless tasks of your to-do list to the “being” mode of mindful awareness – your antidote to worrying and hurrying.

As the breath goes out, really allow it to go out, out, out, dissolving into space. Notice the stillness of that pause at the end of the out-breath.

Learn to rest in that pause for a moment at the end of each breath.

3. Expanding Expand your awareness around your breathing so it includes a sense of the body as a whole, sensations and sense perceptions throughout the body, the tactile points of contact with the chair, the floor or the bed, noticing your posture, facial expression and simply allowing all your experience to “just be” as it is, without wanting or trying to change it.

The Three-Minute Breathing Space is a simple, portable tool to help you step out of the habitual reactivity of automatic-pilot mode and reconnect with the present moment, responding wisely and skillfully to your life’s ups and downs. Anxiety and depression may be easier to bear.

They may even diminish. But even if they persist, you can develop a new relationship with them, one that can reverse the downward spiral of worry and fear and help you experience an upward spiral of relaxation, patience, equanimity, hope – and even joy.

Sources and Resources

1. American Psychiatric Association survey finds increasing anxiety

https://www.psychiatry.org/ newsroom/news-releases/americanssay-they-are-more-anxious-thana-year-ago-baby-boomers-reportgreatest-increase-in-anxiety 2. Blue Cross Blue Shield survey finds increasing depression https://www.bcbs.com/sites/default/ files/file-attachments/healthof-america-report/HoA_Major_ Depression_Report.pdf 3. Mindfulness based cognitive therapy (MBCT) – Finding peace in a frantic world http://franticworld.com/ 4. Three minute breathing space (audio recording by Dr. Patterson) http://www.mindbodystudio. org/?page_id=1594

About the Author Dr. John Patterson is past president of the Kentucky Academy of Family Physicians and is certified in family medicine, mind body medicine, integrative holistic medicine, mindfulness-based stress reduction, physician coaching and yoga therapy. He is on the faculty of the University of Kentucky College of Medicine, Saybrook College of Integrative Medicine and Health Sciences (Oakland) and the Center for Mind Body Medicine (Washington, D.C.). He operates the Mind Body Studio in Lexington, where he offers classes, consultations and coaching to manage stress-related conditions and prevent burnout. He can be reached through his Web site at www. mindbodystudio.org.

ABOUT MIND BODY STUDIO Mind Body Studio

517 Southland Drive, Lexington • 859.373.0033 • www.mindbodystudio.org

september EVENT HIGHLIGHTS Visit us on the web for complete event listings: www.healthandwellnessmagazine.net/calendar

September 25 Medicare Options Presentation Learn about your medicare options with an educational presentation

by Kentucky Health Solutions.

6pm at the Eastside Library. Please call 859-312-9646 to RSVP. www.

KentuckyHealthSolutions.com.

Wednesdays Mindfulness and Relaxation for Health

Even Superheroes Need to Get Their Vision Checked Schedule an appointment for: Complete Eye Exam Dry Eye Clinic Low Vision Visual Rehabilitation/ Therapy: • eye alignment, • athletic performance, • reading difficulties, • balance, and • school performance, • headaches

Relax the body, quiet the mind, open the heart. Arrive 6:00-6:30 and deeply relax, instruction 6:30-8:00 PM. Mobilize inner resources for promoting health, preventing burnout and managing stress-related chronic disease. Study and practice in a supportive group. Gentle yoga, mindful movement, deep relaxation, sitting meditation and discussion. Instructor: John A. Patterson MD, MSPH, FAAFP, Cost $10. Mind Body Studio 517 Southland Drive, Lexington, KY 859373-0033. Full details at http://www. mindbodystudio.org/?page_id=1055

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Fridays Argentine tango Passionate and Romantic, mindful and meditative, a uniquely transformative social skill, art form and movement therapy. No partner or dance experience required. Friday evening 7:30-9:00 PM. You may drop-in to any class- this is not a series. Cost $10 Instructors- Dr. John Patterson and Nataliya Timoshevskaya. Mind Body Studio 517 Southland Drive, Lexington, KY 859-373-0033. Full details at http://www.mindbodystudio.org/?page_id=214

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September 2018

A NECESSARY SPECIALTY

PATIENTS’ CHRONIC PAIN ALLEVIATED OR MANAGED AT THE PAIN TREATMENT CENTER OF THE BLUEGRASS

FOR SOME PEOPLE, ACUTE OR CHRONIC PAIN IS A FACT OF LIFE. BUT PAIN CAN BE MANAGED. THE PAIN TREATMENT CENTER OF THE BLUEGRASS SPECIALIZES IN PAIN MANAGEMENT.

By Tanya J. Tyler, Editor, Health & Wellness “We treat all different kinds of pain and pain issues, whether the pain arises from an injury, illness or disease,” said Heather Wright, CEO of the Pain Treatment Center. “If someone has chronic pain and they are referred to us, we will work with them to manage or alleviate their pain. Pain medicine is a necessary specialty.”

The Center started in the late 1980s with Heather’s father, Dr. Ballard Wright, an anesthesiologist. At the time, pain management was one of the newer disciplines in medicine.

“As anesthesiologists relieving pain during surgery, my father and his colleagues realized people were walking around with chronic pain and there were procedures anesthesiologists could do to make it better,” Heather said.

“They were interventionalists. They were performing epidurals and other procedures that ensured patients didn’t have pain during childbirth or surgery.”

Dr. Wright and his colleagues discovered they could perform some of these same interventional techniques in an outpatient setting to help patients in chronic pain. He started working more in the pain management field.

In 1988, he opened his physician practice, Ballard Wright, MD, PSC. He became board certified in pain management and in 1993 obtained a license for a surgery center, The Pain Treatment Center, Inc. (dba Stone Road Surgery Center).

“Since then we’ve been operating both the physician practice and the surgery center as The Pain Treatment Center of the Bluegrass,” Heather said.

“We’ve expanded from one building on the corner of Regency Road and Pasadena Drive to three buildings within this perimeter. We have 10 physicians from different specialties, most of whom are also board certified in pain management, and they all practice pain medicine. We have anesthesiologists, neurologists, physical medicine and rehab doctors, internal and family medicine doctors, an addiction medicine specialist and a palliative care physician.”

All these specialists work together to evaluate patients with an end goal of alleviating their chronic pain. “Neurologists study how the brain and its pain receptors work,” Heather said. “The physical medicine and rehab doctors look at how the body moves and functions.”

The Center’s physicians utilize techniques from each specialty to diagnose and treat their patients, from interventional procedures to physical therapy and behavioral medicine to appropriate medications. The different departments and services facilitate the physicians’ treatment. The Center has an on-site lab, an imaging suite with a CT scanner, X-ray machine and DEXA scanner, an outpatient surgery center and a rehab and physical therapy department. Also, just down the street at 2201 Regency Road is the building where the Center’s behavioral medicine specialists work.

Patients generally come to the Center upon referral from their primary care physician or another specialist.

“The majority of our patients come because they have seen other providers who have not been able to manage or take care of their pain,” Heather said. “They realize they need a specialist in pain management.”

New patients undergo an evaluation where all necessary paperwork, medical records and information are gathered and assessed.

September 2018

WE HAVE 10 PHYSICIANS FROM DIFFERENT SPECIALTIES, MOST OF WHOM ARE ALSO BOARD CERTIFIED IN PAIN MANAGEMENT, AND THEY ALL PRACTICE PAIN MEDICINE.

PAI

“When we get the referral in, we want to get as many records as possible to review the patient’s pain history, to identify what pain control techniques have been tried by other physicians and discern how we can take over,” Heather said. “We are always encouraging our referring providers to refer patients to us sooner, because the sooner we can get them in to see one of our specialists, the better chance we have to give the patient relief from their chronic pain.”

After the new patient coordinator does an initial review of their records, patients are scheduled to see the physician that can best assist them with their pain problem. The physician then performs an examination on the patient and creates an individualized treatment plan for him or her. The patient is encouraged to be active, involved and committed to the treatment plan, including seeing the behavioral medicine specialist, performing physical therapy exercises and taking medications responsibly and appropriately.

“The best patient is the one who is going to be part of the program,” Heather said. “If they take ownership of it and they want to get better, that goes a long way. We can work with you, but you need to want to do it.”

Another important component of the Center is its behavioral medicine department. Effective pain management requires treatment of both mind and body. Patients in pain often feel anxious, stressed, hopeless and depressed. The behavioral medicine department, which includes a psychiatric nurse practitioner and two licensed clinical social workers, addresses the emotional and psychological aspects of pain.

“Patients dealing with chronic pain have a variety of issues,” Heather said. “They are often dealing with a loss of ability to do things they enjoyed – gardening, picking up their children or grandchildren, playing sports, exercising – because they’re having this pain. They may be dealing with a loss of work because they can’t perform their job anymore. They may even be dealing with family members who now see them as victims or disabled.”

Working with a behavioral medicine specialist, patients learn coping skills to handle the psychological components of pain.

These techniques help patients feel more in control of their situations.

The behavioral medicine specialists are also attuned to the possibility of addiction. “We use behavioral medicine to evaluate if somebody has the potential to have an addictive component to their personality,” Heather said. “We are always careful in how we prescribe medication, but we need to be very careful with those patients who have an addictive component.”

The physical therapy department works closely with patients, teaching them to strengthen certain muscles to alleviate pain and helping them learn to move better. The one-on-one interactions include simple, quick exercises and activities patients can do on their own.

“It all works together – interventional procedures, physical therapy, behavioral medicine and pain medication,” said Heather.

“There are a lot of people out there who have pain and have legitimate reasons for needing to be seen by a pain specialist. Our goal at The Pain Treatment Center of the Bluegrass is to help alleviate or manage our patients’ pain and get them a better quality of life. That is our mission.”

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HEATHER WRIGHT, CEO FOR MORE INFORMATION: www.pain-ptc.com Ballard Wright, MD, PSC The Pain Treatment Center of the Bluegrass 280 Pasadena Dr. | 2416 Regency Rd. and 2201 Regency Rd., Bldg. 100 Lexington, KY 40503 Phone: (859) 278-1316 | Fax: (859) 276-3847

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Massage.

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September 2018

MASSAGE CAN HELP

ALLEVIATE CHRONIC PAIN

e’ve all had a painful day — a headache that seems to drain us or a toothache that won’t abate until we’ve found ourselves in a dentist’s chair. For most of us, those days are few and far between. With a little time and some over-the-counter medications, we can return to our lives and treat that pain as a bad memory. For 100 million Americans, however, high pain days are a never-ending cycle. These men and women live with chronic pain, an ailment that lasts at least 12 weeks and can be disruptive to their daily lives.1 Chronic pain can result from injury, illness or surgery. And it’s not just physical pain. Neurological changes from pain as well as changes to daily routines can lead a long-term pain sufferer to experience depression and anxiety.2 While chronic pain can be debilitating, there are methods of pain reduction that can be quite beneficial. Medications and surgeries can alleviate some pain symptoms. In addition, massage has been shown to be very helpful in lowering both acute and chronic pain.3 Massage helps relax muscle tension and ease the nervous system. In addition, massage has been shown to be effective in alleviating depression and anxiety, two of the hallmark ailments that usually occur with long-term chronic pain.4 Lower back pain, which is chief among chronic pain complaints, tends to respond extremely well to massage interventions. In a 2017 update to its treatment guide, the American College of Physicians declared massage and exercise were more effective and safer in treating non-radiating back pain than medication. 5 When it comes to making massage part of your pain management program, there are many factors to consider. There are many different types of massage and body work, all of which can be beneficial in alleviating pain. Swedish massage, one of the most common forms of body work, uses long gliding strokes to reduce muscular tension and induce a relaxed state. The therapist can adjust the pressure to meet the client’s needs. Deep tissue, another popular form of massage, works slower and

MASSAGE HAS A LONG HISTORY OF PAIN REDUCTION.

deeper in the belly of the muscles to reduce tension in deeper structures.

Deep tissue is favored by many therapists working with a post-injury client. While the bodywork does occur deeper in the body, it does not rely exclusively on pressure and it does not have to be painful.

In some instances, a chronic pain client and the therapist might agree a full body massage is not the most effective use of time. Instead, the massage therapist might work with a group of muscles affected by injury or pain. In that case, a one-hour session may not be necessary.

Massage has a long history of pain reduction. It is always a good idea to talk to your doctor about adding it to your pre-existing pain reduction plan, but massage is considered generally safe. If you have questions regarding how massage might help you, call the Lexington Healing Arts Academy’s massage clinic at (859) 252-5656. With nearly 20 years of history in the Lexington community, LHAA is always ready to help match you with the right therapist.

Sources

1. www.thegoodbody.com/chronic-pain-statistics/ 2. www.psycom.net/depression.central.chronic.pain.html 3. www.ncbi.nlm.nih.gov/pmc/articles/PMC1876616/ 4. www.amtamassage.org/approved_position_statements/Massage-CanReduce-Symptoms-of-Depression.html 5. www.acponline.org/acp-newsroom/american-college-of-physicians-issuesguideline-for-treating-nonradicular-low-back-pain

About the Author Jeff Zutant is a licensed massage therapist (LMT) and a staff member at Lexington Healing Arts Academy. Beyond his role as massage therapist Jeff coordinates the academy's compliance efforts including student retention and placement.

ABOUT LEXINGTON HEALING ARTS ACADEMY Lexington 272 Southland Drive, Lexington, KY 40503 • 859.252.5656 • www.lexingtonhealingarts.com Healing Arts LHAA is a licensed, accredited school offering career education and services Academy in Massage, Personal Training, and Yoga.

Funeral.

September 2018

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FUNERALS, MEMORIALS SERVICES AND MONUMENTS MATTER

understand discussing or pre-arranging a funeral is not a welcome subject for most people. Some even question if funerals or life celebrations are really necessary.

But there are compelling reasons why funerals and life celebrations matter. Whether you choose a traditional funeral or life celebration, it provides a profound experience that ultimately aids in the grieving process.

These are the seven key reasons funerals and life celebrations matter: 1. They bring together friends and family whose support and compassion give us comfort and perspective.

2. They help us express our grief in a safe setting.

3. They let us share memories, tributes and appreciation for the life of the deceased.

4. They help us acknowledge the reality of death.

5. They allow for the expression of faith.

6. They provide us with a sense of continuity — that life goes on.

7. They encourage our acceptance of loss and help us heal.

Virtually everyone who comforts family and friends at a visitation and attends a funeral or life celebration experiences a profound sense of their importance and helpfulness.

More than endings, funerals and life celebrations are bridges of transition.

As time passes and grief subsides, we appreciate more fully the relationship that endures. We see that the words spoken and feelings experienced during the visitation and funeral help us reach a place of fond memory and deep appreciation for the person whose life is celebrated.

As a funeral director, I believe conducting funerals is a sacred trust that allows me to help families transition from what can sometimes be a devastating moment to a time of peace, knowing their loved one is no longer hurting or sick.

In recent years, the rate of cremation has grown as much as 29 percent in the Commonwealth of Kentucky and as high as 77 percent in states such as Washington. A number of people think with cremation, little needs to be done but to have the remains scattered. What people may not understand is cremation is simply a type of final disposition just as burial is a type of final disposition.

For the people left behind, a visitation and service as part of the grieving process for someone who has been cremated is every bit as profound and helpful as a traditional funeral and burial. This ritual still matters for the same reasons a A VISITATION visitation matters when traditional burial is chosen.

The important point is we need ritual and ceremony to help us comprehend major life AND changes. When words are inadequate, we use ritual.

It is no different than the experiences we have at SERVICE IS baptisms and weddings.

As the years go by, having a place of permanent PART OF THE memorialization allows family and friends a tangible GRIEVING area to visit — a sacred spot where you can engage in quiet reflection and rekindle treasured memories of PROCESS. the deceased.

You can choose from a number of possibilities: scattering gardens with permanent markers, urn gardens, traditional urn burial or niches in mausoleums or special areas on cemetery grounds. Some people prefer to keep the urns in their homes and others prefer having their ashes scattered at a remote spot, but I recommend having a special permanent marker placed at a cemetery.

About the Author Joey Tucker has been serving the Lexington community as a funeral director for Milward Funeral Directors since 2007 and has been a licensed funeral director since 2002. Milward is the 37th oldest continuously operated family business in the United States, with three locations in Lexington. Joey can be reached at (859) 252-3411.

ABOUT MILWARD FUNERAL DIRECTORS Downtown: 159 North Broadway 859.252.3411 • Southland: 391 Southland Drive 859.276.1415 Man O'War: 1509 Trent Boulevard 859.272.3414 • www.milwardfuneral.com

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APPOINTMENTS AVAILABLE WITH FPA PROVIDERS AT BOTH LOCATIONS

Family Practice Associates of Lexington, P.S.C.

HAMBURG OFFICE

1775 ALYSHEBA WAY SUITE 201

SPRINGS OFFICE

2040 HARRODSBURG ROAD, SUITE 300 CHECK US OUT ON THE WEB

fpalex.com

859.278.5007

Family Doc.

September 2018

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TREATING

STRESS FRACTURES STRESS FRACTURES ARE MOST COMMON IN THE WEIGHTBEARING BONES OF THE LOWER LEG AND FOOT.

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tress fractures are the painful bane of runners and other athletes such as soccer, tennis and basketball players. These tiny cracks in a bone are usually caused by repetitive stress or force, overuse and walking or running on uneven surfaces. Stress fractures are most common in the weight-bearing bones of the lower leg and foot. Osteoporosis, chemotherapy and other conditions that weaken the bones can also lead to stress fractures. Female athletes are more prone to stress fractures than male athletes.

According to the Institute for Preventive Foot Health (www.ipfh.org), a fracture is a break of any size in a bone. A displaced bone fracture happens when the broken ends of a fracture move away from one another and a gap develops between them. A non-displaced fracture, also called a hairline or stress fracture, occurs when a bone develops a crack or breaks but the broken ends don’t move apart.

The American Academy of Orthopaedic Surgeons (www.aaos.org) says stress fractures occur most often in the second and third metatarsals in the foot, the areas of greatest impact on your foot as you push off when you walk or run. Stress fractures occur over time when repetitive forces result in microscopic damage to the bone. The most common cause of stress fractures is a sudden increase in physical activity, either frequency or duration – doing too much too soon. The AAOS’ research shows stress fractures happen more frequently in the winter months, when vitamin D levels in the body are lower.

Symptoms of a stress fracture include tenderness or pain in the area of the fracture, swelling, discoloration and pain when walking on or moving the broken appendage. Stress fractures near a joint may cause the joint to become dislocated.

Treatment will vary depending on the location of the stress fracture and its severity. Treating a stress fracture usually includes immobilizing the injured area for a period of six to eight weeks. Depending on the type and severity of the fracture, you might wear a cast, boot or brace to support the injured limb and reduce pressure on it. Some stress fractures require surgery to heal properly. Take seriously your physician’s recommendation as to how long to stay off the injured appendage. If you try to go back to your chosen activity too quickly, you may impede the healing process and increase your risk for a larger stress fracture or even a complete fracture.

There are some things you can do to protect yourself from stress fractures in your feet. Be sure to purchase proper shoes for whatever sport you play. They should fit well and have nonslip soles, provide adequate support for your ankles and absorb the repetitive forces that can lead to a stress fracture. Replace the shoes as they wear out. Use proper techniques when performing your chosen activity and start off slowly, gradually increasing your time, speed and distance. When you feel discomfort or pain, follow the R.I.C.E. protocol: rest, ice, compression and elevation. See your primary care provider if your symptoms persist for more than a couple of days.

About the Author

Todd Martin, APRN, is a native of Northern Kentucky. He graduated from Northern Kentucky University in 1990 and completed his master’s degree in 1999, receiving honors in both programs. He is board certified as a family nurse practitioner and has worked in emergency medicine and family practice.

Todd has lived in Lexington with his wife, Lori, for the past 13 years and is an avid fly fisherman and outdoor enthusiast. He joined Family Practice Associates of Lexington in 2013 and believes in treating not just the disease, but the patient, as a complete human being.

ABOUT FAMILY PRACTICE ASSOCIATES OF LEXINGTON TWO LOCATIONS: 1775 Alysheba Way, Ste. 201 and 2040 Harrodsburg Rd., Ste. 300 • 859.278.5007 • www.fpalex.com Proudly serving Kentucky for over 30 years, Family Practice Associates of Lexington is a group of primary care providers who are dedicated to giving family-centered care from birth to later years.

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Family Vision.

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September 2018

VISION PR OBLEMS C AN LEAD TO

CLASSROOM PROBLEMS

s your child having problems in school? Do you frequently receive notes from his or her teacher about misbehavior or attention problems? It may surprise you to realize the child’s difficulties are the result of vision-related learning difficulties.

More than 80 percent of learning is visual. In school, a child constantly has to look from his or her desk or book to the board and back. This involves the necessary visual skills of pointing and tracking. The eyes must work together to focus and send the visual cues to the brain.

Good vision is vital to developing reading and writing skills. Children with poor vision often find it hard to focus on their work. Common vision problems often go undiagnosed – many of them are not obvious – and the frustration, trouble and actual discomfort some children encounter in school can lead to less than desirable behavior.

Children won’t tell you they can’t see because they don’t know they can’t see. They don’t know what normal vision is. Fewer than 15 percent of children have had their eyes examined. But to diagnose problems that affect learning takes more than the standard test that generally includes reading an eye chart to discern 20/20 vision. Vision is much more than just seeing clearly. It is an incredibly complex system. It takes a comprehensive eye exam to measure a child’s ability to track and point his or her eyes.

What are some signs parents can look for that will let them know their child needs to have a comprehensive eye exam? Here are a few cues: • squinting; • reluctance to read; • covering one eye; • turning the head to the side; • using a finger or bookmark to keep track of their place while reading; • poor reading comprehension; • skipping lines or words in the text; • sloppy handwriting; • headaches; and • fidgeting.

When conducting a comprehensive eye exam, the vision therapist will watch the child read to see how efficiently the eyes work together.

Does the child miss words? Does she reverse letters, seeing a “b” as a “d”?

Optometric vision therapy can help children overcome obstacles such as convergence insufficiency disorder, a condition in which the eyes are

CHILDREN WON’T TELL YOU THEY CAN’T SEE BECAUSE THEY DON’T KNOW THEY CAN’T SEE. unable to converge and sustain what they see. With visual therapy, children can learn how to point the eyes together and keep the single vision they produce. They will develop the neurocognitive and visual cognitive skills that are necessary for reading and learning. As they practice and receive proper feedback, their subconscious visual skills improve. The program offered at Family Eyecare Associates usually lasts 30 weeks and incorporates various activities that are specifically designed to help with understanding numbers, letters and shapes. But the results are impressive: Parents often see a three-year jump on their child’s standardized scores and tests. And the child begins to enjoy reading.

For more information about vision problems that can undermine your child’s ability to learn, check out the videos at: http://vild.info/about. html. Then call for a consultation with Family Eyecare Associates to have your child’s vision checked.

About the Author

Dr. Graebe received both his B.S degree in Visual Science and Doctorate of Optometry from Indiana University. He is a Behavioral Optometrist and learning expert. He has been in private practice here in the Bluegrass area for the past 32 years.

ABOUT FAMILY EYECARE ASSOCIATES 105 Crossfield Drive, Versailles, KY 40383 • 859.879.3665 • www.myfamilyvision.com

Family Eyecare Associates

We exist to consistently provide you with the finest, most complete eye care available. Our goal is to develop a life-long relationship with you and your family, both as our patients and our friends.

SUNDAY, SEPTEMBER 9, 2018 * 7:45 AM * THE CLUB AT UK’S SPINDLETOP HALL SPRINT TRIATHLON individual or relay 400 meter pool swim * 12.6 mile bike * 3 mile run

DUATHLON individual or relay 2 mile run * 12.6 mile bike * 3 mile run AQUA BIKE individual 400 meter pool swim * 12.6 mile bike

AQUA RUN individual 400 meter pool swim * 3 mile run ENTRY FEES *prices for individual triathlon THROUGH AUG 14 $80 AUG 15 – CLOSE $90 This is a USAT sanctioned event. See website for all rates and fees as well as discounts for UK faculty, staff and students.

PARTICIPANTS OF ALL AGES WELCOME!

All athletes get a long sleeve T Shirt and a finisher’s medal!

Packet Pick Up*: Thursday, Sept. 6th CrankWorks Southland Drive Friday, Sept 7th Pannel Swim Shop, Tiverton Way Sat. Sept 8th Spindletop Hall *Times TBD – see race website closer to race date

Online registration at www.triforsight.com * follow link to registration page

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September 2018

TURNING THE TABLES: ADAPTING ANIMAL TOXINS FOR PAINKILLERS

TETRODOTOXIN BLOCKS CERTAIN SODIUM ION CHANNELS THAT HELP NERVE CELLS CONVEY PAIN MESSAGES TO THE BRAIN.

POISONS AND VENOMS CAN INHIBIT ION CHANNELS

By Angela S. Hoover, Staff Writer For more than 50 years, scientists have studied toxins in the animal kingdom to create novel painkillers. The noxious chemicals several animals produce are potent and usually strike pain pathways. Animals produce two types of toxins: poisons and venoms. Poisons cause pain or illness when ingested. Venoms, which are injected via a bite or a sting, cause ill effects. Some of these toxins are analgesic, or pain relieving. Other toxins elicit pain. Researchers have experimented with these compounds to identify inhibitors of ion channels on the pain-sensing neurons they target.

Cone Snails There are 800 species of cone snails. Researchers explore them all for analgesic possibilities. In the 1980s, researchers isolated a conotoxin peptide from the venom of the Conus magus and derived a synthetic version of the peptide ziconotide. Extensive functional studies revealed ziconotide blocked N-type, voltage-gated calcium channels, inhibiting the release of pain-transmitting chemical messengers in the central nervous system. Ziconotide, which is a thousand times more potent than morphine, was approved by the U.S. Federal Drug Administration (FDA) under the name Prialt in 2004. Prialt is the only toxinderived analgesic the FDA has approved to date. Used to treat neuropathic and cancer-related pain, it must be delivered directly into patients’ spinal cords through a surgically implanted pump.

Spiders There are more than 40,000 species of arachnids, almost all of which produce venom that has

nerve-attacking molecules that target mammalian pain receptors.

Physiologists at the University of California, San Francisco found two toxins from the Togo starburst tarantula that selectively activated the voltage-gated sodium channel.

The team also characterized one of the toxin’s binding sites, opening a route to developing selective inhibitors for analgesia. In 2017, a group of researchers in Australia reported a peptide from the giant blue bloom tarantula inhibits the pain associated with a particular sodium channel by binding to its voltage-sensing domain. The same group recently identified another sodium channel inhibitor, Cdla, from the African rear-horned baboon spider. They published their findings in the journal Plos One. Pfizer researchers recently synthesized mircoproteins inspired by peptides from the straighthorned baboon tarantula. Last year, Janssen scientists engineered a variant of protoxin II, originally isolated from the Peruvian green velvet tarantula venom, that made rats insensitive to pain by blocking Nav1.7 activation.

Centipedes There are about 3,000 venomous centipedes in the world that are full of ion-channel modulators that may be therapeutically useful.

Centipede venom has a long history as a painkiller. Toxins from the Chinese red-headed centipede have been used in Chinese medicine for centuries. Researchers at the University of Queensland, Australia, found a centipede peptide, Ssm6a, that selectively inhibits a particular voltage-gated sodium channel implicated in pain sensing in mammals, including humans. Last year, a Chinese team

showed another centipede peptide has analgesic properties in mice.

Puffer Fish Tetrodotoxin, the toxin from the deadly delicacy puffer fish, blocks certain sodium ion channels that help nerve cells convey pain messages to the brain. Researchers are also exploring using toxins from sea anemone, jellyfish, frogs, scorpions, snakes and the cactus-like plant African spurge. Challenges

include ensuring the drugs are highly specific to their targets that often lie beyond the blood-brain barrier in the central nervous system. Each family of ion channels involved in humans’ painsensing abilities contains several conserved proteins. Nevertheless, several toxin-derived candidates are beginning to prove their worth in preclinical experiments and a handful of clinical trials.

Dental Care by Gretchen Kinchen, DMD Creating beautiful, healthy smiles in an environment full of Southern Hospitality NEW PATIENTS RECEIVE

FREE

WHITENING TRAYS

At Dental Care by Gretchen Kinchen, DMD we value our patient relationships, making it our priority to deliver gentle compassionate care that you deserve from a dentist in Lexington.

We work hard to make you feel at ease by providing exceptional patient care in a relaxed, friendly atmosphere. We strive to develop lifelong relationships with our patients by combining the latest dental technology with a professional and compassionate staff. The result is a beautiful, healthy smile that lasts a lifetime.

We also believe that patients should have sufficient information to make educated decisions about their oral health, treatment options and choice of dentist in Lexington. You’ll find all of this important information on our website, including directions to our Lexington office, service descriptions, patient forms, patient education resources and more.

Not only is Dr. Kinchen a leading dentist in Lexington, our office is a full-service practice specializing in cosmetic dentistry and providing for all of your dental needs.

BEAUMONT CENTRE

989 Governors Lane, Suite 120 Lexington, KY 40513 (859) 296-0296 www.gkdentalcare.com

Fitness Training.

September 2018

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4 TIP S TO H E L P B U S Y PA R E NTS

FIND TIME FOR FITNESS

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uffer through an hour commute: Check. Do the grocery shopping: Check. Take the kids to soccer practice: Check. Call the exterminator: Check.

There are a lot of tick marks on your to-do list throughout the day, but is there one for exercise? In a world where the kids need attention, the boss needs a report and the tub needs to be scrubbed, it’s important for busy parents to find time to take care of themselves, too. After all, exercise may take energy, but it produces energy in return — the thing you need the most. Try these tips for making time for your own fitness routine.

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Rise and shine 30 minutes earlier Writer Mark Twain has been credited with saying, “Eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day.” Which could be interpreted as getting your biggest task of the day over with early. If exercise is your frog, try setting your alarm clock 30 minutes earlier in the morning so you can make time for a fitness routine.

Do some yoga, step on the elliptical machine or take the dog for a brisk walk around the block. All these things are doable in 30 minutes. Plus, it can provide you some much needed alone time to prepare for your day.

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Grab a kid and a kettlebell There’s nothing that says you have to work out alone. In fact, exercising with your kids can be a great bonding experience, not to mention you might even instill in them a passion for fitness early on. Create a workout routine that everybody can do but offers you opportunities to challenge yourself. Try some planks, push ups, jumping jacks, crunches and the dreaded burpees. Also, incorporate some resistance bands, jump ropes, and kettlebells for the older kids. Working out as a family means you don’t have to sacrifice your together time for exercise.

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Have someone hold you accountable Let’s be honest. It’s easy to slack off and make excuses for not exercising when no one is looking. No judgment here because we’ve all been guilty of it. If you are “that person,” maybe hiring a personal trainer is the

answer to your fitness success because he or she will hold you accountable, which means it’s more likely you’ll stick with your workouts. Having a set appointment time with a trainer can help keep you disciplined with your schedule, too. Not to mention a trainer can help you track your progress, which is another motivator when you see your efforts paying off.

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Lunge at lunch Maybe you just aren’t a morning person and no matter how committed you are, getting up 30 minutes early to work out is not going to happen.

That’s OK, there’s always lunch. No matter where you work, there are probably opportunities for a fitness routine, even if it’s your office. Keep some dumbbells under your desk. Find a deserted hallway and do a few rounds of walking lunges. Grab some office pals and walk a few city blocks or hike some natural trails if your office is more remote. Throughout the day, if you work in a tall building, take the stairs instead of the elevator.

Not sure how to get started?

Lexington Healing Arts Academy offers personal training sessions that are all about you and your needs and fitness goals. LHAA’s Personal Fitness Interns can help you get started for only $10 a session. Even if your schedule means you have to work out at home, they can give you the tools and an individualized program that you can fit into your schedule. Make an appointment to get started on your specific fitness goals and help our interns transition from student to professional.

ABOUT LEXINGTON HEALING ARTS ACADEMY Lexington 272 Southland Drive, Lexington, KY 40503 • 859.252.5656 • www.lexingtonhealingarts.com Healing Arts LHAA is a licensed, accredited school offering career education and services Academy in Massage, Personal Training, and Yoga.

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Orthopaedics

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September 2018

BURNING THE

NERVES

alcohol, phenol and glycerol work to destroy the peripheral nerve, he facet joints in the spine but the flow cannot be controlled can be a source of chronic so the chemical may go to other pain in 15 percent to 45 structures. There is a higher risk percent of patients. The diagnosis of neuroma/neuritis formation is made, but the options are either afterwards. injecting intra-articular anesthetic Radiofrequency lesioning into the joint or the medial branch has been used since the 1950s. of the dorsal rami that innervated Radiofrequency energy at the them. If the pain is eliminated by tip of the electrode lesions the the diagnostic injection, this can targeted tissue. The needle itself indicate facet joint mediated pain. does not keep up, but the tissue The optimal patient for around the tip of the needle denervation of the joint is one usually heats up, causing the who has chronic pain that has denervation of the nerve. This is not responded to conservative the most common form of nerve treatment symptoms of pain in denervation. the spine or who has pain that Radiofrequency denervation radiates into the lower extremities. should be avoided if there is Pain that radiates into the lower ongoing infection, bleeding extremities is suggestive of some disorders or pregnancy. Usually form of nerve patients with irritation as pacemakers and opposed to facet defibrillator do not PAIN THAT joint pain. The receive this type of procedure is treatment.

RADIATES INTO limited to the Complications are levels whether rare, but they can THE LOWER diagnostic did include developing branch blocks that bruising, infection and EXTREMITIES IS show a positive temporary increasing response of SUGGESTIVE OF pain from neuritis that resolution of the usually resolves over symptoms from time, usually no more SOME FORM the diagnostic than two weeks. block. Most Outcomes in OF NERVE commonly three double-blind studies levels are targeted indicate the success IRRITATION to denervate to rate for short-term adjacent facet and long-term relief joints. of facet joint pain is Different forms of denervation anywhere between 47 percent and can be utilized. They include the 80 percent. following: Evidence of radiofrequency Cryogenic denervation could denervation of the medial allow for freezing of the nerve. branch of the facet joint provides These probes are larger in diameter moderately strong evidence for and usually offer shorter-term short-term and long-term relief ulceration compared to other of pain originating from the facet modalities. joint. The mean duration of relief Ultrasound energy does work, is found to be approximately 11 but it is difficult to control the size months. Repeat radiofrequency and temperature of the lesion. denervation success was at 85 Chemical injections such as percent.

By: Harry Lockstadt, MD

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ABOUT BLUEGRASS ORTHOPAEDICS Locations in Georgetown and Lexington • 859.263.5140 • www.bluegrassortho.com We want each patient to feel like they are the center focus. To do so, we combine our commitment of being the most affordable, high quality orthopaedic practice in the commonwealth. Ensuring our time-honored belief that at the core are our values, integrity, respect and compassion. For questions or to make an appointment, please call 859-263-5140.

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Yoga.

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September 2018

YOGA

FOR PAIN MANAGEMENT METHODS Restorative Yoga Much of yoga’s manifestation in mainstream Western culture is represented by poses that bend the body like a pretzel, but that is largely a misrepresentation. Restorative yoga is less about how much physical strength and endurance one has and more about how much relaxation you can find in a pose. In this form of yoga, lots of props (blankets, bolsters, blocks, straps and more) are used to find a very comfortable position. From that place of comfort, you will spend as little as five minutes and often as much time as feels beneficial in this position with the intention of tension release.

There are many restorative poses and most of these can even be practiced in the comfort of your bed using blankets and pillows as props rather than on a yoga mat on a floor with specific yoga props. For recommendations on poses that are appropriate and beneficial to you, seek advice from your doctor about what you should and should not do and then provide that information to a well-qualified yoga instructor for recommendations of specific poses. You may enjoy a taking a class, a private lesson, watching a video or checking out a book on your own. When practicing, cultivate curiosity about your experience and always be compassionate to the amazing body you claim as yours.

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ain is not exclusively rooted in our physical bodies. Perception of pain and the ability to cope with that experience is rooted in the mind as well. Just as when we are sick we may feel moody or how stress often leads to sickness, the mind and the body are not separate entities. Whether pain is chronic or acute, long term or short term, an appropriate yoga practice may provide relief. Much of the research surfacing in recent years hones in on yoga for relief of chronic pain.

Evidence Yogis have known, based on their practice and the results in their lives, the value of yoga practice. Research-based evidence that has surfaced in recent years continues to legitimize claims of the numerous benefits of regular yoga practice. Harvard Health Review cites studies that say among people with chronic low back pain, a weekly yoga class increased mobility more than standard medical care for the condition. It further shares that yoga can help people with arthritis, fibromyalgia, migraine, low back pain and many other types of chronic pain conditions. Psychology Today says lifestyle choices — such as practicing yoga or meditation — have been shown to reduce pain perception and offset the effects of age-related decreases in gray matter volume while helping maintain white matter integrity.

How Yoga Helps An article from YogaU shares seven ways yoga helps reduce pain: 1. Mild to moderate exercise such as yoga decreases physical pain.

2. The increase of oxygen flow to tissues throughout the body enhances energy levels.

3. Breath awareness and physical movement aid in releasing muscle tension.

4. Moving joints through their range of motion and stretching muscles reduces pain intensity.

5. The response to pain and perceived suffering are decreased.

6. Improved stress management has a positive feedback effect on pain.

7. Listening to your body can transform your understanding of and response to pain.

Mindfulness There are numerous ways to practice mindfulness. In the 1970s, Prof. Jon Kabat-Zinn popularized Mindfulness-Based Stress Reduction (MBSR). Yoga Nidra, a guided meditative experience, uses visualizations and restorative poses. Meditation, whether sitting on a cushion or walking in a park, is becoming more popular as a regular practice to enhance our life experiences. Yoga practice is intertwined with the roots of all these approaches to practicing mindfulness. The key to success and pain relief is to find what works best for you and can be incorporated into your daily life.

Sources and Resources

• Article: Restorative Yoga for Chronic Pain (https://yogainternational.com/ article/view/restorative-yoga-for-chronic-pain) • Article: Yoga for Pain Relief (https://www.health.harvard.edu/alternative-andcomplementary-medicine/yoga-for-pain-relief) • Article: 7 Ways Yoga Keeps Chronic Pain from Wearing You Down (https:// www.yogauonline.com/yoga-for-pain-relief/7-ways-yoga-keeps-chronic-painwearing-you-down) • Article: How Does Yoga Relieve Chronic Pain? (https://www.psychologytoday. com/us/blog/the-athletes-way/201505/how-does-yoga-relieve-chronic-pain) • Article: Yoga Nidra and the Five Koshas (https://yogainternational.com/article/ view/yoga-nidra-and-the-five-koshas)

About the Author Lauren Weaver is the Yoga Center Coordinator with Healing Arts Yoga at Lexington Healing Arts Academy. She can be reached at laurenweaver@lexingtonhealingarts.com.

ABOUT LEXINGTON HEALING ARTS ACADEMY Lexington 272 Southland Drive, Lexington, KY 40503 • 859.252.5656 • www.lexingtonhealingarts.com Healing Arts LHAA is a licensed, accredited school offering career education and services Academy in Massage, Personal Training, and Yoga.

September 2018

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“With Today’s Breakthroughs, You Too Can ELIMINATE Type 2 Diabetes, Obesity, Hypertension & More!”

BEFORE TRUE HEALTH SOLUTIONS

Rick Flannery, now 57, was taking 17 medications a day. He was taking 8 Oral meds and 4 Insulin Injections daily for Type 2 Diabetes. He had Hypertension, High Cholesterol, Sleep Apnea, and Obesity, weighing over 246 lbs.

His A1c was 9.2. NOW 6.7 and OFF all meds for Type 2 Diabetes, Hypertension and Cholesterol. He’s eliminated 16 drugs a day (costing thousands a year) and he’s lost over 72 pounds!

Q: Rick, why did you go to Dr. Miller?

A: “My Type 2 Diabetes was terrible and my health was getting worse. I had High Blood Pressure and I really needed to lose weight, but couldn’t. I heard of Dr. Miller and the results he gets.”

Q: You’ve been seeing other medical doctors for your Type 2 Diabetes and Hypertension, what about Dr. Miller was different?

A: “Dr. Miller made it clear, something was not working correctly in my body. He said his approach is to uncover and reveal exactly what that is. Dr. Miller really takes the time to listen and looked at my whole health history. He makes it clear that Type 2 Diabetes, Hypertension and Obesity are being caused by something. My other doctors just didn’t take the time to do this, they never even talked about what was causing any of these. The other doctors just gave me more and more medications. I knew these were just masking symptoms and not fixing anything. Dr. Miller makes complete sense.”

Q: What does Dr. Miller do to find out what’s not working correctly inside your body?

A: “Dr. Miller doesn’t mess around.

He has an amazing blood panel lab he orders through Lab Corp.

He gets the results and does a ‘Functional Medicine’ computer assessment. It is very impressive."

AFTER TRUE HEALTH SOLUTIONS

Q: After Dr. Miller finds what is not working correctly, what’s he do?

A: “Dr. Miller takes the time and goes over everything so I understood. He takes the time to show exactly what needs done and what type of natural treatment he recommends to fix what is causing Type 2 Diabetes, Hypertension, Sleep Apnea and Obesity.

It all makes perfect sense once you see everything.”

Q: Rick, what did Dr. Miller recommend for you to eliminate your Type 2 Diabetes, Obesity and Hypertension?

A: “Dr. Miller just lays it all out so clear. He started off by seeing me every week to ensure I would eliminate the Diabetes, He has amazing instructions on life-style improvements to eliminate all poor health and then stay healthy. He just makes it all so clear and provides great printed instructions. I’m really happy with how he treats me as a client.”

Q: What are the results of your treatment from Dr. Miller?

A: “My results are great! My A1c went from 9.2 to 6.7, after 15 years on medications. I’ve eliminated all my drugs for Type 2 Diabetes, Hypertension or Cholesterol and I’ve now lost 72 pounds! I highly recommend Dr. Miller. I got my health and life back!”

I’m off all medications for Type 2 Diabetes, Hypertension, High Cholesterol and I’ve lost over 72 lbs!

Integrated Care | Nutrition | Chiropractic Dr. Mark A. Miller, DC and Associates, PLLC

(859) 223-2233

www.TrueHealthSolutionsForYou.com You have the right to rescind within 72 hours any agreement to invest in services that are performed the same day in addition to advertised free services.

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Take the first step to bett hearing by calling today a you will receive a FREE hearing screening Some things are too A high percentage peopl important to miss.

Some things too who thinkare they have a Take the first stepfind to better important to miss. hearing loss it is onl hearing by calling today and wax build-up.

Take the first step to better you will receive a hearing by calling today and Some things are too FREE hearing screening.

YOUR SCREENING you will receive a WILL INCLU importantFREE to miss.

A high percentage people hearing screening.

Take the first step towho betterthink they have a A high people FREE hearing consultatio hearing by calling todaypercentage and hearing loss find it is only

Having Difficulty Hearing?

Having Difficulty Hearing?

Having Difficulty Hearing?

Free hearing screening!

you will receive a think they have a who FREE hearing screening. wax build-up. hearing loss find it is only A high percentage people build-up. who think they havewax a YOUR SCREENING WILL INCLUDE: hearing loss find it is only YOUR SCREENING WILL INCLUDE: wax build-up.

FREE video otoscope examination of your ear FREE hearing consultations

YOUR SCREENING WILL INCLUDE: Free hearing FREE hearing consultations FREE video otoscope FREE hearing consultations Free hearing screening!

Free hearing

examination of your ears FREE video otoscope FREE video otoscope screening! screening!

examination of your ears hat are wireless, invisible* and affordable examination of your ears

Solutions that are wireless, invisible and affordable Solutions that are wireless, invisible* * and affordable *

50

439

Solutions that are wireless, invisible and affordable The hearing aid

% OFF

Manufacturer’s Retail Price

$

for those who aren’t ready for a hearing aid.

Fits up to 35dB loss

*Individual results may vary. Invisibility depends on anatomy of the wearer’s ear.

Along with this offer, schedule a consultation to see how much your insurance will cover on NEW HEARING AIDS. Fits up to 35dB loss Fits up to 35dB loss loss Offer ends September 30,Fits 2018 up to 35dB Offer ends September 30, 2018

Great Fall Season Savings!

Wireless.

Invisible. Affordable.

Appointments are limited so call today! *Individual results may vary. Invisibility depends on anatomy of the wearer’s ear.

*Individual results may vary. Invisibility depends on anatomy of the wearer’s ear.

sibility depends on anatomy of the wearer’s ear.

GreatSUMMER Fall Season Season Savings!

GREAT SEASONSavings!

SAVINGS! © 2014 Audibel. All Rights Reserved. 9/14

reat Fall Season Savings!

Appointments arelimited limitedsosocall calltoday! today!

Appointments are

Richmond, Somerset and Winchester

We accept several types of Insurance including BlueCross/BlueShield as well as plans for Toyota Employees.

Call (859) 559-4422 TODAY

Audibel Hearing Aid Centers

Frankfort, Lexington, London, Morehead,

to schedule your appointment!

so call today!

www.CentralKYAudibel.com

© 2014 Audibel. All Rights Reserved. 9/14

7 AUDIBEL LOCATIONS Appointments are limited