Healthwatch January 2015

JANUARY 2015

Fighting the flu Recognizing symptoms | page 6

IN THIS ISSUE • Combatting disease Northeast Georgia Medical Center prepped for an outbreak ............ page 3

• Cold weather blues Anyone can be susceptible to Seasonal Affective Disorder.... page 10

•R elief from jaw pain

Area doctor uses new treatment for TMJ disorder ........................................... p age 17

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Sunday, January 25, 2015

The Times, Gainesville, Georgia |

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‘Live United’ against diabetes Local health care providers unite to assist diabetic patients with medical costs

BY JESSIKA BOUVIER

jbouvier@gainesvilletimes.com Many Americans are without hope when it comes to paying for treatment for an ever-growing population of medically handicapped men and women.

Millions of U.S. citizens cannot afford a basic health care policy, and receiving a diagnosis from a real doctor almost qualifies as a luxury to some. When one must rely on limited personal knowledge and no other resources, manageable disorders such as diabetes can transform into life-threatening conditions at the blink of an eye.

In March 2014, the Northeast Georgia Medical Center and United Way joined forces to provide a program to assist diabetics in monitoring their disease at little or no cost. The patients involved in this program usually gather from the Good News Clinics, the Northeast Georgia Physicians’ Group’s Primary Health Clinic, and Dr. Antonio Rios’ NGPG Internal Medicine practice.

“The diabetes monitoring program is a wonderful opportunity for indigent patients to get free meters and testing strips so they can stay on top of blood sugar readings so they can better manage their diabetes,” wrote Christy Moore, manager of Community Health Improvement for the Northeast Georgia Medical Center.

“Through this project, we may be getting strips to people who have not had resources to get these strips before, and this project will help patients to better understand monitoring and the impact of nutrition and exercise on their health status.”

Diabetes remains among the top 10 causes of death in U.S. citizens, with a large percentage of diabetic cases easily prevented through healthy eating and moderate exercise.

The strips and meters provided by the hospital and United Way are used to determine the average blood sugar level of patients over a 6-month period.

These are often referred to as “A1C tests”.

More specifically, the tests identify what percentage of hemoglobin — a protein in red blood cells that transports oxygen — are coated in sugar.

The higher the blood sugar content of a patient, the poorer their blood quality and the higher the risk for diabetic complications.

Nearly 400 patients are currently involved

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The Northeast Georgia Medical Center and United Way joined forces to provide a program to assist diabetic persons monitor their disorders at little or no cost, such as helping patients receive free meters and testing strips.

with the monitoring program, and the majority of these patients generally yield high blood sugar levels. This is a clear indication to the parties involved that they are reaching those patients that need help the most.

“United Way is excited to be a part of this program because it is a great example of how we live our mission of uniting people, organizations and resources to improve lives in Hall County,” wrote Jackie Wallace, president of United Way of Hall County.

“By providing funding for meters and testing strips to indigent patients, our community can see a clear demonstration of how their investment in United Way is being used … when individuals are able to control their diabetes and be productive and

healthy, we all benefit.”

These tests act as excellent indicators for health care providers and lend insight to the dietary habits and daily routines of individual patients. Although the tests can vary from patient to patient, medical practitioners usually prefer to see A1C test results beneath 7 percent so as to maintain a low risk for diabetic complications.

However, test results can and should be specific to patients. For example, it may be unsafe for a diabetic person to register beneath 7 percent if they suffer from hypoglycemia, or low blood glucose.

Complications can also arise in patients with chronic kidney disease or cardiovascular disease.

Diabetic persons should settle on an A1C

goal with the valued input of their doctor so as to meet their individual needs and establish stability within their disease.

Patients involved with the diabetes monitoring program are asked to sign a contract with the clinic agreeing to schedule and maintain appointments, as well as participate in educational classes that are encouraged by their physician. In order to be considered eligible, prospective patients must have diabetes and must earn an income 150 percent below the poverty level.

The clinics check glucose-level readings at the beginning of the year, the 6-month mark and the end of the year.

For more information, visit the Hall County United Way’s website at www. liveunitedhallcounty.com.

The Times, Gainesville, Georgia |

Hospital ready for outbreaks Health care employees focus on training to combat threat of infectious diseases

BY Amanda Head

ahead@gainesvilletime.com Totaling more than 8,000 deaths last year, Ebola created a worldwide panic, leading hospitals such as Northeast Georgia Medical Center to prepare to handle the worst.

“Every health care organization in conjunction with the Centers for Disease Control and Prevention guidelines began preparing for the very small chance that we could see somebody that came from West Africa with Ebola-like symptoms,” said Mike Raderstorf, Northeast Georgia Health System director of security and emergency preparedness.

Local hospital employees are trained and continue to be trained on the ability to properly screen, isolate and contain a patient who may enter the hospital with an infectious disease.

“Early fall we really didn’t know how this epidemic in Africa was going to unfold,” Raderstorf said. “The good news is that it is being contained by the World Health Organization in Africa.”

Besides discussing what the hospital can do to prevent an emergency and prepare by planning and adding new policies and procedures, hospital employees also go through extensive drills and exercises to ensure that the rules and strategies for isolation were in sync.

“We did training that was above and beyond our normal training that focuses only on Ebola and what we would do with our patients who would come in and how we would react to the situation,” said Sandy Bozarth, infection prevention and control manager.

For employees to meet the most current CDC criteria, Bozarth said new staff members are educated upon hire; all staff members are educated yearly on infectious diseases, and which ones need extra attention and isolation.

Isolation prepares a patient for transport to a Tier 1 hospital, which in Georgia is at Emory University.

“There are other hospitals that are trying to move toward the Tier 1 level of preparedness but the CDC has not disclosed those hospitals yet,” Bozarth said.

At this time, Northeast Georgia does not plan to be a Tier 1 hospital.

“The likelihood of someone walking through our doors with Ebola is very slim,” NGMC public relations manager Sean Couch said. “Nonetheless, we are prepared.”

With only four cases of Ebola firstdiagnosed in the United States, Couch said the flu should be a much larger concern for people than Ebola at this point.

“We keep in close contact with the CDC so we know of any novel illnesses that are coming to our area and at this time it is the influenza,” Bozarth said. “We are at the height of the season now and we have seen a lot of activity in our emergency room with this illness.”

‘We did training that was above and beyond our normal training that focuses only on Ebola and what we would do with our patients ...’

Sandy Bozarth CDC Even though the flu vaccine is never an exact match, the CDC encourages vaccinating because it can still provide protection to related strains of the virus.

Besides being accustomed to dealing with the flu, the hospital has a group specifically prepared for Ebola, and also an entire department that works with infectious prevention control, the CDC and public health.

“For our passion for excellence we stepped up and beyond in our preparedness efforts for Ebola and any other infectious disease so we are prepared if it ever happens,” Raderstorf said, “but the good news is with the national and state monitoring and travel programs the threat has been reduced to a very, very low chance.”

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Sunday, January 25, 2015

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Sunday, January 25, 2015

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Medicaid

Doctors may shun patients

By Adriel Bettelheim Associated Press

WASHINGTON — Beginning this month, many doctors who were likely to expand basic medical care offered to low-income Americans — a goal of the 2010 health care law — could see Medicaid fees drop an average of almost 43 percent.

The development could make the doctors less willing to treat patients covered by Medicaid, undermining the law and potentially creating a patchwork of payment policies across the country.

The doctors are getting paid less due to Congress’ refusal at the end of 2014 to renew a fee bump in the health law designed to level out a historic gap between what Medicaid, the federal-state program for the poor, pays doctors, and what Medicare, the federal program for the elderly and disabled, pays them.

Physician lobbies will try to persuade Congress this spring to retroactively restore the bonuses, but their best hope may be pressing states to step forward and pay the difference

with their own money.

It’s an ominous start to what’s shaping up to be a politically dicey year for doctors. At stake is the availability and cost of care for millions of patients.

Beyond the uncertainty surrounding what’s known as Medicaid pay parity, Congress will also have to decide by the end of March whether to spare physicians from steep Medicare cuts dictated by a 1997 budget law.

Lawmakers will later consider whether to renew funding in the health law for community health centers, as well as loan repayment and training for health professionals.

The pay parity issue affects primary care doctors, the health professionals who conduct physicals, interpret basic tests, counsel patients on lifestyle changes and often serve as a first contact in the health system. The thinking is that without such early intervention, some people would wait until they are sick to seek care, and obtain treatment in costly settings, such as hospital emergency rooms.

■■Please see MEDICAID, 5

Photos courtesy Metro Images

Medicaid fees could drop almost 43 percent, which could mean doctors are less willing to treat patients.

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Medicaid: Georgia has not currently extended coverage to low-income adults ■■ Continued from 4 Doctors aren’t crazy about Medicaid because it has compensated physicians at comparatively low levels since its inception in the 1960s.

The program on average paid 66 percent of what Medicare spent in fees in 2012, before the payment bump took effect, according to the Kaiser Commission on Medicaid and the Uninsured.

But the program is central to the health law’s insurance coverage expansion. The law allows states, which determine who is eligible, to expand Medicaid to people in families with income up to 138 percent of the federal poverty level.

Many states quickly spotted the contradiction of expanding the Medicaid program and simultaneously discouraging doctors from taking patients by cutting fees. Fifteen states last year said they’d use their own funds if Congress didn’t act.

But the 15 states, which

include Connecticut, Maryland, Michigan, Nevada and South Carolina, account for just 15.6 percent of Medicaid enrollees, according to the Urban Institute.

The seven biggest states have opted not to commit, even though four of them — California, Illinois, New York and Ohio — could see an influx of new Medicaid-eligible patients under the health law’s coverage expansion. A dozen states remain undecided.

Georgia has not extended Medicaid coverage to lowincome adults, according to medicaid.gov.

The Urban Institute last year predicted the expiration of the fee bump would reduce Medicaid providers’ fees for primary care by an average 42.8 percent.

The American College of Physicians predicts some doctors will limit the number of lower-income patients they see if the cost of care exceeds Medicaid payments because they’re not required

to participate in the program.

Though dire warnings are frequently aired in debates over doctor pay, undecided states are checking whether rates affect doctor participation.

In Congress, Democratic Sens.

Patty Murray of Washington and Sherrod Brown of Ohio and Rep. Kathy Castor, D-Fla., want to revive an effort they led in the 113th Congress to extend the Medicare payment threshold to Medicaid.

They’re expected to face obstacles. Their best bet may be grafting their proposal on so-called “doc fix” legislation Congress is likely to craft in March to avert the Medicare physician payment cut.

If they don’t succeed, some undecided states may opt in to fill the gap, wagering the longterm savings from preventive care justifies the up-front cost.

That would leave a patchwork of state policies on primary care pay and an uncertain landscape during a critical year of health law implementation.

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Sunday, January 25, 2015

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Flu virus prevention is key

BY ALANA SWAIN

aswain@gainesvilletimes.com Winter is not the only season in full swing —as January morphs into February, the flu season is in its peak months.

Dr. Eileen Javellana, internist at The Longstreet Clinic in Gainesville, said their offices have seen a steady flow of people coming in with flu symptoms.

“We are getting a lot of cold symptoms, and a lot of them do end up being the flu,” she said. “They’ll come in with fevers, sore throats or just terrible muscle aches and fatigue and weakness.”

Other symptoms include runny or stuffy nose, chills, headaches, nausea, vomiting and diarrhea.

Fortunately, Javellana said, a good portion of the patients coming in have done so early enough to receive treatment, which is a key factor in staving off the flu.

“The first thing I tell people if they do end up getting the flu, or suspect they may have it, is to come in within a 24- to 48-hour window of starting to have your symptoms, because then we can test you and if it is

positive for sure, we know it and can treat it,” she said.

If the flu test turns out negative and a person has similar symptoms, they can still be treated, Javellana said. Additionally, “depending on that, we can also treat some of your family members with … Tamiflu to help keep from spreading it around the whole family. A lot of people wait too long or say, ‘My family has been sick for about a week, and now I feel bad.’ That’s a little too late. Seeking early medical attention is key,” she said.

In addition to visiting the doctor, other steps to help treat the flu are getting lots of rest, drinking plenty of fluids to stay well hydrated (especially clear fluids like water, broth and sports drinks), taking warm showers and putting a humidifier in your room to ease breathing problems.

Preventive measures include frequent hand washing with soap and water, avoiding touching your eyes, nose and mouth, getting adequate rest, staying hydrated and practicing other healthy habits.

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FLU: 2015 season predicted to continue through February, possibly into March ■■ Continued from 6 “Don’t let yourself get rundown,” Javellana said. “Also, try to avoid crowds or big places where it may be rampant — schools and hospitals are terrible for it—you can get it within a day’s time of being exposed to a contagious person.”

She recommends wearing surgical masks if you do have to venture out where you may come into contact with sick people.

“And get your vaccines ahead of time. Don’t wait until the last minute, because it takes about two weeks for (the flu vaccine) to take effect,” she added.

However, Javellana still recommends getting the flu shot at this point, as flu season is predicted to go on through February, and can continue through March.

While some reports have suggested the flu shot isn’t as effective this year, “it’s still the most powerful weapon or defense against getting the disease to begin with,” Javellana said.

“It gives you some protection, especially for the people who need the vaccine the most, like people with lung diseases, diabetes, the young and elderly, and other vulnerable and susceptible individuals.”

Javellana said “drifted viruses,” or mutated viruses, are probably the cause of any vaccine issues this year.

“The (Centers for Disease Control and Prevention) tries to predict which strain of flu virus will be more predominant when they prepare the vaccine months before the actual flu season starts,” she said.

When those strains start to mutate, or “drift,” it can have an effect on how well the vaccine performs. However, as Javellana mentioned, the vaccine is still the best defense against getting sick, regardless of those strain mutations.

For more information on the flu, how to prevent it, and treatment information, please visit longstreetclinic.com or flu.gov.

Tests and vaccinations for influenza are used at Comprehensive Care at The Longstreet Clinic in Gainesville.

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Sunday, January 25, 2015

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REFLUX REDUX Disease can mean more than heartburn

BY ELISE PERKINS

eperkins@gainesvilletimes.com How many times a day do you reach for that over-the-counter heartburn medicine? Do you have trouble sleeping because you’re in so much pain because it feels like something is going to come up if you lay down? Is it a constant disruption in your everyday life? Are your symptoms unmanageable even with over-the-counter treatment?

Many people treat their heartburn and reflux symptoms with over-the-counter medication only to find the symptoms continue for weeks, months or even years.

“The majority of people who just walk into Kroger and buy reflux medicine are usually trying to treat just heartburn, but they don’t typically recognize what other things arise from that,” Dr. Casey Graybeal with Northeast Georgia Physicians Group said. “The most severe complication of reflux is that it is the leading cause of esophageal cancer in this country.”

Gastroesophageal reflux disease, better

known as GERD, often goes unrecognized because the most common symptom is often heartburn. Any regurgitation that is happening occurs at the bottom of the esophagus, but the inflammation can lead to difficulty swallowing, sore throat, shortness of breath, cough and hoarseness.

New studies have released recommendations for people to abstain from eating three hours before you go to bed to prevent acid reflux. Will this suggestion change your life? Maybe, maybe not.

Graybeal is part of the team that helped found the Heartburn & Swallowing Center.

An expert in the field of diagnosing and treating esophageal diseases, he’s helped many patients find the treatment that is right for them to manage their symptoms.

“The bottom line of what causes reflux is that the valve at the lower end of the esophagus is not potent enough. When we swallow, the esophagus is a muscular tube that squeezes, that pushes food and ■■Please see REFLUX, 9

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REFLUX: Healthy valve can be strained ■■ Continued from 8 saliva down into the stomach, but that valve has to open up and let things go into the stomach and then it squeezes back and it maintains pressure,” Graybeal said.

“The valve itself may malfunction so that because of a hiatal hernia, or perhaps just deterioration in the strength of the valve or eating habits, you may see a patient then regurgitate.”

There are a variety of other factors that go into diagnosing valve malfunction and reflux.

A healthy valve can be strained because of a meal heavy in alcohol, caffeine or fatty foods. A person’s weight and activity level can impact reflux as well. Bending over or stooping can apply pressure to someone’s abdomen the same way as someone with additional weight pressing down, causing regurgitation.

“If you’ve ever had reflux that’s the most horrible thing on earth. You can’t eat stuff.

You can’t. And when you do, you go to bed and you lay down, and it just comes up in your throat and it’s horrible,” said Cathey McGinnis, from Cleveland, who is a patient of Graybeal.

McGinnis suffered from GERD symptoms for years before being referred to Graybeal after continued hoarseness from inflammation coupled with other symptoms that could not be managed with treatment.

“I could bend over, and actually stuff would come back up. I couldn’t lay down in bed flat every night,” McGinnis said. “I took Nexium, I took Zantac, and still would not get any relief from it, because the reflux was so bad.”

To put how much pain and how disruptive GERD can be to patients’ lives, Graybeal looks to quality-of-life scores collected by asking patients a variety of questions regarding the effects of the disease on their day to day lives.

“When you score patients with chronic gastroesophageal reflux disease, they score just as badly as someone that has a major psychiatric diagnosis like depression or chronic congestive heart failure,” Graybeal said. “So it’s a significant problem and people that don’t have reflux don’t have any idea of how bad it can get.”

From sleeping in recliners to sleeping on the stairs, patients suffering from the disease will go to extraordinary lengths to put up with the symptoms. While most people suffering from reflux don’t regurgitate at night, the ones who do face an added danger when falling asleep due to the tendency to have what comes up stuck in their airway while lying in a semi-comatose state.

Treatment for GERD varies depending on the severity of the symptoms, but cover the spectrum from watching your weight and

exercising to having surgery.

“We had to go through all these tests to double check everything,” McGinnis said.

“When I first went to Dr. Graybeal, I did not know what we were going to do. He gave me the options of what I wanted to do.”

With the knowledge base to adequately determine the severity of a patient’s disease through tests and know how, the first thing they start with at the Heartburn & Swallowing Center is education for the patients. Controlling weight, being aware of diet and avoiding constricting clothes that add pressure to the abdomen, are suggested first, in addition to some of the same over-the-counter medicines found in local pharmacies. While a lot of information is available to the public through ads and store displays, seeing a physician will offer a better understanding of the symptoms based on duration and side effects from the medication.

“Our patients are frequently surprised to find out that their reflux is not gone just because they are taking medication. They may have good control of their heartburn but they cannot understand why they keep having pneumonia,” Graybeal said. “They are not a smoker, they take good care of their lungs. They lie down at night and don’t have heartburn to wake them up, but they regurgitate without feeling it and they are getting lung problems from that.”

Another problem people who constantly use over-the-counter medication face is the effects of the medication on their stomachs.

While reducing the acid reduces the heartburn, it also weakens the first barrier of protection from potentially hazardous foods entering the body. In certain situations, a more permanent solution is required and that is when treatment options shift to surgery.

In 2014, McGinnis was the first patient to undergo surgery to help the valve at the bottom of her esophagus with the Linx system. The magnetic system imitates the barrier created from the valve, expanding to allow food and drink in, but contracting to maintain pressure and create a barrier to reflux.

“I was on other medications for years, several years. I had tried other stuff too, everything you could think of,” McGinnis said. “I had the Linx procedure put in in April and it has been a blessing. No problems since. My quality of life has improved 1,000 percent.”

For many patients, surgery is an extreme measure that offers the most long lasting results, but it is not a first option, or even second or third. The first step to alleviate symptoms associated with GERD is to talk to a physician and consider all the options available.

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Sunday, January 25, 2015

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Shorter days could mean winter blues

Photos by Scott Rogers | The Times

Symptoms of Seasonal Affective Disorder can be similar to depression.

BY Amanda Head

ahead@gainesvilletimes.com Feeling hopeless, feelings of guilt or an overall depressed mood during the winter months could end up being Seasonal Affective Disorder, typically referred to as SAD. “SAD can affect anyone,” Dr. Ana Segarra-Brechtel, from Northeast Georgia Medical Center said. “But the average age for the first episode is 40 years old.”

Also known as winter blues and winter depression, SAD symptoms were first noticed in the north, like in Canada and Alaska, where days are increasingly shorter. As time passed the seasonal symptoms became more apparent in the south.

Similar to depression, SAD symptoms include trouble sleeping, appetite changes, difficulty concentrating, feelings of guilt and hopelessness and, in some cases, suicidal thoughts.

“Treatment wise, an antidepressant is usually prescribed,” Segarra-Brechtel said. “You could also use light therapy, which is where you expose the patient to a special type of bright light one or two hours before dawn.”

Kel Lee Cutrell, the University of North Georgia’s associate director of counseling services, said the disorder is still new in diagnosis, compared to bipolar and other psychological disorders, and some people don’t know about SAD. In dealing with college students in their late teens and early 20s, Cutrell said that she is accustomed to seeing students who fit the criteria for winter depression.

“It’s harder for an 18-year-old to notice a recurring pattern because they have lived through less winters than a 40-year-old,” she said.

Correlating with shorter days of the fall and winter, the recurring mood disorder is more common in the elderly, and in more women than men.

Those in colder climates and higher elevations who have to bundle up in long sleeves and coats for long periods of time could be at a higher risk for SAD than others. The reasoning, Stewart said, is because the sun cannot penetrate the layers to reach the skin, which is how vitamin D is made.

“The lack of daylight and sunlight … really does change our neurological makeup,” Cutrell said. “Your vitamin D levels (plummet). You need to start taking vitamin D if you have SAD.” Working on finding the causes of this relatively new disorder, associate professor Alan Stewart hopes to find potential factors that could start the onset of the ailment.

“What we basically came up with is that vitamin D plays an important role in the background of creating SAD in people,” he said.

But even though vitamin D might play a role, Stewart said, it’s not the only thing contributing to SAD. Knowing that there are some possible genetic components that could contribute to the winter blues, Stewart said that eye color could also play a role in having SAD. ■■Please see SAD, 11

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SAD: Regular exercise, healthy eating habits help patients cope with depression ■■ Continued from 10 “Lighter eyes, such as blue eyes, emit more visual illumination into the eye than darker color eyes,” he said, “and one component of SAD is that receiving too little light won’t stimulate certain parts of the brain.”

At this time, professionals cannot do genetic tests to see who might be at risk due to little knowledge on winter depression.

“Seeing the depression as a pattern is a good thing because those affected might be able to plan so they wouldn’t be as susceptible to the symptoms,” Stewart said.

Helping with SAD, Segarra-Brechtel said that the best thing is to have healthy sleep patterns.

“Use the same time frames to go to sleep and wake up,” she said.

She also added that regular exercise and eating healthier, less fatty meals can help as well.

After trying to improve the depression without any results, seeing a professional is the next step to get the disorder under control.

“Some people still think that seeing a psychiatrist is for people that are severally mentally ill and that’s not accurate,” SegarraBrechtel said.

“In our community and at Northeast Medical, we have a number of psychiatrists that can help,” she added. “The earlier you get it the better.”

Seeing a professional can help with improvement of SAD symptoms.

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Sunday, January 25, 2015

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STI program finds success

BY Jonel Aleccia Associated Press

SEATTLE — A Washington state program that gives people with chlamydia or gonorrhea free antibiotics to treat their partners boosted access to the drugs and may have reduced rates of sexually transmitted infections.

The intervention, outlined in a study published in the journal PLOS Medicine, appeared to approximately double the likelihood that sex partners could receive treatment without having to go to the doctor.

“We think about 50 percent of heterosexuals with gonorrhea or chlamydia were offered medications to give to their sex partners and about one-third received them,” said Dr. Matthew Golden, director of the HIV/STD program at Public Health — Seattle & King County.

The effort appeared to cut rates of the

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potentially dangerous sexually transmitted diseases, or STDs, by about 10 percent, though the drop wasn’t statistically significant and needs to be confirmed in larger studies.

The study included data from 23 local health jurisdictions in Washington state during a 22-month period from October 2007 to August 2009. The sites were randomly assigned in six- to eight-month waves where health care providers would hand out free antibiotics — azithromycin and cefixime — to patients to give to up to three sex partners. Or they’d provide prescriptions for the partners to be filled for free at cooperating pharmacies. In addition, health department staff offered to help patients notify their partners that they had been exposed to the sexually transmitted infections, or STIs. ■■Please see STI, 15

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HIGHLY SKILLED MEDICAL PROFESSIONALS OFFERING THE MOST ADVANCED TREATMENTS AVAILABLE Braxton B. Turner III, MD Medical Degree: Medical College of Georgia Residency: Anesthesiology - Emory University Fellowship: Pain Medicine - Emory University Board Certifications: American Board of Anesthesiology, American Board of Anesthesiology: Subspecialty Certified in Pain Medicine

Steve R. Crider, Jr., MD

STI: Drugs for trial provided by Pfizer ■■ Continued from 14 “It’s the only community-level trial to date to look at ‘Can an intervention decrease STIs at a population level?’” Golden said.

“To date, no one has replicated what we’re doing.”

Over the study period, public health workers distributed nearly 20,000 drug packs to about 500 medical clinics and pharmacies.

By the end of the trial, the proportion of patients who received free drugs jumped from 18 percent to 34 percent, and the percentage of those receiving partner services climbed from 25 percent to 45 percent, the study found.

The intervention demonstrated a level of use of what’s known as “expedited partner therapy” or EPT, that was about five times higher than other places in the U.S., Golden said.

That makes the Washington program a model for communities seeking to reduce gonorrhea and chlamydia, which can go undiagnosed and untreated, impairing fertility and causing other health problems.

In 2013, about 1.4 million people in the U.S. were infected with chlamydia, and about 333,000 had gonorrhea, according to federal statistics. In Washington, there were about 25,000 chlamydia cases and 4,390 gonorrhea cases that year, records show.

The study fuels evidence for proposed guidelines from the Centers for Disease Control and Prevention that call for

doctors and other health care providers to routinely offer the expedited treatment to heterosexual patients with the two common STIs — as long as it’s legal.

“It’s most useful when the partner is unlikely to seek care and not likely to be treated,” explained Matthew Hogben, chief of social and behavioral research in the CDC’s STD prevention division. “We do consider it a useful option for partner treatment.”

EPT is legal in 35 states in the U.S. and potentially allowable in nine states, including Georgia. But it’s prohibited in six states, typically because of existing laws that bar doctors from prescribing drugs without first examining a patient.

Despite those laws, the CDC has recommended EPT since 2006, with guidelines updated in 2010, Hogben said.

The new guidelines, which are awaiting clearance, are the strongest yet, and they’re based on evidence that in a metaanalysis of several trials, so-called “patientdelivered partner therapy” can reduce rates of chlamydia by 20 percent and rates of gonorrhea by 50 percent.

The practice has continued to thrive in Washington since the study ended, Golden said.

For the trial, the drugs were provided free by manufacturer Pfizer and local pharmacies. In the future, Golden said he’d like to see them made widely available the same way that vaccines are available to ensure children are immunized.

Medical Degree: Medical College of Georgia Residency: Carraway Methodist Medical Center; Anesthesiology - Northwestern University Fellowship: PPain Medicine - Texas Tech University Board Certifications: American Board of Anesthesiology, American Board of Anesthesiology: Subspecialty Certified in Pain Medicine

H. Keith Robinson, MD Medical Degree: Medical College of Georgia Residency: Anesthesiology - University of Alabama: Birmingham, AL Fellowship: Pain Management - Wake Forest University, Bowman Gray School of Medicine: Winston-Salem, NC Board Certifications: American Board of Anesthesiology, American Board of Anesthesiology: Subspecialty Certified in Pain Medicine

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Sunday, January 25, 2015

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Metro Images Metro Images

Get up, get moving Study finds sedentary behavior trumps fat as a killer

BY Melissa Healy Associated Press

LOS ANGELES — If you had but one New Year’s resolution to keep, maybe it should be to get up and move a little more.

New research shows that for men and women across the spectrum of body mass index and belt size, those who got even a little exercise — burning up about 100 calories a day in physical activity — were less likely to die of any cause over a 12year period than those who were entirely sedentary.

In a large and diverse European population, the new study suggests that physical inactivity might be responsible for twice as many total deaths as having

a high body mass index. But it found that having a high waist circumference too — a surrogate measure for abdominal obesity — was nearly as powerful a predictor of premature death as was inactivity.

Using 2008 European death figures, the authors suggested that 676,000 of 9.2 million deaths could be attributed to physical inactivity. By contrast, 337,000 deaths could be attributed to obesity.

In the population studied, 22.7 percent reported they got virtually no regular physical activity. Obesity affected 15.8 percent of participants, and 21.9 percent were considered abdominally obese because they had a waist circumference greater than 35 inches for a woman or 40 inches for a man.

The study, which tracked 116,980 men

and 217,181 women throughout Europe for an average of 12 years, was published in the American Journal of Clinical Nutrition.

For all of physical activity’s protective powers, however, the latest research underscores that it works best for men and women who can keep their BMI in the “normal healthy weight” category. Those whose BMI falls between 18.5 and 24.9 benefited most when their routine included at least a modicum of exercise.

Compared with lean but sedentary folk, lean people who were even “moderately inactive” were, on average, 30 percent less likely to die of any cause during the study’s follow-up period. Moderately active slim people were 36 percent less likely to die than were their sedentary but

slim peers. And “active” slim people were 41 percent less likely to expire over the 12-year period.

For those in the obese category — with BMIs over 30 — the findings were not as reassuring. Other studies have established that obesity alone raises the risk of death due to any cause. In the current study, those who exercised even a little were just 20 percent less likely to die during the study than were sedentary obese people, and those considered “moderately active” were at 27 percent less risk of dying.

Obese people at the highest physical activity levels — considered “active” — were 21 percent less likely to die than their sedentary peers. For the obese, the study suggests, moderate exercise may be best.

The benefits of exercise for reducing the death risk in overweight people — those with a BMI between 25 and 30 — lay in the middle.

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Surgeon hopes to help jaw pain

BY ANDI ECKARDT

aeckardt@gainesvilletimes.com Temporomandibular Joint disorder — commonly referred to as TMJ — impacts more than 10 million Americans, making it the second most common facial pain disorder after general toothaches.

Dr. Fred H. Simonton of Gainesville Oral and Maxillofacial Surgery, shed light on the painful disorder.

“We aren’t sure what actually causes the condition, but the majority of cases are of those who are female in childbearing years,” Simonton said.

TMJ disorder can be caused by clenching the jaw and stress on the joint.

“It is usually a chronic problem,” Simonton said. “It could be the way the jaw is aligned or from clenching the jaw from anxiety.”

The joint is a hinge connecting the lower jaw to the skull, enabling your mouth to open,

“The newer bone close and move smoothly anchors are nonmetallic, from side-to-side. The preventing radiographic disorder can prevent distortion and making people from being able to them hypoallergenic chew properly. for patients with metal Other symptoms can allergies,” Simonton include headaches, wrote in a press release. neck aches, earaches, “They also provide much dizziness and even upper Simonton better results for patients shoulder pain. since they have a higher pullout For a proper diagnosis, a doctor can take an MRI of the jaw. strength and require less bone removal.”

The condition can be treated by Since a presentation of outpatient maxillofacial surgery.

Simonton’s at a meeting “More advanced cases are of the American Society of treated by a total replacement Temporomandibular Joint surgery, much like a hip or knee Surgeons, oral surgeons and replacement,” Simonton said. specialists worldwide have Simonton has received started using the now FDAapproval from the Food and Drug approved JuggerKnot™ Soft Administration for an anchoring Anchor to provide better device for TMJ surgery. The outcomes for TMJ surgery device is nonmetallic, stronger patients. and smaller than the previous For more information about metallic device he used to treat Fred Simonton, visit his TMJ in patients.

Gainesville Oral & Maxillofacial The new device is called the Surgery practice website at www.

JuggerKnot™ manufactured by oralsurgeryofgainesville.com.

Bio Met.

Bigstockphoto.com

TMJ disorder can be caused by clenching the jaw and stress on the joint.

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Sunday, January 25, 2015

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Reducing the risk of cancer Lifestyle tips and modifications that can help lead to a healthier future

By Michele Munz Associated Press

ST. LOUIS — Cancer can be seen as striking haphazardly, but research over the past 40 years shows that lifestyle factors play a huge role in cancer incidence and mortality.

Dr. Graham Colditz, an internationally recognized disease-prevention expert at Siteman Cancer Center at Barnes-Jewish Hospital, has put together a list of behaviors that greatly reduce overall cancer risk. And they’re not as complicated as you might think. For a healthy 2015, Colditz suggests starting with one or two from the list. Once you’ve got those down, move on to the others.

Maintain a “healthy weight”

It’s easier said than done, but a few simple

tips can help. If you’re overweight, focus first on not gaining any more weight. That can give your health a boost. When you’re ready, try to take off some extra pounds. Tips: ■■ Integrate physical activity and movement into your life.

■■ Encourage healthy snacking on fruits and vegetables.

■■ Encourage activity during free time.

Get screening tests

A number of important screening tests can help protect against cancer.

Some tests find cancers early when they are most treatable, while others can actually help keep cancer from developing in the first place. For colorectal cancer alone, regular screening could save more than 30,000 lives each year. Talk to a health care professional about which

tests you should have and when.

Photos courtesy Metro Images

Protect yourself from the sun

While the warm sun feels great, too much exposure can lead to skin cancer, including serious melanoma. Skin damage starts early in childhood, so it’s especially important to protect children. Tips: ■■ Steer clear of direct sunlight between 10 a.m. and 4 p.m.

■■ Wear a hat, longsleeved shirt and sunscreen with SPF15 or higher.

■■ Don’t use sun lamps or tanning booths.

Exercise regularly

While it can be hard to find the time, it’s important to fit in at least 30 minutes of activity every day. More is even better, but any amount is better than none.

■■Please see CANCER, 19

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CANCER: Taking multivitamins can help ■■ Continued from 18

snacks, which are high in bad fats.

Don’t smoke

Drink alcohol in moderation

Quitting smoking is absolutely the best thing you can do for your health. Yes, it’s hard, but it’s also far from impossible. More than 1,000 Americans stop for good every day. Tips: ■■ Keep trying. It often takes six or seven tries before you quit for good.

■■ Talk to a health-care provider for help.

■■ Join a quit-smoking program.

Eat a Healthy Diet

Despite mounds of information that can be confusing, the basics of healthy eating are quite straightforward. Focus on fruits, vegetables and whole grains, and keep red meat to a minimum. Cut back on bad fats (saturated and trans fats) and choose healthy fats (polyunsaturated and monounsaturated fats). Taking a multivitamin with folate every day is a great insurance.

Tips: ■■ Make fruits and vegetables a part of every meal. Put fruit on your cereal. Eat vegetables as a snack.

■■ Choose whole-grain cereal, brown rice and whole-wheat bread.

■■ Cut back on fast food and packaged

Moderate drinking is good for the heart, but it can also increase the risk of cancer. If you don’t drink, don’t feel the need to start.

If you drink moderately (less than one drink a day for women, less than two drinks a day for men), there’s probably no reason to stop.

People who drink more, though, should cut back. Tips: ■■ Avoid occasions centered around alcohol.

■■ Talk to a health-care professional if you feel you have a problem with alcohol.

Protect yourself from STI’s

Among other problems, sexually transmitted infections — like the human papillomavirus (HPV) — are linked to a number of different cancers. Protect yourself from these infections. Tips: ■■ Always use a condom and follow other safe-sex practices.

■■ Never rely on your partner to have a condom. Always be prepared.

■■ When appropriate, discuss with children the importance of abstinence and safe sex.

■■ Vaccinate girls and young women as well as boys and young men against HPV.

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Sunday, January 25, 2015

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A fresh look at snacking

Snack makers creating healthy alternatives to satisfy hunger

By David Pierson Associated Press

SAN FRANCISCO — The next generation of food manufacturers are clamoring to satisfy your snack cravings. Just don’t expect another potato chip or pretzel.

At the annual Fancy Food Show in San Francisco, up-andcoming brands touted seaweed chips, toasted coconut shavings, kale crackers, Wagyu beef jerky and baked pasta bites.

Among them could be the next Super Bowl party staple. Today’s emphasis, however, is on guiltfree snacking — the holy grail of nosh. Manufacturers are banking on more healthful products, lower in fat, sugar and salt, but packing the same addictive punch as a can of Pringles chips.

“Even though they’re much

healthier snacks, I’m hoping people don’t stop at one,” said Jerry Bello, maker of Pasta Chips, a ravioli-shaped crispy bite dusted with Italian seasonings.

The surge in snack options comes as Americans have transformed into a nation of grazers. The number of snacks consumed per day has doubled since the 1970s, the U.S. Department of Agriculture says.

Over 90 percent of Americans say they nibble daily, amounting to a $28 billion annual industry for salty snacks alone, according to Nielsen.

Young consumers are driving the change. Rather than partaking in breakfast, lunch and dinner, they’re grubbing around the clock.

“Millennials are redefining snacks,” said Dwight Richmond,

Whole Foods Market’s global purchasing coordinator. He and about 50 colleagues from the Austin-based grocery chain perused the latest offerings at the closely followed trade show, a sort of incubator and marketplace for food brands that aren’t quite mainstream and are typically found in higher-end stores.

“Instead of eating three square meals, they’re juicing and snacking,” said Richmond, who believes the shift away from junk food will grow as more consumers seek out simple, minimally processed fare.

Wendy Meraz, a 26-year-old college student, said she picks up healthful munchies from Whole Foods and Trader Joe’s to avoid snacking on processed junk food when attending classes.

“At my school, it’s so easy to eat bad snacks,” said Meraz as she sipped a smoothie chock full of spinach and kale at a juice bar in downtown LA. “I am against unhealthy snacks existing. It’s food for cheap industrial profit.”

James Russo, senior vice president of Global Consumer Insights at Nielsen, said nearly a quarter of Americans surveyed said they prefer a quick snack over a meal.

“Snacking seems to be replacing meals for many Americans and globally, because of convenience and also as a way to cut down on calories,” Russo said.

Among the new wave of more healthful brands is Dang, a maker of coconut chips. Crunchy and creamy, they are the invention of 30-year-old entrepreneur Vincent

Kitirattragarn, who was inspired by preparing his mother’s Thai lettuce wraps.

“The wraps have seven ingredients, and one is toasted coconut,” said Kitirattragarn, who cornered a Whole Foods buyer three years ago at a Fancy Food Show on the East Coast to taste his chips. “So we bought shredded coconut, put it in a wok on low heat, and the smell filled up the whole house.”

The result was so delicious that the wraps became an afterthought.

A snack, Kitirattragarn reasoned, would command better placement in the grocery aisle than an ingredient, stashed in purgatory next to the chopped nuts and baking powder.

■■Please see SNACKS, 21

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21

SNACKS: Bello has also developed treats for Trader Joe’s, Hain Celestial Group ■■ Continued from 20 With $90,000 in startup capital, Kitirattragarn started developing new flavors to pair with the original chips (which include three ingredients: coconut, cane sugar and salt). There’s caramel and sea salt, chili lime, and to no one’s astonishment, bacon.

Dang, which is named after Kitirattragarn’s mother, is now available at Whole Foods and Sprouts, among others. It racked up $4 million in revenue last year.

Robert Mock and his three business partners were also inspired by an Asian ingredient: seaweed.

Three of his partners have children that attend the same school. They watched as the kids devoured seaweed snacks.

“I love seaweed too, but I’m used to tortilla chips and queso,” Mock said.

So the dads started Ocean’s Halo, a company that introduced the Seaweed Chip, a crunchy green ribbon built for dipping. Every bite is packed with protein and vitamins. It’s also organic, gluten-free and low in fat — prerequisites for many of today’s discerning snackers.

“There’s nothing like it out there,” said Mock, who used to sell financial derivatives for JPMorgan.

He was wooing supermarket buyers at the Fancy Food Show.

The winter fair is in its 40th year.

Originally geared toward imported European specialty food, it helped popularize brands such as Ben & Jerry’s ice cream, Perrier sparkling water and Walkers Shortbread.

Snacks have always been central to the event, though the trends (think bagel chips and chocolate-covered pretzels) have come and gone. In one corner of last week’s convention hall — tucked behind the chocolatiers, olive oil makers, seasoned salt purveyors, fermenters and sprouters — was Bello and his Pasta Chips.

The New Jersey native has a knack for inventing original snacks.

There were the Veggie Straws, chips that resemble hollow French fries that he sold to the Hain Celestial Group, owner of brands such as Terra Chips and Rice Dream.

Bello also developed Trader Joe’s Pita Bite Crackers and a biscotti he “Americanized” by using more butter and creating a softer center.

The Pasta Chips are his latest, inspired by a trip to Tuscany with his wife. It took two years of tinkering in the test kitchen to arrive at the proper snap around the edges and tenderness in the middle.

Genaro Molina | Associated Press

Pasta Chips, created by CEO and founder Jerry Bello, are on display at the Winter Fancy Food Show in San Francisco.

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Cardiac catheterizations, including coronary and peripheral artery stenting, stress testing, transesophageal echocardiography and pacemaker devices are performed at the Northeast Georgia Medical Center.

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Sunday, January 25, 2015

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How hugs can help health

BY Jill Daly

Associated Press You’ll get no argument from most people — especially on a cold winter’s night — that hugs make you feel warm inside.

But can that good feeling protect your health?

Over the past decade or so, researchers have sought to explain the positive effects credited to the nonverbal gesture of human connection. It comes alongside research that says chronic stress is linked to shorter lifespans, higher rates of heart disease and diabetes, depression and less effective immune systems.

The science takes two points of view: Hugs as a method of social support, buffering the body from stress, and hugs as a physiological experience that lowers blood pressure and levels of the stress hormone, cortisol.

Noted psychologist Sheldon Cohen of Carnegie Mellon University has led new research that reports people who experience high levels of social support and frequent hugs were protected from a higher risk of getting sick when under stress.

Published recently Psychological Science, the 404 subjects in the study — healthy people who were exposed to flu and cold viruses — were monitored for 14 days for times of stress with other people, number of hugs and amount of viral antibodies in their blood (a sign of virus infection), and any mild or severe symptoms of illness.

Since the mid-’80s, research by Cohen and others reported on the ways a social network can help a person cope with life’s stressful events, including interpersonal conflicts. By 1999, research found that people who had stress from conflict with other people and were exposed to the common cold virus had a higher risk of being infected. The first part of the latest CMU study was begun in 2000.

“Our interest has been historically in social support,” said Cohen. “Our lab and others have developed a lot of evidence that

in people who have strong social support networks, their network will buffer them from the effects of stress. Less known is how that happens; how social support is conferred to people.” Generally, the CMU psychologist explained, the amount of social support for a person has been measured by asking people what support they have, not in what people do to show this support. In the recent CMU study, hugs were considered markers of close interpersonal relationships.

“In times of stress and conflict, that’s when support from people in your life is important,” Cohen said.

“It may make less difference in other times in your life.”

“Overall, other studies about nonsexual touch (have found) it can buffer acute physiological markers of stress,” he said. “We wondered if it would work in the real world.”

The journal article says participants with low levels of social support and more frequent interpersonal tension and conflict were found to have a greater likelihood of being infected after exposure to a virus. Both social support and hugs seemed to offset the negative effect of tension and conflict in being susceptible to getting sick.

“If you have high levels of conflict, you’re more likely to get infected,” Cohen said, “but you’re protected from that if you have either high levels of social support or high levels of hugs.”

In the camp pursuing the study of the body’s physiological responses to touch is Tiffany Field, director of the Touch Research Institute at the University of Miami School of Medicine. She said there is already well-known published research showing that massage can improve the body’s immune responses.

“We know that massage alters immune function,” she said. “There is data showing an increase in natural killer cells (that destroy) bacterial, viral and cancer cells.”

“And the literature shows that hugging between couples alleviates stress,” she said, naming

Michael Henninger | Associated Press

Jess Garrity, left, and Pamela VanHaitsma, hug their friend Jamie Phillips, center, while standing first in line to apply for a marriage license inside the City-County Building in downtown Pittsburgh.

2005 research, also cited in the CMU study, that showed that after hugging before a stressful event, such as a test, cortisol levels in a person are lowered.

Field was cautious about the CMU study design.

“It’s an amazing study,” she said, referring to the multiple blood samples taken and the steps to infect people with flu and cold viruses. “We can’t draw blood from people who aren’t ill,” she said, wondering how difficult it would be to get a university’s institutional review board to approve a similar study today.

She sits on her university’s review board.

Cohen explained the study went through a rigorous review beforehand, and the human subjects had to be in near-perfect health.

In the most recent study, 315 of the 404 participants became infected with the virus they were

exposed to — 78 percent. Of those, 127 had enough extra mucus and nasal congestion to be considered clinically sick. There were far more days with hugging, a median of 68 percent, than days with interpersonal tension or conflict, a median of 7 percent.

Field disagreed with the study’s finding that stress was buffered by hugging and social support because she saw no evidence that stress caused infection, or that there was much helpful effect from hugging. Neither stress nor hugs seemed to affect the extent of illness, she said.

Cohen said the statistical interactions of the CMU study are complex, but he theorized that because there were few days reported with conflict, and many hugs on days without conflict, perhaps they were giving protection from the stress that came on a day with conflict.

Field supports research on the

physiological and biochemical effects of hugging.

“With touch, there is a cascade of events: stress hormones lowering, natural killer (immune) cells increasing. Hugging is not just social support.”

Recent studies at the Touch Institute involve pain, she said, but results indicate the value of touch: “We have shown moderate stimulating pressure leads to lower heart rate, lower levels of cortisol, the brain is in the more relaxed state. One would expect that hugging would also do that.”

Explaining the difference in their two outlooks, Cohen said, “Markers are useful to look at … but they are not disease or disease processes. … Cortisol and epinephrine, blood pressure are markers of activation of the body’s response to stressors, but in and of themselves they aren’t necessarily markers of disease or risk of disease.”

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