Inside Medicine Magazine Winter 2019

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The Road to Pain Relief Starts Here. Precise Pain Relief for: Back & Neck Pain Nerve Pain and Sciatica Knee and Hip Pain Shoulder Pain Discogenic and Radicular Pain Shingles Pain Cancer Pain

Non-Surgical Solutions to Restore your Active LIfestyle.

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HUNTSVILLE

MADISON

ATHENS

DECATUR

Orthopaedic Surgery Sports Medicine Joint Replacement Spine Surgery Neurosurgery Physiatry Podiatry Workers’ Comp

256.881.5151 4

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TREATMENT

that stands up A strong back is essential to doing all the things you enjoy. Being active again can come from a balanced treatment approach designed by our rehab specialists, physicians and nurses. With a custom treatment plan you are one step closer to getting back to your life.

(256) 533-1600 | spineandneuro.com Inside Medicine | W inter Issue 2019

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features &

CONTENTS

Sharing with Purpose

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VOL 2

ISSUE 12

CO N T R I B U T O R S

FEATURES The Gift of a New Year

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looking at the bigger picture

What is My Diagnosis

helping others and yourself

Kimberly Waldrop, MA

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Ray Sheppard, Jr., MD

Hernia Mesh: Is it good or bad

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You are Getting Sleepy... Not!

Your Mental Health keeping positive and good mental health

Larry Parker, MD Shivani Malhotra, MD

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David Kumbroch Stephanie Perez, PT, DPT Dr. Elizabeth McCleskey

ways to help you sleep and stay asleep through the night

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Elisa Brooks

Dr. George Faison

one physician's views on hernia sugery

a story of hand, foot and mouth disease

Let's Get Healthy

CONTENT

Kari Kingsley, MSN, CRNP

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William T. Budd, PhD Kristin Scroggin Rachel Sullivan Mark Beaird, LPC, NCC Christen Burns Bridges

Join our mission to establish and grow an alliance among our community and healthcare providers. Together, we can change the way healthcare information has been and will be distributed for years to come.

To reach our readers, whether through editorial contribution or advertising, please contact Kelly Reese at kellyreese. im@gmail.com or 256.652.8089

Making a Difference

MD

Anne C. Jewell S A LE S & M A R K E T IN G

Kelly Reese, Founder Lisa Layton, VP Sales/Marketing Heather Mendez Will Steward CH I E F E D I T O R I A L WRITER

Kimberly Waldrop, MA G R A P H I C D E S I GN

Leigha Parker Karen Gauthier

The information and opinions contained in this publication constitute general medical information only and should not be construed as medical advice. Before making important medical decisions, readers should consult with a physician or trained medical provider of their choice and have their needs and concerns assessed in a clinical setting appropriate for their problem.

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P U B LI S H E R S

Blake Bentley, President www. in s ide me dic in e ma g az ine.com


} FROM THE EDITOR

cozy up

with Inside Medicine

As we enter into another New Year, we are so excited here at Inside Medicine. It is so awesome to see God’s hand in all that we are trying to accomplish with our publication. It does our hearts so good to hear and see testimonies from readers and contributors that are learning and growing by reading our magazine. Even if it is a simple new remedy, an uplifting editorial, or a newfound medical procedure or professional, we hope and pray you find something you can use. In this issue of Inside Medicine, we have several articles that discuss the New Year and what can be associated with the changing of the calendar. Elisa Brooks provides us with an article reminding us that a resolution starts with ourselves but should show a positive effect on others. It is so good to remember to look at the bigger picture that includes those around you. It is also an emphasis in Christen Bridges’ article, Let’s Get Healthy. As part of her journey to lose weight and be healthy, she uses her family as a motivation to help herself as well as others. As always, Kari Kingsley provides us with an interesting and uplifting feature article. While Rachel Sullivan’s article gives us a good view on keeping positive and having great mental health. All of these things are important reminders as we move into 2019. Along with these awesome stories, we’ve got lots of information packed in this edition. You can read about things from hand, foot and mouth disease to hernia surgery to pelvic rehabilitation as well as lumbar fusion. It is interesting and helpful information that I hope you find something you can use and share with others. At Inside Medicine, it is always our prayer to be here to help our community and show a love for our Savior. There are so many stories out there and we want to share them with you! We are always looking for new content and features. Please contact us if you ever have an idea, comment, or suggestion, or just want to be included in our magazine. We love hearing from you and appreciate your support!

We wish you happiness and blessings.

Kimberly Waldrop

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} HEALTH FEATURE

The gift of a

NEW YEAR by Elisa Brooks

If you are like me, by the time you are reading this article, you will have most likely been asked more than once if you have made any new year’s resolutions. For one, it’s an easy conversation topic. And two, at least half of Americans truly embrace making resolutions. Forbes.com estimates that around 40% of Americans make New Year’s resolutions. The promise of a fresh start is so appealing! You’ve heard the slogans, right? New Year, New You! We could create a long list of similar sayings. The idea of a new beginning, a strong beginning, a better year … it sounds so good! I never make resolutions at the start of the New Year. It’s not because I dislike the idea of a clean slate. It’s not because I don’t set goals for myself. I know there are opportunities for growth in my life, my fitness, my relationships, my family, etc.! I am more than willing to admit there is space in my life for improvement. However, I have seen that resolutions tend to focus on one person. YOU.

I will lose 10 pounds this year. I will stop biting my nails this year. I will eat healthier this year. I will save more money this year. Do you see what I’m seeing? All of these start with “I”. The focus is often on yourself as you make a resolution. I have worked in a gym setting for many years, and it never fails that clients approach me at the beginning of a year because “this year I want to really make changes”. I get it! Just by showing up at the gym to train and engage and workout, they are already well on their way. I also know that the times in my life that I experience the most fulfillment and the most joy are not when I am focused on myself. They occur when my focus shifts to others. It is like the old adage “it is more blessed to give than to receive” REALLY is true! If I stare at myself in the mirror too long, I notice the gray hairs starting to shine or the acne that is worse in my thirties than it was in my teens. I think to myself, better keep working on those squats, girl, so that your legs will look good. The focus is on me and what all I need to work on. What happens when the focus is off me and on others? I notice that my second born son needs a little extra snuggle time after a hard day at school. I see that my friend’s smile looks 8

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weary when I talk to her, and I can make the extra effort to remind her that she is loved and offer a helping hand. I listen to voices in the community that share a way to assist those in need and become a part of the solution to a problem. I remember that my husband has a long week ahead and make his favorite apple pie to remind him how proud I am of him and all he does. There is a huge difference in the two paragraphs. One is self-focused. The other? Well, it puts others first. It might be true, you might be able eat healthier, exercise more, and need to save more money this new year. But serving yourself leads to a dead end. Serving others, though, widens your circle and your eye gaze. It lifts your sights up off yourself to see a bigger picture and be a part of it! Each New Year is a gift! A fresh start. A new opportunity. Perhaps it is not just an opportunity to make an improvement for yourself. Maybe, just maybe, it is a moment to think about what really matters. Relationships. People. Being present in the moment. I believe that you will find what I have found to be true. When I’m less focused on myself, I become my best self. It just naturally happens when I ask God to help me love the one He puts in front of me throughout the day. So maybe this year? Leave the resolutions behind and take notice of the chance to invest in others - you’ll find that you begin to grow without having to tell yourself to improve. Elisa Brooks, ACE Certified Personal Trainer, ACE Certified Sports and Fitness Nutrition Specialist


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} SURGICAL TECHNOLOGY

Hernia Mesh Is it Good or Bad? by Ray Sheppard, Jr., MD

If you watch TV, you have seen them-advertisements by lawyers warning you of “dangerous” hernia mesh. Since more than 1,000,000 hernias are surgically repaired each year with mesh, literally millions of Americans are wondering, “Should mesh be used to fix hernias?”

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Since the early 1990’s, nearly all hernia repairs have utilized hernia mesh. Mesh based repairs have become the “gold standard” because surgeons observed significant problems with tissue based repairs. The most common hernia is the inguinal or groin hernia. Over 70 different types of nonmesh or tissue based repairs have been reported in the surgical literature. The large number of different repairs is a clue to the fact that a good, reliable repair has been difficult to discover. Hernia recurrence following these tissue based repairs is routinely reported as high as 35%. Techniques to reduce these recurrence rates have incorporated multiple suture lines of permanent suture (which may actually be similar to a mesh) and frequently are associated with prolonged post-operative pain. Alarmingly, even such efforts are associated with unacceptable hernia recurrence rates. The story is even worse when one considers the type of hernia that is seen in an old incision from a patient’s previous abdominal surgery. Hernia recurrence rates with non-mesh repairs for this type of hernia are commonly in the 50% range. With such poor results of tissue based repairs, a desire emerged to find a better way. During the past 25 years, different styles of mesh and different methods for utilization of mesh


have been employed. A drastic reduction in recurrence rates has been observed. In manycases, post-operative pain has been reduced with a faster return to the normal activities of life. If this is the case, then why do we see these “bad mesh� ads? One thing which is important to understand is that risk is associated with every choice that we make. Everyone understands the risks involved with sky-diving. Most decide to never take that risk. On the other hand, we all know that thousands of people are killed in automobile accidents every year, yet we take that risk every day. When it comes to driving our cars, we have judged the risk to be low compared to the benefits. There are some adverse events that can occur after a mesh repair, but these occur only a small percentage of the time. Alternatively, the risks of hernia recurrence are much more frequent and carry life-threatening consequences. Hernia experts have carefully analyzed these outcomes and have judged that the risk of hernia mesh is actually very low compared to the great benefits. Another critical fact is that mesh must be used wisely and with a safe technique. There are actually inappropriate methods of deploying mesh. This has led some patients to experience mesh complications. The main cause for this concern has been in procedures that are not related to abdominal wall hernia surgery. These complications have been primarily found in surgical repairs of the pelvic floor for women suffering from pelvic prolapse. For more information please visit the

FDA website: fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/UroGynSurgicalMesh/default.htm. This highlights why hernia patients are best served by surgeons who are wellversed in the best practices for mesh utilization, as well as in a variety of hernia repair techniques. Although our current results with mesh repairs for abdominal wall hernias are better than has ever been seen in the history of mankind, we are always searching for improvements. Many of us who are most involved in hernia surgery have joined forces in the Americas Hernia Society Quality Collaborative. This is an effort to pool our experiences and identify strategies to obtain better results for our patients. Despite the fact that complication rates from hernia mesh have been occurring at a very low rate, the medical device industry has expended and continues to spend millions of dollars to research even better mesh and bring the complication rate as close to zero as possible. Together, surgeons and researchers are working to make our already outstanding outcomes even better. So, is mesh good or bad? Once you have more of the information, hopefully you can see that hernia mesh is not as bad as TV commercials would have you believe. I’m a hernia surgeon, and I wouldn't have my hernia repaired without it! Ray Sheppard, MD - General Surgery raysheppardsurgery.com

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} SURGICAL TECHNOLOGY

LumbarFUSION What’s the best Approach? by Larry Parker, MD

Let’s say you have severe back pain or severe leg pain or even perhaps, a combination of both. It is very likely you have tried to get better with physical therapy and spinal injections. Perhaps you have had a previous back surgery to repair a disc herniation and the pain has returned. Your spine surgeon has recommended a spinal fusion. You have heard that some people have it done from the front, others from the back. You have researched spinal fusion on the internet and have seen that there are different approaches to do the surgery. So how does your surgeon decide the best approach for you? Let’s discuss… Your spine surgeon may recommend a spinal fusion as a part of your surgical plan if you have certain conditions. Recurrent disc herniation, spondylolisthesis, scoliosis, and severe degenerative disc disease are common reasons to consider a fusion to correct your condition. In the modern fusion era, spinal fusion surgery offers different techniques that are designed to limit exposure and reduce recovery time. Most patients stand and walk the day of surgery. Some patients can even go home the same day and very few patients need more than a two day hospital stay. The most common spinal fusion is done posteriorly or through the back. This method seems logical. After all the spine is in the back. Posterior approaches allow the surgeon to perform spinal nerve decompression for disc herniations and spinal stenosis. Typically pedicle screws are placed for a posterior lumbar fusion (PLF). An interbody fusion can also be done to allow fusion to occur in the disc space. Trans foraminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are well established techniques. The 12

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bottom line is a posterior approach is best if you need direct nerve decompression for conditions like severe spinal stenosis. An anterior approach or ALIF allows for direct access to the disc space without having to displace the nerves. Usually the approach is assisted by a general surgeon or vascular surgeon to expose the front of the spine. Degenerative disc disease especially at L5-S1 and L4-5 can be addressed through the anterior approach. Restoration of disc height and placement of large surface area implant devices are advantages of the anterior approach. As a general rule, anterior approaches are less painful and easier to recover from. Anterior approaches are a good option for single level degenerative disc disease or in cases where restoration of disc space height is necessary. A newer technique known as extreme lateral lumbar interbody fusion or XLIF requires an incision on the flank. This technique offers similar advantages and has similar indications as an ALIF but can be an easier way to access the upper lumbar areas like L3-4 and above. Finally, in some cases an anterior and a posterior approach is recommended. In cases that require multi-level fusion or in patients with more complex problems a combination anterior/posterior approach may be the best choice to address the problem. An experienced spine surgeon will employ all these different techniques and provide a good opinion on what is the best choice for your case. Remember, the goal is to fix the problem with the least invasive technique that allows the fastest recovery time. Feel free to visit my website to see animations of all these techniques. www.visittoc.com


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Ask Anesthesia

by, George Faison, MD

When you are pregnant and about to deliver your baby, you more than likely will be faced with the decision, “Do I get an epidural or have natural childbirth?” Personally, I think any type of vaginal delivery is natural childbirth, no matter what kind of pain control is used. But, for the purposes of this article, I will describe “natural” childbirth as labor and delivery with no epidural. “Natural” childbirth could mean one of two things: (1) the patient receives no analgesia (relief of pain) or (2) the patient receives an alternative pain medicine, usually intravenous (IV) narcotics. The effectiveness of analgesia in this form depends on one’s particular pain of labor, one’s pain tolerance, and one’s tolerance to the narcotic itself. A pleasurable experience of labor and delivery can be obtained if these factors are in the patient’s favor. Unfortunately, most of the time, at least one or more of these factors is not, and the experience can be a bit unpleasant. Another major drawback to IV narcotics is that these drugs cross the placenta and go into the baby’s bloodstream. When this happens, they can cause excessive sleepiness and slowed, or even absence of, breathing in the baby. These effects can also be seen in mom as well, but typically to a lesser extent. Often, the obstetrician will not give IV pain medicines after a certain point in the progression of labor to avoid these problems in the newborn. Unfortunately again, the later period of labor and the delivery itself tends to be the most painful time for mom. An epidural avoids these issues since little, if any, narcotics are used, and only the smallest amounts of the medicine are absorbed into mom’s bloodstream; this means that essentially none crosses the placenta into the baby’s circulation. An epidural is primarily a local anesthetic (numbing medicine) that is placed around and absorbed directly into the nerves that are involved with the transmission of pain impulses, causing them to stop transmitting those impulses and resulting in the loss of the perception of pain. The epidural is done most often by continuous infusion, so it doesn’t wear off like IV narcotics do. The side effects of the epidural are minimal, but include numbness and weakness in the lower extremities, difficulty urinating, and initial drop in mom’s blood pressure. But these side effects are easily managed. The blood pressure can be stabilized with IV fluids and medicines. The bladder dysfunction is not an issue because a urinary catheter is used during labor to keep the bladder empty and out of the way of the baby’s path through the birth canal. All of the side effects go away soon after the epidural is discontinued. Epidurals sound pretty fantastic, and they are; but they aren’t perfect. The nerves involved in feeling pressure are resistant to the anesthetic medicine, and that pressure can get very uncomfortable at times. Furthermore, the nerves involved with actual delivery are much thicker and more difficult to numb. As you can imagine, the stretching of tissue at delivery can be profound. This often causes the patient to think that her epidural is wearing off. Believe me, that pain would be much, much worse without the epidural. The medicine given by the epidural can also spread unevenly throughout the epidural space 14

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for reasons not well understood, leading to “hot spots� of pain or even one-sided analgesia. These things can usually be resolved with extra dosing, epidural catheter manipulation, or even catheter replacement (repeated procedure). Another common issue is that the baby, which is supposed to travel through the birth canal head first and face down, will often turn face sideways or even face up. When this happens, the pain of labor is greatly increased and sometimes less controllable than we would like; but again, it is controlled much better than without the epidural. Finally, the two most common concerns of patients regarding epidurals are whether the epidural puts them at risk for chronic back pain or even paralysis. All medical procedures carry risk, but the risk of permanent paralysis from an epidural is extremely low. The causes of paralysis can primarily be narrowed down to two factors: infection and bleeding. They can cause epidural abscess or hematoma, respectively. Both produce high pressure around the spinal cord and can compromise blood flow, leading to spinal cord damage. Early diagnosis and emergent surgery are essential to prevent the damage. Epidurals are performed using sterile technique and carry an extremely low risk of infection. Patients with depressed immune systems, however, are not good candidates for epidural. Significant bleeding is extremely rare as well. Patients with bleeding disorders or who are on strong blood thinners are not candidates either. Sometimes the obstetric condition often referred to as toxemia can lead to low platelets, a blood component involved with early blood clot formation. Patients with this condition are also often not candidates. Aspirin therapy does not disqualify one for epidural placement. This may sound

scary, but I have been practicing anesthesia for 24 years now and have yet to see a patient develop an epidural abscess or hematoma. Chronic back pain is more common than paralysis, of course, but is still very rare. It is difficult to distinguish whether or not back pain is the result of an epidural, especially since the weight of the pregnant tummy is very stressful to the lower back. Typically, the patient will experience mild to moderate soreness for a few days but then it goes away.

I hope this information helps you make your decision. Of course, I am probably a bit biased, but in my experience, the epidural is usually the better choice because it works directly on the pain carrying nerves, is continuous, and the medicines remain outside of the bloodstream, resulting in better pain control with fewer serious side effects in both mom and the baby. George Faison, MD 201 7th Street SE, Decatur, AL 35601 256.341.2000

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} COVER FEATURE

What is my DIAGNOSIS? by, Shivani Malhotra, MD

A 28 year-old man presented to an outpatient clinic with a four day history of low grade fever and red spots on his toes and fingers. Symptoms began two days prior to the onset of the blisters with a fever of 100.6, chills, and muscle pain. Lesions started on his left hand and over the next 24 hours, similar lesions appeared on the palm of his right hand as well as the plantar surface of the left and right feet, more prominently on the tips of the toes. He stated lesions burn and hurt to touch. Lesions stopped spreading after two days and he denied experiencing any lesions on the trunk, face, or inside his mouth. As a side note, he noted his brother’s one year old son whom he spent the prior weekend had painful ulcers in his mouth. 16

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Diagnosis: Hand, Foot and Mouth Disease.

WHAT IS HAND, FOOT AND MOUTH DISEASE? Hand, Foot, and Mouth Disease (HFMD) is a viral syndrome most commonly caused by the Coxsackievirus that is characterized by a painful maculopapular or vesicular rash often affecting the hands, feet, and oral mucosa (lining of the mouth). Associated symptoms include fever, sore throat, and an overall feeling of being unwell (malaise). Various strains of Coxsackievirus have been shown to cause HFMD but the most common strain is the Coxsackievirus A16 followed by Enterovirus 71. Since 2008, a novel coxsackievirus A6 genotype has been associated with atypical features and more severe disease in both children and adults than generally occurs with "typical" HFMD, including high fever, a wider distribution of rash, longer duration of illness, palmar and plantar desquamation one to three weeks after HFMD, and nail dystrophy one to two months after HFMD. TRANSMISSION OF THE VIRUS: The viruses that cause Hand, Foot, and Mouth Disease (HFMD) are usually transmitted from person to person by fecal-oral route. However they can be transmitted by contact with oral, respiratory secretions and vesicle fluid. WHO IS TYPICALLY AFFECTED? It is primarily a childhood disease so outbreaks are commonly seen in schools and daycare settings. Coxsackievirus however can also affect adults with some strains affecting a higher percentage of adults than others. HFMD is typically seen in summer and early autumn and often occurs in outbreaks. INCUBATION PERIOD AND COURSE OF ILLNESS? The usual incubation period is 3-5 days, respiratory shedding of the virus is often limited to 1 week. Resolution of symptoms takes from 7-10 days although blistering can persist well beyond this period. DIAGNOSIS? Diagnosis is mostly clinical based on location of lesions in mouth and extremities. For definitive diagnosis, culture from the vesicle can be taken to detect the virus.

COMPLICATIONS? Hand, Foot, and Mouth Disease (HFMD) is usually a mild illness and self-resolving. However in rare cases it can cause severe symptoms such as aseptic meningitis, acute flaccid paralysis, or pulmonary edema. TREATMENT? Treatment for Hand, Foot, and Mouth Disease (HFMD) is mainly supportive treatment. Things you can do to alleviate symptoms include over-the-counter medications to relieve pain and fever (Caution: Aspirin should not be given to children) topical oral anesthetics to help relieve the pain of mouth sores. Cool liquids, sucking on ice pops /ice chips, also avoiding salty and acidic foods help with mouth symptoms. In severe cases, where oral intake is limited, intravenous hydration may be necessary.

PREVENTION? Wash your hands often with soap and water, especially after changing diapers and using the toilet. Clean and disinfect frequently touched surfaces and soiled items, including toys. Avoid close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease. ARE ANY VACCINES AVAILABLE TO PREVENT HAND, FOOT AND MOUTH DISEASE? There is no current vaccine available in The United States but research is ongoing to develop vaccines to help prevent hand, foot, and mouth disease in the future. SUMMARY: Hand, Foot, and Mouth Disease (HFMD) may often go undiagnosed and lead to over diagnosis and treatment specially if is atypical presentation. Therefore, it is important for the physicians to be familiar with manifestations of common childhood illnesses in adults. Reference: CDC.gov www.cdc.gov/mmwr/preview/mmwrhtml/mm6112a5.htm www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/ Documents/M3_HandFoot.pdf www.uptodate.com/contents/hand-foot-and-mouth-disease-and-herpangina?search=hand%20foot%20and%20mouth%20disease&source=search_result&selectedTitle=1~24&usage_type=default&display_rank=1#H456270599

Shivani Malhotra, MD Assistant Professor, Associate Program Director UAB FAMILY MEDICINE UAB Medicine | Huntsville Regional Medical Campus Alexander McQueen PGY-3 Resident Physician UAB FAMILY MEDICINE UAB Medicine | Huntsville Regional Medical Campus

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Researchers identify new candidate genetic risk factor for type of dementia by David Kumbroch

We deeply value all contributions we can make to the understanding of dementia. The scientific community is making strides in understanding the genetic underpinnings of a number of neurodegenerative disorders. - Richard M. Myers, PhD, HudsonAlpha Faculty Investigator

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} RESEARCH

Scientists from the Myers Lab at the HudsonAlpha Institute for Biotechnology contributed to finding a newly-identified risk factor for one of the more common forms of early-onset dementia. The finding will help researchers by narrowing the focus for potential diagnostics and one day even treatments. The researchers found that variation in the MFSD8 gene associates with a greater risk of developing frontotemporal lobar degeneration (FTLD), a disease that often has an early age of onset, and which can include difficult-to-manage symptoms, ranging from inappropriate social behaviors to speech problems. The data collected in this new research, which was published in the scientific journal Acta Neuropathologica, suggests that rare MFSD8 variants make it harder for cells to dispose of their waste, which may lead to a toxic buildup of aggregated proteins associated with FTLD. The University of California, San Francisco (UCSF) was the driving force behind the research, while scientists at the Albert Einstein College of Medicine also significantly contributed. HudsonAlpha assisted with the computational efforts as part of the Institute’s first work with the Memory and Mobility Program. “Identifying the risk factors that accompany rare and early-onset forms of dementia gives us a better chance to understand neurodegenerative disorders as a whole,” noted Nick Cochran, PhD, a postdoctoral fellow in the Myers Lab. “With early-onset cases, we can more successfully isolate the genetic factors that go along with a variety of symptoms, which helps us build our knowledge base for the entire field.” Bruce Miller, MD, director of the UCSF Memory and Aging Center, said, “Our continuing efforts to identify the genetic determinants of neurodegeneration will open new doors for predicting, diagnosing and treating these diseases. We are constantly adding to that knowledge bank, and this work is expedited by our collaboration with partners such as HudsonAlpha.” Primary support for this study was provided by the Rainwater Charitable Foundation. Additional support was provided by the Memory and Mobility Program through the HudsonAlpha Foundation. HudsonAlpha Institute for Biotechnology

hudsonalpha.org/foundation

601 Genome Way, Huntsville, AL 35806 www.hudsonalpha.org

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Pelvic Rehabilitation:

More than Just Kegels by, Stephanie Perez, PT, DPT

Pelvic rehab is starting to become more of a “hot topic,” but many people are still unaware of this group of muscles and how they affect our everyday lives. The pelvic floor is a muscular hammock that sits in the bottom of our pelvis and helps to hold our organs up. They are present in men and women. Just like any other muscle in the body, injuries can occur, weakness can develop, or tension and trigger points can build resulting in pain and dysfunction. Pelvic floor dysfunction can take on various presentations in different populations. One of the most common symptoms is urinary leakage. It has almost become mainstream to think it is normal to “pee a little” when you sneeze, cough, laugh, or jump. Stress incontinence is a symptom that there is a problem with the pressure system in your body. We all have a normal resting intra-abdominal (inside the abdomen) pressure and we manage this pressure during activity with proper breathing, core activation, and pelvic floor activation. If we do not have adequate awareness of these integral pieces, the system becomes imbalanced and symptoms occur. Another common, yet incorrect, belief is that kegels are the answer to pelvic floor problems. Women are instructed to perform kegels all day to strengthen the pelvic floor. As stated previously, the pelvic floor is a group of muscles, just like other muscles in our body. We would not walk around all day performing bicep curls if we had a problem with our arm! Symptoms could be a sign of weakness OR a sign of excessive tension or tightness in the system. Due to this discrepancy, it is of upmost importance to go see a pelvic PT and get an assessment, so you know exactly what the problem is and how to fix it! Common populations where pelvic dysfunction occur are in pre and post-partum women and the elderly, but ANYONE can experience these problems. Many athletes, even elite men and women will encounter leakage (urinary or fecal) with their specific activity. Getting instruction by a physical therapist on proper breathing mechanics and muscle coordination during activity is a great way to keep healthy pressures in your system to prevent problems while exercising. Aftercredit: pregnancy andPregnancy delivery, a woman attends a Image PACN Community Assistance Center North www.pacncommunity.org 6-8-week post-partum follow-up appointment with an 20

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OBGYN to assess healing and be released for return to activity. This is a great time to talk with your OBGYN about getting a referral to see a physical therapist to help you ease back into exercise safely. During pregnancy there is a lot of shifting and stretching of muscles that could potentially lead to discoordination and problems on return to exercise. You may have developed some diastasis recti (abdominal separation). During the birthing process, tearing can occur that can lead to restrictive and painful scarring. A physical therapist can assess the extent of the diastasis recti, strength and coordination of the core and pelvic floor, and help develop strategies to improve posture and alignment so that safe and optimum return to activity can be achieved. Pelvic floor dysfunction also presents itself in the form of pain. Some women experience pain with intercourse, inserting a tampon, or during an internal medical exam. This pain and tension can be a result of hormone imbalances, scar tissue, muscle tension or weakness, or impaired posture. This is a real problem that a physical therapist can address and help improve so you can feel better! Pelvic floor dysfunction is a real diagnosis with many treatments available. You have a voice! You don’t need to live another day with pain or incontinence. We need to remove the normalcy that has been labeled to these issues and empower each other to get help and feel better. We need to eliminate the shame and embarrassment and open-up the lines of communication between patients and physicians. We have to take care of our bodies and be our own advocate. A physical therapist can help. I am here for you!


READY TO FEEL

BETTER?

WHAT ARE YOU WAITING FOR? There’s no time like the start of a new year to work on a new you! TherapySouth can help you heal, move better and overcome the challenges of your physical life. If you haven’t tried physical therapy for the things that keep you from moving without pain—we’re here for you! We can help you get back to the things you love.

Start now and make 2019 your best year ever! TherapySouth is an outpatient physical therapy practice with a fun, family-oriented environment. Our experienced physical therapists know our patients by name and strive to help you achieve your physical goals. You don’t need a doctor’s referral to see a PT, so give us a call today!

Huntsville 6485 University Drive, Suite C | 256.513.8280 www.therapysouth.com

Drop by and meet Clinic Director Michael Beuoy and his team in Huntsville!

WHO IS

YOUR

PT?

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Sweet Dreams

Additional information: sleepfoundation.org/bedroom/index.php Dr. Elizabeth McCleskey Board Certified in Family and Lifestyle Medicine 103 Intercom Drive, Suite B, Madison, AL 35758 256-280-3990 HealthStylesDr.com 26

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what might be lurking

IN YOUR THYROID GLAND by, Kari Kingsley, MSN, CRNP

Ah, the joys of heredity! My mom is the youngest of 11 siblings. Her 5 older sisters give her a chronological idea of what she will look like in the years to come. Genetics and ancestral similarities run strong in our family. I am basically a Xerox copy of my mom at 35. Her sisters are stair-step cookie cutters of one another with only subtle differences such as a touch more grey hair here or a tad more smile lines there. They have a lighthearted spirit when they joke about the Aldridge family genes and what we have in store for us.

Human genomics is currently at the forefront of medicine. We are not yet born with an expiration date, but is the day coming that a single drop of blood from a baby's foot will stamp the date they will leave this world? My genetics tell me I’m in line to develop a few things: a bunion, glaucoma, and thyroid issues. Not the worst gauntlet to walk through in the world of blood lines. I am diligent to get my eye pressures checked, and thankfully my feet don’t hurt, but I have a palpable suspicion that something sinister is lurking in my DNA, specifically in my throat. My mother underwent a thyroidectomy for a what she thought was a benign thyroid nodule in 2009. Surgical pathology came back as a surprise confirming papillary thyroid carcinoma. Thankfully, surgical margins were clear and she required no further treatments. 28

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Being the ever-hypochondriac that I am, I diligently went in for a thyroid ultrasound. After a few squirts of squishy jelly and a few passes from an ultrasound probe, it was apparent my thyroid was in perfect structural order. No nodules. No large lobes. No cancer. Pleased with the results, I assumed I could check off thyroid cancer from my “To-Do” list for the time being. But my provider suggested thyroid labs. My thyroid function tests came back normal, ruling out chemical thyroid issues such as hyperthyroidism or hypothyroidism. But my Thyroid Peroxidase Antibody (TPO-Antibody) was elevated. I did what any logical thirty-five-year old would do… I opened my laptop and googled all the horrible things elevated TPO could entail. Basically, an elevated TPO suggests high antibodies. Antibodies are the gunships your immune system sends when it is anticipating a fight. Well that didn’t sound good. Why was my thyroid preparing for battle? So, with a very confused look on my face, I asked my doctor, “So you’re telling me that I don’t have thyroid problems now, but I will?” The test is suggestive she told me. The idea of a dormant-thyroid-attacking-monster lurking in my throat doesn’t exactly sit well, especially when coupled with my Mom’s history. But it isn’t the end of the world; and it has certainly made me more diligent about my thyroid health.


Thyroid structure and function can get down right complicating. Perhaps because that’s just it…. It’s two processes to treat: Structure and Function. Further complicated by each is treated by its own specialty. Endocrinologists focus on the hormonal function of the thyroid whereas ENT physicians focus more on the structure (i.e. nodules, enlarged lobes, and cancer). But there are a few things you should know to help optimize the health of your thyroid. As an Ear Nose and Throat Nurse Practitioner, I wish I had a dollar for every patient that thought their thyroid was the root of their fatigue. I am definitely no hypocrite and I’ve had mine drawn a time or two, (or 20), hoping I had found an explanation for why the snooze button keeps hitting itself each morning. But fatigue is a huge indicator of thyroid dysfunction. Abnormal hormone secretion in the thyroid will affect regulation of our metabolism. Thyroid dysfunction to detect hypothyroidism and hyperthyroidism can be evaluated with simple blood tests to measure how well the thyroid gland is performing. But function is only part of what can go awry in the thyroid gland. Structural abnormalities should also be on our radar. Thyroid nodules are small solid or fluid-filled masses that can develop inside the thyroid gland. The majority of nodules aren’t serious, however, they should always be evaluated and monitored for enlargement with thyroid ultrasound and occasionally CT imaging of the neck. A small portion of thyroid nodules do contain thyroid cancer (right Mom?). Many times, ENT physicians, Endocrinologists, and some family practice providers will recommend a biopsy of a nodule(s) called a fine needle aspirate to detect cancer cells. Risk factors for thyroid cancer include a known family history of thyroid cancer, prior head and radiation exposure, being female, and having a history of breast cancer. Thyroid goiter is an abnormal enlargement of the thyroid gland that can be associated with many thyroid diseases. Abnormal signaling of hormones can cause increased vascularity and increased size of the gland itself. As the thyroid gland gets larger, compression to surrounding vital structures in the neck occur. Symptoms include hoarseness, difficulty swallowing, lump sensation, or pressure within the neck. Screening evaluation of the thyroid with thyroid palpation by a trained professional is important. Thyroid ultrasound is critical in evaluating nodules and thyroid size. Biopsy is crucial if suspicious nodules are noted. Screening thyroid labs will help detect thyroid dysfunction. Other lab investigations and scans may be warranted once initial screening tests are performed. Treatment depends on the underlying cause. I am grateful to know my family history and what I'll (possibly) have in store for me in the years to come. It is somewhat disconcerting to think about all the cute shoes my future bunion will prevent me from wearing, but I am glad to know to keep a close eye on my thyroid and what may be lying dormant inside.

SIGNS OF THYROID DYSFUNCTION CAN INCLUDE: Hypothyroidism • Fatigue or tiredness • Weight gain • Elevated cholesterol level • Cold intolerance • Constipation • Dry skin • Hoarseness • Muscle weakness • Aching joints and muscles • Dry hair or hair loss • Itchy and dry skin • Concentration and memory issues • Depression • Irregular or heavy menstruation Hyperthyroidism • Swelling of the thyroid gland • Prominent or bulging eyes • Irregular or rapid heartbeat • Heat Intolerance • Tremors or shaking hands • Increased sweating • Irritability and restlessness • Anxiety • Increased bowel movements or diarrhea • Weight loss • Weakness • Sleep dysfunction • Brittle hair and or hair loss • Irregular menstrual cycles in women

“Kari Kingsley, MSN, CRNP is an otolaryngology nurse practitioner with over 8 years of ENT experience who currently works at Huntsville ENT (256-882-0165). She is a medical writing consultant for Inside Medicine and enjoys writing articles on pertinent material to keep the residents of North Alabama up to date on the forefront of medicine.”

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1918 epidemic

The Importance of Vaccinations by, William T. Budd, PhD

“It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce”, wrote a US Army physician. One can imagine a number of situations in which an Army physician would encounter such a horrific experience. In this case, the physician was stateside serving as resident physician for Ft. Devens Massachusetts in 1918. The deaths described were not casualties of war but were deaths from influenza. During that flu season, over 500 million people would become infected and at least 50 million would die from the illness. The world was fighting two simultaneous wars, World War I and the Spanish Flu. Referring to the influenza outbreak of 1918 as the Spanish Flu was the result of wartime censorship as governments wanted to maintain soldier morale by limiting their understanding of the infectious outbreak. Ultimately, influenza would claim more lives than World War I and affected nearly every country. This influenza outbreak differed than most. Typically, persons over the age of 65 are more likely to die from influenza related complications and in the early stage of the pandemic this was the case. However, as the outbreak progressed the virus mutated. It is hypothesized that conditions associated with the war favored selection of a deadlier virus. Crowded conditions in military camps and hospitals in combination with poor sanitation allowed the virus to spread more rapidly. Even though there have been tremendous advancements in our understanding and treatments for influenza, the virus continues to pose a significant risk for the overall public health. Each year there exists the possibility that another large outbreak of influenza can emerge that has the potential to claim millions of lives. The winter months mark the begin-

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ning of respiratory infection season including influenza. After Christmas, the rate of influenza diagnosis grows exponentially in North America and will peak around Valentine’s Day. Many people confuse a variety of viral infections with influenza. During an average year, influenza infects approximately 10% of the population and can be deadly, especially to the very young and old. There are years in which the incidence of infection spikes (epidemic/ pandemic). There have been multiple pandemic outbreaks from influenza in the last century. None compare to the 1918 Spanish Flu epidemic. The most recent occurred in 2009 in which approximately 61 million persons were infected with the illness and deaths were more common in younger and middle- aged persons. In April of 2009, a novel influenza virus appeared containing a unique combination of genes not previously observed. This novel influenza virus was commonly reported as the Swine Flu due to a close relation to other influenza viruses found in pigs. However, there was no evidence that the virus originated in pigs. It is estimated that over 60 million people were infected with the virus and approximately 15,000 died from the infection. Much of the hype associated with the 2009 epidemic was due to the novelty of the virus and its similarity to the 1918 strain. Scientists did not have pre-existing data required to predict the severity of the outbreak and responses were based upon worst case assumptions. Thankfully, the virus was able to be


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contained and the death rate was limited. The 2009 influenza (H1N1) virus continues to circulate and is in fact the dominant strain so far this season (2018-2019). What is and what is not the flu? The flu is not a bad cold or gastrointestinal distress (stomach flu). The flu is a respiratory infection and is a serious illness characterized by high fevers, cough and body aches that can lead to life threatening pneumonia. The flu is caused by a virus known as the influenza virus. There are four main types of influenza viruses Type A- D but only two pose significant health risks to humans. The most serious type of influenza is Type A, which can cause devastating outbreaks and is the strain most often associated with death. Type B influenza is the second most common cause of flu. However, it is generally not as severe as Influenza A and rarely causes large outbreaks. Typically, an influenza infection will occur within 48 hours of exposure to the virus and last approximately 7 days. The virus is spread through contact with infected respiratory droplets. Direct contact occurs when you inhale respiratory droplets from someone that has sneezed or coughed. Viruses are non-living entities and as such can remain infectious on contaminated surfaces for several days, making indirect contact the most common method of exposure. Indirect contact occurs through an intermediary device that the infected person has touched after sneezing, coughing or touching their nose/ mouth. It is for these reasons that surfaces should be frequently cleaned and disinfected during flu season.

The best treatment is prevention. The Centers for Disease Control (CDC) recommend that everyone above the age of 6 months get vaccinated for influenza. It is highly recommended that children under the age of 5, adults over 65, pregnant women, persons living in long term care facilities and persons with any of the following health conditions; asthma, heart disease, COPD, diabetes, kidney failure, liver failure, HIV, or have a body mass index over 40 as the incidence of complications is much higher in these individuals. As in all vaccines there are associated side effects including low grade fever, injection site soreness and general body aches. Some people are hesitant to vaccinate against influenza due to fears about the safety of the vaccine. Many of these fears stem from the 1976 swine flu vaccine which was associated with a slightly increased 32

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risk of Guillen-Barre syndrome (neurological disorder). 450 people developed the disorder after vaccination, however there were over 45 million vaccines administered. Subsequent studies have shown that the rate of GBS was only marginally higher (1 per 100,000 people vaccinated) than normal. Influenza vaccines are safe and subjected to strict clinical trials. After vaccination, handwashing is the second most important practice to prevent influenza. Each day, we all touch thousands of items, many of which have been handled by others and are potentially infectious. Recent studies should that only 70% of people wash their hands after using the restroom and most are ineffective. Handwashing using soap and vigorous friction for at least 20 seconds is effective at destroying the influenza virus and preventing infection. It is recommended to wash your hands every time you use the restroom, prior to eating, and after each sneeze/cough.

Treatment of influenza is largely management of symptoms. Avoid dehydration by drinking lots of water. Give your immune system the energy it requires by getting rest and limiting activity. Use pain relievers such as acetaminophen and ibuprofen to combat body aches. Protect your community by isolating yourself. Medications such as Tamiflu or Relenza may limit the duration of the illness if started within 24 hours of symptom onset. Over the counter substances such as elderberry syrups have been shown to be as effective as prescription medications at limiting the duration of the illness. It has been 100 years since the deadly outbreak of influenza. Despite the advancements in healthcare, influenza remains a global concern and pandemic outbreaks are always a possibility. Vaccination and handwashing are the most effective methods at preventing infection. Rest and isolation are essential once the illness has taken hold. William T. Budd, PhD Chief Scientific Officer of Madison Core Laboratories www.madisoncorelabs.com 34

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EMERGENCY CARE WITH

LESS WAITING

E.R. In a medical emergency, every minute matters. So, at Crestwood Medical Center, you’ll find faster care in the emergency room. We work diligently to have you initially seen by a medical professional with the shortest wait time possible.* And, as a full service community hospital, we can provide a lot more care if you need it.

For less waiting and faster care, count on the E.R. at Crestwood Medical Center.

One Hospital Drive • Huntsville 256-429-4000 • CrestwoodMedCenter.com *E.R. wait time, which is defined as the time it takes from check-in at the E.R. desk until a patient is initially seen by a provider, can change quickly. This time is dependent on the severity of the illness and other patients also in the E.R.

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Bidding on the

"HOT HORSE" by, Kristen Scroggin

During a trip to Louisville, Kentucky, I went to my first horse race and “bet on some ponies.” Don’t get excited, it was $5.00, but I learned an important lesson. When you get a tip about a “hot horse,” you should bid more on it.

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I’m not saying buy a racehorse. I’m not saying abandon your job and bet on horses from now on. I’m saying, bet a $20 instead of a $5 because when it wins, you’ll win. In December of 2017, while researching new US census projections, I found some unusual patterns emerging. First, 47% of the American population is UNDER 33 YEARS OLD! How will that impact your current company succession plan? Next, Millennials, ages 14-33, are the largest generation in US history (86 million people) and will stay between 43%-41% of the eligible workforce for the next 30 years. There are so many of them that the birth rate and death rate balances. This information makes the Millennials a “hot horse” you should definitely bid on. Let me put the next 30 years into perspective for you. • As the economy turns around (as history predicts), many of those Baby Boomers (ages 65-74) who are already retirement age, but haven’t retired due to MONEY (not because they are panicked about not having anything to do), will actually retire. • 2030: ALL Baby Boomers are officially “retirement age.” While the first ten years of the generation has been clinging to their corner office, the second ten years, aka “flower children” ages 53-64, are not quite as obsessed with work. IF they have the money, and their kid finally move out of the basement, they will retire. That’s only 12 years from now! • 2040: The majority of your current upper-middle management, (ages 43-53) WILL be retiring. Hear me on this, genX will be getting out the MOMENT they can, which means for ten years you will lose people rapidly. Our recent genX focus group told us most don’t plan on waiting until 66 to retire, they’re aiming for 57 and we hear this number consistently. Estimate: 22 years •2050: ALL of the genX/Xennials (ages 33-43) are “retirement age.” Assuming they haven’t already cashed in their 401K’s and bolted, you will likely lose all of your middle management if you aren’t steadily bringing in, and promoting, Millennials as of 2018. Estimate: 30 years +/This data becomes more significant considering US companies are having a difficult time RETAINING Millennial employees for longer than 18 months.


Our research shows this is partially due to the current design of the American workplace, which is utterly unappealing to this generation. Quite honestly, it’s unappealing to most genXers & Xennials too, but they don’t have the numbers (only 40 million, half the size of Boomers or Millennials) to force significant changes. Additionally, Boomers aren’t retiring from policy-making positions, so genXers don’t have the power to make the changes that often appeal to Millennials unless they start their own companies. In a 2017 Forbes survey about companies where Millennials most want to work, most of the top 10 are either run, or founded by, genXers. Amazon Founder Jeff Bezos is 54; Google Founders, Larry Page, and Sergey Brin are 44; and Apple’s CEO Tim Cook is 57, just to name a few. However, companies implementing benefits Millennials want not only are attracting the best of the generation (we call them the “Rockstar Employees”, but they are retaining them, thus ensuring their companies live past the next 30 years. They are betting big on the “hot horse” and instituting changes that make sense in the 21st century. This year, I hope you consider genWHY Communication’s “hot tip” during succession planning. We get it, a major overhaul of the American workplace is daunting. The idea that we may not need to track hours, but efficient task completion, and that we can still be productive without coming into an office daily or ever wearing a suit again may seem unimaginable. Assembling a mix and match benefit package that offers more than two weeks PTO, gym memberships, and healthy food in cafeterias may even sound laughable. However, organizations who keep their standards high, but their policies flexible, will likely be the ones who survive. You have no succession plan without Millennials, BET EARLY AND BET HIGH!

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} HEALTH FEATURE

&

New Year Your Mental Health Welcome to the New Year! This is a time for new beginnings, a fresh start, and a clean slate. But what if you do not feel that way? While many people are channeling the excitement and making New Year’s resolutions, others are just surviving. If the thought of a new year does not bring feelings of excitement and opportunity, you are not alone. An often overlooked part of turning the calendar’s page is an inventory of your mental health. Mental health is a vital aspect of overall wellness, a critical piece that not only compliments your physical wellbeing, but often contributes to it. Yet, all too often we brush aside taking care of that essential part of ourselves. Why is that? While there are any number of factors, I believe it is partially due to the ongoing stigma surrounding mental health care. I also believe it is because many are unaware of the importance of mental health. Lastly, I believe there is a general lack of knowledge about where to start when it comes to taking care of one’s mental health. Let’s take a moment and unpack these points a bit.

Mental health is not just for people with problems. Surely you have heard the comments “therapy is just for crazy people”, “how is a stranger going to help me, this has been a problem in my family for generations”, or how about “only weak people get therapy”. Ouch. That last one stings. The reality is, strong people attend therapy. Struggling people attend therapy. Accomplished, well-off people attend therapy. Broken, hopeless people attend therapy. You see, therapy is, in its very nature, designed to help people exactly where they are starting from, regardless of the factors that bring them in. Therapy can even be used as a tool to increase satisfaction in your life and relationships, even if there is not an immediate problem! Mental health awareness is important, and benefits everyone. Mental health literally means the health of your mental status. For some people, that status is great, they are flourishing. For others, they need more assistance. Regardless of your current state of mental health, being aware is important. Caring for our brain, which plays a big part in our emotional wellbeing as well as our physical welfare, is vital to operating at our optimal levels. Our brain and body work in tandem

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by Rachel Sullivan, MFTA

throughout our life span. When one of these components is unhealthy, it directly affects the other. For example, when we feel depressed our body has physical symptoms which often lead to a decreased desire to be physically active. A study published in The Journal of Clinical Psychiatry explains this in turn can cause complications with multiple body systems. Persistent anxiety can lead to alterations in brain functioning, which may affect social and work environments. The truly scary part? Often these mental health issues show up in physical form first so they may be difficult to recognize. Maybe you have repeatedly felt just blah, but chalked it up to being overly tired. Or had an increased heart beat in social situations, but assumed your gut is telling you there must be something to keep an eye out for. Sound familiar? You are not alone, but where do you even start?


Start a conversation. According to the National Institute of Mental Health nearly one in five U.S. adults live with a mental illness. It is estimated that only half of those people receive treatment. That is a lot of people going without much needed assistance. Talking with a trusted friend about where you are at with life is a great starting place. There is power in personal connection. You can also speak with your primary care physician. They are aware of how mental and physical health complement each other and can get you in touch with a mental health care provider. These trained professionals are equipped to assess symptoms and develop a course of treatment that best suits your needs. Some of these professionals will even be able to help your family learn how to best support you in your journey to wellness. Wherever you fall on the mental health spectrum, be mindful of you. The New Year does not have to feel like more chances to fail or fall short. 2019 can be the time you finally get serious about taking care of your mental health and start working on the best version of you. Rachel Sullivan Marriage and Family Therapy Associate Solid Ground Counseling Center 9694 Madison Boulevard, Suite A7 Madison, AL 35758 256-503-8586

FOR SPINE TREATMENT THAT STANDS UP you need a doctor who stands tall. “Techniques have advanced since I started in neurosurgery in 2002. Applying past experience and recent training, I strive to provide safe and effective care for a broad range of neurosurgical problems.” — Dr. Stephen Sandwell

We’re happy to welcome Dr. Stephen Sandwell to the region’s largest, most experienced team of neurosurgeons.

spineandneuro.com | (256) 533-1600 Inside Medicine | W inter Issue 2019

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}MISSIONS

Live like a S.H.A.R.K.

Depression Recovery by Mark Beaird, LPC, NCC

Depression is a common ailment noticed more during the winter months, perhaps because of the gloominess of winter and reduced hours of sunshine. Just the same, people of all ages experience depression year-round. Unfortunately, many of them will have struggled for years before seeking help. Misunderstandings about depression that stigmatize individuals who admit to being depressed are being “just lazy” or as having a negative attitude or they just need to “cheer up.” None of these are true. Depression is not an attitude; it is a physical ailment that can greatly affect one’s attitude. According to the National Institute of Mental Health, symptoms include: • Persistent sad, anxious, or “empty” mood • Feelings of hopelessness, or pessimism • Irritability • Feelings of guilt, worthlessness, or helplessness • Loss of interest or pleasure in hobbies and activities • Decreased energy or fatigue • Moving or talking more slowly • Feeling restless or having trouble sitting still • Difficulty concentrating, remembering, or making decisions • Difficulty sleeping, early-morning awakening, or oversleeping • Appetite and/or weight changes • Thoughts of death or suicide, or suicide attempts • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment Not all of these symptoms have to be present for a person to be depressed. For example, many people who have depression never experience a desire to harm themselves. Depression can also be at a mild, moderate or severe level. Some levels of depression require medical treatment and some do not. See a qualified professional. Those dealing with depression usually have the tendency to withdraw, isolate and become inactive. Having suffered from depression myself in years past, I’m well aware of how enthusiasm runs low. Commitment can waiver. Isolating feels natural. These and many other temptations can lead a person to give in to the darkness of depression. 42

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One day when thinking on this issue, I thought about sharks needing to constantly move to stay alive. As it turns out, the shark needs to keep oxygen-rich water constantly flowing over the gills. My analogy for those battling depression is to be like a shark. Keep moving. To become motionless threatens our survival.


Some of the more common symptoms seen in patients at The Smith Family Clinic for Genomic Medicine include, but aren’t limited to:

The Smith Family Clinic uses the power of genomic medicine to diagnose diseases impossible to diagnose through other means. From your DNA, we derive answers that can guide care and make therapeutic decisions.

• Epilepsy • Cognitive or developmental delay • Adult-onset neurological disease (neuropathies, dystrophies, myopathies) • Primary immune disorders • Congenital heart defects, cardiomyopathies, or arrhythmias • Other unexplained or unusual disease processes

The Smith Family Clinic could help. Talk to your doctor or contact the clinic today.

256.327.9640

701 McMillian Way NW, Ste.A., Huntsville, AL 35806 on the campus of HudsonAlpha Institute for Biotechnology

Crystal Ditto needed a recipe for relief. Thanks to back surgery and the expertise of neurosurgeons from the Spine and Neuro Center at Huntsville Hospital, her smile is back and she can get back to dishing out the friendly customer service that had become a hallmark at her restaurant. Watch the rest of Crystal’s story at

myreason.org.

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...cont’d from page 42

To illustrate my point and to give some concrete steps to take, let’s use the acronym, S.H.A.R.K.

Set a pace of life you can maintain. Often, I encounter people

suffering with depression who have overextended themselves in both time and commitments to others. These are often the people who also do not feel they are depressed, but rationalize their feelings as being ill-tempered or stressed because of their busy pace of life. Reasonable expectations for activity, productivity and socialization each day are essential to dealing with depression. Instead of trying to reach big goals, focus on developing consistency in activity and productivity throughout each week.

Hold to your purpose. For the person working to recover from depression, it is important to remember to stay focused on achieving your goal of feeling better emotionally and physically. Trying to set your mind on achieving too many additional goals can increase your difficulty. Simplifying your life and narrowing your focus to what is really important can yield better results. Your purpose is to move forward in life productively—not to impress or please others. Becoming physically and emotionally healthy is essential to beating depression. Simple actions can help. For instance, in spite of the desire to isolate oneself, resolve to stay in touch and active with supportive individuals or social groups. Have as much “fun” as possible. Talk with your doctor about an exercise plan. Eat healthy and work to improve your sleep quality. Alternate between tasks. Motivation can run low when one is depressed. Life can easily feel like a rut. While maintaining a routine can be helpful, most people need more than one task or activity in which they can invest themselves. When energy runs low for one, switch to the other and vice versa. Alternating between defined and prioritized tasks—not purposes—provides variety. A variety of experiences each day will help one stay out of a “rut.” In each day, plan to include a mix of tasks, enjoyment, and exercise. Reward yourself. Periodic times of enjoyment, even in a

busy hectic life, are necessary for good mental health. As long as the reward is physically and emotionally healthy, take time to indulge yourself. Of course, this excludes excessive eating, alcohol use or other substance abuse or behaviors that can become addictive. Reward yourself in a healthy way for your healthy behavior by getting a massage, having a meal at your favorite restaurant, going to a movie with a friend, take a day off work to go do something you enjoy. Celebrate your progress, speak positively to and about yourself and stay away from negative people.

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Keep moving. There doesn’t have to be monumental progress every day, but there needs to be progress or sustained effort. During times when we are tempted to become inactive, I often suggest that people resort to using an egg timer or a timer on your phone to create active time periods which have a clear beginning and end. The idea is to designate a beginning and an end to activities we have low enthusiasm for, such as cleaning house, doing paperwork, and other necessary chores and commitments. For example, set a timer for 20 minutes and do whatever needs to be done nonstop for 20 minutes. At the end of the 20 minutes you can stop. If a person does this three-times-a-day, they will have at least one hour of productivity per day. Obviously that 20-minute period of time can be repeated throughout the day as many times as you wish. There are many resources as well as medication that is not addictive and can’t be abused. Medication is not always required; nonetheless, an acceptance of what you are experiencing will be required before the healing can begin. Let today be the day your healing begins! Mark is a therapist and co-owner of Covenant Counseling and Consulting www.covenantcc.co

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Good health begins with good information. Healthgrades has announced that Huntsville Hospital is the only hospital in Alabama to be included in America’s 50 Best Hospitals for Cardiac Surgery for five consecutive years (2015-2019). The respected national organization also recognized Huntsville Hospital as the only one in Alabama to be among the Top 5% of hospitals in the nation for Spine Surgery for 2019. And if you’re counting stars, Healthgrades also gave a Five-Star distinction (its highest rating) to Huntsville Hospital’s Total Knee Replacement program.

Improving lives.

huntsvillehospital.org

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} HEALTH FEATURE

let's get

HEALTHY by Christen Burns Bridges

Are you ready to lose weight?? It’s not easy but let me tell you, it’s worth it. Losing weight and then maintaining a healthy lifestyle is key to so many medical issues and your overall well-being. My story is like so many others. I have been overweight since puberty but never really got serious about losing weight until about three years ago. I was a 30yr old, full-time working wife and mother of two and I was sick and tired all the time. I had no energy. I was on medications for high blood pressure, was pre-diabetic and had zero motivation or willingness to do anything about it. I suffered from psoriasis as well and I knew I was unhealthy. Many doctors, including my dermatologist, would tell me that my health concerns would greatly decrease if I could lose weight. Even though I am also in the health care industry, I thought they were wrong. How could my weight truly affect my skin disorder?? Well, no matter what, I knew things weren’t going to miraculously change. I considered weight loss surgery but I knew in my heart that if I wanted to be healthy, I had to make the change myself. I wanted to get off the couch and be active with my kids. My family is a driving force behind what keeps me going with my health and fitness. I do this for them, to be able to live an adventurous and active lifestyle with my family. I want to teach them healthy habits for a longer life but also to love themselves no matter what they look like. I want them to have the confidence to do anything they want I started by changing my diet. Here in the south, every event, graduation, birthday or holiday calls for a family gathering. Every gathering in our family involves food. It was VERY hard in the beginning to see everyone eating Southern Comfort food while I ate my “diet” food, as they called it. When I first started dieting, the main thing that I cut out was bread. I began to notice that the more weight I lost (from not eating bread) the more my psoriasis cleared

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up. I began doing my own research and discovered that psoriasis is an auto-immune disorder and that many auto-immune disorders are irritated or worsened by gluten. I immediately started a gluten-free diet and am happy to report that as long as I’m not consuming gluten, the psoriasis stays at bay. And, I will credit my dermatologist for trying to tell me this long ago. I started to see the weight fall off almost immediately and then I was hooked! I felt great! I began exercising. Just walking on my lunch break at first. After about 30 pounds, I hit a plateau. So I changed things up and got a gym membership! I also switched over to counting macros at this point. I increased my cardio and before you know it, another 30 pounds gone! I found that working out not only helped me to lose weight but helped to alleviate stress and allowed me to decompress after work. I’ve gone from walking on my lunch break 2-3 times a week to 6-8 workouts per week. The more I stay active, the better I feel. Today, three years later, I’ve lost and have been able to maintain about a 65-70lbs weight loss. My ultimate goal three years ago was to lose 100lbs. I am so close to that goal! The more weight you lose, the harder it is to get the weight off. I constantly have to change things up now to


keep from hitting plateaus. I have to change my diet, routines, and workouts. I also know creating goals can be a huge motivator to keep me going. Knowing what you are working for, having a plan to reach them and then crossing them off your list is the most satisfying thing ever. It helps even more than actually seeing the weight drop off. Being able to say “I did that” is so satisfying. I make yearly, monthly, weekly and daily goals in all aspects of my life. My biggest and hardest goal for 2018 was to participate in one 5k per month. I just completed #12! I will be able to say “I DID IT!” My next big goal is the Bridgestreet Half Marathon in April 2019. While I did make fitness resolutions at the beginning of 2018, it is never too soon to start your journey. Don't wait until after the holidays, until after the New Year, until after vacation. Start now. Three months from now, you will thank yourself. Unfortunately, two months ago, I was diagnosed with Poly Cystic Ovarian Syndrome. This has made the struggle to lose more weight even greater. One of the biggest side effects from PCOS is obesity. Research shows that a lowcarb diet is beneficial specifically for women with PCOS.

Going about this journey as well as seeing others navigating it, I have found the most important thing to eating healthy and staying on track is meal prepping. My favorite quote here is “fail to prepare and you have prepared to fail”.

come with many sacrifices but none outweigh the benefits of being healthy. We have one life and one body and I intend on not wasting mine. I want to make the most of this life, for as long as I am able. It's so easy to change your lifestyle to prevent long-term illnesses such as Hyperlipidemia, Hypertension, Diabetes, etc. compared to having to deal with them by taking medications and using insurance or paying for different doctors to manage your care. I have brought my lunch and dinner, even out to restaurants, to ensure that I hold myself accountable. It’s not always easy, in fact sometimes it’s so hard that I have missed gatherings because I knew I would not be able to resist temptations. Staying motivated is the other key factor. When someone asks me about my motivation, aside from just being healthy, I always answer quickly with “my kids”. There are days that are hard to find my motivation but I go back to my “I don’t” attitude. I just refuse to give in to mental weakness, a bad day, a bad week, or any force of distraction trying to derail me. I started an Instagram page to hold myself accountable. I hope that by posting my progress I motivate other people to make positive changes in their lives. My husband (who has been 150% supportive of me the entire journey) has recently joined the gym and the kids are able to come and witness us working hard towards our goals together. I want you to know you can do it too!! Do it for yourself, your health, and your family!

While getting to the gym and working out are not issues for me anymore, the nutrition aspects are much, much more difficult. So moving forward I will be more conscientious of what I eat. Again, a way to help create a healthy me is focusing on my weight and my nutrition. As I continue my career as a healthcare worker, I see firsthand the long-term effects of not taking care of yourself. I see how much time and money are required for medications and doctors’ appointments. My new lifestyle has

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Knowledge Sharing

Healthcare Resources Available to You and Your Family Managing your health in today’s health care system can be exhausting, frustrating, and expensive. Luckily, help is available and we nurses want to make sure you know we are here for you! Your health care team is interested in the person you are as a whole, and not just as a diagnosis. Employment obligations, family responsibilities, mental health issues, and nutritional concerns all contribute to the particular needs of each individual. When you attend physician appointments, do not be afraid to share a change in economic status, living condition or even a new health concern. For example, your diabetic medicine may become too expensive, or you might change jobs, get divorced/married, and your insurance coverage may change. Informing the doctor of your concern facilitates an open conversation about the possibility of changing medications or patient resource programs that might be available to you. It is also recommended that you keep important information with you at all times: your insurance card, your primary doctor’s name, and a short list of medications you take- with dosages.

Huntsville Hospital Diabetes Control Center 420 Lowell Drive, Suite 500 Huntsville, Al 35801 256-265-3069

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Below, are a few resources that are available from friendly, area nurses. • Call your doctor’s office and ask about programs or medication samples • Call United Way #211 • Call the Senior Center if over 55 or disabled • Call or email the manufacturer of the drug you take • Call your insurance company • See if your medication is on the free or 7.50 supply list at Wal-Mart or Publix • Check the program familywize.org to see how prices differ depending on where your prescriptions are filled


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