VOL VOL 33 ISSUE ISSUE 21 21
BREAST CANCER OVARIAN CANCER COVID-19
underdiagnosed, undertreated lower back pain
talking with Madison’s Mayor
CHRONIC PAIN TREATMENTS A Local Musician’s Story
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Simply the best.
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BEST Regional Hospital and #2 in Alabama The evaluation also includes data from Madison Hospital and Huntsville Hospital for Women & Children.
High performing in 11 areas: • Aortic valve surgery • Abdominal aortic aneurysm repair • Spinal fusion • Colon cancer surgery • Diabetes • Heart attack • Heart bypass surgery • Heart failure • Hip replacement • Knee replacement • Stroke
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Sharing with Purpose
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FEATURES Living with Chronic Pain
Breast Cancer diagnosis and decisions
problems & symptoms
CO N T R I B U T O R S
Kimberly Waldrop, MA Micheal A. Cosgrove, MD Kelly Reese Traci McCormick, MD Timo Sandritter, PhD
Mayor Paul Finley
an interview with Madison's mayor
Sacroiliac Joint Pain common cause of low back pain
COVID-19 delta variant
improving detection and treatments
William Matthew Sykes, DO, CAQSM William Budd, PhD Sarah Sharman, PhD
Ann Jewell Jason Lockette, MD Winston T. Capel, MD, MBA, FACS,FAANS Rachel Sullivan, LMFT
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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.
Inside Medicine | W inter Issue 2021
This issue is no different..
We are bringing you information on breast cancer treatments, chronic pain treatments, and covid testing... just to name a few. We love meeting and talking with community members to hear their heart and passions. After sitting down and talking with Madison’s Mayor, Paul Finley, we have been validated in knowing he is using his position to better the city. We appreciate the time he gave us and the fact he is letting us share some of his focus. The debate surrounding the covid vaccine is still prevalent and so we are providing a doctor’s opinion on the topic. We also have information on long term care and looking at preparing for future healthcare needs. Goodness, we love providing this resource to our readers. Our heart is in this publication and we hope you enjoy it as much as we do! As always, all of us at Inside Medicine are so thankful for your support. We love interaction and involvement from our readers so please reach out and let us know if you have an idea or comment.
Time keeps ticking by. So many good and bad things continue to happen around us and we typically have zero control over it all. Isn’t it such a peaceful feeling knowing that we don’t have to be in charge? God is and always will be the Ruler of all situations. At Inside Medicine, we truly feel this way…and we feel this way about our vision with this magazine. It is what it is because of Him. It is such a good way to spread great information and be a reminder to be a shining light for our Creator.
Until next time...
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chronic pain by: Kelly Reese
In today’s medical market, we continue to witness exponential growth in almost every area of healthcare specialty. Often times, stigmas around sub specialties like pain management have created many hesitations for both patients and physicians. Nobody wants a “push under the rug” approach of pills and addictions. But they do want effective treatments. Patients living with moderate or severe chronic pain have a significant decrease in their quality of life and deserve the best treatments. The amount of these patients continues to rise. 8
Inside Medicine | W inter Issue 2021
Researchers report that
U.S. adults experience chronic pain based on analysis of new data
They estimate the total value of lost productivity due to chronic pain to be nearly $300 billion annually. With more patients desiring the treatment of chronic pain, the surge in fellowship trained and board-certified sub specialists demand has been on the rise. This has led to the improvement of the quality of care across all areas of healthcare; especially in the are of chronic pain.
The stories are many..
but one in particular involves a local musician, David Hood. David is a bassist by profession and has produced songs with the best of the best in the music industry, including Willie Nelson and Cher. He also has played bass on albums for Joe Cocker, Aretha Franklin, Cat Stevens, Rod Stewart, and Sheryl Crow, just to name a few. Unfortunately, this amazing musician has dealt with chronic back pain for a little over a decade. It continued for so long, it just became a way of life. David even learned to aid his handicap by strategically placing walking canes in rooms of his home to help get him place to place. But after his pain started to become debilitating and leaving him feeling helpless, he knew he had to seek treatment. David received a referral from his primary care physician to go visit Dr. Michael Cosgrove, board-certified anesthesiologist specializing in pain management, Regenerative Medicines, and interventional medicine. Dr. Cosgrove’s initial thorough examination and MRI evaluation of David concluded his candidacy for an innovative device designed to target and relieve pain at the source. When David learned he was a candidate for a spinal cord stimulator; a device that is implanted sending low levels of electricity directly into the spinal cord to relieve pain, he was elated. Luckily, the device has been a game-changer David. He gives all credit for his treatment to Dr. Cosgrove and the new technology available. “I am the picture of a satisfied patient. I was in such bad shape. Overall, I am doing so well! Dr. Cosgrove has turned things around for me.” David has put the canes away and is back to enjoying playing bass in the recording studio. David’s success story is definitely one worth sharing, and there are lots more! Dr. Cosgrove uses a tailored approach to achieve the best patient outcomes. He delivers a comprehensive care plan which requires collaborative market innovation and evidence-based medicine, always utilizing revolutionary technologies.
photos by Billy Reid
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for Inside Medicine Magazine,
Spinal Cord Stimulation: HOW LONG HAVE YOU SUFFERED WITH CHRONIC PAIN? I have suffered with chronic pain for years. I had a back surgery in my early 60's that provided some relief for about five years. After that, it was right back to moderate to severe pain that became increasing worse until it affected my ability to function normally. WHAT LED YOU TO GETTING THE SPINAL CORD STIMULATOR? I was referred to Dr. Cosgrove by Dr. Stephen Howell, my pain management specialist in Florence. We had tried shots, medications, braces, physical therapy and it was to the point that nothing was relieving the pain. Dr. Howell thought I might be a good candidate for a spinal cord stimulator. WHAT WERE SOME ACTIVITIES THAT YOUR CHRONIC PAIN HINDERED YOU FROM DOING? Everything had become difficult. Even sitting passively through a dinner out with friends was difficult. Walking had become so difficult that I was using a cane to get around. Most importantly, I am a bass player and the pain was hindering my ability to work as a musician. Music is how I feed my soul so I was very depressed about that. My wife and I love to travel and it had become very difficult to walk through airports, fly on planes, etc. Long trips in the car were also very hard. We live on the lake and love to cruise in our boat, but even that was intolerable.
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DO YOU FEEL LIKE THE SPINAL STIMULATOR HAS HELPED YOU GET BACK TO DOING THINGS THAT YOU WERE NOT ABLE TO DO BEFORE? Absolutely! When they did the trial procedure I was amazed at the outcome. I had suffered from severe pain in my lower back and down my right leg. The stimulator targeted that pain and blocked the pain messages to my brain. It was like a miracle. I was so excited to think about “getting my life back.” I had given up hope, and suddenly all of these possibilities were opening up for me. WHAT TREATMENTS WERE YOU RECEIVING PRIOR TO GETTING A SPINAL CORD STIMULATOR? Surgery, shots, medication, physical therapy, chiropractor. DO YOU FEEL LIKE YOU LIVE A NORMAL LIFE WITH THE SPINAL STIMULATOR? I’m 78 years old, so “normal” becomes a relative term but I am functioning at a much higher level than I was before the implant. I had the spinal stimulator implanted when I was 75 and these past three years have been so much better. WHAT DO YOU LIKE ABOUT HAVING A SPINAL STIMULATOR? I like not having to take so many meds for pain. HOW DO YOU ACCESS YOUR THERAPY FOR SPINAL CORD STIMULATION? I access it through my iphone. WHAT DO YOU LIKE ABOUT THE SPINAL CORD STIMULATION THERAPY YOU USE? It’s easy to use and understand. The technicians who work with me to calibrate my stimulator are so courteous and knowledgeable and always just a phone call away.
HAS THE SPINAL STIMULATOR HELPED YOU IN YOUR DAY TO DAY LIFE?
Yes, said David Hood...
Actually, I am very lucky to be 78 and still playing my bass on recording sessions. I don’t know too many 78 year old bass players so I am very thankful. As a session bassist, studio owner and member of the legendary Muscle Shoals Swampers rhythm section, David Hood has recorded with a vast range of musicians. He has worked with Aretha Franklin, Wilson Pickett, Otis Redding, James Brown, Clarence Carter, Etta James, Percy Sledge, Johnny Taylor, Bob Seger, Steve Winwood, Rod Stewart, Paul Simon, Cat Stevens, Joe Cocker, Duane Allman, Linda Ronstadt, Jimmy Buffett, Willie Nelson, Merle Haggard, Glen Frey, the Staple Singers, Boz Scaggs, Jimmy Cliff, Levon Helm, Delbert McClinton, Steve Cropper, Sheryl Crow, Alicia Keys and many more. Although he has played on hundreds of hit records, he may be best recognized for his signature bass lines in the Staples Singers classic “I’ll Take You There,” during which Mavis Staples refers to him as “Little David.” David and his fellow musicians in the Muscle Shoals Rhythm Section were immortalized as the “Swampers” in the Lynyrd Skynyrd song titled “Sweet Home Alabama.” Hood was inducted into the Alabama Music Hall of Fame in 1995 and into the Musician’s Hall of Fame in 2008. In early 2020, he was rated as one of the top 50 bass players in the world by Rolling Stone magazine, coming in at #27. I n s i d e M e d i c i n e | W i n t e r I s s u e 2 0 2 1 11
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From the first time my wife and I met Dr. Michael Cosgrove we knew we were in good hands. He was so encouraging and upbeat about my prognosis. That was refreshing because the other doctors had pretty much given up on me. Dr. Cosgrove is a compassionate and skilled doctor, and his treatment was a game changer for me. We have recommended him to several friends. We sing his praises all the time.
David’s success story is definitely one worth sharing, and there are lots more! Dr. Cosgrove uses a tailored approach to achieve the best patient outcomes. He delivers a comprehensive care plan which requires collaborative market innovation and evidence-based medicine, always utilizing revolutionary technologies. Dr. Cosgrove at The Orthopaedic Center delivers pain solutions that allow patients, like David, to get back to their daily, productive lives. If you are in need of relief from chronic pain, give them a call today! (256) 539-2728 TOC South Huntsville www.VisitTOC.com/DrCosgrove
I’ve been seeing Dr. Cosgrove for my degenerating spine for years. He’s kept me going and I couldn’t be more grateful for his kind and professional manner. Dr Cosgrove spends enough time with his patients to address concerns; answer questions & discusses any necessary follow up treatment. He is kind & considerate. A true Gentleman. My visit with Dr. Cosgrove was extremely good. Dr. Cosgrove listened to my concerns and took me very seriously. He spent a great deal of time going over options and seemed to genuinely care for my health. I was pleasantly surprised today. The off ice staff was friendly and polite, I didn't have to wait too long, and Dr. Cosgrove was very personable and answered all my questions and I didn't feel rushed at all.
Michael A. Cosgrove, MD Pain Management Spine Non-Surgical
TOC South Huntsville (256) 539-2728 VisitTOC.com/DrCosgrove I n s i d e M e d i c i n e | W i n t e r I s s u e 2 0 2 1 13
TARGETED RELIEF. AT THE SOURCE.
TALK TO YOUR DOCTOR
T O S E E I F P R O C L A I M™ D R G N E U R O S T I M U L AT I O N M AY BE RIGHT FOR YOU The Proclaim™ DRG Neurostimulation System is a non-opioid technology specifically designed to help manage chronic nerve pain following surgery or injury. Dorsal root ganglion (DRG) therapy may be able to provide you relief in the following areas1:
• FOOT • KNEE • GROIN
• ANKLE • HIP • RESIDUAL LOWER LIMB
LEARN MORE AT AB OUT YOUR PAI N.COM 1. Deer T, Levy R, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017;158(4):669-681.
Rx Only Brief Summary: Prior to using these devices, please review the Instructions for Use for a complete listing of indications, contraindications, warnings, precautions, potential adverse events, and directions for use. The system is intended to be used with leads and associated extensions that are compatible with the system.
Abbott One St. Jude Medical Dr., St. Paul, MN 55117 USA, Tel: 1 651 756 2000 Neuromodulation.Abbott
Indications for Use: Spinal column stimulation via epidural and intra-spinal lead access to the dorsal root ganglion as an aid in the management of moderate to severe chronic intractable* pain of the lower limbs in adult patients with Complex Regional Pain Syndrome (CRPS) types I and II.** *Study subjects from the ACCURATE clinical study had failed to achieve adequate pain relief from at least 2 prior pharmacologic treatments from at least 2 different drug classes and continued their pharmacologic therapy during the clinical study.
**Please note that in 1994, a consensus group of pain medicine experts gathered by the International Association for the Study of Pain (IASP) reviewed diagnostic criteria and agreed to rename reflex sympathetic dystrophy (RSD) and causalgia, as complex regional pain syndrome (CRPS) types I and II, respectively. CRPS II (causalgia) is defined as a painful condition arising from damage to a nerve. Nerve damage may result from traumatic or surgical nerve injury. Changes secondary to neuropathic pain seen in CRPS I (RSD) may be present, but are not a diagnostic requirement for CRPS II (causalgia). Contraindications: Patients who are unable to operate the system, who are poor surgical risks, or who have failed to receive effective pain relief during trial stimulation. Warnings/Precautions: Diathermy therapy, implanted cardiac systems or other active implantable devices, magnetic resonance imaging (MRI), computed tomography (CT), electrosurgery devices, ultrasonic scanning equipment, therapeutic
radiation, explosive or flammable gases, theft detectors and metal screening devices, lead movement, operation of machinery and equipment, pediatric use, pregnancy, and case damage. Adverse Effects: Painful stimulation, loss of pain relief, surgical risks (e.g., paralysis). Instructions for Use must be reviewed for detailed disclosure. ™ Indicates a trademark of the Abbott group of companies. © 2020 Abbott. All Rights Reserved. 37548 MAT-2001811 v1.0 | Item approved for U.S. use only.
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BREAST by: Traci McCormick, MD
If you are reading this, it is likely that you or a loved one has been diagnosed with breast cancer and you have some tough decisions to make.
You’ve just been told you have cancer. Your head is probably spinning. And your surgeon wants to know what kind of surgery you want. Your first instinct is probably to just get it out as fast as you can, however you can. But I encourage you to slow down and think. You’ve got time. This is an important decision and it’s worth educating yourself on your options. First, you should know that there are 4 components of breast cancer treatment: surgery, chemotherapy, radiation, and endocrine therapy. I’ll also add a 5th component not traditionally discussed….lifestyle and nutrition. In this article, I’d like to discuss your surgical options, as surgery is the first step of breast cancer treatment for most women. On occasion, chemotherapy may be recommended prior to surgery, but this is unusual in our area of the country. Your options for surgery include having the entire breast removed (mastectomy) or just having the cancer removed while preserving the remainder of the breast (lumpectomy). The important thing to know about these options is that both mastectomy and lumpectomy lead to EQUAL RATES OF CURE!!! The chance of recurrence within the breast after lumpectomy or mastectomy is less than 5%. That’s pretty darn good! I have many women that come to me thinking that they want a mastectomy because they want to be as aggressive as possible “so they don’t have to worry about the cancer ever coming back”. These women are under the mistaken impression that if the breast is removed, it is impossible for the cancer to come back. Unfortunately, the cancer can come back in the tissue that is left behind after mastectomy. This is called a chest wall recurrence. It doesn’t happen often, but it does happen.
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The important point here is that breast cancer returns in the soft tissue of the chest wall after mastectomy just as often as it returns in the remaining breast tissue after lumpectomy. So neither mastectomy or lumpectomy is more or less aggressive than the other when it comes to getting rid of the cancer in the breast. Let me insert here that a double mastectomy (having both breasts removed) is very rarely indicated. Rates of double mastectomy have skyrocketed over the last several years even though there is no medical data indicating that double mastectomy improves prognosis. We suspect this is due to what is referred to as the “Angelina Jolie” effect. There have been a number of celebrities with the breast cancer gene (including Angelina Jolie) that have undergone double mastectomy and have been very public about it. This has led many women to follow suit, feeling like they are increasing their odds of beating the cancer by having both breasts removed. What the media doesn’t always make clear is that double mastectomy is only indicated if you have the breast cancer gene, which applies to less than 5% of women with breast cancer. So now that you know that your choice of surgery doesn’t affect your prognosis, how do you decide which surgery is right for you.
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WHY CHOOSE MASTECTOMY?
There are a number of reasons that a woman might prefer a mastectomy. Unfortunately, the number one reason I see in my practice is that, despite my attempts to educate women that having a mastectomy won’t increase their odds of beating their cancer, they simply don’t believe me or the data. They have a mastectomy because they believe it is more likely to cure them than a lumpectomy. It helps them sleep better at night knowing the breast is gone. Other women choose mastectomy because they want to try to avoid radiation. After lumpectomy, radiation therapy is almost always indicated. After mastectomy, it is possible that radiation will be needed, but it isn’t as common. Radiation can be time-consuming and require time away from work. Treatments are given daily, therefore women that live a long way from a radiation therapy center may choose mastectomy because daily travel would be difficult. Radiation also has potential side effects that should be considered when making a decision about which surgery to choose. Some women choose mastectomy under the mistaken impression that it will make it less likely they will need chemotherapy. However, the type of surgery you choose has no impact on whether or not you will need chemo. There are also a few medical reasons that your doctor may recommend mastectomy. These include a very advanced tumor or a tumor that involves multiple areas of the breast, current pregnancy, or a history of prior radiation to the breast. In some cases of large tumors, the surgeon will recommend doing chemo first to shrink the tumor so that a lumpectomy is still possible.
WHY CHOOSE LUMPECTOMY?
The reasons women choose lumpectomy are more straightforward. Most women that choose lumpectomy typically do so for one of two reasons: •They like the idea of a smaller surgery with less risk of complications and less recovery time. •They want to keep their breast.
SO WHICH SURGERY SHOULD YOU CHOOSE?
In my mind, the most compelling reason to undergo mastectomy is to avoid radiation if the idea of radiation scares you. Although the vast majority of my patients will tell you that radiation isn’t nearly as bad as they feared it would be. The most compelling reason to choose lumpectomy (again, in my mind) is to preserve the natural breast. Preserving the breast may sound like a superficial reason to some, but the psychological effects of mastectomy can’t be understated. Depression, low self-esteem, and sexual aversion are all potential consequences that not many people talk about. For women that undergo reconstruction after mastectomy, a number of them are pleased, a number of them say that it just isn’t the same as their “real” breasts, and a number say that the procedure was so difficult and time-consuming that they wouldn’t do again. Ultimately the decision is yours based on your priorities and concerns. You can’t make a wrong decision in terms of what is best for your cancer. Your cure rate is the same regardless of what surgery you choose! As always, I’m here if you have any questions. Please do not hesitate to contact me or call my office for an appointment. I’m happy to help you in any way I can.
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fear of failure
hindering your ability to innovate? by: Timo Sandritter, PhD
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Just like everyone has a different personal mindset, the same goes for companies and their culture. Organizations are all rooted in different core beliefs and goals which means that will ultimately transfer to their employees. There are companies that give you the option to succeed or to fail. There are also companies that give you the option to succeed or to learn.
WHICH COMPANY ARE YOU? It is key to foster an environment that encourages innovation and allows for learning along the way. To create and innovate, you must have the opportunity to try new things and explore new ideas. Failure will naturally occur. Leadership practices must encourage innovation, which includes viewing failure as a learning opportunity, allowing for innovative developments, and offering your team the proper resources to become champions in their workplace. At Ripple, we consider our people a championship team. To build a championship team, we must equip our people with the tools they need to be successful. We must also realize that championship teams can fail and get knocked down but it’s how they learn from the failure that matters.
WE CANNOT FORCE PEOPLE TO BE INNOVATIVE, BUT WE CAN SET THE ENVIRONMENT THAT ALLOWS AND FOSTERS CREATIVITY.
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DISCOVER. ENABLE. IMPACT. SUCCEED. By using Ripple chat, you can share patient records, discuss matters, or simply schedule a meeting, all from the touch of your screen. Reach, any user within the Ripple platform can be reached via Chat, Message, or by scheduling an event within the Ripple calendar. Ripple’s chat module is GDRP and HIPPA certified to protect your conversations and information shared.
IT'S TIME. TO BE BETTER. Let RippleWorx drive the overall performance of your people so your organization can thrive!
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Get Your Omega-3 Fatty Acids for Better Health by: Matthew Sykes, DO, CAQSM
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Omega-3 fatty acids are vital components of cell membranes and include: Alpha-lineoleic acid (ALA), eicosapentaenoic acid (ELA), and docosohexaenoic acid (DHA). ALA is considered an "essential fatty acid" which means that that body is unable to produce it, therefore it must be obtained from dietary sources. Foods rich in omega-3 fatty acids include but are not limited to salmon, mackerel, oysters, flax seeds, chia seeds, hemp seeds, seaweed, and spirulina. Omega-3 fatty acids supplements are also readily available overthe-counter. Below are some health benefits of omega-3 supplementation!
Omega-3 fatty acids have been shown to decrease the risk of stroke and heart attack. Getting your omega 3s can help raise your HDL ("good") cholesterol, reduce triglycerides by 15-30%, and lower the risk of abnormal heart rhythms. The anti-inflammatory properties of omega-3s can also prevent hardening of arteries, and also improve their elasticity. Omega-3 supplementation can benefit both male and female reproductive health. Mice fed diets high in omega-3s were shown to have greater reproductive success later in age. Observational studies in humans have also shown an association between diets rich in omega-3s and greater fertility in both men and women. Optimal omega-3 levels have been correlated positively with increases in ovarian follicle counts in women, as well as improving fertility after the age of 35, and possibly decreasing the risk of Down Syndrome in late-life pregnancies. Omega-3s also promote healthy fetal brain and eyesight development, and may decrease the risk of developmental delay, ADHD, autism, cerebral palsy, and behavioral health issues. In men, optimal omega-3 levels are associated with increased sperm count and quality. The cardiovascular benefits of omega-3 fatty acids may also aid in the treatment of erectile dysfunction. Diets rich in omega-3 fatty acids, especially ALA, have been associated with improved bone mineral density, and decreased risk of osteoporosis. The anti-inflammatory properties of omega-3s can also decrease joint pain associated with rheumatoid arthritis and osteoarthritis. Improve your mental health! Omega-3 fatty acid supplementation has been shown to decrease the risk and severity of depression and anxiety. Omega-3s can decrease symptoms of schizophrenia and bipolar disorder, lower risk of Alzheimer's disease, dementia, and cognitive decline. Consider incorporating omega-3 fatty acids into your healthy lifestyle!
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COVID-19 Delta Variant: Emergence of an Emergency by: William Budd, PhD
Covid19 virus, specifically the Delta variant, is once again creating a surge across the United States. This current surge erased what had been a steady decline in cases since January 2021. Compass Laboratory performs testing for a large section of the southeastern US focusing on Alabama, Tennessee, Mississippi, and Arkansas. Since the middle of July, we have been experiencing record numbers of samples with very high positivity rates. We have communities that are experiencing positivity rates of up to 30%. The vast majority of samples are the delta variant.
9 VACCINAT 1 D I VI
...cont’d from page 27
Our laboratory is one of the few labs in the region that test most of the positive cases and then determines the specific nature of the variant that causes the positive test results. What we have been able to determine is, beginning about the middle of July, the dominant strain that had been circulated in our community was known as the alpha strain, also called the B.1.117 or more commonly referred to as the UK variant. That strain was very quickly replaced by the delta variant. Within two weeks, the alpha variant was outcompeted by the delta variant. Positivity rates quickly skyrocketed from 1% to 2% from samples that were submitted for testing and we began to enter into a very large upward trajectory of positive samples again to an average daily rate of over 20% with some communities experiencing much higher rates. We know that the Delta variant is much more contagious than previous other variants of the SARSCoV2 virus and appears to cause more severe illness in persons that are unvaccinated. Even though unvaccinated persons are at the highest risk of severe illness and death from the Delta variant, vaccinated individuals can experience a breakthough infection and spread the virus to others. Data has shown that persons that are fully vaccinated clear the virus more quickly than their unvaccinated counterpart. For these reasons, it is now more important than ever that vaccines are utilized as they are our most reliable weapon to prevent deaths from Covid19. The vast majority of persons getting tested for Covid 19 are symptomatic. This is very different from what we saw with the last surge ending in January of this year. At that time, a lot of patients were asymptomatic or had very mild symptoms. With the delta variant, most of the patients are experiencing a lot of symptoms including difficulty breathing, cough,
lethargy, and fatigue. They get sick very quickly and the amount of virus in their respiratory tract increases very quickly. We are also seeing patients that are vaccinated have breakthrough infection with the delta variant. One of the challenges we are experiencing in the south is that the overall vaccination rate is very low so we're having a high number of people who are still vulnerable to getting infected. We have a high reservoir for the virus to still pass through in our community, the more people are able to get sick the more likely this virus is to mutate and create new variants. I encourage everyone to continue wearing masks, social distance and vaccinate if you are not vaccinated. Just because you have been infected in the past doesn't mean you are going to necessarily be immune to the virus. There are many people that have been infected with Covid 19 more than once. Unfortunately, we are still in the early stages of this current surge. We have not yet peaked and it is growing exponentially. Now is not the time for us to be divisive as a community. We have to come together and unite and fight this virus or this virus will continually mutate and continue to kill a large number of people. Even now, our laboratory has samples of young children who are coming in that are quite ill and recently we have quite a number of kids that ultimately succumb to this virus. Again, I encourage everyone to continue to social distance, wear masks and get vaccinated. And, as we all know, if you have been exposed to anyone who is sick we encourage testing and if you are positive, we encourage everyone you have gotten in contact with to get tested.
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PAUL FINLEY by: Kelly Reese
As soon as you sit down in the room with the Mayor of Madison, you realize his focus on improving quality of life is real. When asked what that improvement looks like, Mayor Paul Finley shared that “accomplishing actionable results with meaning” is the Madison teams focus.
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ince Paul Finley became Mayor in 2008, he has seen the beginning and ending of such projects as James Clemens High School, Hogan Family YMCA, greenway expansions throughout the city, Target, and the Shoppes of Madison, Madison Hospital, Toyota Field, and multiple major infrastructure improvements. Now in his ninth year as Madison’s Mayor, his focus on actionable results continues for the citizens of Madison.
Mayor Finley pointed to the addition of Madison Hospital as one of, if not the most, positive quality of life enhancers he and his team have supported during his tenure. Opening in 2012, the hospital has brought doctors, specialists, and ER services that are needed in a city the size of Madison. Madison Hospital has also opened the Highway 72 corridor for more business and economic development as well. Thus, there is more revenue to put into achieving a higher quality of life in all areas.
During the past year of managing the Covid-19 pandemic, Madison Hospital was a major asset and team player for the community. While the national political parties politicized it for their own gain, Mayor Finley and Madison Hospital President Mary Lynne Wright were part of the local team working daily to educate and lead our community.
Now a city of 57,000, Mayor Finley points to controlled growth as his team’s main focus in the next few years. “Our stellar school system, location to Redstone Arsenal, and incredible job opportunities will keep people wanting to plant their roots in Madison,” said Finley. “We must continue to utilize our revenues for improved roads, strong public safety, and recreational improvements that mean something to our citizens.” Recent accolades including being named Alabama’s #1 Zip Code to Live by Niche along with Money Magazine naming Madison the #12 Best Place to Live in the United States are examples that Madison must be doing something right. The City of Madison has experienced vast city-wide improvements under the leadership of Mayor Finley and his team. While the work is not done, residents are able to experience a high quality of life for their families. Mayor Finley hopes to keep progress moving forward while accolades for Madison continue to roll in!
The City of Madison should be proud of the work Mayor Finley has done and what he sees as his vision for the future.
Ovarian Cancer Research
improving detection and treatment strategies
you have been out and }Ifabout this month, you may have seen teal flags, bows or banners in your neighborhood or around town. Teal is the color that is designated for ovarian cancer survivors, patients, and their supporters. Although many national cancer organizations have long recognized September as Ovarian Cancer Awareness Month, this year President Biden officially declared September 2021 as National Ovarian Cancer Awareness Month.
by: Sarah Sharman, PhD
The oﬃcial recognition of an awareness month is important for raising funds to support research and technology used to detect, treat, and eliminate ovarian cancer. Let’s learn about ovarian cancer and what scientists are doing to develop new ways to detect ovarian cancer earlier and improve treatment strategies.
Welcome neighbor. Everyone at Madison Hospital is passionate about providing quality care and excellent customer service. While we take care of you and your family, we pledge to treat you like a member of our family. •
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} } What is ovarian cancer? Cancer is a disease in which some of the body’s cells grow out of control, and in many cases spread throughout the body. Normally, cells grow and multiply to form new cells to replace old or damaged cells. In cancer, the orderly process of replacing cells breaks down, and abnormal or damaged cells grow and multiply instead of dying and being replaced. Ovarian cancer originates in cells of the ovaries, fallopian tubes, or peritoneum, which is the tissue that lines the abdominal wall and covers the abdominal organs. Ovaries are the reproductive organs that produce eggs in females. They are also the main source of the female hormones estrogen and progesterone. The ovaries are made up of three types of cells that can each develop into a diﬀerent type of tumor. Epithelial tumors originate from the cells that line or cover the outer surface of the ovaries and fallopian tubes. The majority of ovarian tumors are epithelial in nature, with 80 percent being classiﬁed as serous epithelial ovarian tumors. Germ cell tumors start from the cells that produce the eggs, while stromal tumors begin in the structural tissue cells that hold the ovary together and produce female hormones. The risk of a woman being diagnosed with ovarian cancer in her lifetime is 1 in 78. Researchers have discovered several risk factors that might increase a woman’s chance of developing epithelial ovarian cancer. Age and family history of ovarian cancer are currently the two strongest risk factors. Ovarian cancer is rare in women under the age of 40 with half of all ovarian cancers being found in postmenopasal women 63 years of age or older.
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About one in ten women who are diagnosed with ovarian cancer will have either a strong family history of ovarian cancer or a mutation in a gene that increases risk of the disease. A small portion of ovarian cancers occur in women with inherited mutations in the BRCA1/BRCA2 genes, as well as a number of genes related to other family cancer syndromes linked to an increased risk of ovarian cancer (PTEN, STK11, MUTYH, and many genes that cause hereditary nonpolyposis colon cancer). In addition to inherited mutations that increase risk for being diagnosed with ovarian cancer, all ovarian cancer cells acquire mutations as the tumor cells divide and grow. Scientists have not yet speciﬁcally linked any environmental or lifestyle factor to the cause of acquired mutations in ovarian cancer. Although it is still rare to get ovarian cancer, the risk factors above, along with obesity, gynecologic surgery, HPV infection, breast cancer, hormone therapy, and never becoming pregnant, are all thought to increase a woman’s chance of developing ovarian cancer.
How is ovarian cancer diagnosed and treated? According to the National Cancer Institute, an estimated 21,410 cases of ovarian cancer will be diagnosed in the United States in 2021. Of those diagnosed, 13,770 women are expected to die from the disease. A major factor for the high mortality rate of ovarian cancer is the lack of early diagnostic tests. Unlike breast cancer for example where mammograms can detect very early signs of cancer, screening for ovarian cancer is diﬃcult. In addition, early ovarian cancer often has no symptoms, and the few symptoms that do occur are associated with other disorders. As a result, ovarian cancers often go undetected until they have reached advanced stages. Pelvic ultrasound and blood tests for high levels of a protein called CA-125 that is common in ovarian cancer are currently the best tests for diagnosing ovarian cancer. Ovarian cancer patients generally have surgery to remove as much of the tumor as possible, which sometimes involves removing the ovaries, fallopian tubes, or uterus. Surgery is usually combined with chemotherapy to stop the growth of cancer cells by killing the cells or by stopping them from dividing. Immunotherapy, which uses the patient’s own immune system to ﬁght cancer, is in clinical trials for use in ovarian cancer. Targeted therapy that identiﬁes and attacks speciﬁc cancer cells are also used in ovarian cancer treatment. For example, drugs called PARP inhibitors can be administered to women whose tumor has mutations in BRCA1/2. The ﬁve-year survival rate is over 90 percent when ovarian cancer is diagnosed and treated at its earliest stage. However, as mentioned above, because of the lack of reliable screening tests only 20 percent of cases are found early. If the cancer is found in a late stage, the ﬁve-year survival rate can be as low as 28 percent.
cases of ovarian cancer will be diagnosed in the U.S. in 2021.
Of those diagnosed,
women are expected to die from the disease.
What are scientists doing to improve treatment strategies? While progress has been made in the ﬁeld of ovarian cancer, not all treatments are eﬀective for all patients. In addition, treatments that initially work well for a patient often can become ineﬀective over time as the tumors become resistant to the drug. There is much research ongoing in the ﬁeld to identify new drugs, new drug targets, and new combinations of drugs to overcome current treatment limitations.
The team hopes to use this information to build tools that give physicians the ability to predict what a patient’s response to treatment will be. This will help them avoid administering a treatment that will not work, and allow them to administer a treatment that is most likely eﬀective. Cooper and her longtime collaborator Rebecca Arend, MD, an assistant professor in the University of Alabama at Birmingham (UAB) Division of Gynecologic Oncology and associate scientist in the Experimental Therapeutics Program at the UAB
Comprehensive Cancer Center, are also studying new treatments for ovarian cancers with resistance to platinum-based chemotherapies. In a recent study, the team tested a new drug that inhibits a signaling pathway that is associated with a poor prognosis in ovarian cancer. Their data showed that a combination of the inhibitor and a chemotherapy drug called paclitaxel enhances the immune system and decreases tumor growth better than either agent alone. These data, generated using a mouse model of ovarian cancer, have motivated further investigation of this pathway in human tumors. Those studies have revealed evidence supporting the potential for this strategy in patients with ovarian cancer. These are just two examples of how scientists and physicians are trying to ﬁnd new drugs or treatment strategies to overcome chemotherapy resistance and more successfully treat ovarian cancer.
HudsonAlpha Institute for Biotechnology Faculty Investigator Sara Cooper, PhD, is focused on understanding the diﬀerences between tumors and how resistance develops so that doctors can more accurately determine the right treatment for the right patient at the right time in their treatment. Cooper’s lab is using genome-wide CRISPR screening methods to identify genes associated with chemotherapy resistance in ovarian cancer. This information can be used to make predictions about how a patient might respond to each possible treatment.
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Long-Term Care and Your Future by: Anne Jewell
There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.” - Former First Lady Rosalynn Carter
of people turning age 65, will need some type of long-term care services
Long Term Care (LTC) is pervasive in today's world. Research states, 70% of people turning age 65, will need some type of long-term care services in their lifetimes. LTC includes a wide range of medical and support services for people with cognitive disorders, prolonged illness, degenerative conditions, or for the result of trauma or accidents. If these numbers make you think that long term care affects older individuals, you are correct. But younger people also need to consider long term care as part of their overall risk-management plans because accidents and illnesses prey on younger people, not just the aging. To better understand, think of LTC as not only medical care but also "custodial care." This can involve providing assistance with activities of daily living such as eating, dressing, bathing, transportation or supervision of someone who is physically or cognitively impaired, or both. Long term care can be provided in many settings including your own home, adult day care programs, assisted living facilities and nursing homes. The need to make plans for Long Term Care coverage is real, especially now, living through a pandemic, there are many reasons to consider products that offer such coverage. Most importantly among these is to preserve your independence and freedom of choice to stay at home or move to a specified care facility. LTC
coverage removes the burden of your care from your family members, it can preserve a spouse's standard of living, and it can preserve and protect assets. Longer life expectancy and rising health care costs are trends that will continue to increase the value of a good LTC plan. Clint Eastwood likes to say, "Are ya feeling lucky?" We'd rather say, “Isn't it smart to do a little planning... just in case." What's your plan for living a long life? Into your 80s or 90s? Maybe even longer? Today, long term care is the greatest uninsured risk Americans face. Planning now - while you are younger and still in good health - is a critical step to protecting your financial independence, your retirement assets, and your future choices. I urge you to call us for a no-cost consultation as an opportunity to learn more about the potential risks, costs, and options available. coxassociatesinc.com
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VACCINE by: Jason Lockette, MD
Growing up, my dad told me that I would need to learn to control two things – my
bowels and my emotions. When discussing the COVID vaccine with some people, it would appear that we have collectively lost our ability to control the later. Where you stand on masks and vaccines, to some, is synonymous with your political affiliation while other people, it would appear, are capable of believing some bizarre theories. There is no evidence that the vaccine affects fertility in women but there is definitely data to support that COVID infection is dangerous to both the mother and the unborn child. There MIGHT be a tremendously low rate of heart inflammation in younger people, essentially all of whom fully recover. We know that COVID infection can be very dangerous, especially if you are older, overweight or have chronic health problems such as high blood pressure, diabetes, or lung problems. Patients with these problems often suffer tremendously with COVID and we see these patients every day in our offices and emergency departments. I have seen numerous patients who refused vaccination for various reasons - it wasn’t FDA approved, they didn’t trust what was in it, it was developed too fast, etc. Yet when they get sick with COVID, they are quick to listen to their healthcare provider and will often seek out equally unapproved treatments with little to no data to support their effect. This flawed logic is apparent with regard to treatments such as azithromycin and hydroxychloroquine. I am not aware of any large studies that show these drugs to be effective against COVID infection. Regarding Ivermectin, there are some smaller studies that show a possible benefit but there are numerous others that do not. At best, the verdict is still out. What we do know, though, is that the mRNA vaccine has been used more that all of these treatments and we have numerous studies and mounds of data that show it be safe and to reduce the risk of hospitalization and death from COVID. I never cease to be amazed at the logic behind refusing one of these vaccines while seeking out treatments that are also not FDA-approved and have little to no evidence of benefit.
Unfortunately, this has become a very politically charged debate. In case you are wondering, I am firmly libertarian. I will resist being “forced” to do something like wear a mask or take a vaccine. I can understand the dangerous precedent that such action creates. I am, though, diligent enough to gather data and opinions from both sides and make an informed decision and the data are clear on a couple of points. First, if you are obese, you have about a 50% increase in the risk of death from COVID. I wish my profession was more diligent in proclaiming this fact and helping those patients reduce their risk. And second, the vaccines are safe and greatly reduce your risk of being hospitalized or dying from COVID.
I challenge everyone reading this to do their own independent research. Look, objectively, at opinions from all sides and then seek expert advice. And, in case you are wondering, the experts in this area are those of us who treat COVID patients day in and day out. We are the same healthcare provider you will seek out if/ when you get COVID and are struggling to breath. Because you trust us in those situations, you should listen to us now and I am not aware of any of my Emergency Medicine colleagues who are not vaccinated.
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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 44
Inside Medicine | W inter Issue 2021
Drop by and meet Clinic Director Michael Beuoy and his team in Huntsville!
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Sacroiliac Joint Pain by: Winston T. Capel, MD, MBA, FACS, FAANS
A common cause of low back pain, often underdiagnosed, undertreated for a problem that can be very debilitating.
L ow Back Pain (LBP) is a universal life experience for all of us.
Most LBP is self-limiting and has a manageable baseline but commonly has exacerbations of varying severity and duration. Most LBP responds to observation, anti-inflammatories, heat, frequent changes in position and core conditioning. When LBP becomes intractable it is important to: exclude malignancy, infection or occult fracture.These sources of LBP make up to 5% of all LBP and need to be identified in order to preserve function, allow treatment when the delay of treatment can put patients in severe jeopardy of life and function. 95% of LBP is due to degenerative conditions and non-life threatening. Of these degenerative conditions, degenerative disc disease is the fundamental pathology and pain generator 75% of the time. Recent data identifies the Sacroiliac Joint (SIJ) as the responsible pain generator for the remaining 25%. Given the frequency of LBP in the general population (2nd most common reason for primary care visits after the common cold) there are many people dealing with SIJ pain and dysfunction. Commonly there is significant delay in the accurate diagnosis of SIJ pain origin.
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Sacroiliac Joint Pain SIJ pain is more common in females; this is thought to be due to pregnancy and the pelvic adaptations of gestation and labor. SIJ is more common in patients that have had lumbar fusions. Pelvic trauma can also cause chronic SIJ pain. ANATOMY: The SIJ is the interface of the spine to the pelvis where major loads are transferred from the torso to the pelvis. This joint is broad with extensive ligament support. SIJ pain comes from arthritic changes in the joint, ligament or bone injury from trauma.The spine terminates at the sacrum the sacrum articulates with the pelvis at the important SIJ.
CLINICAL FEATURES: The back pain localizes low and off midline, this is indistinction to degenerative disc disease where patients localize their pain to more of a midline location. On exam patients will point to the SIJ as their pain source. It is always below L4-5 clinically. • Pain is sensitive to different changes in pelvic loading like stairs, stooping, standing on one leg, ect. • Leg pain: SIJ mediated leg pain can mimic radiculopathy from lumbar disc herniations. The key differences: SIJ leg pain starts in SIJ, is generally above the knee and without motor or sensory changes. 48
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DIAGNOSIS: Patients will point to the SIJ on exam (Fortin’s Finger Test) • SIJ pain is very sensitive to SIJ provocation on clinical exam where the joint is stressed. • The diagnosis is a clinical diagnosis not by x-ray/MR imaging. When in doubt of the etiology of the leg pain an MRI lumbar should be obtained. • The most definitive diagnostic method is a diagnostic block where the joint is blocked with a local anesthetic by an interventional pain specialist. Patients will experience an immediate > 80% or more reduction in their pain with the block which confirms the diagnosis TREATMENT: • Anti-inflammatories (NSAIDs) both oral and topical. This joint is relatively close to the surface and topical NSAIDS are safe adjunct to oral NSAIDs in most patients. Combined oral and topical Diclofenac is a good option unless medically contraindicated. • Physical Therapy: exercise, manipulation and deep heat stimulation can help. • Therapeutic Injection: at the time of the diagnostic block in the same syringe is corticosteroid which may relieve, control or give temporary benefit, its onset of effect is usually around 24 hours after the injection. There are 2 phases with the SIJ injection: diagnostic phase early and up to 8 hours after, then the diagnostic phase generally the next day. • SIJ Belts: not commonly used due to limited effectiveness but some patients can have improvement of symptoms with the use of these belts that compress across the joint to reduce motion across the joint. • Surgery: only for intractable pain that has been refractory to all non-surgical treatment. Many 3rd party payers require 2 positive diagnostic blocks and an MRI of the lumbar spine to exclude lumbar pathology.
Surgical Outcomes for SIJ Fusion Prior to the development of highly effective minimally invasive SIJ fusion procedure, SIJ fusion was a large and open procedure with outcomes that rarely justified SIJ fusion except for pelvic trauma with overt instability. The iFuse SIJ Fusion Technique was introduced in 2009 and was the first minimally invasive and the primary evidenced based technique today. Over 55,000 iFuse fusions have been done worldwide. It is one the best studied spinal surgical techniques in contemporary spine surgery with multiple randomized, prospectively controlled studies (Class I data) demonstrating efficacy and safety. The surgery is almost always performed on an outpatient basis with high level patient satisfaction. 82% of patients at 12, 24 and 60 months would “have the procedure again for the same result.” The technique is done with the patient in the prone position under fluoroscopic guidance (C arm) using 4 distinct views of the pelvis to navigate k-wires across the joint avoiding important structures like the sacral neuroforamina and sacral boundaries. Implants are passed across the joint over the k-wires after drilling and broaching. The implant immediately immobilizes the joint eliminating painful motion. The implant is designed for maximally osteogenesis leading to permanent bone growth across the joint. The risks of the procedure are low but include: bleeding, infection, nerve injury and failure of fusion.
Surgical Positioning of Implants Across the Joint After surgery patients have restricted weight barring across the joint (touchdown only) with the use of crutches or a walker for 4 weeks. During the 5th week after surgery patients progressively add weight, if there is no pain, patients can bare full weight but avoid running, jumping and heavy lifting (>15-20 lbs.) until completely healed at approximately 3-6 months. There is generally slower healing in patients with osteoporosis and may require longer periods of restricted weight barring.
In summary, SIJ pain is common with effective tools for accurate diagnosis and effective treatment. These patients can have very incapacitating pain and if non-surgical treatments are ineffective in controlling pain and improving function the above described surgical procedure leads to highly satisfied patients with dramatically increased quality of life through a minimally invasive, well studied and effective procedure.
by: Douglas S. Sutherland, MD
I’m a radiologist specializing in interpreting patient images, specifically oncology imaging and women’s imaging. The most rewarding part of my profession is making a positive difference in the lives of the patients by detecting breast cancer, diagnosing the extent and severity of a cancer and directing further treatment to provide the most timely and optimal patient care. As a physician, I am surrounded by the medical challenges of life and one’s own mortality. Recently, this hit home for me. I had lost my father. A person so close to my heart, I haven’t known any closer, until recently. As an only child of a single parent for the entirety of my life, our relationship was truly unique and special. We never missed an opportunity to tell each other our feelings. We were never restrained in saying I love you. He showed me and my children all the love in his heart. He exemplified the love of Jesus his whole life. Ironically, my father did not attend church regularly and wasn’t a fan of organized religion. I know in my heart he had faith, but I had never been direct with him regarding Jesus until the day before he passed. I am so grateful for the spiritual moment I had. Standing next to his bed in a nursing facility, we were having a good talk about day-to-day life activities. His health was no better or worse than any other day. He was not acutely ill. I experienced a wave of unexpected emotion out of nowhere that caused me to well up in tears. I was embarrassed by it, not by doing it in front of him, but that it arose unexpectedly and so suddenly. I told him that I was saddened he wouldn’t be around forever and I felt helpless in trying to reverse or improve his current condition. He was always so encouraging and positive even at this moment. It was then that I asked him, dad you believe in God right? He gave me a confused look like I was crazy and of course said yes. I said dad you believe Jesus was the son of God and died for our sins? He said “yeah and I talk to him every day”. I definitively knew at that moment he had a relationship with Jesus. And the next day he passed peacefully and painlessly. My earthly father showed me a love like I believe Jesus asks us to show one another and my heavenly Father, through the work of the Holy Spirit in me and by His Grace, gave me the blessing of peace before my father was welcomed home. As a radiologist and a physician, I interpret images and help people. As a Christian I am learning to interpret the heart, as shown by my father and my Savior.
Eulogy Gregory Douglas Sutherland My father was the greatest man I'll ever know. He taught me through his actions - how to love and be loved. To me his love was so unconditional and without flaws. It was not until I became a father myself that I could fully comprehend the dedication it took to excel at being, not only my father, but also fulfill the duties required by a mother. He learned when to be gentle and nurturing, he also knew when to be tough and stand firm in his decisions. I knew without a shadow of a doubt that my father was behind me, believed in me and supported me. In return, he only requested that I gave my best in everything I aspired to become or accomplish. He was truly my best friend, strongest advocate, and truly my biggest fan! And he never let me forget it! His personality was infectious, and his heart overflowed with care and compassion for everyone he met. I know he touched so many lives in a positive way. Recently, I watched my Father’s health decline. The support of family and friends through these difficult days was overwhelming - I received an outpour of love and will have new memories and stronger relationships, as a result. Reflecting on my Father, today, I see how he was a pillar of strength and accomplishments, but it was his hard work, his dedication and the relentless way he served others that will remain with me. To know Greg was to love Greg. No one could have been prouder to be a father, grandfather and best friend than my dad... He was my everything. With loss comes grievance... and our family is certainly grieving... but there is peace in knowing my father is reunited with Our Savior. I will close by sharing that today, tomorrow and for however long it may be until we meet again, I know you will always watch over me!
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Inside Medicine | W inter Issue 2021
&communication by: Rachel Sullivan, LMFT
Ahh, relationships and communication. One of the most frequent requests I receive is to help improve the communication within family or organizational units. I love this request because I believe in basic tools being outstandingly effective.
While all humans are unique, there are some common tenants that can help lay the foundation for productive conversations. Relationships, although deeply rewarding, are hard work. If you are up for the challenge – keep reading!
...cont’d from page 53
I imagine most of us can think of an example of when a conversation went downhill fast. Every time that happens our brain says something like “this type of conversation is not effective”, “this topic is not safe to talk about”, or even “this person is unwilling to resolve this with me”. After any number of attempts to communicate the best we know how, we begin to assume the other person does not care, is incompatible with us, or some other untruth. While it is possible people exist that we simply cannot have a conversation with, I believe that we can communicate with just about anyone if we have the right tools and knowledge. A foundational piece is to communicate fairly and clearly. This helps conversations proceed in an effective, productive manner. This includes speaking respectfully without belittling, assuming the best of the person in front of us and doing our part to facilitate an atmosphere of safe communication. Let’s look at some other helpful techniques. 1. DETERMINE WHAT YOU REALLY NEED
To help the person in front of us understand what we need we must be able to identify it first. It is unfair and unproductive to expect that person to read our mind (if you are like me, you may need to read that again). Writing down the need, and why it is important can be helpful in bringing clarity to the request. Consider asking yourself “Why is this conversation important?”, “Do I have a desired outcome?”, “How would that outcome make me feel?”. These questions provide an outline to your needs. 2. MANAGE YOUR EXPECTATIONS
Have you ever had an exchange with someone where you ended up upset due to them not meeting your expectations? When you think about that situation, did you go into that conversation expecting something that never was expressed? As previously mentioned, people are not mind-readers. If we need something from someone, we need to talk about it. Unspoken expectations lead conversations into disaster more times than not. We can navigate this step by considering how practical the answers are to our above questions. Perhaps we need something from that person they cannot give at all, or to the degree we require. If we recognize the potential for
this ahead of time, we are managing our expectations. We can also scale expectations by identifying what we ultimately need as well as what we are willing to start with. For example, maybe we ultimately need reassurance surrounding a specific issue, but are willing to start with the other person being open to a conversation around this topic. 3. LISTEN TO HEAR, THEN REFLECT RATHER THAN RESPOND
One of the most hurtful things that can happen in a conversation is to pour our heart out only to have someone respond defensively, or not even hear what we said. When we listen to hear we use active or reflective listening. Active listening requires us to listen to the speaker with the intent of being able to reflect their communication and why they found it important to share. Reflecting what we heard ensures that we understood what the speaker was saying and gives them the opportunity to gently correct us if we misheard their message. Reflection may sound like “What I think I heard you say is it is important to you that we minimize distractions during conversations, so we don’t have to repeat ourselves.”There is very little room for misunderstandings when a conversation contains two active listeners! 4. PRACTICE! If these tools seem overwhelming, I suggest you begin with #1. Going into a conversation with knowledge about what you are asking for is key. If you find yourself frequently listening, then focus on #3. While these techniques work best when used together, making them a habit will take time. Like any good skill in life, effective communication takes practice. The outcome can be a life full of effective conversations and fulfilling relationships, so keep at it!
Our simple cheek swab can help empower you to make important healthcare decisions for you and your family. Learn about your genetic risk for certain cancers including breast, ovarian, colorectal and prostate cancer. In collaboration with your physician and a genetic counselor, use the information to plan future medical care. What you learn could potentially impact your parents, siblings, children, cousins and others. The test is offered FREE to any woman or man between the ages of 28-30 in Madison, Jackson, Limestone, Marshall and Morgan Counties in Alabama. The test also is offered at a reduced cost of $129 to adults 19 and over in those five counties. genetic testing for cancer risk
Genomic surveillance using the genome to track and monitor viruses by: Sarah Sharman, PhD
Viruses are tiny organisms that can wreak major havoc on human health worldwide, something that we have all witnessed first hand over the past year and a half. Some viruses, like influenza and HIV, are endemic foes, existing at constant levels in certain areas throughout the world. Others, like the SARS-CoV-2 virus, emerge anew and cause widespread outbreaks before they can be identified and controlled.
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The ability to quickly identify and start combating viruses is paramount in minimizing death and devastation. Advances in genomic technologies have given scientists the ability to study viruses at a genetic level, allowing them to ﬁnd ways to target the virus with drugs, make vaccines to prevent infection with the virus, and track and monitor the spread of viral outbreaks. Let’s learn more about how scientists use genomics to help combat viral pandemics.
What are viruses and why are their genomes so useful? Viruses are microbes that can infect nearly all forms of life. Viral particles consist of DNA or RNA wrapped in a protective layer of proteins. Viruses cannot replicate on their own and rely on host cells for replication. To successfully survive and reproduce, viruses must move through three stages: contact with a susceptible host, infection and replication within the host, and transmission to other individuals. When a virus enters a host (usually through the mouth, eyes, nose, or open wounds in the skin), it must quickly mount a successful infection before it is caught and killed by the host’s immune system. Many viruses have evolved speciﬁc interactions with host cells to achieve infection. For example, human ﬂu viruses and SARS-CoV-2 viruses have proteins on their surface that bind to matching receptors on human respiratory cells.
The inﬂuenza virus has proteins on its surface that are recognized by the immune system. Mutations in the genes that code for these proteins occur frequently which is the main reason that people can get the ﬂu more than one time and why the ﬂu vaccine composition must be updated each year. Scientists are able to determine how the inﬂuenza virus has changed thanks to genome sequencing. Genome sequencing is a process that helps scientists decipher the sequence of DNA and RNA nucleotides that make up each virus’s genetic code. By studying the genetic code, scientists can pinpoint mutations that viruses may have picked up over time. Knowledge gained from the genomic sequence of a virus can help scientists discover drugs and treatments to alleviate disease in infected individuals and produce vaccines to prevent infection with the virus
Once inside the host cell, the virus hijacks the cell’s reproductive machinery and copies its own genetic material to make more viral particles. Replicating viral cells damage or weaken host cells which can cause symptoms of disease like fever, body ache, and other tissue speciﬁc symptoms. The new viral particles can be passed to another individual through bodily ﬂuids, for example the ﬂu is generally transmitted through sneezes or coughs. Because viruses replicate so quickly, they can quickly develop random mutations in their DNA or RNA. Most mutations will have no eﬀect, or will have a detrimental eﬀect on the virus itself. However, a small proportion of the mutations may enable the virus a beneﬁcial edge, allowing it to infect the host better, spread from individual to individual faster, or survive longer outside of a host for example.
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Why is genomic surveillance important during an outbreak? In addition to helping treat and prevent viruses, scientists and epidemiologists also use viral genome sequencing for genomic surveillance to track and monitor the spread of viral outbreaks. By consistently sequencing viral genomes from many infected individuals, researchers can monitor how the virus changes over time, understand how these changes aﬀect the characteristics of the virus, and use this information to better understand how it might impact an individual’s health. Genomic surveillance is vital for detecting and characterizing new variants as they arise, a crucial part of the eﬀort to control viral outbreaks. Detecting variants early in their lifecycle allows scientists to quickly determine important factors such as the rate the variant is spreading, the severity of disease, whether existing diagnostic tests will detect the variant, and whether existing vaccines will protect against the variant. Successful genomic surveillance programs are fast and immediately make data publicly available to inform real-time decision-making by public health oﬃcials and vaccine manufacturers. The programs also consistently screen positive samples at multiple sites across a country or region to ensure the most comprehensive coverage of the viral landscape.
Tracking SARS-CoV-2 variants Genomic surveillance has proven especially important during the ongoing COVID-19 pandemic. Countries with strong genomic surveillance programs in place, like the UK and Denmark, have been able to quickly detect emerging variants. For example, in the UK, the Alpha variant was detected early in its lifecycle. By studying the variant, scientists found several mutations in the spike protein that made it easier for the virus to infect human cells, making this particular variant more infectious.
Inside Medicine | W inter Issue 2021
Experts estimate that sequencing 10 percent of SARS-CoV-2 positive samples is highly eﬀective at detecting the variants in a population, but randomly sequencing ﬁve percent of the positive samples may be suﬃcient. The United States is well under the targeted goal of sequencing viral genomes from ﬁve percent of the positive cases in the country. As part of the eﬀort to increase the number of positive samples that are sequenced in the United States, the HudsonAlpha Institute for Biotechnology’s Genome Sequencing Center is sequencing thousands of positive samples from across the state of Alabama. The project, led by Jane Grimwood, PhD, was initially funded through the CARES Act and is now funded through an award from Testing for America. By sequencing viral genomes from SARS-CoV-2 positive samples throughout the state of Alabama, Grimwood and her team aim to help oﬃcials track variants of concern, track viral mutations over time, and detect any viral breakthrough that may occur after vaccination. The sequencing also helps to identify possible sources of new hotspots of infection in Alabama. So far, the team has sequenced more than 1700 samples collected from 57 of the 67 counties in Alabama. Using the genome sequences, the scientists separated the samples into groups based on sequence variation and mutations. The scientists are also able to detect variants of concern, like the delta variant, among populations in the state to determine if there is an uptick in infected individuals. Sharing this kind of data with state and national databases helps experts better understand the genomics and patterns of SARS-CoV-2 transmission across the United States by adding an Alabama perspective to the picture.
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