Inside Medicine Issue 18

Page 1

VOLUME 3 ISSUE 18

COVID-19

HEALTHCARE IMPACT

ONL

Y

LESSONS LEARNED

KNO

WS

the present

of being present

spinal Fusion


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} FROM THE EDITOR

features &

CONTENTS I n s i d e M e d i c i n e | V o l u m e 3 I s s u e 81

S har ing with P ur p ose

FEATURES Spinal FUSION

CONTENT COVID-19

25

Why would fusion be necessary?

The impact on the healthcare industry

14

V o l u m e 3 , I s s ue 18

Dear Readers– CO NTRI BUTORS

Jacqueline Makowski Heather Morse MS, ATC, OTC Kari Kingsley, MSN, CRNP Kelly Reese Elizabeth McCleskey, DO

The Present of being Present 17

SURVIVAL 12 Instinct Give yourself needed credit for this years accomplishments.

the gift of attentiveness is one which blesses not only the recipient but the giver as well.

EYE PROBLEMS 08

SAFE SCAN 34

Making it safe for work place environments, hospitals and doctors offices

Dry Eye Syndrome and common eye disorders

Tiernan O'Neill Winston T. Capel, M.D., MBA William Matthew Sykes, DO Dr. Paul Vandiver, OD Rachel Sullivan, MFTA Tripp Skipper Kimberly Waldrop, MA

Join our mission to establish and grow an alliance among our community and healthcare providers.Together, we can change the way healthcare information

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SA L ES & MARKE TING

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 |

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Kelly Reese, Co-Owner Lisa Layton, VP Sales/Marketing

CH I EF EDI TO RIAL WRITE R Kimberly Waldrop, MA

PU BL I SHE R Blake Bentley, President

GOD ONLY KNOWS

Dear Readers– Wow. Would we have ever imagined we would have lived through a pandemic??? We are hopefully on the upside of the crisis but every day It’s kind of unsettling to look ahead to next year. What does 2021 brings about something new. New data, new stories, new trials and have in store for all of us? After a year of so many ups and downs… new successes, we are watching so much unravel before us. Everyone the downs far exceeded our expectations…it feels natural to be seems to have opinions and everyone is looking for answers. apprehensive about a new year. This time last year, it seemed like Putting together this issue of Inside Medicine has been quite different. the world was coasting along, not a care to be seen, and then We have worked tirelessly to bring you very informative, up to date boom….it all changed. The world became uncertain in a pandemic information while staying true to our calling. It is such a blessing to be that overflowed into every facet of everyone’s lives. a part of this publication that allows us to meet so many people and As Christians, it should be easy for us to feel peace. We know who bring their stories and expertise to you in print form. holds the past, the present, and the future. Unfortunately, the Whilehuman this is an unprecedented time for all of us,the I’mspiritual excited for side of us all sometimes overtakes sideyou and we to see what weforget have to offerhands this gowe round. I just know arealmighty going tohand almost Who’s rest in. We rest you in the enjoy this and learnbe something or have something to share of edition God and praise to Him. new Without it, we would have no hope with others. I hope and pray you come away after reading through our and no future. stories, more knowledgeable, moreas caring, andinto more up we to speed on the But, we do…and with that, we head 2021, know that the world around us. knows what’s coming is GOD. Only Him…Only God only ONE that

GODonly knows

Onceknows…. again, Kari Kingsley gives us a great editorial. This time, she explains meditation andissue how of it helps her life. we Shetake challenges In this special InsideinMedicine a goodthe look at reader some to joinissues her and let faced go of because worries of and restlessness. Along the we’ve 2020. Rachel Sullivan’s article, same lines, we have 2 more health pieces in this issue. Survival Instinct, goesmental right along with the theme we areRachel trusting in Sullivanfor gives insight onyear. findingWith our own mechanisms while she theusupcoming her coping professional background, Elissa Brooks explains howof wethings can find ourselves whilefor dealing withgoing gives us an outline we can hold onto positivity whatever comes along.no Allmatter three articles are great into a situation, what it looks like. examples of many things weDr. areElizabeth all lookingMcClesky for help with these times. has during provided us trying with an editorial about being present in the moment. Sometimes we don’t realize the need Also in this edition of Inside Medicine, you will find quotes from we have for relationships and personal connections. Just looking teachers dealing with teaching during quarantine, how a local hospital over the past year, our day to day dealings with friends handles infection control, opinions on whether to wear a mask or not and evolved changed. Through itwhile all though, to wearcounterparts a mask, how has surgeons areand dealing with operations being the human connection and need for it remains the same. It has safe, telemedicine, and even a story about high tech pain relief. There become a gift that most didn’t realize was so important. is so much good information packed in this time! You’llatalso findMedicine some helpful information inproviding this edition. article Our team Inside is passionate about you An with about eye issues that develop because of overuse of electronics, the best information out there. We also want our readers to know we spinal COVID and has affected are praying forfusion you allinformation, and sendinghow well wishes love to allhealthcare, of you! As and much more. always, we hope you enjoy our magazine and will share it with others. of us Inside Medicine hope youfor have a healthy and If you everAllhave anyatquestions or concerns, ideas stories, or want to safe holiday season as well as a prosperous New Year! As always, our be a contributor, please let us know! prayer is to be a light in our community, for you as our neighbors and also for our Savior. Please let us know if you have an idea or would like to contribute to our magazine. We love you! And cheers to 2021! Remember…faithfully, Only God knows….

Kimberly Waldrop

Kimberly Waldrop

www.in s idem edic inemagazine.com

I n s i d e M e d i c i n e | Vo l u m e 3 I s s u e 1 78

7


} FROM THE EDITOR Dear Readers-

GOD only knows

Psalm 46:10 NIV 10 He says, “Be still, and know that I am God; I will be exalted among the nations, I will be exalted in the earth.”

It’s kind of unsettling to look ahead to next year. What does 2021 have in store for all of us? After a year of so many ups and downs…the downs far exceeded our expectations…it feels natural to be apprehensive about a new year. This time last year, it seemed like the world was coasting along, not a care to be seen, and then boom….it all changed. The world became uncertain in a pandemic that overflowed into every facet of everyone’s lives. As Christians, it should be easy for us to feel peace. We know who holds the past, the present, and the future. Unfortunately, the human side of us all sometimes overtakes the spiritual side and we almost forget Who’s hands we rest in. We rest in the almighty hand of God and praise be to Him. Without it, we would have no hope and no future. But, we do…and with that, as we head into 2021, we know that the only ONE that knows what’s coming is GOD. Only Him… Only God knows…. In this special issue of Inside Medicine we take a good look at some issues we’ve faced because of 2020. Rachel Sullivan’s article, Survival Instinct, goes right along with the theme we are trusting in for the upcoming year. With her professional background, she gives us an outline of things we can hold onto for positivity going into a situation, no matter what it looks like. Dr. Elizabeth McClesky has provided us with an editorial about being present in the moment. Sometimes we don’t realize the need we have for relationships and personal connections. Just looking over the past year, our day to day dealings with friends and counterparts has evolved and changed. Through it all though, the human connection and need for it remains the same. It has become a gift that most didn’t realize was so important. You’ll also find some helpful information in this edition. An article about eye issues that develop because of overuse of electronics, spinal fusion information, how COVID has affected healthcare, and much more. All of us at Inside Medicine hope you have a healthy and safe holiday season as well as a prosperous New Year! As always, our prayer is to be a light in our community, for you as our neighbors and also for our Savior. Please let us know if you have an idea or would like to contribute to our magazine. We love you! And cheers to 2021! Remember…faithfully, Only God knows….

drop

Wal y l r e b m i K

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Digital Eye Strain and Screen Induced Dry Eye:

Can We Intervene?

by Dr. Paul F Vandiver, OD

We have all been affected in some way or another by COVID-19. All aspects of life have been altered in some way. Most every family is making difficult choices moving forward: How to appropriately set new guidelines when planning events, asserting priorities differently, making appointments while creatively diverting from taking new risks of exposure, sacrificing some of our own plans in order for more important priorities to get accomplished, etc. While our criteria to keep our lives in a state of normalcy seem to be fluid, subject to change at any moment, one particular variable has remained on an astronomical incline - screen time. As an optometrist, I hear the common complaint of dry, itchy, watery, red or irritated eyes on a daily routine. Intermittent “foggy vision” or the “lack of focusing ability on the computer as

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the day wears on” are routinely mentioned visual complaints. Increase in screen time is a consistent element reported by many patients, regardless of age. Here in the Tennessee Valley, where I practice, approximately 75-80% of patients employed are using the computer a minimum of 8 hours per day. Meetings are now in virtual format while kids are now using devices to see their friends. More time at home these days equates to more time on a device or screen of some sort — browsing the internet, streaming, channel surfing, and gaming to name a few.

Dry eye syndrome (keratoconjuntivitis sicca) and digital eye strain are two ocular diagnosis I have seen on the rise. This increase is in large part secondary to increased time our eyes are exposed to some type of screen on a daily basis — whether occupation, hobby, entertainment, or even habitual.


/20 LIGHT ARTIFICIAL 20/20

DIGITAL

EYE STRAIN O R C O M P U T E R S Y N D R O M E ,

V I S I O N

Digital eye strain, or computer vision syndrome, is a description of a group of eye and vision problems that result from the prolonged use of devices comprised of back lit screens (computers, tablets, phones, e-readers, etc), usually at arms length or about. Symptoms I hear often include: - sore, or pressure behind the eyes - burning eyes - eyes tearing more as the day continues - scratchy, gritty, or “something in my eyes” usually with blinking - a desire to “close my eyes” or overall tiredness - a “foggy” or “filmy” covering increasing throughout the day - a “ghosting” image of words on the screen, or double visionAdd a subheading

Treatment for digital eye strain For digital eye strain there are a few ideas that have been shown to help: 1. The 20/20/20 Rule - A consistent routine of 20-30 minute intervals (realistically at least once per hour at a minimum), intentionally look away from your computer screen, 20 feet or further for about 20 seconds. Or another way: maybe remove yourself from the current screen gazing position and walk around briefly — perhaps a water break, viewing through a window if available, or even looking at an object across the room (picture, clock, etc.). The twenty feet association is to allow for your eyes’ focusing mechanism to relax for a bit. Otherwise, a plethora of issues mentioned above eventually become symptomatic for many.

BLUE

TEARS

2. Potentially dangerous and invisible to the human eye, blue wavelength light exposure has been shown to be destructive to the circadian rhythm or routine sleeping pattern. Computer glasses, sometimes referred to as “occupational lenses”, are glasses that include a specific coating serving both as an anti-glare coating, plus a blue light filter. Blue light has been shown to disrupt melatonin an important hormone produced by the pineal gland that regulates the sleep- wake cycle. More blue light exposure means less REM sleep, which then means less rest and less concentration. This concept is true for gaming as well. The blue light concern has been on the incline due to more time spent on digital devices. Studies have shown that the later in the day (closer to bedtime) one uses a screen is directly proportional to the level of REM sleep reduced..

3. Keep preservative free artificial tears available near your working area. Preservative free artificial tears are a great way to supplement the tears you may have lost due to the lack of blinking. It is well understood (among dry eye panels, organizations, and text books with ocular surface authority used at all schools of optometry), that computer users blink at a substantially lower rate than non-users. Pharmaceutical research continues to evolve more efficacious products, both prescription and over the counter, specifically designed to interrupt the inflammatory cascade responsible for these undesired physical and visual symptoms.

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According to a study of pediatrics the prevalence of dry eyes in children have increased. Screen time has found to represent a significant risk for dry eye syndrome in children. Tearing, eye redness, eye rubbing and headache were common symptoms characteristic of screen time associated dry eye within the pediatric population. Dry Eye Syndrome (KCS) is more complex than the term “dry eye” seems to suggest. There are two types of dry eye: Evaporative Dry Eye and Aqueous Dry Eye. Evaporative Dry Eye: This means that tears produced evaporate too quickly, as the eye is open in longer intervals than normal. The oil layer is eitherinsufficient or absent. The role of this layer, much like oil on water, is to coat the watery layer of the tears and ultimately prevent the tears from evaporating when the eye is open. This is particularly the case with many computer or screen users in bulk hours. This type of dry eye is far greater than aqueous deficiency.

Aqueous Dry Eye:

The lacrimal gland cannot or does not produce enough of the watery layer to cover and moisturize the highly sensitive cornea. Lesswatery tears will result in a more viscous or protein saturated tear This makes vision foggy and inconsistent.

These images are of significant dryness on corneal surface. Fluoroscein staining viewed under a slit lamp.

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The tear film is a protective barrier that preserves the cornea. It consists of three layers, each providing a different role and is pivotal in protection from dry eye symptoms. Mucous Layer: Bottom layer of tear film responsible for anchoring the film to the cornea. It is the first coat and helps distribute tears evenly across the surface. Produced by goblet cells on the conjunctival surface.

Aqueous Layer:

Watery and most volume of the film. Produced by the lacrimal gland, this is the “emotional tear” or “reflex tear.” When smelling onions or watching a sad movie our lacrimal glad is in overdrive.

Oil Layer:

The outermost layer of tear film that acts as a protectant cover, and maintenance of tears; just as oil surfaces when mixed with water. This layer is produced by many small glands that line the eyelids called the meibomian glands. These little oil glands are prone to getting clogged thus unusable and unable to release this oil when blinking. Blinking is the mechanical process that releases the oil surfactant that prevents the remaining tear film from evaporation.Some suggestions for screen time induced dry eyes


(continued from p.13)

Helping others increases positive brain chemicals. Why do you find it hard to stay home? If you are a natural extrovert who thrives on interaction, try phone or video chat to check on others that may not have family available. What about a volunteer organization or even getting to know a neighbor who may need you to run an errand? Let’s put your strength as an extrovert to work and boost those brain chemicals. Tidy environments reduce stress and improve sleep. Is your home or yard so out of control you don’t know where to start? Start with admitting there is a problem with where to begin. Maybe a peek at a website or a call to someone whose home/yard you admire can provide suggestions and motivation. But if push comes to shove, just pick up that sock and into the hamper it goes. Make the bed. Then fold that basket of clothes and put them away. Next, pull all those clothes off the pseudo clothes rack (i.e., exercise bike) and get them sorted and into the washing machine. One task at a time will lead to a much tidier room, and tidier rooms lead to a tidier home. Reducing negative exposure reduces overall depression and anxiety. Limit news watching to no more than 30 minutes twice a day. Too much bad news increases your stress hormones driving up blood pressure and blood sugar. Counteract negative thoughts by recording a daily gratitude list and spend an equal amount of time (i.e, one hour) enjoying hobbies, music, etc. Picking up a new healthy habit can reduce or prevent chronic diseases. Binge watching and eating junk food can result in weight gain and chronic diseases not limited to those of the brain like dementia or addiction. Let’s look at some healthy habits you can establish over time which support the brain or reduce the progression of debilitating disease. • Get plenty of sleep; it builds neurons and restores the body. • Learn to cook healthy meals; they contain the body’s building blocks which originate in unprocessed foods. • Get moving. No need to join a gym; a 30-minute walk after a meal can decrease blood sugars and improve mood and sleep. • Learn something new through a self-improvement program that teaches you to play an instrument, master a new language, explore your genealogy, pursue a new hobby or learn new skills related to an old one. You will be helping your body to build neurons, reducing stress, and maybe making new friends. While none of us has asked for this challenge, let’s try to use it advantageously. It is an opportunity, so let’s come out of it on the other side better and brighter and filled with the hope of the “best of times.”

Board Certified in Family and Lifestyle Medicine Madison, AL 256-280-3990 HealthStylesDr.com Inside Medicine |

For Emergencies 911 Boys Town for Kids, Teens, & Parents 1-800-448-3000 Substance Abuse & Mental Health Services Administration National Helpline 1-800-662-HELP (4357) National Suicide Prevention Line 1-800-273-TALK (8255) Veterans’ Crisis Line 1-800-273-8255 National Domestic Violence Hotline 1-800-799-7233 or 1-800-787-3224 (TTY for the Deaf) Disaster Distress Helpline 1-800-985-5990 National Alliance on Mental Illness 1-800-950-NAMI (6264) | Nami.org

Dr. Elizabeth McCleskey

14

Most of us have not experienced loss, empty store shelves, empty wallets, or stay-at-home orders. If you experience worsening depression, anxiety, substance use, hunger, suicidal thoughts, or are a victim of abuse, please contact one of these national organizations for referral to resources local to your area.

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Feeding America FeedingAmerica.org


Some suggestions for: screen time induced dry eyes

• Artificial Tears- Try keep artificial tears near your working environment. Preservative free (PF) tears are very safe. There is no indication suggesting that one could use too many drops of PF tears. Use as often as needed, even if every hour. Vision and comfort will likely improve, but a downside may be that the improvement is short lived. There are many kinds of preserved and non-preserved tears on the market today. It is generally safer to start with preservative free first. Your eye care professional can confirm which tears (or combinations) are best for you after evaluating your eyes’ blinking rate, tear production, lid margins, oil gland function, and corneal surface quality. • Blue light absorbing antireflective coating- A customized computer prescription or occupational prescription with this coating are recommended. Blocking glare and blue light, as mentioned above, can decrease symptoms of ocular fatigue. This may be more subjective - but when your eyes are exposed for many hours at a time, even the smallest amount of unwanted dry eye or computer fatigue symptoms tend to eventually build to an unavoidable and undesirable level of discomfort.

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• Prescription Therapy- There are several FDA approved ocular prescriptions (topically administered) indicated for either signs and/or symptoms of dry eye or signs of KCS. Whether one of these drops, or combinations, would improve the signs or symptoms — or both — can sometimes take weeks. Compliance is crucial to determine the most effective and appropriate management for each patient’s specific dry eye diagnosis. • Hot Compresses- Warm to hot compresses (if indicated by your eyecare professional) will assist the lids in their major role in oil release after blinking. Well over half of dry eye diagnosis are related the loss of the oily layer over time. The oil layer is crucial in keeping the layers of tear film in place. Like oil in water, it remains on the outside. No oil means evaporation of the layers underneath, and ultimately a burning, watery and sensitive cornea. Untreated, this inflammatory cycle will worsen in magnitude and become exhausting for anyone depending on the use of screens to be productive.) If these symptoms sound familiar, I recommend seeing an eye care professional for a thorough evaluation.

There are several therapeutical interventions we know of and it continues to evolve. We know technology progresses — it looks like, at least for now, we’ll be using screens for a long time, certainly not less.


Succeed Impact Enable

2020

Discover

HINDSIGHT The "rearview mirror for 2020" does not only display the pandemic and US politics but also encompasses a paradox that will shape our future. Working from home and the associated productivity, a sense of belonging when being part of a distributed workforce plus the effects of the civil unrests on the workplace. What a crazy year. I believe most people agree that it is time to be done with 2020. BUT again, there are lessons learned here and mainly the ones around the following two aspects: the human factor and the digital age. THE CURRENT PARADOX¡ THE HUMAN FACTOR vs. THE DIGITAL AGE And, yet, the making of this perfect storm could have been seen in 2018 -- at least some of It. The Human Factor The Human Factor in the US became apparent with the increase of labor strikes and political demonstrations in 2018 and 2019 (1 ]. We had more strikes for fair wages, better working environments, equity and other factors than in the 1980's. These earlier events foreshadowed the level of unrest brewing and finally, boiled over. At the same time, in a completely separate effort, nearly every organization, in almost every sector, engaged in the race to digital. Data flow from paper to binary code is at an all-time high and organizations are busy transforming themselves to remain relevant in the future. The Digital Age The need to increase automation, predictability, and performance/production also began before 2020. "Digital Transformation" became a staple, budgeted initiative for many companies, sports teams, and government entities. Somehow, the concept of human technology created a fear of replacing humans in the workforce with artificial intelligence - jeopardizing acceptance and adoption. However, 2020 paves the way to change the game of the digital age, articulating the importance of people, the human factor, for the future. 2020 is the great accelerator -Or, at least it can be!

When there is no other option, but technology available for human communication and interaction, in an environment of uncertainty and unrest, it becomes the great clarifier and facilitator. It now drives human topics forward from performance, to potential, belonging, and purpose - acting as a friend and not a foe to humans. Look at the perspective of how technology can help us and not replace us. In years to come, when we look back at 2020, the myriad of events and the resiliency of nations, we will have benefited from, or at least adapted to the advancements in tech. Technology is no longer limited to automating processes and outputs-it now drives the wellbeing of your people.

Angela Sandritter

Angie Sandritter, CEO RippleWorx RippleWorx, is a digital solution designed to provide a holistic approach to human performance and engagement - emotional, cognitive, and physical performance.


Instinct

SURVIVAL

GOD ONLY KNOWS by Rachel Sullivan, MFTA, CFLE

Anyone else feel like this year has been the

1. We need each other. We are a human race

longest ever and simultaneously gone by in

designed for connection. So often this year I heard

one big controversial, confusing blur? 2020

the cries of depression, overwhelm, and defeat. This

was a year for the books. Whether it is the

takes a toll on our mental health. When people are

kind you keep on the coffee table for frequent

given the opportunity to be heard, it shifts

reflection, or the type you tuck out of sight on

something for us mentally and emotionally and

the shelf, it has been a year.

refuels a part of us necessary to keep pushing. When

At the beginning of this spring, I recall hearing so many “If this goes on much longer, I’m not sure what I will do”, “I don’t know how to navigate this situation” “I have never gone this long without seeing ____”. Employers let people go. Some jobs moved to a virtual platform. Kids had to learn through a new medium. There was a collective breath of “I’m not sure I can do this”. Now, 9 months later, here we are. Having made it through what I hope will be the worst, because now we know a little better what to expect. There is something powerful about knowledge. We are a human race of truth-seekers. Answer-needers. Dategatherers. At the beginning, we did not have what we needed to help us go “it will be ok”. It took some time to gain our footing and realize what we were up against. One of the most amazing things I have seen throughout 2020 was how our human nature to survive surfaced to help us through the most mentally, emotionally, and physically challenging year most of us have ever experienced. Sure, I know that by default we are wired for survival and self-preservation. Our brains are literally designed in such a way that we can tuck away the difficult things, the pain, and continue moving. Our bodies are constantly putting out new tissue and atoms, on a path of never-ending rebirth. It is not new news, but this year… this year was different. So many were starved of the basic human needs of connection and physical touch. And yet, the way the instinct to survive showed up was a thing to behold. We stretched our technology skills, got creative about meals together, and celebrated in brand new ways. I am not ignorant to the fact that many aspects of life will never look the same. However, I believe there are some facts that ring true. Things we can grab onto moving forward, whatever the world will look like.

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we pull together, the solidarity motivates us to keep striving for change. People who need you, and whom you need are all around you. They may be friends, they may be family members, or perhaps they are professionals in your community. Find them, seek out their support, support them and then repeat. We need each other. 2. We choose our focus. People are showing up for themselves. Showing up for others. Is it all good? No, of course not. But we have the choice to focus on the good stuff happening around us and keep pushing to see more of that. Or we can sink back and let the overwhelming amount of negative information paralyze us into non-action. How do we start shifting our focus? Start by identifying 1 good thing each day. Build yourself up to 2, 5, 10 good things. Over time your brain begins to see more of what you have asked it to focus on. This is not about being naïve about the hard things – it is about being healthy enough to do something about them. Choose your focus and use it as your platform for change.


I

believe

ourselves we

we

need

credit

have

to

for

give what

accomplished this

year.

3. We are incredible. I am constantly blown away by how inspiring people are. This year I have seen the nurse collapse in my office, unloading 50 minutes of stress so they could show back up for another grueling shift. I have watched the dad break down in worry over not being able to support his family should there be one more downsize at his company. I held space for the couple who showed up week after week to learn how to communicate more effectively so their house is one of peace for their children. I cried with the single parent who literally had nothing left but who, upon leaving the office, musters enough energy for today, counting on fresh grace tomorrow. I am humbled to be a part of each of their stories. All these amazing people exemplifying the need to survive, amid great hardship. I believe we need to give ourselves credit for what we have accomplished this year. Pay tribute to the journeys we traveled and celebrate how incredible we really are. Our efforts this year are extraordinary. God only knows what the new year will look like. What I know is that people will continue to show up. They will continue to fight for growth. We will continue to be driven by the need for survival. We will adapt to the landscape of next year like we did to 2020, and we will exemplify the attributes we were born with. Because that is what we do.

Stay Rachel

Sullivan,

well,

friends-

MFTA,

CFLE

Solid Ground Counseling Center 256-503-8586 www.solidgroundmadison.com

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SARS-COVID-19: ITS IMPACT WITHIN THE HEALTHCARE INDUSTRY AND LESSONS LEARNED by Tiernan O’Neill

Wow, what a year 2020 has been for all of us, inside and outside of the medical community. The SARS COVID-19 global pandemic has tested and strained, I am sure, each and every one of us in some unique way or another. There has been obvious praise and recognition, which will unfortunately never be enough, for the frontline medical workers. And while that is much deserved and nice, I still feel far too many people have no full comprehension for the ways in which the entire medical community (primary care, specialists‌) was presented with enormous obstacles in the ways they delivered healthcare and performed their jobs.

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One often misconception I hear frequently is that this pandemic must have surely been an economic boom for our industry. I can speak from experience within the primary care setting, this was hardly the case. It was a year full of worries, economic hardships and developing new policies on the fly much like any industry faced. I have to mention briefly that unfortunately much of healthcare and specifically private healthcare in this country is a business no different than any other. State and local lock downs, as well as general patient population fear, were financially crippling and reportedly would see the permanent closure of over 20% of primary care offices that could never recover. As for the other 80% the financial affects and damages to business interruption will be present for years to come. Lack of business which clinics depend on such as appointments, procedures, surgeries and more completely altered our financial landscape in a way that was completely never expected in our business models. So much like any industry, healthcare clinics and personnel were left scrambling and adapting to the situation for mere economic survival. As a product of it could be good to focus on and reflect the ways in which we handled such adversity and how they will be valuable lessons for years to come.


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kellyreese.im@gmail.com or 256.652.8089

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Probably first and foremost, the events of the last year showed all of us we simply failed to adequately prepare for such a scenario. It would be shallow to react and say how could we have possibly prepared for a once in a lifetime global pandemic for three main reasons. First, this pandemic may have been once in a lifetime but that is not to say there was absolutely no history in the world of it. Second, recent times have shown us other health outbreaks, that while possibly may not have developed to be as severe they still should have, served as adequate notice. But third and most importantly, this pandemic took advantage of major deficiencies in our preparations and protections in emergent circumstances. From major hospital chains and all the way down to little single doctor private clinics we can now safely say we better understand the need for personal protective equipment as well as other safety protocols or procedures that will best protect ourselves, our staff and our patients. Hopefully this will be a lesson not too soon forgotten. As mentioned earlier, lock downs and public fear changes much of the way we in healthcare could best serve our patients. From limited mobility, due to travel restrictions or other ways in which our communities locked down, healthcare was presented with many unexpected challenges in ways we could serve our patients and remain financially viable. From the patient’s side, this past year was a year in which many patients were stranded or neglected in the health care maintenance they had been accustomed to. In reaction to such the pandemic and year 2020 saw the proliferation and ingenuity of virtual medicine, drive through testing as well as many other ways in which we could deliver care and assistance to patients in unconventional ways. While these forms of ingenuity have helped may of us to survive, I still feel many of these carve outs are not sustainable for the future of healthcare. Many branches within the business of medicine have relied heavily up to now on in-person services. This pandemic has definitely forced us to adapt, but I can’t say confidently that the methods by which we reinvented are long term fixes. At best, we now know the system by which we operate is very fragile and hopefully we can use that knowledge and lesson to be more proactive in the future of changing our business models The enormous public and private fear which has surrounded this pandemic has been tangible. From patients, to clinicians and all the way to each and every support staff member within healthcare this has been a troubling year for the unknown. But this fear of the unknown has definitely shown us the importance of communication and transparency. From a matter of professional operations, the clinics and offices which proactively sought information,

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answers and updates on the crisis were clearly much more prepared and at ease for all of the challenges which presented. This knowledge and whatever solace was gained was of much more value when it was then shared. Keeping staff up to date on all policies, recommendations and developments of the crisis whether scientific or administrative was crucial. You then had to make sure you relayed this information in the best way possible to your patients and the community. Reinforcing the necessity and safety of patients to continue to receive care was crucial. And this often was accomplished by simple acts such as temperature checks upon arrival or by being fully transparent as to your cleaning/sanitizing protocol. I can personally say by keeping staff and patients in the loop as often and as much as possible was essential. This was always made fully evident not only by accomplishing minimal business interruption but was so clearly visible each and every time you spoke on the faces of those who trusted and depended on us. The importance of communication can often be forgotten or overlooked and while definitely useful in a crisis, we would be foolish not to continue outreach and transparency in healthcare for all matters. Very soon at the beginning of the pandemic I was often asked for my thoughts. This was a rather open ended question and could have been interpreted many ways. Were those around me looking for information from a matter of clinical information or medical perspective? Regardless, I often gave two answers. First as a silver lining, I would say “while the situation was clearly horrible, at least it wasn’t my fault.” Second, “while it is terrible we weren’t prepared better for such a situation at first, the real crime would be if we weren’t ready for it later.” The first point was an attempt at being lighthearted and a calming influence to others. But the second is a more important point which should reverberate throughout this entire article and for years to come. I know our clinic took every measurable step to prepare itself best for the increased infection rates we saw in our community as 2020 progressed. As such you would be hard pressed to find anyone criticize our methods and readiness. While we clearly weren’t prepared as a country, industry or clinic, it was and is imperative for us to adapt, be proactive and learn. All of the roles we found ourselves in not just as a business but as an especially crucial component within healthcare and the community, should make sure we never forget and forget to plan for the importance of Preparation, Invention, and Communication.

STAY SAFE AND BE WELL –

Tiernan O’Neill Panacea O’Neill Medical Group (Owner/Manager)


present

THE PRESENT O F

B E I N G

by Dr. Elizabeth McCleskey

When we talk about healthy coping skills for life stresses, mindfulness is often mentioned. We know that focusing on where you are at this point in time rather than reliving past events or worrying about future ones can help refocus your thoughts and priorities and provide a mental resiliency to current circumstances. But have you ever thought about how your attentiveness to the moment affects others? Too frequently, one observes a family together but individually isolated as they tap or scroll on their phones. We shake our heads and say, “how sad.” Later, while simultaneously finishing up a spreadsheet for work, we text one person while attempting to hold a phone conversation with another. In our minds that is justified because multitasking is encouraged and considered “efficient.” But, for whom? Maybe, just maybe, a part of your mind acknowledges that you missed part of the conversation.

Did she realize I was distracted? I wonder how my lack of attention made her feel. And, possibly some of the following questions arose. Did you brush those few moments off as unimportant or assume the topic will come up again? Feel a tiny bit guilty for not listening due to your lack of focus? Did she realize I was distracted? I wonder how my lack of attention made her feel. Ask a military family that has endured separation: Is it the presents that the returning family member brings home or is it the presence of the service member that brings smiles and happy tears to loved ones? Think back over holidays and celebrations. What do you remember? While an occasional gift maybe mentioned, most people talk about the relationships. Baking cookies with your mom where you talked about everything and nothing.

The fishing trip with your siblings with stories late into the night about “remember when.” The getaway weekend with a friend with time to be silly or serious. “A person wants a witness to his life.” This is paraphrased from Susan Sarandon’s character in the movie “Shall We Dance.” People need to be heard. By having someone listen to their hopes, dreams, and experiences, it confirms the importance of their lives. That “old man” in assisted living might be a military veteran with an important message for your generation. Inside Medicine |

Vo l u m e 3 I s s u e 1 8


To hear that lesson it requires taking the time to see him as a person of value and not an obligation. This is not just about older people though. Everyone, including young children, needs to feel they have value. Listening and engaging with them in a meaningful (not distracted) manner helps them understand their feelings, hopes, and dreams, and helps us to learn from them. During this time of national stress, many people are feeling isolated and alone. They do not need a national platform; they just need an engaged you and me. Maybe the best present you can bring to someone is your time and your attention. Really listen to what they have to say. Plan events to create memories--a camping trip, game night, or create a memory book by asking someone about their past.

DR. ELIZABETH MCCLESKEY BOARD CERTIFIED IN FAMILY AND LIFESTYLE MEDICINE

MADISON, ALABAMA 256.280.3990 HEALTHSTYLESDR.COM

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Perhaps it will be what a creative or clever child you have. Maybe the story you expected to hear for the 20th time, may be a new anecdote revealing how your family was a part of history. Rather than avoiding that time of mourning with a friend embrace it as you embrace them, and you will find the times of joy to be even sweeter. You may even hear a nice word about yourself during these moments. For you see, the gift of attentiveness is one which blesses not only the recipient but the giver as well. Plan time to just sit and talk. It does not have to be time consuming. Have a meal with no phones. Put down social media, fix a cup of tea and spend 15 minutes of real engagement with someone who is special to you or who needs a lift. This is a gift we can give anyone. Then see what wonderful things you learn.


Did you know organically grown foods can contain significantly higher levels of nutrients than non-organic? Eating nutrient dense foods can help you achieve satiety sooner, and maintain your energy levels for longer. Avoid potentially harmful pesticides and hormones which can potentially be toxic to the natural states of your nervous, reproductive, and endocrine systems. By making an effort to consume more organic foods, you can also support sustainable farming practices, help protect our delicate ecosytems, prevent antibiotic resitance, and improve your precious health. Plus, organic foods tastes better! But, don’t take my word for it. Hit up your local produce section or farmers market and test them out for yourself, you’ll be glad you did!

organic by William Matthew Sykes, DO

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t c a imp PATIENT, PROVIDER & COMMUNITY

Nearly five years ago, Inside Medicine was created to bring together patients, physicians, and communities into a central platform where local healthcare information is shared with your health in mind. A purpose driven company, Inside Medicine is transforming the healthcare market as we bring together relative content for every generation. Before Inside Medicine, there was no dedicated space for patients to find organized medical options, but now through the exclusive content we provide, Inside Medicine provides readers with a trusted source for relative content. Our users have access to a powerful digital tool, optimized for easy access from anywhere, communicating relevant and practical information to benefit your health and happiness.

this time next year, if the I'M application is on your device you will have joined a healthier and happier community. As we continue to deal with the challenges presented by COVID-19, it is crucial you have confidence in the healthcare advice you receive.

Patients need information that is valuable to their treatment, but healthcare providers are short staffed and overwhelmed. COVID-19 has created fear, and our healthcare system is strained to the breaking point, but what if that fear could be replaced with peace of mind? What if patients could receive more efficient solutions to address their healthcare challenges with more communication but less contact? In 2018 we developed an app with the logo I'M. We built relationships with specialist who contribute to Inside Medicine, we increased our readership and now we are in a global pandemic that puts the need for a medical platform at the highest priority for each individual. We help finding information faster, understanding your medical community easier; delivering connection you can trust when you need a brand you can count on. Our team believes in the commitment of our community. How medical advice is distributed, what sites are reliable; matters most. I am proud of the fact that Inside Medicine has become one of the most reliable and trusted healthcare resources in the industry. The technological advancements in healthcare are changing the market, and Inside Medicine is at the tip of the spear related to this change.

Inside Medicine can now connect patients and healthcare providers in more cities than ever before. Our geographic reach has expanded greatly because our passion is to make communities healthier and happier emotionally, mentally, physically, and spiritually. Our teams industry experience and business knowledge, keeps Inside Medicine evolving into one of the most influential medical publications in existence today. As Inside Medicine continues to experience unprecedented growth we cannot be successful without you. We challenge you to share your testimony, inform your neighbors of the local resources that we provide. We are asking you to partner in your own health. Be risk adverse in your health and go #I'M in 2021. The growth of Inside Medicine hinges on the trust of our contributors, support of our partners, and most importantly our users who find our content valuable as a reader. I would say this time next year, if the I'M application is on your device you will have joined a healthier and happier community. One game changer at a time. #I'Magamechanger

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Inside Medicine exists to bring together patients, physicians, and communities into a central platform where local healthcare information is shared with your health in mind. Our users have access to a powerful digital tool, optimized for easy access from anywhere, communicating relevant and practical information to benefit your health and happiness.

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Before Inside Medicine, there was no dedicated space for patients to find organized medical options, but now through the exclusive content we provide, every provider that cares for you has an opportunity for their voice to be heard. Inside Medicine seeks to increase a healthcare advisors reach, allowing them to impact the wellness of your community.

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stop pain BEFORE IT STOPS YOU. GET YOUR LIFE BACK!

Neurosurgeon Sanat Dixit, M.D. John Johnson, Jr., M.D.

Spine Surgeons Curt Freudenberger, M.D. Javier A. Reto, M.D.

Physiatrists Kristina Janssen Donovan, D.O. Ryan Aaron, M.D.

Pain Management Victor Chin, M.D.

256.881.5151 Huntsville

Madison

Athens

Decatur

Fayetteville


SPINAL FUSION

neurosurgical treatment

featured procedure

Spinal Fusion The definition of fusion means to unite; in spinal surgery, fusion is to arrest motion between vertebrae. The spine was designed to be mobile and allow motion while at the same time protect the neural elements: the spinal cord and spinal nerves.

By Winston T. Capel, M.D., MBA, FACS, FAANS Spinal Neurosurgery

Why would fusion be necessary?

Decompression (the removal of bone,

Fusion is necessary when the

ligament and disc) is required if

stabilizing elements of the spinal

symptoms are intractable and there is

column: bone, disc, ligaments can no

failure of non-surgical treatments to

longer provide the protection of the

relieve pain. If instability exists

neural elements (spine is unstable).

before decompression or results from

These stabilizing elements can be

decompression reconstruction then

compromised by:

fusion is necessary to restore or

1. Trauma: fractures, dislocations and ligament injury

maintain stability. Stability being grossly defined as the spine’s ability

2. Tumor: primary tumor

to move physiologically without

metastatic (spreading from other

Sometimes it is necessary to fuse the

(originating in the vertebra) or

organs)

jeopardy of the neural elements. lumbar spine because normal motion

3. Infection: bacterial infection can

produces intractable pain that has not

compression

such as: exercise, physical therapy

weaken bone and cause neural

responded to nonsurgical treatments

4. Degeneration: degeneration

and medications. Spinal cord

supporting structures and cause

to degenerative (spondylosis) will

(osteoarthritic) changes can weaken instability resulting in intractable

compression in the cervical spine due require decompression.

pain and or neural compression requiring the removal of disc, ligament or bone.

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Examples of Some Common Fusion Scenarios Cervical Disc Herniations The cervical segment of the spinal column is very mobile and subject to excessive and early degenerative changes. These degenerative changes are accelerated by: genetics, wear and tear, repetitive trauma, heavy labor and nicotine exposure. When the disc breaks down in degenerative disc disease it can lose its mechanical integrity and start to migrate and fragment. This can lead to nerve and spinal cord compression. There is opportunity to manage the nerve compression nonsurgically with things such as: time, traction, neuromodulation drugs (Neurontin, Lyrica), and injections. Often, symptoms of nerve compression (radiculopathy) will improve and surgery can be avoided. If not, the problem is most commonly treated by an anterior approach where the disc is removed to decompress the symptomatic nerve. The removal of the disc has resulted in instability. There are 2 options: fusion and nonfusion. Fusion is to replace the disc with a polymer, autograft (from the patient) or allograft (bone bank) with the intent of growing bone were disc was. This bone growth requires bone forming cells (osteoblasts) to be protected from shear forces that interfere with bone growth. A metallic plate (titanium) is used to provide immediate stability while bone is growing over the next 3-4 months. If bone growth fails, the fusion fails and the plate will usually fail at the bone metal interface (loose screws) or less commonly metal fatigue (broken screws). Almost all fusions require or are greatly facilitated by the use of metallic instrumentation to optimize osteoblast activity. It is not uncommon for more than one disc (level) to require this decompression, reconstruction and fusion. The non-fusion option involves the use of an artificial disc (Total Disc Replacement) where a combined metal plastic designed unit preserves motion and replaces the mechanical stability of the disc. Disc replacement surgery is limited to one level and insurance coverage is still variable.

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Lumbar Spondylolisthesis "In my opinion, a highly motivated patient, (without the above characteristics) with intractable pain can do well with lumbar fusion or TDR."

Spondylolisthesis is the forward displacement of one vertebra on another. This is most often a degenerative process that occurs later in life but can be due to defect in the vertebrae at the pars interarticularis which results in premature disc degeneration allowing the slippage to occur.

Spondylolisthesis is commonly associated with stenosis (narrowing) of the exiting foramen and or the spinal canal. The combined spondylolisthesis and stenosis can often be managed non-surgically with exercise, physical therapy, medications and injections. When these measures fail a decompression is required. Decompression tends to make the spondylolisthesis globally unstable resulting in progressive slip and reoccurrence of the stenosis. A fusion at the time of the decompression has been shown scientifically to result in a better clinical outcome than decompression alone. There are various techniques and surgeon preferences that determine the method of fusion. All of the techniques will require the application of bone or bone forming substances and most often instrumentation. This is usually done from a posterior approach but occasionally a combined anterior and posterior approach is required. If the degree (grade) of the spondylolisthesis is high, often times a reduction (realigning) of the vertebra to maintain proper balance of the spine is required. Corrective forces are generated by the applied instrumentation.

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Fusion for Chronic Low Back Pain from Degenerative Disc Disease (DDD) The application of fusion to the treatment of low back pain (LBP) can be controversial. In general, the perceived failure of spine surgery can most often be attributed to this application of fusion. In my opinion, it is the proper selection of which patients receive this type of surgery that can be a great challenge. Often the failures to achieve the expected outcomes can be reduced to patient selection. It is known that patients with certain characteristics do not do as well clinically when fusion is applied for the treatment of chronic LBP secondary to DDD. The expected and desired outcome is: pain reduction, improved quality of life with increased functionality. This is less like to occur statistically in patients with these characteristics: 1.Secondary Gain: Worker’s compensation patients and third-party personal injury patients do not do as well generally as patients without this attribute. The spine literature in describing efficacy for fusion almost always will separate these patients out of patient populations to better understand clinical efficacy and outcomes. Litigation plays a significant role in perceived and or real outcomes for fusion in chronic LBP for DDD. 2.Psychology of the patient: Patients with depression and anxiety do not do as well statistically. In the process of patient selection many spine surgeons will send patients to a pain psychologist to screen for the presence of psychopathology that can jeopardize a good outcome. Functional issues (including marital conflict) can factor into a poorer outcome if the chronic pain issue is interconnected to the social support system for a patient. 3.Nicotine Usage: In all fusions, bone growth is the primary determinant of outcome. Nicotine antagonizes osteoblastic activity and is strongly associated with poorer clinical outcomes. Most spine surgeons will not do elective fusion procedures in smokers. In general, the fusion rate for a smoker is 30% lower than for a nonsmoker.

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4.Opioid Dependence: This is a complex issue especially given the current environment. The reality is that many patients with chronic LBP will be opioid dependent. An expected outcome by most is the reduction or elimination of the need for opioids after successful fusion surgery. The quantity used and the duration of chronic opioid maintenance therapy have predicted poorer outcomes in fusion surgery for chronic LBP secondary to DDD. 5.Obesity: Obese patients have poorer outcomes due to a number of reasons. There is a lower fusion rate with morbid obesity with a higher rate of complications. Surgery on obese patients is more technically demanding for the spine surgeon. In my opinion, a highly motivated patient, (without the above characteristics) with intractable pain can do well with lumbar fusion or TDR. Patient selection is a critical determinant of a good clinical outcome in elective fusion operations especially in the treatment of chronic LBP secondary to DDD. Trade offs and implications of fusion. All surgery is irreversible and is associated with trade offs. Fusion surgery will result in: 1. Decreased range of motion: in the cervical spine, for each level fused there is a decrease in 9 degrees of flexion and extension. This usually is not noticed in day to day living. 2. Increased stress on adjacent segments. A fusion may increase the stress, and wear (degeneration) at adjacent segments. This may result in need for future surgery. In general, there is approximately a 15-20% rate of future surgery associated with all fusions. Total disc replacement surgery lowers junctional stresses significantly but does not eliminate it. 3. Failure of fusion (pseudoarthrosis). A failed fusion almost always results in pain and will require repeat surgery (revision). WINSTON T. CAPEL, M.D., MBA, FACS, FAANS Spinal Neurosurgery


& Orthopaedic Surgery C VID-19 By the time this article is printed and available to read this summer, the impact and threat of the novel 2019 coronavirus pandemic will have changed - hopefully for the better! As I write this article on Monday, April 6, 2020, the coronavirus just like the weather, is in full bloom. The current projection is that the hospital admission rate will peak in 12 days on April 18, so there is hope that by the time you are reading this article our lives will be closer to some normalcy, though what was considered normal just a few weeks ago could be redefined for a long time to come. In our communities here in Huntsville and Madison, the hospitals are under a state mandated moratorium on elective surgery. Orthopaedic surgery is largely elective because patients can limp around on an arthritic knee or hip for a few extra weeks or months because their condition is not necessarily life threatening. However, several orthopaedic conditions that involve trauma and spine related conditions can be emergent or at least urgent. Hip fractures or other broken bones and disc herniations with neurologic deficits are examples of conditions that must be taken care of expeditiously. Fortunately those patients are being taken care of if surgery is needed without hesitation. I have been overwhelmingly impressed by the adjustments being made on a daily basis to provide safe surgical care. The nurses and OR technicians and anesthesia care providers are truly heroes in the effort to take care of patients. In times like these, the true heart of the healthcare worker shines brightly. The Orthopaedic Center is considered an essential business, and our clinics are open and seeing patients every day. We have implemented the practice of social distancing in the waiting rooms. Patients can sign in

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By Larry M. Parker, MD

and wait in their cars then receive a text when it is time to go back into the exam room. TOC is also providing telemedicine appointments to evaluate and treat patients remotely. The coronavirus pandemic has created a huge impact on the orthopaedic community for both doctors and patients: Some of the changes that are taking place will probably change the delivery of healthcare for a long time, and some of the changes could be permanent, but I am confident that we will always be able to provide quality orthopaedic care both in the clinic and in the operating room just as we always have. I look forward to reading this article in June, and hopefully we will be in a much better position with regards to this viral pandemic here in the Tennessee Valley and around the country. Be safe! Sincerely, Dr. Larry Parker

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WALK ITOUT... When I walk alone, I pray. And, when I pray, I get closer to God. So, that has been a huge benefit from getting out and getting moving. By: Kimberly Waldrop

So many things can have an effect on our well-being. Without even realizing it, outside influences can change our physical and mental states. With all the stress and craziness going on in the world around us, our bodies can respond physiologically without us even knowing. Things can show up through weight gain, fatigue, hair loss, stomach ulcers, depression, anxiety, etc. You name it, and it could be a side effect of things going on around you. Typically, these things are out of our control and are an inevitable part of life.

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ONE APP YOUR COMMUNITY HEALTHCARE

Download the Inside Medicine app today. Follow I'M as we create a LOCAL world of medical advisors for YOU!


Throughout our quarantine time and “safer at home” orders, I have

Get better sleep

relied more and more on my family and close neighbors/friends to get me through some tough

Ward off depression

things. All of us have been dealt a

and anxiety

hand we didn’t choose and for some reason, it seems to just pile on.

We need an outlet or

someone to help alleviate the extra heaviness we are all feeling.

Improve brain function

I found in the beginning, just getting out and moving helped so much. I would call a friend and we

Aid in eye sight

would WALK. Walking has been such a good “out”. It has helped in more ways than one.

Get closer to God

Until now, I never

realized the benefits from a walk. Alone or with a friend, it is good for the mind, body, and soul! Many studies have proven that

Well, I added the last one from my own study. When

a brisk, 30 minute walk, can help

I walk alone, I pray. And, when I pray, I get closer to

in weight control.

God. So, that has been a huge benefit from getting

Typically, you

can burn around 150 calories. So

out and getting moving.

that’s good in and of itself. Did

Why don’t you try it? Enjoy the outdoors, bundle up

you know walking can help in

in the cold, and get out for a good walk. I promise it

other ways as well??

will make you feel better in more ways than one!

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Be Still My

Fitness

Beating Mind By Kari Kingsley, MSN, CRNP

T

he roots of my struggle with meditation run deep. Every time I attempted to meditate, the stillness and calm was bombarded by the never-ending adulting To-Do list on autorepeat in my mind. My type A, getit-right-the-first-time personality wanted not only to learn how to meditate, but to master it. I wanted to be the World Champion Meditator. (Because that’s a thing…) The funny thing about meditation is, the harder you try to do it perfectly, the harder it is. Meditation can especially be a white whale for control freaks like me. I developed a sort-of meditation stage-fright. Telling my mind to be still felt like trying to hush a room full of Kindergarteners hyped up on Mountain Dew. I have this major affliction that if I can’t do something well, I’d rather not do it. Each time I sat down to meditate, I failed. Thoughts screamed in my brain and the last thing I felt was inner peace. I stopped wanting to try. Meditation has been around for centuries. You can take classes on meditation, read books, listen to podcasts, and, yes, there’s an app for that. Oxford defines meditation as “the practice of focusing your mind in silence, especially for religious reasons

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or in order to make your mind calm.” Simple enough, right? But how? You are what you think. Negative subconscious thoughts or paradigms give way to negative attitudes and those negative attitudes get married and have little baby negative attitudes. Meditation is a wonderful way to reset your daily intentions and turn that brain frown upside down. (Subtract 2 points from article quality for cheesiness). Meditation also has positive physiologic effects including anxiety reduction, lowered blood pressure, and improved sleep quality. Mental health providers encourage meditation to help treat PTSD, depression, anxiety, and bipolar disorder. Scientists suggest it improves brain plasticity. It literally rewires your brain circuits to improve your physical and mental health. Cool. It’s like a facelift for your gray matter. In my research, I kept coming across the term “mindfulness.” Mind-full-ness. I think they meant mind-empty-ness. My brain was anything but empty. Things changed when a friend suggested listening to a guided imagery meditation. For the first time I felt my brain relax and let go. As the soothing voice of the narrator guided my thoughts through

Vo l u m e 3 I s s u e 1 7

a forest and down a gentle stream, I could feel my brain emptying of the constant background noise. The peace I felt afterwards was indescribable. Days later, I tried again, only to fail (or so I thought). I then set out on a journey to learn how to meditate. I had to break down the failure. Who was judging this as a fail? I was. Who was I trying to impress with my outstanding meditation skills? Me. Who would be missing out if I never learned to meditate? I would. I put a gag on the internal judge and decided to be kinder to myself. Instead of saying that failure is not an option, I took failure off the table. Learning what I want and need from the practice led me to the biggest breakthrough in my meditation journey. The opposite of a cracked-out hamster doing an Iron Man on his tiny wheel after slamming a case of Red Bull. I began to realize the encouraging fact that I had been meditating all my life. One familiar example is the twilight between wakefulness and sleep. Those sacred few moments lying in bed when the brain begins to let go of the day’s events and becomes still. As meditation became less unknown, I recognized it all over the place. Each time I closed my eyes and opened my mind to my senses


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Alert Management and Threat Mitigation According to Wikipedia, a news article discusses current or recent news of either general interest or of a specific topic. Political or trade news magazines. Quoted references can also be helpful. References to people can also be made through the written accounts of interviews and debates confirming the factuality of the writer’s information and his reliability.

Key Features Fully integrated APP and kiosk based systemOptimized for monitoring employees, students, nursing home and assisted living residentsFollows CDC recommendations for self-checks an be customized to meet specific situations Configured be completed at specific time frames Answers indicating a possible health risk initiates alerts and pre-defined mitigation protocols Centralized dashboard for data management, reporting, and contact tracing

To read more about SafeScan visit www.safescanrts.com

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SAFE SCAN

A PURPOSE DRIVEN COMPANY MAKING HOSPITALS AND HEALTHCARE PROVIDERS SAFE AND SECURE By Tripp Skipper

During challenging times, companies with purpose are often better positioned to adapt and endure than peers without a purpose. Why? Purpose serves as a vision and lens for smart decisionmaking during both good times and bad. More than just a reason for existing, purpose can help leaders prioritize stakeholders, redirect resources, and more precisely respond during crises such as COVID-19. SafeScan, a division of GlobalScan, LLC based in Opelika, Alabama is just such a purpose driven company. As the COVID-19 pandemic began to sweep across the United States, Eric Hare, a decorated military veteran, launched SafeScan, a veteran owned and operated small business focused on delivering reliable, sustainable, and compliant employee wellness self-check, non-contact temperature screening, and remote management solutions. SafeScan’s leadership team is composed of individuals with multiple years of experience in providing cutting edge screening and security solutions for private, public and government sectors. They have a highly integrated advisory board comprised of senior leaders supporting their commitment to 100% compliant services while delivering industry leading economic value to their customers.


A Time To Shine Infection Control During a Pandemic By Macy Magnusson, MS

Hospitals are a place of healing and recovery. Unfortunately, they are also a place where infections can spread rapidly if proper precautions are not taken. According to the Centers for Disease Control and Prevention (CDC), 1 in 25 hospitalized patients will get an infection as a result of the care that they receive, and an estimated 75,000 patients with healthcare-associated infections will die each year. Because these infections pose a major threat to patient safety and in turn the safety of the community, hospitals have made the prevention and reduction of infections a top priority, depending upon their Infection Control teams to lead the charge. At Crestwood Medical Center, a lot of time, hard work, research, and education goes into preventing the spread of infection. Crestwood’s Infection Control Team is made up of 2 Infection Preventionists, Amy Stephens, RN, and Roslyn Richardson, RN. Infection Preventionists are experts on practical methods of preventing and controlling the spread of infectious diseases. They tend to wear many hats. They look for patterns of infection within the facility; provide education to patients and staff members; audit practices; develop, review, and update the facility’s protocols and procedures for infection control; investigate infections and outbreaks; advise hospital leaders and other professionals; and coordinate with local and national public health agencies. Their roles and responsibilities require expertise in microbiology, epidemiology, statistics, human resources, education, public policy, and clinical practice. Most of the work Stephens and Richardson do is typically done behind the scenes. When COVID-19 hit, they found themselves in the spotlight, their roles proving to be more critical than ever before. Their primary roles immediately shifted to the hospital’s preparation and response to potential COVID-19 cases. Each day, Stephens and Richardson are responsible for reviewing the guidelines and recommendations on safely caring for patients with suspected and confirmed COVID from governing bodies like the Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), World Health Organization (WHO), and Alabama Department of Public Health (ADPH). From those guidelines, they 34

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Roslyn Richardson, RN, & Amy Stephens, RN

have written and implemented policies and procedures for preventing the transmission of COVID-19 within the facility. They have been involved in key decision-making and planning with regard to issues like personal protective equipment (PPE) supply and use, to ensure that all staff members had appropriate PPE at all times, and helping to optimize infection control in the design and set up of Crestwood’s COVID units. In addition to researching and planning, Stephens and Richardson have worked closely with the clinical staff, educating them on hand hygiene and appropriate PPE usage and addressing any issues that the staff encountered along the way. Because of the excellent job that Stephens and Richardson have done, as of the date of this publication, Crestwood has been able to keep 100% of its team members healthy, provide appropriate PPE to all of its staff during the country’s PPE shortage, and continue to give excellent care to all patients. Their hard work and dedication to keeping everyone safe also reduced the risk of spread within the community. In moments of crisis, there are always helpers and heroes. For Infection Preventionists like Stephens and Richardson, this pandemic has been their time to shine. They have shown our community just how important infection control is and the positive effects infection control can have on keeping everyone safe and healthy.

IF IT’S AN EMERGENCY, YOU AREN’T SAFER AT HOME. We know you are concerned about your health. We are, too. And if you experience sudden symptoms of an emergency, getting fast medical care could save your live. We are taking extraordinary precautions to be sure our emergency room and other care settings are safe. So, don’t delay care in an emergency. If you experience chest pain, sudden dizziness, weakness or numbness in your arms or legs, severe abdominal pain, high fever, or any other symptoms of a possible medical emergency, seek emergency care immediately.

Learn how we’re keeping patients safe. Visit CrestwoodMedCenter.com/COVID-19

In an emergency, call 911.


SafeScan Non-Contact Temperature Screening thermography solutions are optimized for the early detection and alerting of elevated body temperatures often associated with viruses and other systemic illnesses. As we have all learned, medical offices and hospitals have become ivory towers that you now have to be well to enter. The beauty of SafeScan’s technology is that it eliminates all human-to-human contact and on-site staffing, provides high-throughput optimized for areas such as private and public businesses, schools, stadiums, airports, and of course hospitals, and nursing homes. In addition, the equipment contains advanced thermal and visible camera technologies with high-resolution accuracy at a distance up to 8 meters, providing elevated body temperature alarming and alerts for immediate threat mitigation. Eric and his team have developed a customized solution for hospitals and medical providers that allows for non-contact temperature screening and employee wellness self-check which is exactly what our over worked health care providers need as they continue to deal with the uncertainty of COVID-19. SafeScan’s technology frees up a hospital’s human resources and site management staffing, so everyone can focus on what really matters, patient care. While I was impressed with SafeScan’s technology, what I am most impressed with is the values that guide this great company. As Eric said when I had the opportunity to interview him, “our company is guided by a core purpose, strong corporate values and a commitment to always do the right thing.” That is just the kind of company that healthcare providers need and deserve during these trying times.

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TO MASK OR NOT TO MASK? By Kari Kingsley, MSN, CRNP

COVID-19 is changing the way we live our lives from the ground up. The new (and sometimes incorrect) recommendations circulating can leave us in a tailspin. Most people get the basics. Wash your hands. No, really, wash your hands. Sing “Happy Birthday” … count to twenty… do whatever you have to do to make sure your hands get the just came off a fishing charter, changed a baby diaper, and then cut raw chicken deep scrubbing they deserve. Or use an alcohol-based hand sanitizer. Don’t touch your face. Ok, louder, for those of you in the back. DON’T TOUCH YOUR FACE. Easier said than done. The average person touches their face up to 3000 times a day. That’s a little over 2-3 times a minute. Avoid sick people. Like the plague. If you get sick, don’t panic. Get a COVID-19 test if you meet the requirements (fever, cough, shortness of breath, you get the gist). Then avoid people like the plague. Stay home from work, school, and for

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the love of all things healthy, stay out of Walmart. Practice good manners and cover that cough. Use proper etiquette by coughing into your elbow. Maintain social distancing measures, especially in areas of potential community-based transmission. While this remedial information may seem like COVID 101, there is still a lot of confusion circulating on when to mask and when not to mask. Recommendations seem to change rapidly and casual grocery store people watching reveals we may not all be acting as we should. At the present time, the Center for Disease Control has recommended using simple cloth face coverings to slow the spread of the COVID-19 and prevent asymptomatic carriers from transmitting the virus. What are the appropriate recommendations for when and where to wear a mask? We asked a local Infectious Disease Specialist, Ali Hassoun, MD, FACP, AAHIVS, FIDSA, to weigh in.


(continued from p.26)

I crave moments of solitude because that is how I re-fuel. Yet I never asked for time alone. Working out is one of my greatest joys, but I kept sacrificing my own workout time to work more hours at the gym. I was dying to the wrong things. There are things in life that we have to do that might not be our preference. I do not enjoy doing dishes. It always feels like a chore! The dishes still have to be done. Yet there are many other things in life I still have the choice to say “yes”, “no”, or “not now”. Are you, am I, saying yes to the right things? Over about a 9 month period, I began to adjust my schedule. My husband helped me create better boundaries because he recognized the exhausted wife, mother, and person I had become. He helped me commit to not taking on a second early morning class at the gym and made me promise to him I would only do one early morning each week. We re-worked our budget in order for me to have more time at home. I gave myself permission to say “no” to lunch meetings if I needed some solitude - and refused to feel guilty about it! I prioritized getting my own personal workouts each week. And in the middle of this pandemic - spring 2020??? I reminded myself that I love to read. I love it! Since fitness centers are still closed and my work hours are different, I have given myself permission to pick up some fictional novels that I have wanted to read for a long time. I continue to find that when I say yes to things that bring life to my soul, I am a better mother, wife, and friend. I have a fullness of life to share with others, instead of little bits of leftovers. One simple but profound way to help find out if you are dying to the wrong things is to make two simple lists. Make a list of the things that fill you up. Bring you joy. Maybe it is time in nature, or time with friends. Whatever those things are - write them down! Then write a second list of things that drain you. Be honest on both. Then compare. Our pastor suggested doing this as we look at our Sabbath days, the day we need to take rest. Rest is not doing nothing! Rest is taking time for what fills you up! Ask yourself: is my life filled more with things that energize me? Or is it filled with things that drain me? If you find yourself constantly exhausted and irritable, perhaps it is time to begin to make adjustments. Adjustments take time. You and I cannot wave a magic wand over our schedule and repair what we have been overcrowding for years. But we can take one step at a time to make a difference so that we enjoy fullness of life. Each small step of weeding out something that drains you and creating space for people and activities that fill your soul to the brim matters. I promise that you will find yourself as you do it! The girl inside me that laughs, jokes, hugs more, is patient, silly, energetic … she comes out more and more when I am careful to live for the right things and give myself freedom to die to the wrong things. Each season of life provides us moments of growth if we are willing to embrace growth and change. Sometimes change can feel scary or simply unknown! This season is no exception: the opportunity lies before you. Don’t sit and wait for COVID-19 to disappear and life to return to “normal”. You can find life and beauty even right now - make the choice to live for those things!

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