Inside Medicine February-March 2017

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february-march 2017

A Mom’s perspective on

Autism

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features &

CONTENTS

Sharing with Purpose

Inside Medicine | februar y-march 2017

Vol u m e 1 , I s sue 3 C O N T R I B U T ORS

Michael Dohrenwend, MD Karen Fox, CRNP

FEATURES A Mom’s perspective on Autism

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Learning to celebrate every little success

Sarah’s Story The inspirational story of a young girl embracing a challenging condition

Colon Cancer Awareness Learn about warning signs and who is at risk

CONTENT What will You Leave Behind?

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When is it too much, and too soon?

Fighting Obesity Advancements made towards a cure

Amy Fruchnicht Connie McGougan Adrienne Dowd, MS, RDT, RYT H. Cobb Alexander, MD Emily McIntosh, DMD

Resolutions ideas we can all apply in the new year

Youth Sports

Katie Edwards

Matthew Clayton, MD

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Tiernan O’Neill Pat Ballew Sunita Puri, MD Lauren Marsh

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S A L E S & M A R KETING

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

Join our mission to establish and grow an alliance among our community and healthcare providers. Together, we can change the way healthcare information has been and will be distributed for years to come. To reach our readers, whether through editorial contribution or advertising, please contact Kelly Reese at kelly@insidemedicine.biz or 256.652.8089

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.

C H I E F E D I T O R I A L WRITER

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

Karen Gauthier P U B L I S H ER

Brandon Reese, President Blake Bentley, Vice President w w w . i n s i d e m e d icine.biz


} FROM THE EDITOR

Dear Readers– We have some of the best resources right here in our area. I’m so excited about this edition of Inside Medicine. We have gone to the

wisdom and inspiration

best to get the best! A Mom’s Perspective on Autism offers such insightful wisdom from local moms about their day to day dealings. Without “walking a mile in their shoes” we can’t fathom what they deal with. Their story paints a picture we can only try to take in. What Will you Leave Behind is written by a sweet, Christian lady with some great advice. With the New Year, we all want to “better ourselves”. Katie Edwards gracefully helps us do just that. And I love the article about Sarah. Sarah lives in Madison and she has quite the story to tell. You can’t help but get wrapped up into her personality. I am thrilled we got a chance to sit down and talk with her and share her life with our readers. Included in this edition are also stories from HudsonAlpha researchers, medical doctors, dentists, pain and wellness consultants, and professional business persons. We hope you enjoy reading and learning from our experts! Our team at Inside Medicine is passionate for our community and for our Savior. We want our work to benefit you and HIS kingdom. If you ever have an idea for a story or want to be included in our magazine, please contact us.

Kimberly Waldrop


}RESEARCH

GeneMatchers

Dr. Greg Cooper

HudsonAlpha Faculty Investigator

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HudsonAlpha researchers identify genetic variants that cause intellectual delay in children Matchmaking website helped connect international research team for project Researchers at the HudsonAlpha Institute for Biotechnology, a nonprofit genetics and genomics research institute in Huntsville, AL, along with an international team of collaborators from six countries, have identified a new genetic disorder that causes intellectual and developmental delay in children. GeneMatcher, an online “matchmaking” system for scientists researching rare genetic variants, connected the team members. The research is published online December 22 in the American Journal of Human Genetics (AJHG). “Essentially, we did experiments to understand how variants in the EBF3 gene might change its function during development,” said Drew Hardigan, a graduate student in the Myers Lab at HudsonAlpha and a co-lead author. “The role of EBF3 had been studied in terms of neural development, but had not been previously described as a gene in which mutations cause intellectual and developmental delay. We were able to demonstrate that changes to the gene are the cause of a clinical disorder.” EBF3 was identified at HudsonAlpha as an interesting gene for research through a pediatric genomics program led by Greg Cooper, PhD, a faculty investigator at HudsonAlpha and a senior author for the AJHG publication. Through genomic sequencing and analysis, Cooper’s lab had identified two patients with changes to EBF3. However, his team could not find any similar cases or publications on the gene to confirm the variants were causing the patients’ symptoms. The genetic changes were labeled variants of uncertain significance, or VUSs. The group turned to the website GeneMatcher, which operates like a matchmaker site for scientists interested in genetic variants. Using the online system, Cooper’s team was able to contact researchers around the world who were also interested in VUSs in EBF3. Once connected, the international group performed a statistical analysis confirming the gene was very likely the cause of the symptoms for 10 patients located on three continents. The group then used a variety of genomic assays to investigate the function of the variants.


“It’s an honor to be able to help in even a small way with these significant medical challenges.” “Our experiments help support the statistical data biologically,” Hardigan said, “providing clues to further understand the role of this transcription factor for normal neuronal function.” As the group explain in their paper, the experiments demonstrated that the genetic changes to EBF3 – the same changes found in those 10 patients – disrupt important functions required for normal development. They also found that changes in this gene were likely the cause of about one in every 1,000 patients with unexplained neurodevelopmental disorders. “We were able to combine statistical and computational analyses of genetic data with the results of biological experiments to provide these 10 patients with an answer,” said Cooper, the HudsonAlpha investigator whose pediatric genomics research began this scientific journey. “While this particular diagnosis may not have a simple treatment, these families can stop the often long and costly process of medical testing and specialist visits that accompanies having an undiagnosed disease. It’s an honor to be able to help in even a small way with these significant medical challenges.”

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} HEALTHY LIVING

Sports YOUTH

too much, too soon? by H. Cobb Alexander, MD

Fifty years ago, organized youth sports were largely limited to Little League baseball and perhaps Pee Wee football. Girls in sports? Yeah, you can go cheer for the boys…. or maybe do ballet or tap. Childrens’ play tended to be much less organized—pick-up games on an empty lot or even in the street were the norm. Go outside after school; find some buddies, and just play by simple rules. In the summer it was baseball, and in autumn, flag football reigned. Playing one sport year-round, particularly an organized sport, was unthinkable. Different seasons demanded different skill sets, leading to a more holistic physical development for growing bodies.

........................................................................................................... Beginning in the 1970’s and accelerating ever since, the trend among youth has been to start organized sports at increasing younger ages, and focus on one sport ever earlier. Sports opportunities for girls have thankfully expanded greatly, and there is now a plethora of options from which to choose. Travel sports now comprise a $7 billion industry, with families expecting to spend several thousand dollars a year on fees and travel expenses. Yet, for all the time and resources expended on youth sports, there are some troubling trends. According to a survey by the Sports and Fitness Industry Association, in 2014 there were 26 million youth aged 9-14 playing team sports, down almost 4% from 2009, and an average of 10% fewer sports were being played. The physical cost of concentrating on just one sport yearround is also taking its toll. Dr. James Andrews, in his excellent book Any Given Monday, relates that almost 40 percent of ALL sports injuries seen in the Emergency Room are for children under the age of fourteen, and overuse is the cause of nearly half of all adolescent sports injuries. Many sports medicine experts are becoming increasingly alarmed at the negative effects of the trend to train children younger, harder, and more sport-specific. The problems range from being a strain on family finances—and time together—to the all-too-common scenario of a child being pushed at an early age to participate in one sport at the “elite” level—only to burn out in the early teen years and give up sports altogether. CDC statistics show that in the past 30 years, obesity rates doubled in children and quadrupled in adolescents, with more than one third of people in these age groups classified as overweight or obese. Although poor dietary habits and video games have certainly contributed to this ominous trend, a lack of exercise is clearly a major factor as well. Even worse, 75-80 percent of obese adolescents will be obese as adults, increasing the risk of everything from heart disease to diabetes to the need for joint replacement. 8

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So how should we, as parents, respond? John O’Sullivan, former pro soccer player and author of Changing the Game, has identified some behaviors to avoid. First, resist the push to become “elite.” The odds of any child going to college on a sports scholarship are exceedingly small, and even if that elusive offer is the goal, the child will be much more likely to get there by developing a broad range of athletic skills, from gross motor to hand-eye coordination, speed, agility, strength, and flexibility. This can only be done by exposing the young athlete to a variety of sports, since each will favor the development of different skill sets. This will prove invaluable in whatever single sport the athlete may focus on later. Studies have shown that single-sport athletes are 70-90% more likely to suffer an overuse injury than those participating in multiple sports. Even college football coaches are recognizing the superiority of having multi-sport players, with one nationally-prominent program having a recent recruiting class composed of 43 multi-sport athletes and only 5 single-sports. Second, avoid the emphasis on winning at all costs. When children were surveyed about the things they found enjoyable in sports, winning was number 48 in a list of 81. Much more important to the child was the comraderie of being on a team, being respected by the coach, and having playing time. Trophies, cool uniforms, and other things parents often consider so important, barely made the list. This doesn’t mean that there should be no winners—children need to learn how to win, but also how to lose, using both to focus on improving the next time. For the same reason, giving a trophy to everyone—regardless of effort or attitude—demeans both the deserving and the undeserving. Third, sports should above all be fun for the child—not a means of gratification for the parent. The more a parent pushes a child to practice and to focus on one sport year-round, the more likely the child will burn out. The youth sports inactivity level was 20 percent in 2014, and appears to have been even higher in 2015. Also, children, especially in their younger years, should be encouraged in free play— the children decide the game, the teams and the rules with no adult interference.

Whether touch football, tag, or simply hide-and-seek, free play encourages imagination, socialization, and maturation as the players learn to settle rules and disputes among themselves, without parental hovering. For those engaged in team sports, Dr. Andrews has even more specific recommendations:

1. Proper preseason strength and conditioning. While staying fit is a full-year goal, preparation for any given sport should start two or three months before the first day of practice. The majority of injuries occur in the first few weeks of the season due to inadequate preseason preparation. 2. Young athletes need to take off a month or more each year to give their bodies a chance to rest and recover.Overtraining always increases the risk of injury, and a period of low-impact activity is necessary for the musculoskeletal recovery phase. 3. Cross training is also very beneficial, either by a deliberate regimen or by participation in a completely different sport during the off-season. 4. Follow the 10 percent rule—do not increase weight training activities, distance, or pace by more than 10 percent a week. “No pain, no gain” has no place in youth sports. 5. Strength must be balanced with flexibility. Tight muscles are more easily torn, and tight joints more easily injured than those which are supple. Studies have shown that children who participate in sports do better in school, are more likely to go to college, and are much more likely to become healthy productive adults than those who don’t participate. As parents, we should do everything we can to foster in our children a life-long love of staying active and physically fit, and to have happy memories of their time in sports. That way, they’ll be there for us when we get old!

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} FEATURE

A Mom’s Perspective on

by Amy Fruchnicht and Connie McGougan

You walk hand in hand over the obstacles until you’ve

conquered every single one

for that day, and start over again the next.

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I’ve been living in the autism world for 8 years now and my perspective changes daily, sometimes hourly. The world I live in is unlike the life of most people I know. Autism controls every facet of my life, and I’d be lying if I told you otherwise. Autism controls what time we get up in the morning and what time we go to bed at night. It controls where we go in public and which way we drive to get somewhere. Autism controls who we can visit and where we go to eat. It controls what we have in our home and what therapies we have to schedule. It controls the numerous specialists we see, the daily battles we fight, and the sleepless nights. Autism controls the inconsolable crying, head-banging, hand-flapping and screaming. It controls the medication, the behavior plans, the public stares, and the angry glares. It steals the smiles, the dreams, and the happily ever after. In the beginning, it is hard to see anything else. It feels as though you’re drowning and you can’t come up for air no matter how hard you fight. It’s suffocating, lonely, depressing and heart wrenching. Hope is lost and fear takes over. You long for the life you’ve always dreamed of while being stuck in a horrifying place. You lie awake at night weeping and wonder what you did wrong in life to deserve such a painful sentence for your child. Why them? Why not me? Why did autism have to steal my child from me? It’s a long, dark and terrifying road. You’re just trying to make it from minute to minute, hour to hour, day to day. Everything in life comes to a standstill except finding the help your child needs to have the best life pos-


You learn to slow down and enjoy life at your child’s speed, and constantly love and praise every single success.

sible. You start learning the ropes of talking to other parents who have traveled the same path and getting advice on therapies, doctors, play groups, support groups and any other thing that will help you along your new path. You start finding little bits of hope along the way and you cling to them with all your might. You find that as you surround yourself with support, things start looking brighter. You find hope again. You no longer feel so lost. You even find yourself smiling and laughing again, and are startled at the realization. Soon, you will see your child is starting to make small gains. You learn to cherish the tiny pieces of hope and progress. You start to retrain your brain and truly celebrate every single success. No success is ever too small to celebrate! When your child communicates a need for something as simple as a cup, you jump up and can’t contain your delight at such a wondrous thing. Your life is starting to replace the fear, depression and pain with hope, joy and happiness. You see your child laugh and smile as they find joy in learning something new and you beam from ear to ear. Life is good and you start seeing the good in so many things you’ve never seen before. Your beautiful and perfect child teaches you to see the beauty in everything. You learn to slow down and enjoy life at your child’s speed, and constantly love and praise every single success. You cheer for your child and help them with every struggle; for there will be many. You walk hand in hand over the obstacles until you’ve conquered every single one for that day, and start over again the next. You are a beautiful team, mother and child. You can’t imagine your life any other way, and you see the beauty of autism and cherish the many things that make your child so special. There will always be struggles, but with an endless supply of hope, love and perseverance, there will never be a battle you can’t win. – Amy Fruchtnicht

Autism affects 1 in 68 children in the U.S. It is 4-5 times more common in boys according to the Center for Disease Control. Autism and Autism Spectrum disorder are both general terms for a group of complex disorders of brain development. The disorders are characterized by difficulties in social skills, verbal and nonverbal communication and repetitive behaviors. Individuals with autism often suffer from numerous co-morbid medical conditions which may include: Fragile X, allergies, asthma, epilepsy, bowel disease, gastrointestinal/digestive disorders, persistent viral infections, PANDAS, feeding disorders, anxiety disorder, bipolar disorder, ADHD, Tourette Syndrome, OCD, sensory integration dysfunction, sleeping disorders, immune disorders, autoimmune disorders, and neuroinflammation. Autism is the fastest growing developmental disorder, yet most underfunded. Currently there is no cure for autism, though with early intervention and treatment, the diverse symptoms related to autism can be greatly improved, and in some cases, completely overcome. -National Autism Association

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} HEALTHY LIVING

What will you leave behind? by Katie Edwards

People everywhere are coming up with ideas on how to make 2017 better than 2016. I’m not much for New Year resolutions. But today, as I spent a little time in the Word, the Lord revealed to me...

A Few Things I Need to Leave in 2016... #1- Perfectionism. “Not that I have already attained all this, or have already been made perfect, but I press on to take hold of that for which Christ Jesus took hold of me.” -Philippians 3:12 Perfectionism is a huge struggle for me. It may not be a struggle for you, but before you write this off as something you are free of, consider it again. Perfectionism comes in many, many forms. Your house may not have to be perfectly clean to entertain guests, but what if someone you love very much seems disappointed in you? Is your less-than-perfect-performance (in their eyes) going to send a crushing blow to your spirit? That’s just as much perfectionism as having to have your home spotless and clean before the first guest arrives. And it can enslave you. That Paul. He just has a way with words, doesn’t he? “...I press on to take hold of that for which Christ Jesus took hold of me.” Friend, Jesus has taken hold of you! And for a very specific purpose. When you and I allow the bondage of perfectionism of any kind to take hold of us, it is taking the place of Jesus. He is the only thing that should have a hold on us.

#2- Gossip and Negativity with My Mouth. “Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen.” - Ephesians 4:29 Any unwholesome talk? Unfortunately, this verse doesn’t just apply to people who have a problem with swear words. Actually, I would venture to say that it applies much more to those of us who have a tendency to just “say what we’re thinking.” Look at it this way...What if we text it instead of saying it? That should make us look at it differently…If the thought we are about to broadcast, whether it be on social media, via text or phone call, or word of mouth...whether it be to one person or thousands...if it is not 14

Inside Medicine | februar y-march 2017

helpful for building others up according to THEIR needs...we are to quite simply...HUSH. When we restrain ourselves in this way, Jesus is honored. I believe that is what the very next part of that sentence means... “that it may benefit those who listen.” We shouldn’t give them juicy information or something to laugh about or cause them fear or... whatever. Truly benefitting someone else means honoring Jesus. The opposite of this is found in the very next verse (v. 30 of Ephesians chapter 4)... “And do not grieve the Holy Spirit of God...” Less grieving the Holy Spirit, more building others up in 2017.

#3- Negative Thoughts. “We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.” - 2 Corinthians 10:5 I’d like to start by saying that I’m not a “sending out positive vibes” kind of girl. What is a vibe? I know what a prayer is. I know what a thought is. Vibes? Not so much. It just kills me when people say they’re sending positive vibes. I literally have no clue what they’re saying. Anyway, I digress... I just want you to know that because I think that when people say, “I’m leaving behind negative thoughts” it can create the idea that somehow MY thoughts can change situations and circumstances. God clearly says “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts.” (Isaiah 55:9). We are to make our thoughts, His thoughts. Finding out what God says about what I’m thinking is where I plan to start 2017.

#4- Comparison. “But, ‘Let him who boasts boast in the Lord.’ For it is not the one who commends himself who is approved, but the one whom the Lord commends.” - 2 Corinthians 10:17-18 Theodore Roosevelt said that comparison is the thief of joy. Can I get a witness? There’s not much that has to be said about this subject because we are all so familiar with it. When we seek to compare our lives, our spiritual walks, our finances, our homes, our families, our relationships, our work, our successes, our failures, our...everything...with others, we are devaluing what God


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#5- Need for Human Approval. “Am I now trying to win the approval of men, or of God? Or am I trying to please men? If I were still trying to please men, I would not be a servant of Christ.” -Galatians 1:10-11 So, I saved my worst one for last. This is THE one. This has been my hang up in 2016. (Who am I kidding? Many, many more years than 2016.) I wonder if so-and-so enjoys being around me? I wonder if so-and-so only wants to be around me because of what I can do for her/him? Does so-and-so think I’m a good mom/wife/friend/worker/leader/servant/Christ-follower/housekeeper/the list goes on and on and on and on and on and on.... The enemy has had a FIELD DAY in this area with me this year. I have been so concerned with being hopeful that people would approve of me that I forgot that, as a follower of Jesus, I am only trying to win the approval of God...and that when I strive to please humans primarily, my service to Christ is sacrificed. That’s changing this year, too. You may not get where you want to go, unless you know where you’ve been. What are YOU leaving behind?

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[ Her condition does not make her ambitious; she makes herself ambitious.

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} FEATURE

Then, the idea to share our interview as a Q&A with fabulous graphics and a collage of pictures seemed appropriate. I could envision the layout perfectly. I knew her parents would be proud, the local community would enjoy the information and Sarah’s story could be read. But really, I would be taking away the beauty of what Sarah shared. The opportunity that I now feel humbled and called by God to share His love for His children through this ministry has me writing as I feel led to do. I was well-prepared for my conversation with Sarah. I had studied her portfolio, read the articles submitted in other publications and interviewed her father. Yet, nothing had me prepared for what I discovered. The mind and heart of Sarah Switzer went

by Kelly Reese While sharing my passion for advocating the Tennessee Valley’s medical resources with Jeff Hamilton, CEO of The Orthopaedic Center (TOC), we both agreed our community was full of testimonies. With excitement, he began to share a story of a girl who had accomplished so much in her lifetime. He described her journey as a “True Inspiration.”

On Sunday January 15th, 2017, I had the opportunity to interview Sarah Switzer. I hope one day soon to introduce her as “the world known Sarah Switzer” of the suburban area right here in Madison, AL. The unveiled story of Sarah’s accomplishments throughout her 17 years of life integrate patterns of an area I feel compelled to share. Initially, I wrote a story highlighting the finest points of Sarah’s life, from the history of her loving parents, to the buildup of her diagnosis, to the all exclusive tales of Sarah’s life today and her future goals. This story too would have been great.

true inspiration

much deeper than a diagnosis or a condition she would live out the rest of her life. She is truly embracing it. Sarah’s parents learned 18 weeks into their pregnancy that she would be born to the only life she would know as a human with a condition known as Spina Bifida. We are all human and our differences and unique patterns help mold us into what we become. In Sarah’s case, she was lucky to have had two parents who loved her very much and considered all obstacles as their own blessings. Sarah’s mother, Trish, underwent a risky surgery, only having been performed 50 times, in order to give their daughter the best chances for success and a better quality of life. Having been seen by several specialists, Mike and Trish entered into this world a baby they would call ‘Sarah’ who was considered “born again” since her first surgical procedure was performed through an open incision to her mother’s uterus, months before she arrived. Born twice at 4lbs. 6oz., Sarah celebrates her birthday August 22, 1999, a date 9 weeks earlier than expected. My curiosity peaked as I began to learn more about Sarah and less about her story. She was well spoken with confidence and responded to my many interruptions and direct questions as they continued to layout her almost perfect puzzle, a vision that clearly displays God’s gift in her. Before our interview, she was all the things I plan to share; but more than that, she is human. Her condition does not make her ambitious; she makes herself ambitious. Her sacrifice and work ethic come from a deeper embedded meaning within Inside Medicine | februar y-march 2017

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If you would like to help... At the US Nationals in October 2016, Sarah Switzer was selected as one of 13 athletes to represent the United States at the World Disabled Water Ski Championships in Myuna Bay, Australia. However, she must cover all of her expenses, including flight, lodging, accommodations, food, transportation and travel. It is estimated that the total she needs to be able to compete is $5,000. If you would like to help Sarah represent our country and help Team USA win their 5th consecutive overall gold medal, you can make a donation at : www.gofundme.com/sarah-world-waterski-championships/donate Sarah and her team greatly appreciate your support!

Additional opportunities for disAbled athletes in our community... UAH Ability Sports Network UAH ASN is an adapted youth sport league focusing on Paralympic sports and intended for middle and high school students with physical function limitations. To learn more about ASN, visit: www.uah.edu/asn www.facebook.com/uahasn/

(Sarah’s Story –continued from p. 17)

herself than one would know without asking the questions or taking the time to learn about Sarah. Born to her father’s career which supported our country’s freedom and bared all the responsibilities a Major of the US Army would carry. The Switzers, through many relocations, experienced many cool attractions while living in various places. Sarah described a childhood no different from what I remembered myself. She encountered obstacles that truly affect more children than parents are aware, being exposed to criticism by her peers who were uneducated themselves of Spina Bifida, a condition that left Sarah dependent on bracing in order to stand due to weakness in her legs. If an activity required standing for a long length of time or walking a distance was involved, she was dependent of her wheel chair. Diagnosed in utero with Spina Bifida, Sarah had undergone 3 surgeries: 1 in utero; 1 detethering; 1 successful ankle surgery (performed right here in Huntsville, AL by Dr. Buckley at TOC). With childhood memories of annual evaluations that included X-rays to monitor Sarah’s growth plates and scoliosis- a condition not uncommon for patients with Spina Bifida-, she balanced an active list of achievements, both physically and academically. At the age of seven, she was approached by a ski instructor who introduced her and her family to the idea of water skiing for the disabled, a nationally recognized sport. Naturally, her love for the water had her committed right away. Her mother’s initial response had hesitation to the idea of enlisting her in such an extreme sport. However, she ended up being her biggest cheerleader. By 2011, Sarah had begun her training in the water sport division for the disabled. By 2014, she was competing at the sport that included ski ramps as tall as 5ft with 90ft distant jumps. WOW, I replied. You are paraplegic, and you can do things that I cannot imagine overcoming the fear to try. I want to include a tag pulled from her Facebook page, when announcing this athlete with Spina Bifida, she is the youngest of 13 selected to compete in the World Championship taking place in Australia. I’m honored, humbled even, to introduce you to the youngest member of our 5-PEAT US DisAbled Water Ski TEAM, Ms. Sarah Switzer. I remember seeing her in Life Magazine in 1999 and being awed at the site of her. I asked her to send me some non skiing photos ... I was overwhelmed when I received them. Is it any surprise her hero is God? Talk about an Overcomer! WOW, WOW, WOW. And by the way ... notice her muscles and her grip ... this girl was made to be a World Champion Water Skier. This 2-week trip would include the mental and physical training of climate change, a drastic shift from training in fresh water to the buoyancy difference in Salt water, where the competition will take place. The preparation includes dry land training as well as salt water training. Sarah describes skiing as a competition against one’s own goals. It is unlike the wheel chair basketball league she competes with, where she focuses on team strategies.


} FEATURE

Skiing is a process of achieving your own goals. Even though Sarah describes herself as a perfectionist, this has allowed her to be even more successful. The ability to see herself visually creates an awareness for her to develop change, allowing her to outperform her competitor’s, making her the youngest Champion to attend a prestigious event like Worlds. Her solo-performance at this event still involves contributors for her success. Sarah’s life goals are deeply embedded and influenced by the mentors she surrounds herself with. Sarah described how her mother has been there to support all of her dreams. Caring in-state, outof-state for training and competition, fueling her every step of the way and making sure she had all the tools she needed for success. Emotionally preparing Sarah for life’s friendships and failures. The moments that most often break a spirit had been moments her mother has used to strengthen Sarah’s heart. Trish made known the importance of understanding no one was made perfect, but Christ. Through Faith in Him, she would find a peace in what she was called to do. Sarah’s dad, Mike, has always given the advice Sarah needed to guide her future. She said through his experiences she understood the importance of the life lessons she was brought through. At such a young state in her adulthood, Mike and Trish have prepared their child for success, with the confidence to achieve her goals and the discernment to know what gives glory to God. Mike and Trish prepared Sarah for a future that would include her academic studies. Sarah’s college education had always been a primary focus in her life. She’s always had plans to attend college after high school. Although my list of personal questions during my conversation with her had not been disclosed prior to us talking, her preparation for challenging questions had an affirmative tone. With no hesitation, Sarah’s plans had been well thought out and planned. She hopes to attend The University of Alabama or Auburn University (“Roll Tide” when asked if she had a Fan Favorite) with a primary focus on the medical field. She could see herself as a veterinarian or even a psychologist with an interest in nature. With her involvement with the high school French Club, her undergrad had easily been narrowed down to foreign language studies. Until her busy schedule had her unable to stay committed to an active involvement, Sarah says she enjoyed her role in her school’s French Club. Her motivation comes from wanting to make her family proud. “I’ve always wanted to live up to what I see through them: never give up, always work your hardest, always work for God, and never worry about what people think.” One of her last statements before we finished her interview, “I

love helping people. If I could share my story to help someone else, my goals would be accomplished.” I do not believe that Sarah’s intent was more than an opportunity to help other disabled individuals to succeed, dream and accomplish their goals, as she has a proven track record for achieving. That goal alone would be inspiring, but Sarah’s story is way more than that. She has helped me realize the story had not yet been revealed of a young adult whose Faith supported her values. Her accomplishments could inspire anyone through any faucet. She was truly a miracle for more reasons than a diagnosis, and had she seen this yet beyond her parents, coaches and teacher’s eyes. Had a stranger like myself not yet peeled back her story past the medical phenomenon that her goals had well exceeded her limitations, but the heart and soul of this individual would open her doors to so many opportunities. Ones I pray my children can have. I tell you Sarah Switzer will one day be much more than a resident of our community that we are lucky to have. She will be much more than just that, because she already is. It wasn’t hard to learn Sarah’s story could be one of those people who respond to as, “Wish I could be that way…. BUT.” Given the opportunity, most people would say they couldn’t imagine their life different from what it is; so the ability to think of their response to this situation is something they could not develop. However, for Sarah, she knows nothing else, and for that, she has made the very best of her circumstances. Sarah by definition may have a handicap; but if you ask me, she allows me to see the crutch in all of us as humans. We wear this brace around our mental state that controls our physical mind. But in most of our case and unlike Sarah, this handicap comes without a definitive diagnosis. This mental state of restriction hinders us from making the most out of our circumstances and giving thanks to our blessings. We uncomfortably but almost naturally feel compelled to wrestle with the “I can’t” or “I don’t know how” more often than those who truly have a disadvantage. Sarah sets the bar high, higher than that of which we set for ourselves. She allows her mental state and the influence of her loving parents to operate her physical response, which emulates a determined and motivated inspiration for all people to be more like her, able to achieve her goals. Without limiting herself by what is unfortunate to some is truly a blessing. Without her disability, how would anyone see her reaction as glorifying to God? She allows a vision to live within her, to believe she can do all things through Christ who strengthens me. Philippians 4:13. This life is only but a small fraction of a large picture God has planned for His children. Inside Medicine | februar y-march 2017

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} HEALTH FEATURE

ANTIBIOTIC Prophylaxis by Emily McIntosh, DMD

When to Premedicate for Dental Treatment?

As dentists, we meet patients daily who have medical conditions or have had medical procedures that may put them in a risk category for needing an antibiotic before dental work. However most patients do not know if they need to premedicate, and often they are hearing about it from their dentist for the first time after a change in their medical history. Guidelines have changed considerably over the years which has contributed to the confusion, but below are some of the most up-to-date indications developed by the American Dental Association, American Association of Orthopedic Surgeons, and the American Heart Association. Antibiotic prophylaxis, or premedication, is the act of taking antibiotics one hour prior to certain dental procedures and dental cleanings. We all have normal levels of bacteria in our mouths, and a number of dental treatments can allow bacteria to enter the bloodstream. For someone with a healthy immune system, this bacteria isn’t a problem. However, for those with a weakened or compromised immunity, there is concern that the bacteria can cause an infection elsewhere in the body. The most common types of patients that may need to follow an antibiotic guideline are those with prosthetic joints/orthopedic implants, and those with certain heart conditions.

Heart Conditions

In 2008 the AHA (American Heart Association) changed the guidelines for premedication to a smaller group of patients with specific heart conditions: • Artificial Heart Valves • A history of infective endocarditis (an infection of the lining of the heart or heart valves) • A heart transplant in which a problem developed with one of the valves • Heart conditions present from birth such as: o Unrepaired cyanotic congenital heart disease o Defects repaired with a prosthetic material or device o Repairs with partial defects still present

Prosthetic Joints/Orthopedic Implants:

In the past, premedication was necessary for any patient with prosthetic joints, however as of January 2015, the American Dental Association’s Council on Scientific Affairs determined that most patients are not at a high risk for developing joint infections, and therefore, should not have to take an antibiotic prior to dental treatment. However the new guideline does indicate that some patients may still be at risk to develop infection and are candidates to premedicate based on their medical status. An increased risk of infection is possible with: • Compromised immune system due to diabetes (primarily Type 1) • Rheumatoid arthritis, systemic lupus • Cancer • Chemotherapy • Chronic steroid use It is important to understand that not every heart issue or prosthetic joint requires antibiotics before dental procedures. Antibiotics themselves can cause side effects, from mild stomach upset to allergic reactions. While guidelines for antibiotic prophylaxis are tremendously helpful to patients and clinicians, it is imperative to your health that you discuss with your physician, orthopedist, and dentist the best treatment for you.

Inside Medicine | februar y-march 2017

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} SURGICAL TECHNOLOGY

knee

the forgotten

...with natural motion, you might forget it’s been replaced

by Matthew Clayton, M.D.

Multiple studies have documented that up to 95% of patients report good to excellent pain relief after undergoing a total knee replacement. Unfortunately, only about 85% of patients report that they are fully satisfied with the outcome of their new knees. This begs the question, what is the cause of these patients’ dissatisfaction despite their pain relief ? I believe that this interesting difference between pain relief and satisfaction is likely due to two important factors. The first factor is that patients may have unrealistic expectations of their surgery. One of the most important tasks that a surgeon should complete prior to performing a surgery is to fully explain the likely outcomes and expected recovery from the surgery they are recommending. When realistic expectations are set and clearly understood by the patient, they will be very unlikely to report that they are dissatisfied when the expectations are met. However, if grand expectations are presented to the patients and the outcomes, while still good, fall slightly short, patients will likely report that they are not fully satisfied with their outcomes. As the saying goes, if you promise the stars and the moon and only deliver the stars, they will still long for the moon. The second factor, which has significantly affected my personal practices in total knee replacement, is that many of the knees on the market today are designed to provide stable motion, 22

that often times does not recreate the natural motion of our knees. While the idea of manufacturing a total knee implant that will allow for a natural motion sounds intuitive, very few knee implants are able to accomplish this goal. It is because of this unnatural kinematic motion that I believe patients with pain free total knees may still report that they are not fully satisfied. This is also what has led me to use a knee implant that allows for the most natural kinematic motion of any knee prosthesis on the market today. The Microport Evolution total knee system was designed to mimic patients’ natural knee. It provides great stability to the inside of the knee, while allowing for rotation along the outside of the knee, which is how our knees normally function. This is commonly referred to as a “medial pivot” knee. When you provide this natural motion with a pain-free knee, I have found that you are more likely to

Inside Medicine | februar y-march 2017

have a patient with what I refer to as a “forgotten knee.” This occurs when the knee replacement feels so natural that they forget it has been replaced. This is the best outcome possible after knee replacement surgery. While this is my personal goal for all of my patients, it is not what I tell them to expect. I explain that they can expect a pain-free knee. When this goal is achieved, I have a satisfied patient. Thankfully, since I have started using a knee implant that provides a natural motion, more patients are forgetting that their knee has been replaced. If you are considering a knee replacement surgery, I strongly recommend that you look for a surgeon that you trust. Don’t be afraid to ask questions about the procedure and the expected outcomes. Inquire what implant they will use and why they will use it. Once your questions have been answered and you have made the decision to move forward with surgery, be confident in your decision. A confident, positive patient in the hands of a skilled surgeon will produce a great outcome.


Alleviate Your Knee Pain and Set Your Own Pace My legs are stronger now than ever before! -Terry Bradshaw

The Evolution®MP’s unique design overcomes the limitations of traditional knee replacements with 3 key benefits: Provides stability during everyday activities such as walking down stairs1 Recreates the function and feeling of a healthy knee2 Increases control throughout range of motion3 Experience the difference for yourself, and reclaim your lifestyle with confidence.

To find a Physician near you, please visit: www.MyNewKnee.com Every patient is different, and individual results vary. There are risks and recovery times associated with surgery. Consult your doctor to determine if knee replacement surgery is right for you.

Trademarks and Registered marks of MicroPort Orthopedics Inc. © 2016 MicroPort Orthopedics Inc. All Rights Reserved. 011994 1) Pritchett JW. Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplasty. 2011;26(2):224-8. 2) Freeman MR and Pinskerova V. Journal of Biomechanics. 2005; 38(2): 197-208. 3) LaMontagne M, et al. Quadriceps and Hamstring Muscle Activation and Function Following Medial Pivot and Posterior Stabilized TKA: Pilot Study

Terry Bradshaw is a recipient of the Evolution®MP implant.


} FEATURE

colon cancer Dr. Michael Dohrenwend Center for Digestive Health 256.430.4427

Karen Fox, CRNP

Are you 50 years or older? Time to get screened for colon cancer... Rectal bleeding, change of bowel habits, abdominal pain? Please feel free to call our office for an appointment or visit our website cdhhsv.com. We are happy to help with questions, concerns, and screenings. Center for Digestive Health 7738 B Madison Blvd. | Huntsville, AL 35806 256.430.4427 | cdhhsv.com

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Inside Medicine | februar y-march 2017


–Benjamin Franklin, 1736

Franklin’s famous quote originally was addressing fire safety, however it has been adopted by most as a reference to health care. The goal of preventive medicine is to avoid an undesirable outcome from happening rather than treating an illness once it has happened. A little prevention is worth a pound of cure. Keeping a problem from happening is much better than fixing one. We live in a busy society. We are saturated with family, careers, always somewhere to be and the to-do list is never ending. We are challenged to find time for taking care of ourselves. It seems like there is always an appointment, a child’s function, a deadline at work or a family obligation that competes with time we need to care for ourselves. However, if we don’t take the time to invest in our own health (an ounce of prevention) then we may be faced with a burdensome diagnosis (requiring a pound of cure). March is Colon Cancer awareness month. Colorectal cancer (or just colon cancer) is a cancer that occurs in the large intestine. Colon cancer is one of the most preventable types of cancer. There are currently more than one million colon cancer survivors in the United States. Most of us know someone that has been diagnosed or affected by colon cancer. Colon cancer affects men and women equally. Ninety percent of colon cancer occurs in people over age 50, the risk does increase with age. The National Cancer Institute reports colon cancer is the 2nd leading cause of cancer deaths in men and women in the United States. The lifetime risk of getting colon cancer, according to the Colon Cancer Alliance, is 5% or 1 out of 20 persons. The American Cancer Society estimated 136,830 new cases of colon cancer in the U.S. were diagnosed in 2014. Who is at risk? Anybody age 50 or over is at “Average Risk”. People with a personal history of colon polyps or colon cancer, inflammatory bowel disease such as ulcerative colitis or Crohn’s disease, a genetic condition such as familial adenomatous polyposis or a first degree relative (parent or sibling) with a history of colon cancer are considered at “High Risk” for colon cancer. The U.S. Preventive Services Task Force report of 2016 recommends colon cancer screening for average risk individuals beginning at age 50 years and continuing until age 75.The decision to screen for colon cancer in adults age 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. The American College of Gastroenterology reports the development of 90 percent of colon cancer can be avoided through early detection and removal of precancerous polyps.

The risk and benefits of different colon cancer screening methods vary. Alternative methods include flexible sigmoidoscopy, stool based test (Hemoccult, FIT, Cologuard), ACBE and CT Colonography. The decision on which screening method is best can be made between you and your health care provider. The American College of Gastroenterology Practice Guidelines of 2009 recommend colonoscopy as the preferred colon cancer prevention method. This screening should occur every 10 years for average risk individuals. Colonoscopy is a comprehensive method to examine the entire colon. It is performed by a health care provider who has been specially trained in performing colonoscopies. A colonoscopy is usually an outpatient procedure performed under sedation that takes less than 30 minutes. During a colonoscopy, the health care provider examines the colon looking for polyps or other abnormalities of the colon with an endoscope. A colon polyp is a growth on the lining of the large intestines. Colon polyps can be the forerunner to colon cancer and are therefore removed when found during the colonoscopy. Often there are no obvious symptoms when colon cancer or colon polyps are detected during a screening colonoscopy. A colonoscopy can detect and remove polyps before they develop into cancer. In addition, colon cancer detection at an early stage leads to better outcomes. Remember, “An ounce of prevention is worth a pound of cure”. Warning signs and symptoms of colon cancer are rectal bleeding, change of bowel habits and unexplained abdominal pain. These would be symptoms that would warrant a diagnostic evaluation. A common scenario we see in our office is a person with signs and symptoms they assume are “nothing” but are actually from a serious medical condition. The interval between surveillance colonoscopies is dependent on the results of your prior colonoscopies. Surveillance colonoscopy intervals are based on the number, size and character of the colon polyps found on a prior exam. If you are unfortunate enough to be diagnosed with colon cancer at the time of your colonoscopy, do not despair. Earlier stages of colon cancer are very curable and currently most colon surgeries can be performed laparoscopically. Our office has witnessed several success stories thru early detection. When a patient returns to our office and recognizes how their colonoscopy saved their life, we celebrate together. Getting cancer screening is an investment in your health. All adults should discuss with their health care provider appropriate timing and age of all cancer screenings. Cancer screening is recommended for breast, cervical, colon and lung cancers by the U.S. Preventive Services Task Force in 2016. Take the time for yourself and get screened for cancer. Early detection saves lives and may shorten a treatment plan compared to cancers detected at later stages. The short time it takes to be screened for cancer is a wise investment toward longevity.

Inside Medicine | februar y-march 2017

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Dr. Michael Dohrenwend Board Certified, Gastroenterology

Karen Fox

MSN, Certified Registered Nurse Practitioner .......................................

Are you 50 years old or older?

Time to get screened for colon cancer. Heartburn, trouble swallowing or stomach pain? We can help with your gastrointestinal concerns.

March is Colon Cancer Awareness Month Dr. Michael Dohrenwend

Board Certified, Gastroenterology

Photo by: Jade Cooper

256.430.4427

7738 B Madison Blvd. • Huntsville, AL 35806

www.cdhhsv.com

ridgeline construction residential / commercial

roofing & exteriors

256-325-1345 26

Inside Medicine | februar y-march 2017


Fortress

by Lauren Marsh

Truly he is my rock and my salvation; He is my fortress, I will never be shaken. Psalm 62:2

A few years ago, The Weather Channel rated the top 10 cities for tornados and guess who was number 1: Huntsville. I was actually shocked when I read that; A lifetime of living in this area has cultivated a slight “normalcy” to storms for me. However, there is no doubt that we live in an area that is affected by true seasons and violent storms. It is fair to say that North Alabamians desire the peace of mind of a “fortress”. That was our intent when it came time to build our own home. My husband, Terry and I own Ridgeline Construction which focuses on roofing and exteriors for residential and commercial properties in the Huntsville and Mobile areas. Prior to Ridgeline, Terry worked for builders in Florida and Alabama. Experience has taught us a few things that we felt imperative to incorporate (and not incorporate) into our own home. 1. Invite the Holy Spirit in for protection. 2. Combine the best structurally-sound building methods. 3.Build a storm shelter (a “no-brainer”). In the words of Mark Batterson, author and pastor of National Community Church, “work like it depends on you and pray like it depends on God”. Anyone who has built a home, whether themselves or with a contractor knows that it is a labor of love. Terry was there daily watching over every detail of the building process. I made it my mission to walk thru the house writing on framework the bible verses that I hoped would infiltrate our home. In regard to structural soundness, we used poured concrete foundation and basement walls as opposed to other foundation choices. Not to say that other foundation types are not good options, but the strength that poured concrete offers a stronger house in general. Be prepared for sticker shock! If this is important to you, than you may find worth in trimming other areas of your construction budget to suffice. Engineered trusses top it off (designed by CBS).We also used Tamko Woodgate asphalt shingles. They are both beautiful and offer high

quality roof protection and have an outstanding warranty that Tamko stands behind. Of course, a storm shelter has become a staple in our storm-scarred area. For our shelter, we poured a few extra walls in the basement and added a Liberty Safe Door (provided by Haley’s Flooring and Interiors). It serves as ultimate protection and an ultimate for the “man cave”. The first sirens sounded not too long after we moved in, and I was so grateful for that room! Some other important storm tips worth noting: • • • • • • •

After high winds, eye your roof to ensure that shingles have not blown off. If you notice any shingles in your yard, call a professional to inspect. Keep your gutters free of debris and clean them out regularly. After a hail storm, look for possible hail damage. A professional roofer is licensed and insured and is happy to produce these documents to clients. Even better, the roofer should be a part of the BBB with an A or better rating. If a large storm comes thru, be weary of pass thru contractors. We do not ask clients for payment prior to work being completed. If a contractor asks for payment up front, be especially weary.

It is my prayer for your home to be a fortress as we prepare for the beautiful yet turbulent spring season ahead! Ridgeline Construction has locations in Athens, AL and Spanish Fort, AL. Visit us online and Facebook for more information.

Inside Medicine | februar y-march 2017

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Trying To Be

AIR HEALTHY

The Tennessee Valley is a beautiful part of this great country, and I am proud to call it my home. Almost anywhere you go, you will see beautiful landscapes of rolling hills, farmland and mountainous regions. This beautiful valley that we live in is also known to hold the pollen and other airborne substances that seem to wreak havoc on many of our nasal passages during certain times of the year. You know, those seasonal allergies that always seem to be “in season” to many of us. Unfortunately, these particles in the air don’t just hang around outdoors. They seem to find their way into our homes and into our lives with no escape. While we can’t walk around outside in an airtight bubble every day to avoid contact with these natural born “enemies”, it is important to our families to minimize these allergens from inside our home the best we can. Not only do our homes become the final resting place to particles originating from our natural environment, they are also the dormitory of many other substances that can be harmful to our health. Dust is the primary ma-

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by Brandon Reese

terial that circulates and settles within our homes. This fine powder of earth and waste is usually made up of the plant pollen previously mentioned, human and animal hairs, textile fibers, paper fibers, minerals from soil, human skin cells, and other materials found in the environment. It is hard to imagine that our lungs have to attempt to filter clean air out of this disgusting combination. While our bodies are remarkable machines, protecting it comes with a price and can unfortunately be limited. Allergic reactions to pollen and other airborne particles can, at some level, be managed. Unfortunately, exposure to certain environmental toxins like mold can arguably lead to more severe health conditions. These health conditions are believed by some to range anywhere from respiratory infections to cancer. While it is still hard to prove if and what environmental circumstances could lead to cancer, it shouldn’t be ignored. As we journey into the New Year, it is important to have our homes prepared to protect our loved ones against these potential harmful substances. Many of these preparations are simple and inexpensive measures that shouldn’t be shrugged off as not being a big deal. Things like replacing air filters every 30 days or ensuring ductwork is free of dust and residue build-up are just a couple of preventative measures. Another important precaution is to have your home inspected for mold and unsatisfactory moisture levels. Our southern heat can make attics and crawl spaces seem to sweat with moisture if proper ventilation systems are not in place. We are always looking for help to rid our homes of unwanted pests. Air pollution is a big one! In upcoming issues, we will have expert advice providing tips, tricks and recommendations. There are companies in the area that provide this wonderful service! When it comes to making the air in your home the healthiest it can be, look for a certified Air Systems Cleaning Specialist to help you. www.airessentials.com


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Live life with less pain Advanced nonsurgical pain relief

If you have persistent back or neck pain or have been told you need surgery, Tennessee Valley Pain Consultants has good news. You can get relief with advanced treatment options that are more convenient and less invasive. Our double-board certified physicians are the most experienced in the Tennessee Valley with a combined 100 years experience. Our team provides leading edge pain management with X-ray guided injection therapy for accuracy and IV sedation for comfort. More people choose Tennessee Valley Pain for nonsurgical pain relief than any center in Alabama. In fact, more than 18,000 people trusted our center this year. We shouldn’t be a last resort, but your very first call.

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What we treat: Back and Neck Pain Complex Nerve Pain Discogenic and Radicular Pain

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“Take Two Days at the Beach and Call Me in a Week”

by Jarrod Roussel, PA-C

Many of us have had beach vacations, or know someone who has, where our lives just seem to melt away the moment our toes hit that warm sand. We let the cares of our daily responsibilities disappear, and we become totally absorbed in that moment. Our bodies and our spirits feel instantly better. For some, the mere presence of the warm sunshine makes us feel completely renewed. It would make sense that decompressing makes us feel better, but I think there is more to it than just that. There are some physiologic reasons that contribute to our new onset sense of peace and balance. Being in that setting may actually replenish things that we lack physically. The first benefit is the most obvious which is temporarily removing the daily stressors in our lives. For that designated time, we don’t have to worry about our jobs, our businesses, our homes, our usual commitments, etc. We can just relax enjoying the sand, water, sunshine, and breeze. There is a hormone called cortisol that is released by our adrenal glands, which sit on top of our kidneys. There is a normal daily pattern or rhythm of cortisol release with our levels being highest in the morning after we awaken with the level slowly dropping during the day. It has a number of different functions such as controlling immune function and inflammation. Additional spikes of cortisol are released as it prepares our bodies for the physiologic demands common in stressful situation whether it is mental, physical, or both. These spikes are meant to be temporary with a quick return to baseline levels once the stressor is gone. Regretfully, many of us have filled our lives with continuous or frequent repetitive stressors so that we have chronically high cortisol levels that can have damaging health effects. Paradoxically, prolonged high stressful situations can eventually lead to very low levels of cortisol, which can also be dangerous, because our adrenal glands experience fatigue and can no longer maintain even normal cortisol levels. Spending those several days without long traffic lines, incessant phone ringing, people yelling, or whatever is relevant to you can give our adrenal glands much needed rest. Next is the ever popular sunshine. It is more widely

known that sunlight produces “Vitamin D”, or cholecalciferol, in our skin. Cholecalciferol is actually a prohormone, or precursor, that is converted to its most active form of calcitriol within the kidneys as our bodies need it. The most popular function of Vitamin D is the regulation of calcium in our bodies through absorption in our gut. This ultimately affects calcium levels not only in our bones, but also nerve and muscle tissue. Beyond this, I think we are only scratching the surface of what Vitamin D does. There are studies that show a correlation between low levels and depression. It is believed there may be a link between its deficiency and certain cancers such as colorectal cancers. Thankfully, we can supplement our diets, but I feel nothing truly beats making it naturally. When we spend that extended time in the sun, Vitamin D levels start to rise, which I believe starts to lift our mood. On a related note, some studies suggest that bright light, such as sunlight, can reduce cortisol levels, which one could deduce that this might help control cortisol elevations, but I have not seen any empirical evidence as of yet to support that. It is widely known that our bodies deal with free radicals as byproducts of metabolism and dealing with environmental pollutants such as tobacco smoke and food additives such as nitrates. Free radicals are molecules that have lost an electron in their outer shells. These free radicals are looking for “balance” so they will steal electrons from other nearby molecules which can eventually lead to structural damage of more important molecules. We can help control this with eating foods high in antioxidants, but there is some research to suggest that being physically connected with the Earth causes a flow of electrons into our bodies with the weak electrical current that is omnipresent throughout Inside Medicine |

februar y-march 2017

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The Digital Eye on Health and Wellness

The technology market has grown at an exponential rate leaving people with more options today than ever before. We call upon devices to store agendas, secure journals and find information that ultimately becomes an advisor. Keeping an accurate “digital” eye on health and wellness is also important to many people today. We rely on technology as our main resource for health tips and solutions. Billions of dollars have been spent by individuals trying to find the right tool to offer real-time monitoring of steps, calories, blood pressure, heart rate, sleep quality, mood sensory and even calibrated ECGs/EKGs. With a variety of widgets on the market, finding which product works best for your lifestyle is essential. It is important to remember that health indicator devices are not medical devices. All abnormal readings/information should be confirmed by

an FDA approved medical grade device. However, for less than a dollar per day, health indicators can provide 24/7 monitoring of you and your loved ones. What a relief in a world where so many people care or give guidance to elderly parents and family members. Through app downloads and sharing of alerts, you can stay connected from ultimately anyWEAR you have service, or battery life….

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Inside Medicine | februar y-march 2017

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(continued from p. 31)

the Earth’s crust. These electrons will then satisfy the need required by the free radicals so that they do not produce any further damage. This concept is called “Earthing” or “grounding”. While it may not be widely accepted by everyone, no one can dispute the pleasure one feels from standing on warm sand or a cool, grassy patch of dirt. If this is indeed true, we will spend hours or even days while at the beach with a direct connection to the ocean water or wet sand. This extended time may give a boost to our overall health that presents with a quick improvement in our sense of well-being. While a vacation may be “just what the doctor ordered”, it may not be practical or possible to just relocate to your favorite beach. Good news, however, you don’t have to move to enjoy some of these same benefits. Getting regular sun exposure will produce the same effects. Studies show that 10-15 fifteen minutes of sunlight on exposed arms and legs can produce 10,000 IUs in fair skin. Walking barefooted on grass or dirt can give you the same effect for grounding that the beach gives you. One caveat is to be aware of any chemical treatments applied to the grass. One recommendation stated 45 minutes a day of barefoot exposure to the ground. Concrete can also provide a direct link as well. This may not be practical, but getting regular exposure may make you feel better. Staying indoors and wearing shoes outside insulate us from that connection. I still encourage you, however, to regularly consume plenty of fresh fruits and vegetables to supply your body with antioxidants as well as other vital nutrients. Seth Godin is quoted as saying, “Instead of wondering when your next vacation is, maybe you should set up a life you don’t need to escape from.” Again, it may not be practical to just up and permanently leave our lives, but I think we can all find ways to either reduce stress or find better ways to cope with them. As for today, you can start by simply going outside to get some fresh air and sunshine.

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Inside Medicine | februar y-march 2017


} HEALTHCARE

HMO/

Managed Care Plans Objectives and Requirements

by Tiernan O’Neill

A popular but well bemoaned insurance coverage option for many people has been HMO Managed Care Plans offered by insurance companies. Often these products are offered through private purchase rather than employer benefits, and can almost always be found on the state exchanges in one form or another. They are popular because the premiums tend to be much lower than other options, even including high deductible plans. They are frequently bemoaned because too often patients do not understand the limitations they have now placed on their health care and can subsequently incur greater medical expenses as a result. To understand the reason why these plans exist is best explained by the insurance company’s expectation that their costs generated by patient care will be minimized and contained by the involvement of a physician involved in all health care decisions. They believe this is best served by patients identifying, coordinating and receiving authorization for all of their care by an established and long term Primary Care Physician (PCP). Basically, they expect the involvement of such a physician to be more cost effective than simply allowing patients to coordinate their health care on their own; this is especially relevant in the case of specialists the patients need or want to see.

Here are some of the misunderstood or overlooked guidelines of these plans where most patients encounter their problems:

1 2 3

4 5

The PCP you select must actively accept this role; this is not a one way decision of the patient’s and can’t be determined by the insurance company either. And this relationship needs to be established ahead of the critical times you require them Any and all referrals needed must be initiated and authorized by your PCP; most physicians will require you to see them ahead of your specialist visit in order for them to determine, justify and agree for the need of this appointment. When the term of your initial authorization expires you will need to receive a new referral or extension from your PCP; this should be done well in advance allowing for clinical and administrative timeframes. More importantly, most PCP’s will require you to see them ahead of and in order to receive a new referral. This is because it is within their discretion and responsibility you are receiving effective and appropriate follow-up from these specialists. These three mentioned stipulations need to be satisfied prior to any specialist visit. Most PCP’s will not and actually won’t be allowed by insurance plans to retroactively authorize services for other providers, whether it is an intentional act of the patient or a simple oversight. Lastly and most importantly, all four conditions above and any other not mentioned are the responsibility of the patient. Never allow or assume a third party such as a specialist or insurance company will take care of these for you. Just the same as the financial responsibility of any non-covered services will fall completely on you and you alone if the limitations of this plan are violated.

So really despite the pervasive attitudes that these plans are too difficult to adhere to, they can in fact be a good way for patients to lower their premiums and other health care costs. They do however require your attention to the limitations, expectations and responsibilities. It would be really hard to argue PCP involvement, knowledge and expertise in coordinating your health care needs/services to be a bad idea. It does however require planning and adherence by patients; all of which are reasonable and pretty common expectations for any insurance coverage plan.

Inside Medicine | februar y-march 2017

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} HEALTH FEATURE

Save Time. Train at Home.

by Pat Ballew, 2015 Mr. Alabama

Are you ready for a better you? Then look no further! Today I’m going to share a few tips to help you start living a healthier and happier life. We are going to get started with everyone’s favorite subject, “food”. Remember healthy eating is not a diet, it’s about making better choices when it comes to the food that we put into our bodies. Most people tend to over think their food choices and make healthy eating way too complicated. What I recommend is starting with a four meal, meal plan split up throughout your day. This is a great way to spread out your food intake and speed up your metabolism in the process. I know what you are thinking. What kind of foods can you eat? In my opinion, our meals should be a combination of proteins, carbs, healthy fats and vegetables. The list of meal options is limitless. In each meal, around 50 percent of calories should come from protein and the other 50 percent should be split up evenly between your carbs, healthy fats, and vegetables. Most people find that between 2200-3200 calories per day is sufficient. However, no two people are the same, so you may need to adjust those numbers accordingly to achieve your desired outcome. Now we get to talk about the fun stuff, fitness, aka Cardio! Cardio is one of the most important things you can do for your body. With that being said, cardio can be anything that gets your heart rate elevated to your desired target zone. It only takes 20 to 30 minutes a day, four to five times a week, to reap major benefits. Most of us spend way more time than that watching television. One of my favorite forms of cardio is what people like to call HIIT (High Intensity Interval Training). What is HIIT? HIIT is a training technique in which you give 100% max effort for a burst followed by a slower moderate pace, then back and forth until failure is reached or your desired time limit is up. This helps you burn more fat in less time. Consistency will be the key to your success. Take it one day at a time and look at it as a marathon, not a sprint. Your health is an investment, now invest wisely.

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www.homefitconsulting.com Inside Medicine | februar y-march 2017

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} FEATURE

Fighting Obesity to Prevent the Big “C” by Adrienne Dowd, MS, RDN, RYT

The food we eat, the beverages we drink, the

High Nutrient Dense Foods

environment in which we live, all have great impacts

Calorie dense, nutrient poor foods can lead to undernourished,

on our health. Eating a healthy diet not only helps

obese individuals. A general rule of thumb is to go for foods that

prevent cancer, but other diseases too, such as diabetes, heart disease, obesity, etc. Even with this knowledge, our country is still in an obesity epidemic where one in three adults in the United States are considered obese (BMI >30) and only

are not highly processed. Avoid foods such as fast foods, most snack foods and sodas. Plant-based foods like vegetables, fruits, and whole grains have high amounts of phytonutrients to feed your body. These ‘phytonutrients’ (literally meaning the nutrients that are found in plants) contain antioxidants, flavonoids, chlorophyll, glucosinolates, carotenoids, etc. to

2.7% of Americans meet the four major healthy

help protect your cells from oxidative damage, which can

lifestyle characteristics: not smoking, getting enough

lead to cancer. A lot of “diet” foods have low calories, but

physical activity, eating a healthy diet, and not

also have few nutrients which can leave your body wanting

having over the recommended amount of body fat. Keeping a healthy weight and creating an optimal environment inside and outside your body is one of the best ways to decrease your disease risk. Below are four methods in which to keep your weight (and cancer risk) in check.

more since it has not been properly “fed”. Consider the fuel grade you put in your car…the higher quality, cleaner fuel you use, the better your car will run right? Same with the “fuel” we put in our bodies. Go for quality, not quantity.

Fiber When we are eating more plant-based foods, we naturally receive more fiber. Fiber is great for keeping you feeling full and helps with your ‘morning constitution’ (provided you are also staying hydrated!), which facilitates the removal of body waste and other toxins. Many fibers, known as prebiotics, help feed the good bacteria in your gut. This good bacteria network is known as your gut microbiome. Foods high in prebiotics include asparagus, leeks, onions, garlic, bananas, and legumes just to name a few. Having poor mircobiome diversity has been directly shown to be linked with obesity and associated diseases such as diabetes and high blood pressure. As discussed earlier, obesity is a factor in cancer risk.

Low Glycemic Load Glycemic load is different than the glycemic index as it provides a more accurate look at what effect food has on your blood sugar. Some foods that may be high on the glycemic index will actually have a low glycemic load. Grapes, (continued on p. 41) 38

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Adoption is not a fairy tale. It is full of loss, pain, and grief. But, our God is greater than all of these and He is a redeemer.

Inside Medicine | februar y-march 2017

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} FEATURE (continued from p. 38)

bananas, watermelon, carrots and sweet potatoes are often

can also disrupt your natural hormone balance.

shunned due to their high glycemic index, but in fact have

We all know now that BPA is harmful and have actually

a low glycemic load. Eating foods with a high glycemic load

been banned from baby bottles. However, what about

(refined carbohydrates such as sugary beverages, candies,

other plastics? Many companies have replaced BPA with

cakes, pastries, cookies, white bread/crackers/cereals/rice/

BPS. About 80% of Americans have detectable levels of

pasta, etc) on a regular basis can lead to weight gain, poor

BPS in their urine. Research is showing BPS is no safer than

gut bacteria, and insulin resistance. We know these factors

BPA. Exposure to these endocrine disruptors can have a

increase the risk for diabetes and metabolic syndrome and

negative effect on body weight and metabolism. Store and

all contribute to cancer risk. It’s a slippery slope!

reheat foods in glass rather than plastic and use a reusable glass or stainless steel water bottle.

Low Environmental Toxin Exposure Your best bet is to eat foods grown locally from a farmer who

In addition to eating a nutrient rich diet and keeping a

does not use pesticides/herbicides. If this isn’t an option,

healthy weight, make sure to get some exercise daily, spend

choose foods that are organically grown. Produce stickers

some time outdoors, and get eight hours of good quality

that start with a ‘9’ indicate they are organic. Check out the

sleep. Unfortunately, there just isn’t a magic bullet. It truly

Environmental Working Group’s Dirty Dozen list for the

takes an overall healthy lifestyle to ensure you are creating

twelve fruits and vegetables that have the highest amounts

an optimal environment for your body to thrive. After all,

of pesticide residue. Pesticides are known carcinogens and

you only get one body.

At His Feet

1 Peter 5:7 NIV. Cast all of your cares on Him, for he cares for you.

I recently observed my sister’s dogs at play. Thor, who was the smallest one, had some difficulty keeping up with the other dogs. Whenever he needed a rest, he would run to Avie and sit beside her feet. I imagine that he felt safe there from the rough and tumble of the other dogs and because she was someone that he trusted. After a few minutes of rest, he would resume play with the other dogs. This reminds me of many individuals mentioned in the Bible, as well as some that I know who took refuge at the feet of Jesus. A leper with a contagious and dreaded disease recognized the possibilities if he could only get close to Jesus. Defying the social norms, he made his way to Jesus and knelt at his feet. Yes, Jesus was willing to heal and restore. (Mark 1:40-45) I think of a demon possessed man who lived among the tombs of the dead and was tormented by Legion. He was found clothed and in his right mind while sitting at the feet of Jesus. What a transformation! (Mark 5:1-20) Then there was the woman who was sick with an issue of blood for longer than any of us would want to be. Her health was restored through faith in Jesus as she stooped to touch the hem of his garment. (Luke 8:43-48 NIV)

I think also of the centurion who had previously doubted that Jesus was the Son of God until he stood at the foot of the cross. (Matt 27:54 NIV) We too get tired of the pain and struggles that we go through in life. We are constantly on the go dealing with jobs, family, education, illness and even attacks from the enemy. Sometimes the more we are challenged, the more we struggle. Isn’t it time for us to take a break? What are the possibilities for you and for me today if we were to sit at the feet of Jesus. He has so much to offer us: peace, contentment, hope, healing, forgiveness, salvation and so much more. Just as Thor felt safe at Avie’s feet, we too can be assured that we will be safe at the feet of Jesus. There is a saying that a dog is a man’s best friend. I would like to suggest that Jesus is man’s best friend. He is a friend that sticks closer to us than a brother. Whatever you are in need of today, it is available at the feet of Jesus. He has invited us to come: “come unto Me all who labor and are heavy laden and I will give you rest” (Matt: 11-28 NIV) –Myrna Brandon Inside Medicine | februar y-march 2017

41


#lcsforkids

#iconnect

virtualschool at Limestone County Schools

Career Technical Center

To learn more about Limestone County Schools contact Superintendent Dr. Tom Sisk at: 300 South Jefferson Street • Athens, Alabama 35611 (256) 232-5353 • Fax: (256) 233-6461 • Website: www.lcsk12.org

@lcsforkids

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by Velvet Black

Mission The LCCTC offers a real-world learning experience where career dreams become reality. Through professional instruction and hands-on experience, we ensure students develop the skills necessary to become productive citizens.

We love to have the public come out to see what we have to offer! For more information on the center and how to schedule your tour, visit www.careertechnical.org

The LCCTC’s faculty and staff are committed to offering its students a diverse, rigorous, technology advanced, business and industry driven curriculum. The program list is quite extensive (23 are available). From engineering to Cyber Security to Health Science to Architecture and Drafting to cosmetology, to food service, to law enforcement and teacher/training, the Limestone County Career Technical Center offers a chance for students to “go pro with learning that works”. Students can choose from programs in any one of the 16 Career Clusters offered by the Career Technical division of the State Department of Education. The center works together with local Business and Industry to ensure students are learning relevant skills for the marketplace. As an extension to the local curriculum students that attend Limestone County Schools and Athens City Schools, in grades 9-12, enjoy hands-on courses that allow an easier transition from school to college and career. 2.5 hour sessions are offered in either the morning or afternoon. Social studies classes and special education classes are also found on the campus. In addition, the system’s Virtual School is housed at the center. In our job centered world, a career technical education can put students ahead of the class with necessary skills as well as Industry Recognized Credentials. One such credential is the Certified LabVIEW Associate Developer title by National Instruments. This certification, which is given to programmers proficient in programming language specific to engineering programs, has only been awarded to nine high schoolers in the world. Five of those individuals are or have been students at the Career Technical Center. Industry, which has been experiencing a shortage of these certified employees, reached out to the center to see if it would allow its students to train for the program as well as test for the certification. This certification, according to Superintendent Dr. Tom Sisk, is a testament to the caliber of the LCCTC faculty and the many programs it has to offer. Whether a student is college bound, career bound or both, professional educators lead the way - giving these students a vast set of life skills that prepare them for the rest of their lives. All of the programs at the LCCTC involve a rigorous curriculum which includes soft skills essential to obtain a job and to maintain a successful career. The center employs Career Coaches that ensure that all seniors have a four-year plan. Prior to exiting the CTC program, all seniors will have the opportunity to obtain an industry-recognized credential, go through the process of mock interviews conducted by leaders of industry, and leave the program with a professionally-written resume. With its diverse opportunities, LCCTC empowers students to be successful citizens, employees, and leaders in the ever-changing global economy. Inside Medicine | februar y-march 2017

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} FEATURE

I was a young, first year OB/GYN resident-in-training in a busy hospital in India. It was an exciting environment. I was eager to learn. I enjoyed the constant challenge of learning the art of medicine. Malpractice insurance, medical marketing companies and encounters with lawyers were rare. Physician’s skills were dependent on close observation, careful history taking, learning to “see” with all the senses, and listening to the patient with open heart and mind. The wonders of ultrasound and pregnancy tests were reserved for patients in whom they were considered crucial; ordering them routinely would have caused raised eyebrows among one’s colleagues. Patients were simply pleased with the opportunity to be seen by a doctor. Some of them had to travel for several hours by train, bus and foot to reach the hospital. One of my assignments was a primigravida (a woman who is pregnant for the first time) in her early 20’s in her third trimester. I had diagnosed her baby as an extended breach. The young woman came for her prenatal check-ups with a sparkle in her eyes. Late one afternoon according to schedule, her labor pains began, and she came to the hospital. She progressed through the first stage of labor and began the second stage as the sun went down. I was not worried about the delivery as my attending had assured me that she would be there to supervise me. The nurse on duty and I encouraged the patient to push. My patient complied. The delivery of the body of the baby was textbookperfect. Suddenly, the longest 20 seconds of my career began when the electricity went off. It was so dark in the delivery room that I knew I must see with my hands if this baby was to survive. I palpated the baby’s head and felt the umbilical cord around

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Inside Medicine | februar y-march 2017

the neck. Groping in the dark, I found a hemostat and scissors while telling the nurse to open the window curtains. A glimmer of moonlight entered the room. I managed to cut the umbilical cord and remain outwardly calm. However, my pulse was racing as I delivered the head without any problem. I stimulated the baby in the dark delivery room and was relieved to hear its first cry. As if it was on cue, the power was restored with the baby’s cry, and the room was suddenly flooded with the modern miracle of electric light. Even today, recalling that special delivery so many years ago causes my heart to race and the proverbial goose bumps to return.


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} HEALTHY LIVING

dO YOU REALLY KNOW ABOUT TYPE 1 DIABETES? by Jennifer Grady Jeffers

Development Coordinator for JDRF

In my world with JDRF (formerly the Juvenile Diabetes Research Foundation), there is rarely a day that goes by that I don’t have to explain the difference between type 1 and type 2 diabetes. Many often confuse the two, which is very normal as they do have some similarities. However they are extremely different. Many believe that when a child is diagnosed with Type 1, it is brought on by being overweight or because their parent’s allow them to eat too much sugar, but that is just not the case. Let me explain:

Type 1 diabetes (T1D) is an autoimmune disease that

cannot be prevented. It occurs when a person’s pancreas stops producing insulin, a hormone that enables people to get energy from food. People with T1D experience both dangerous high and low blood sugar levels and may have potential ties to genetic and environmental factors. T1D usually strikes in childhood, adolescence, or young adulthood and lasts a lifetime. Children and adults must balance blood sugar levels (BSL) consistently as well as take multiple injections of insulin daily or continually infuse insulin through a pump to just stay alive. Counting carbs and exercise are also critical T1D management. T1D comes with lifelong complications and battling something such as a common cold can sometimes be a challenge. Another misnomer is that children with T1D cannot have sweets. People with T1D can enjoy all types of food including sweets. However, like with everyone, moderation is key. The only difference is a person with T1D has to account for the amount insulin they take in to offset whatever they eat. 46

Inside Medicine | februar y-march 2017

Type 2 diabetes (T2D) is tied to your metabolism

and genetic factors. A person’s body still produces insulin but is unable to use it effectively. T2D is usually diagnosed in adulthood. However, increased obesity has led to a recent rise in the cases of T2D in children and young adult. People with T2D do not always require insulin injections and in many cases, T2D can be prevented or delayed with diet and exercise. Those living with T2D also rarely experience the immediate dangers associated with low blood sugar levels but do have to combat high blood sugars that can have long term effects on the entire body. As someone with type 2 myself, I can attest to the continuous uphill battle with high sugar levels. I’m at the point that if I even look at a donut, my BSL is elevated. So I do my best to stay on top of it by following my Doctor’s instructions closely. This brings me to my last point; people with T2D also need a lower carb intake versus counting carbs, so limiting those wonderful yummy treats are a must! As you can see, there is a significant difference between the two. And to clarify, taking insulin does not cure any type of diabetes, nor does it prevent the possibility of the devastating effects of the disease including kidney failure, blindness, nerve damage, heart attack, stroke, and pregnancy complications. By understanding the two diseases, hopefully people will have better insight on the significant dangers caused by both. Specifically, the damaging effects T1D has on our young children and the burden they carry every day. (continued on p. 48)


A New Phase in Life...

“The longer I live the more beautiful life becomes.”

It has been more than 17 years since I entered a new phase in life and journeyed into the world of senior living. Like many seniors who plan to retire but not for senior living, I prepared for a career in healthcare but not in senior living. However, once I discovered the joys of senior living, I found myself saying like so many seniors who make the choice for assisted living do, “Oh, how I wish I had done this sooner!” I found so much more than a career. I found my calling; I found my passion…serving seniors and their families through this new phase of their life. What does this new phase look like for seniors? Independence! When a senior chooses assisted living, they often find more of the one thing they fear losing the most – their independence. Because the support system is built in to the assisted living community, a resident has the support for things they may need like meals, housekeeping, maintenance, transportation and activities of

daily living such as bathing, dressing, grooming, and medication assistance if needed. Sometimes, it is just the simple peace of mind that someone is there. I do not make light of the transition of moving from your home into an assisted living community. However, I can tell you what hundreds of residents and families have shared with me over nearly two decades. On the other side of the move, there is so much more than housekeeping and meals, more than birthdays and bingo! Residents find meaning and purpose, renewed hobbies and perhaps the discovery of new ones. There is conversation, laughter and friendship. There are precious memories being made, every day. Independence. That is what this new phase in life looks like for the senior who chooses assisted living. As I have served seniors in many wonderful communities and had incredible mentors along the way, I am thrilled that today

Frank Lloyd Wright

my new phase in life brings me to a fantastic new senior living community just around the corner from my alma mater (Grissom High School) and the church where I was baptized (Willowbrook). A new community where our founder was raised with excellent customer service principles and in 2008 decided to bring a new, innovative approach to assisted living. A community where our President was a Resident…a community where it is truly Assisted Living Like You’ve Never Seen Before! With this new phase in life, I am Thriving! As Robert Browning said “Grow old along with me! The best is yet to be.” Do you have questions about Senior Living Options? Please call to explore the options available in the North Alabama area. Michelle Herrin-Anderson 256.429.0038 michelle.anderson@thriveatjonesfarm.com

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} FEATURE

(Diabetes—continued from p. 46)

JDRF has a strong presence in Alabama with a Chapter office in Birmingham and a satellite office in the Huntsville area

Before 1970, a T1D diagnosis was basically a death sentence to most. This was the premise for JDRF, founded over 40 years ago by two mothers with children diagnosed with T1D.

............................................................ If you would like more information on free diabetes education for you, your child’s school, your business and/or organization, or would like more information on how you can support our One Walk, please contact Jenni Jeffers at jjeffers@jdrf.org or 256.794.1970. You can also visit walk.jdrf.org/northalabama. Please help us create a world without type one!

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When children are initially diagnosed with T1D, they usually spend a minimum of 3 days in the hospital. Many end up spending multiple days in the ICU because their tiny bodies have gone into a life-threatening condition called diabetic ketoacidosis or more commonly referred to DKA. DKA is when the body is unable to get the sugar needed for energy due to the lack of insulin. This in laymen’s terms ultimately poisons the blood stream. Through my tenure with JDRF, I have seen hundreds of children and parents terrified by this diagnosis. It’s intimidating, overwhelming and once discharged, both parent and child carry the burden of basically becoming a medical professional, a necessity to keep the child alive. The entire family is impacted. Those everyday simple tasks we all take for granted become not so simple anymore. The ease of running through the drive through to pick up dinner for your family on a busy night is just not that simple anymore. Everything that a child puts in their mouth has to be accounted for as it relates to carb counts. It then has to be entered into a long and arduous math problem for a minute amount of insulin. There are days when a child cannot participate in recess due to low BSL. Children with T1D cannot attend school-related activities such as fieldtrips, sports, etc… unless a R.N. or their parent/guardian is in attendance. Their lives become complicated and turned upside down. Before 1970, a T1D diagnosis was basically a death sentence to most. This was the premise for JDRF, founded over 40 years ago by two mothers with children diagnosed with T1D. JDRF has made tremendous strides and is on a very strategic mission to not only raise money for a cure for T1D, but also use research dollars to develop better treatments and possible prevention, to hopefully relieve some of the burden the families are faced with on a day to day basis. JDRF is the world’s leader in T1D research with currently more than 50 clinical trials, some of which are in the final stages and pending FDA approval. In addition, we do have programs related to T2D’s as well. Our Clinical Trial Connection matches children and adults all over the world with research initiatives that could ultimately and positively impact your diabetic-related medical care. JDRF has a strong presence in Alabama with a Chapter office in Birmingham and a satellite office in the Huntsville area. Our focus is on fundraising, advocacy and community education. We host a variety of educational sessions throughout the year for schools, corporations and newly diagnosed patients. Our annual North Alabama One Walk to Cure Diabetes is hosted by HudsonAlpha and the Jackson Center. This year’s One Walk will be held April 22nd at 9 AM. With tremendous support from organizations such as Huntsville Hospital’s Women & Children, Redstone Federal Credit Union, Digium, Iron Mountain Solutions, Torch Technologies, Intergraph, ADTRAN, Renasant Bank, Target, NBC Bank, LAMAR and many more, we are able to host this family-focused and super fun event each year! We will have multiple food vendors, kids activities in Clayton’s Kids Village including a Lowe’s Build and Grow project, an Art Station by Spirited Art, a Hair Art Station hosted by the Paul Mitchell School and much more! New this year will be retail vendors including LuLa Roe by Wendy Adkins, The Little Mended Table, Premiere Jewelry and more. A portion of the retail vendor sales on Walk Day will benefit JDRF! More importantly, we will have multiple diabetes-related companies on-site to help answer questions related to insulin-pumps, insulin, BSL testing, research and on-site diabetes testing and more! There is no charge to walk or to attend, - it’s a FREE event, but registration is required. Because of the kind donations we receive, we are able to host this event at no cost to our participants, leaving over 80% of funds raised to support our mission!

Inside Medicine | februar y-march 2017


married to medicine by Lisa Layton

I have a confession to make. Twenty six years ago, I fell in love with a married man. I fell in love with an orthopaedic resident who was married to his job. As a young wife, I had all of the hopes and dreams of any newlywed. In all reality, I was in a mostly one person marriage, and strangely, I could not have been happier. I got to see first-hand how my husband was living his dream; he was utilizing his gift. His hands were becoming tools that would serve his patients. Many people don’t realize that as medical residents, being the perfect doctor for their patients is priority; the marriage is not. That is the beauty and the beast of this occupation. It is the ‘for better and for worse’ of being married to medicine. We have two children who learned to be night owls, waiting to see their dad for just a little bit. My 16 year old son recently remembered his kindergarten teacher lending her son to be his stand-in dad on Daddy Donut Day, since his real dad was not able to attend. He said he cried and was scarred for life, or at least until recess came! While the early days could be a struggle, hearing the story of a patient whose painful quality of life was improved, or of an athlete who got a scholarship due to a full recovery from a successful surgery, made the hard days worth it. Those experiences show us there are purposes in our struggles. The rewards outweigh the sacrifices. I realize now that medicine is not a job my husband does. It is a job we both do every day. It takes 100% of everything I have to be a wife, mom and occasionally, to be a dad too. Other times that 100% is simply the effort to smile through exhaustion; but isn’t that life in general? Isn’t that all God asks of each of us every day? Some days we can give more, but every day we are to give all we have in order to finish the race. As doctors’ spouses, we may feel like our identity disappears behind the shadow of their white coat and scrubs, but to see a patient smile and tell you their story makes those of us married to medicine know it was worth it. Think about that favorite doctor of yours and know that you are not just a patient…you too are part of this journey.

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Inside Medicine | februar y-march 2017

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In search of solutions to

Bridge the Gap Physician Extenders to Close the Ranks of Emerging Healthcare Shortages by Kari Kingsley, MSN, CRNP

Legs slightly crossed, with my back posture as stiff as that of a military cadet, I nervously clear my throat as my interview for what I consider to be the cremdelacreme of nurse practitioner positions begins. Sitting across from the impeccably dressed and perspicacious otolaryngologist, I silently pray she won’t notice the bead of sweat forming on my upper lip or the faint quiver in my voice as I try to answer her straightforward questions in the most astute way my nervous 29-year-old brain could formulate. Luckily, she missed my dry heaves in the ornate Viburnum bushes landscaping her charming office parking lot, after the interview concluded. Thinking back on that moment, a smile inches across my face. My nerves got the best of me. At the time, I would have bet the entire Powerball Lottery I wouldn’t be getting the job offer. I’d never been so happy to be wrong. I now con-

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} FEATURE

sider my collaborative physician to be not only my mentor, but one of my dearest friends and confidants. I jokingly embellish the retelling of my interview story by adding that I made sure to find out Dr. Neeta Kohli-Dang’s dress style and shoe size before we agreed on terms so that I could take full advantage of her flawless taste in clothes and accessories AND her generous heart when it comes to lending me outfits for special occasions. I count my blessings daily for the working relationship I have with my boss. I have nurse practitioner and physician assistant friends at all ends of the spectrum in terms of job satisfaction and fulfillment. They range from highly salaried slave labor positions in which they work grueling hours, rarely seeing their families all the way to those seeing 5 patients a day, begging for more work. I’m happy to fall in the middle. We run a state of the art ENT practice performing cutting-edge in office surgeries using low radiation CT imaging, complete with in office neck and thyroid ultrasounds, a speech pathology department, and audiologic testing. Likewise, Dr. Dang recognizes in me a very hardworking, OCD, type-A nurse practitioner that loves to solve the puzzles human anatomy and physiology can pose. While exemplary patient care is always our top priority, we still find a few minutes here and there to laugh and sip lattes. As our aging population continues to grow and as we continue to make astonishing advancements in medicine, raising the cost of healthcare, the American medical paradigm is shifting into uncharted waters. As our Baby-Boomers retire, the growing demand for healthcare abuts our government’s dwindling reimbursement deterring many young medical school graduates from a career in primary care… or a career in medicine altogether. Reduced reimbursement also lays a heavy burden on specialists requiring heavier patient loads with less time to spend on one-on-one care. Dawn C. Joy, Accredited Practitioner and Nursing Instructor at Gannon University has said, “I feel that the healthcare system is an upside-down pyramid; we have the personnel with the most education and knowledge farthest away from the patient because of administrative and regulatory requirements.”

So, what’s the solution when you need to connect two separate forces and bring the patients at the top of the pyramid to meet physicians at the bottom? To put it simply: You build a bridge. Physician extenders such as nurse practitioners, physician assistants, and nurse midwives are specially trained individuals, licensed to perform certain tasks and procedures that might otherwise be performed by physicians themselves. They work under the direction of a supervising or collaborating physician to bridge the gap. Physician extenders are not meant to replace physicians, simply to extend highly-skilled, quality medical care such as determining differential diagnoses, implementing protocols of care, using critical thinking skills to interpret laboratory tests and medical imaging, and performing patient education regarding various treatment modalities. Physician extenders alone will not solve the tough healthcare reform changes America has to face. But they do provide a valuable solution to an accelerating need by providing competent medical care. Metaphorically (and possibly literally), nurse practitioners and physician assistants will be the bridge on which we will carry our patients from the top of Dawn Joy’s pyramid to the bottom. Bariatric physician extenders are reaching for their back braces as they read this. When I put ink to paper and list the top characteristics my “Dream Job” would entail, my position with Dr. Neeta KohliDang at Huntsville Ear, Nose, and Throat fulfills them all. She and I have formed an enthusiastic working relationship with a strong passion to provide exemplary care to our patients, which enriches both our lives. These strong interpersonal relationships between physician and physician extender are vital to support our efforts to bridge care to patients. And it doesn’t hurt that I get to borrow Dr. Dang’s Jimmy Choo’s. Kari Kingsley is a board certified acute nurse practitioner. She graduated from the University of Alabama in Huntsville with a Master of Science in Nursing. She maintained a 4.0 GPA throughout her training and graduated with honors. Kari is licensed by the Alabama Board of Nursing and certified by the American Nurses Credentialing Center. She currently serves on the Board of the North Alabama Nurse Practitioner Association and is the Huntsville Chair-person for the American Foundation for Suicide Prevention.

Inside Medicine | februar y-march 2017

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Carry me Safely Downstream by Andy John King Campus Pastor, Lindsay Lane East

When I was in college, my friends and I traveled to Tennessee for a weekend white water rafting trip. While I do enjoy white water rafting, I’m not much of a risk taker or an adventure seeker. Truth be told, I usually err on the side of caution, so when the river guide gave us the safety speech, I made sure to pay attention. During that speech, the guide told us that if a rapid tossed us over the side and we found ourselves under the raft and in the water to “SWIM ONE WAY”. The reason for this instruction is due to the feeling of panic. Panic would send a swimmer in that situation in all kinds of directions seeking a way out, but it would ultimately delay escape to safety. Wouldn’t you know it, half way down the river, a rapid tossed a few of us out of the raft and into the water; and when my head came to the surface of the water, the raft was on top of me. Quickly I remembered, “Swim One Way”. I began to swim like a gold medalist in a single direction and within seconds the rapids sucked me up from beneath the water and carried me safely downstream to where I shortly joined my group again. I can still remember those few seconds… sheer panic. In that brief moment, I had a choice between feeling or faith. Everything within me wanted to absolutely freak out, fall apart, and

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move at random for anything that felt right; but faith said to trust the guide. Not only was the guide a knowledgeable expert, but the guide had our best interest in mind. He knew the ride would have its struggles, unexpected circumstances, and even possible falls, but he also knew how to get us to the end. I didn’t understand all of the guide’s advice and perspective, but he did and when compared to my knowledge and perspective, I chose to trust the guide. Hopefully the point is becoming clear by now. Ours is the choice to trust our feelings or to trust the Guide. In Proverbs 4:23, the Bible instructs man “guard your heart above all else, for it determines the course of your life”. This is warning towards living according to how we feel. Living by feeling is limited and does not keep perspective, leaving one to swim in circles within the here and now. Proverbs 3:5-6 suggests that we trust the Guide: “Trust in the Lord with all your heart; do not depend on your own understanding. Seek His will in all you do and He will show you which path to take.” Though living by faith can be difficult, it is dependable because the object of our faith – Jesus – is our dependable, experienced, knowledgeable, compassionate, all powerful, eternal guide.


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