Inside Medicine Volume 3 Issue 17

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Volume 3 Issue 17

TELEMEDICINE

& THE BLOCKBUSTER VIDEO EXPERIENCE

let's look to the

best

Cervical Disc Replacement M6

$4.95 US


A Different Kind of House Call

When you can’t see your doctor in person, a telehealth visit may be the solution. Telehealth simply means a doctor visit on your smartphone, tablet, or computer. You can talk with your provider from any location just as you would in the doctor’s office.

Call 1-888-261-3422 or visit CrestwoodMedGroup.com to find out how to connect with a provider.

Many insurance plans cover telehealth. Check your plan coverage or ask when you make an appointment.

MEDICAL GROUP CrestwoodMedGroup.com



HOPE. HEALING. One out of two adults has back pain. When it keeps you from doing your routine, then it’s time to find the options that are right for you. Call us to treat your entire spine. It’s care that helps get you back to your life.

(256) 533-1600 | spineandneuro.org



features &

CONTENTS

Sharing with Purpose

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FEATURES Cervical Disc Replacement M6

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Alternative Surgical Option for those with Neck Pain

Let’s Look to the Best

Finding Ourselves No Matter the Season

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Thriving in Unknown Seasons

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Transform Your Challenges into Opportunities

Telemedicine & The Blockbuster Video Experience

CONTENT

High Tech Pain Relief

Be Still My Beating Mind

CO NTRI B UTORS Elisa Brooks Sanat Dixit, M.D. Kari Kingsley, MSN, CRNP

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Individualized Pain Relief for those with Chronic Pain

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Macy Magnusson, MS Jacqueline Makowski Elizabeth McCleskey, DO

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Valeria McConnell Larry M. Parker, M.D.

Learning to Meditate

How COVID-19 is Reshaping Healthcare

Javier Reto, M.D. Rachel Sullivan, MFTA Tara Vardaman, MS, RDN, LD

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

change the way healthcare information

has been and will be distributed for

years to come. To reach our readers, whether through

editorial contribution or advertising, please contact Kelly Reese at

kellyreese.im@gmail.com or 256.652.8089

Making a Difference

MD

SA L ES & MARKE TING

The information and opinions contained in this publication constitute general medical information only and should not be construed as medical advice. Before making important medical decisions, readers should consult with a physician or trained medical provider of their choice and have their needs and concerns assessed in a clinical setting appropriate for their problem. 6

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

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

P U BL I S HE R Blake Bentley, President www.insidem e dicine .com


} FROM THE EDITOR

Dear Readers– Wow. Would we have ever imagined we would have lived through a pandemic??? We are hopefully on the upside of the crisis but every day brings about something new. New data, new stories, new trials and new successes, we are watching so much unravel before us. Everyone seems to have opinions and everyone is looking for answers.

Living Through a Pandemic

Putting together this issue of Inside Medicine has been quite different. We have worked tirelessly to bring you very informative, up to date information while staying true to our calling. It is such a blessing to be a part of this publication that allows us to meet so many people and bring their stories and expertise to you in print form. While this is an unprecedented time for all of us, I’m excited for you to see what we have to offer this go round. I just know you are going to enjoy this edition and learn something new or have something to share with others. I hope and pray you come away after reading through our stories, more knowledgeable, more caring, and more up to speed on the world around us. Once again, Kari Kingsley gives us a great editorial. This time, she explains meditation and how it helps in her life. She challenges the reader to join her and let go of worries and restlessness. Along the same lines, we have 2 more mental health pieces in this issue. Rachel Sullivan gives us insight on finding our own coping mechanisms while Elissa Brooks explains how we can find ourselves while dealing with whatever comes along. All three articles are great examples of many things we are all looking for help with during these trying times. Also in this edition of Inside Medicine, you will find quotes from teachers dealing with teaching during quarantine, how a local hospital handles infection control, opinions on whether to wear a mask or not to wear a mask, how surgeons are dealing with operations while being safe, telemedicine, and even a story about high tech pain relief. There is so much good information packed in this time! Our team at Inside Medicine is passionate about providing you with the best information out there. We also want our readers to know we are praying for you all and sending well wishes and love to all of you! As always, we hope you enjoy our magazine and will share it with others. If you ever have any questions or concerns, ideas for stories, or want to be a contributor, please let us know!

Kimberly Waldrop

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Cervical Disc Replacement M6 Javier Reto, MD, was the first surgeon in Alabama to implant the M6 artificial disc replacement for the cervical spine. By Javier Reto, MD

Neck pain occurs in approximately 2 out of every 3 adults throughout their lifetime and chronically in 15% of the population at any one time. As a result, treatments for neck pain have become increasingly utilized. Thankfully, the vast majority of folks that experience neck pains recover uneventfully. For the subset that require further assistance, physical therapy and over the counter anti-inflammatory medicines, e.g. ibuprofen, naproxen may be necessary to aid in recovery. Interventions such as injections and prescription medications typically become next-step options if needed. Finally, we consider surgery for those unfortunate enough to fail all measures. There are a significant number of younger people identified, typically falling into 20-50 age range, that become surgical candidates. In the past, these folks were given the option of living with the pain, repeat injections or neck fusion surgery. Neck fusions, where two adjacent vertebra are fused together with intervening disc entirely removed, have been a time-proven and quite successful option for reducing or eliminating pain. However, these surgeries come at the expense of eliminating motion at the particular level or levels involved. In the long run, the loss of motion increases stresses at adjacent disc levels and can lead to more surgery in 20-30% of patients.

“

As a spine surgeon I am invested in finding both innovative and effective options that function best for patients in all age ranges. As such, options like the M6 device which provides accurate reproduction of motion in all planes, including compression, can be a better option than the typical fusion.�

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} FEATURE

Cervical Disc Replacement surgery is an alternative surgical option for those with little to no arthritis with the added benefit of preserving motion and thus potentially reducing the incidence of disc breakdown at adjacent levels. The last few years have seen several cervical disc replacement options come to market. While they all exhibit motion-preservation technology the manner in which this is accomplished varies and can significantly impact their overall effectiveness. Keep in mind that the ultimate goal of any disc replacement device is to reproduce normal spinal motion or kinetics. But what defines normal, and how is this measured? Luckily for us, spinal kinetics have been well-studied and a few guiding principles have been identified. A well-functioning device should have the ability to mimic normal motion in all normal anatomic parameters. It serves no good purpose for an implant to allow 360 degrees of rotation as humans are not owls! Likewise an implant that allows less than normal motion is restrictive and will result in early wear and likely failure. Normal neck motion is 80-90 degrees of forward bending, 70 degrees of backward bending, 2045 degrees of side to side bending, and up to 90 degrees of side to side rotation, as well as abc vertical distraction/ contraction. Most disc replacement options do a good job

at reproducing the majority of normal neck movements, but do not necessarily cover all the movements well. The Orthofix M6 device has been out in the European market since 2006 and in the US market recently in 2019. I was the first surgeon to implant the M6 last August and chose to use it because of its promising characteristics. Laboratory testing has shown that it does among the best at hitting all ranges of normal motion well, including the up and down distraction/contraction movement. It has a shock-absorbing center (nucleus) and outer wall (annulus) that work together to replicate the controlled range of movement and cushioning effect of the natural disc. As a spine surgeon I am invested in finding both innovative and effective options that function best for patients in all age ranges. As such, options like the M6 device which provides accurate reproduction of motion in all planes, including compression, can be a better option than the typical fusion. Ultimately the goal is to fit the surgical solution to the specific pathology as opposed to one size-fits-all approach. For those that are identified as appropriate candidates, the cervical disc replacement device can be a wonderful option. If you have on-going significant neck or arm pains it would be wise to consult with a spine specialist about the right options for you.

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COPING IN Unusual Times By Rachel Sullivan, MFTA, CFLE

Coping mechanisms are the tools we draw upon to help us combat stress. It is no surprise that stress can do strange things to our bodies and minds. It can induce lethargy, intense anxiety, high blood pressure, depression, and change the way our brain makes decisions, all of which can make coping exceedingly difficult. Most people have some identified coping mechanisms that assist with striking a balance between the stressful event or circumstance, and a healthier state of functioning. Unfortunately, when stress happens during nonnormative times there can be additional factors at play including a decrease or complete lack of our usual coping options or an inability to gather support from the people we normally would. Regardless of the change in factors, there are some tools that are helpful for coping, even when times are unusual. Understanding your triggers. We have talked about triggers before, and likely will again – because they are important! These are those situations or people that poke some internal part of our emotions or memory and stir us to feeling out of control, or unsafe. The result of feeling out of control or unsafe usually begins a spiral of thoughts and behaviors that are unhelpful to us regaining the peace we are seeking. When we work to identify our triggers then the situations that would cause them to become less surprising, and thus our reaction to them changes. Triggers during times of unusual stress may include feeling helpless, hopeless, optionless, isolated, or stuck in a certain circumstance. Understanding a trigger can take some work and may not be something achievable without professional help. Resource List. This is a tool that frequents my clinical practice. A good resource list helps an individual outline what their resources are during a time of peace or neutrality, with the intent to be drawn upon during times of stress. Recall that stress forces the brain to make decisions about what functioning it will focus on – and typically logical thought gets excluded at some point in the process. So, creating a resource list during times of low to no stress is best. A good resource list should contain items, such as:

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Indicators you may be feeling excessively overwhelmed (you may be surprised at how difficult it is to recognize this when you are in this state!). Note the behaviors, feelings, and physical characteristics that you exhibit when your stress is high, and you are not at your best.

Coping mechanisms that can be utilized without outside assistance. These are things such as exercise, journaling, listening to music, taking a bath/ shower, or meditation. The items here


should be actual activities that you know are helpful, this is not the time to try out new things! The key here is productive coping, so any action that is unhealthy or self-injurious should not make the cut. •

People you can turn to in the event the above items do not work. The individuals on this list should be reliable and know enough about you to know what is helpful for assisting you in times of need.

Signs your stress levels are decreasing. This is important because being able to identify what is happening when you are starting to function more effectively gives you feedback that what you are doing is helpful. So, outline what you are doing and how are you feeling when you find yourself more balanced.

A list of local emergency numbers. Although no one enjoys thinking about what happens when our stress is so high we cannot handle it anymore, the fact is that everyone has that threshold. Having a list of your local emergency room number and location can be helpful in the event your situation escalates to an unsafe level and you need to reach out for medical help to stay safe.

Professional help. While there are plenty of ways that we can assist ourselves, sometimes the best option is to seek professional help. During unusual times of stress our resources may look different, our triggers may be stronger, and our coping strategies may not be working as effectively as they do during more normal times. When that is the case, there is nothing wrong with using outside assistance. Mental health professionals are trained to help people through difficult seasons and circumstances. Counseling may be the best option if you find yourself unable to regulate your emotions, your stress level remains consistently elevated, or none of the typical ways you cope are helping. It may be helpful to know that everyone has a certain threshold for dealing with stress. How we cope may look different, the tools we draw on likely vary, but the reality is all of us are coping with stress on a continual basis. How effectively we do so depends greatly on how much we are required to deal with at one time, and how well equipped we are to tackle the task. My hope is that utilizing the coping resources listed here will give you the advantage the next time you are faced with high stress. Stay well friends! Rachel Sullivan, MFTA, CFLE Solid Ground Counseling Center 256-503-8586 www.solidgroundmadison.com I n s i d e M e d i c i n e | Vo l u m e 3 I s s u e 1 7

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let's look TO THE BEST

By Elizabeth McCleskey, DO

I “ t was the best of times; it was the worst of times...” to quote Dickens.

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N

othing like a national emergency to help us sort the wheat from the chaff within our lives. Times of trial bring opportunities for new reflections on our lives. For years, people have been living “busy” lives. Now, many people have been brought face-to-face with the reality of what the effects of their lifestyle priorities have produced, and some of the “best” include: • Volunteers using their time, talent, and materials to make protective equipment for first responders and healthcare workers. (As a recipient, let me say thank you!) • Researchers posting tasty recipes from 1930- depressionera cookbooks that require minimal ingredients. • Family members exercising, dusting off and teaching the kids board games, defining and working on home projects, schooling, or just talking TOGETHER. • Young people helping older folks with shopping, yard work, errands, and even pitching in from their own pockets when seniors come up short in paying at the grocery store. • First responders and medical professionals with limited resources and an unknown enemy, swallowing their fear and finding their strength to attend the sick and dying. • Truckers, grocers, utility workers, local government employees, waste disposal workers, order pickers shippers, and all the others who work to keep us fed and our households running because of their integrity and work ethic. On the flip side, change may also reveal the negatives in our lives. Sometimes these are things that we may not have even noticed creeping in because there is a comfort and security with “routine.” While stress can bring out the good, it can also lead us to acknowledge dissatisfaction with the realities in our lives. Recent examples include: • Parents report they don’t like their kids. • Numbers of runaways are increasing. While some are due to domestic violence, many do so because they are mad, bored, or just want to see their friends. • Some are complaining about anything and everything, although they still have a home, loved ones, a job, food, toilet paper, and other creature comforts • Over consumption of processed food has led to weight gain and worsening diabetes and hypertension in others. Despite having time to cook, they chose this path because cooking is “hard and boring.” • Many are reporting tales of incessant social media, Netflix binges, and 24-7 news programs (much of which is designed to arouse negative emotions) leading to lack of time to accomplish anything meaningful. So, as with any challenge, there is also opportunity. As people are reporting feeling unmoored during this time, they believe there is nothing they can do to help themselves. This is far from the truth. Now is the time you can step up

to the challenge and reclaim your life. This is not a time to become self-critical, but to become insightful. As humans, we make mistakes. Sometimes by choice, sometimes based on poor information, and sometimes because of what has been modeled for us as the “right” way. Don’t waste time on fault and put aside blame and guilt. Instead, put your energy into evaluation and change. To start, ask yourself what has been important in your life that has been stripped away or changed? What do you or did you like to spend your time on? Did it help or harm your health/relationships? Flesh out your responses with the five Ws—who, what, where, when, why, and don’t forget “how.” Some starting-point examples might be: • If you don’t like your children or your teen won’t stay home, who has been assuming the responsibility to raise them? • What can’t or won’t you face at home that requires you to consistently want to escape? • Where did your practice of disparaging others or blanketly excusing others come from? • Why don’t you want to learn to cook? • When did watching media become more important to you than a hobby, learning something new, interacting with family, etc.? The common denominator here is EFFORT. Over the years, we have all brought “so” into our lives to justify our decisions. We wear it as a badge—I’m so busy, so tired, so discouraged, so important, so overextended, so indispensable, etc. No wonder there’s no time or energy for a mundane chore like, for example, cooking. (By the way, these folks likely eat many of their meals out and otherwise fill in with processed foods; eventually their health will reflect these poor choices.) So, what about you? Now that some of the busy-ness has been stripped away from your days, take the time to reevaluate what needs to come back. Do you want to maintain the status quo with the possibility of chronic disease and chronic medication, or do you want to take this time to build a healthy infrastructure to your days and improve your physical and mental health along with your relationships? Healthy relationships positively impact your health. Stress hormones increase your risk for several chronic diseases. If your relationship with your children is stressful, think about why. Have you unknowingly allowed teachers, coaches, music instructors, daycare workers, and others to usurp you as the parent? How can you better engage with your family and get to know each other as individuals? Couples in supportive relationships have better health outcomes. Has this time together brought you closer to your significant other? Sometimes we use busy-ness to avoid looking at how things really are. Do you have a contentious relationship which has been ignored? Have you settled into a routine with very little support or interaction? Are you ready to make some decisions about how you want the relationship to move forward? (continued on p.14)

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(continued from p.13)

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

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

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

Dr. Elizabeth McCleskey

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

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Feeding America FeedingAmerica.org


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

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

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


Should you wear a mask at home? No, unless you are taking care of someone who is sick with COVID. Should you wear a mask in the car? No. Should you wear a mask while visiting a friend? Yes, if you cannot maintain physical distancing. Should you wear dentist’s office? Yes.

a

mask

at

the

doctor’s

or

Should you wear a mask while getting your hair or nails done? Yes. Should you wear a mask to the grocery store and other crowded areas? Yes. Should you wear a mask during a run or while exercising outside? No. Should you wear gloves? No. Thoughts on hand sanitizer vs. washing hands? Hand sanitizer containing 60% alcohol used for 20 seconds is the best way as its more accessible. You should keep hand sanitizer in your car, home, office etc,. Washing your hands with water and soap is also an option but you need several minutes for it to be effective. Additional general recommendations to prevent the spread of COVID-19: Physical distancing and hand hygiene are the most important aspects in prevention. Wearing a mask in public is an additional measure that can help.

Surgical or procedural face masks are a better option than cloth masks in prevention. The face mask is mainly beneficial when you are in an enclosed space and near other people when you can’t maintain physical distancing of 6 feet or more. If you use face masks, please remember these can get contaminated easily, so don’t touch the mask. If you take them off place them in a brown or plastic bag. If they are soiled or dirty, get a new one. Cloth masks should be washed with hot water and soap regularly. Dr. Ali Hassoun is Board Certified in Internal Medicine and Infectious Diseases. He has been serving the Huntsville - Madison community for more than 15 years. He completed his Internal Medicine Residency from NY Medical College and completed an Infectious Diseases Fellowship at Albert Einstein School of Medicine in Long Island Jewish Medical Center in New York. He has also practiced in Auckland, New Zealand with the Australasian College of Physicians. Currently he is a Clinical Assistant Professor with UAB School of Medicine - Huntsville campus, an adjunct Faculty with UAH nursing school, Director of Infection Control for Huntsville Hospital, Madison Hospital, and Crestwood Medical Center. Dr. Hassoun also has extensive research experience including presenting manuscripts at local and national scientific meetings as well as writing book chapters. Information and recommendations regarding COVID-19 are updated almost daily as new scientific data becomes available. Please continue to check the CDC website for additional updates on COVID-19.

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Teaching During A Pandemic By Kimberly Waldrop, MA

If you ask any teacher why they got into the profession, more than likely, they will answer the same. Teachers love the interaction with their students. They love the classroom community and the school environment. They look forward to seeing their students face to face, day to day. They are involved in their lives and care about their students as much as any family member. This year, teachers have been faced with something so outside of their control and comfort zone. A profession that is based around human contact and social interaction has been turned upside down. No longer are teachers using their creativity, their true skills, and their true desire but they have been forced to become facilitators of online learning. Something none of them chose. I spoke with several local teachers just to get an idea of what they think… Teaching is a great honor. I still remember our last day together on March 13th. I am so grateful that I can see their faces online, but having to close the building early has left an ache in my heart. I miss the every-day things that happen in a classroom setting. I miss watching them play and hearing them talk with each other. I miss seeing their creativity in action. I miss getting to share stories and books with them face-to-face. I miss their hugs and giggles. I miss getting to celebrate their wins as they

“To teach is to touch a life forever...”

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learn new things. I miss hearing their perspective on any and everything. I miss them. My children and this time have taught me not to take one single day of teaching for granted. Every day we get to spend together is a gift. Children are a gift. The connection with students in the classroom is what fuels the desire and drive to teach. While days in the classroom can be long and tedious, the rewards from smiles, hugs, and those “aha” moments when students have a breakthrough make challenging days worth it. E-learning has been difficult, mostly because the connection between student and teacher is different and disjointed. There are not as many close conversations and the lack of human contact can make even the best online sessions feel somewhat sterile and empty. At the same time, I realize that for some students their daily dose of e-learning may be a bright spot in an otherwise challenging and lonely day. I can’t wait to be back in the classroom with my students in the near future! I am stressed and anxious. I worry even more about my students than I did before. Do they understand the assignment? Are they eating? Are they safe? What do they need? That is why I gave out my cell number and told them to call me anytime. Teaching during this time is putting more stress on me than ever before. I need to see my students, hug them and look into their eyes to know for certain they are ok.


Teaching has been my dream ever since I was a little girl who was inspired by so many wonderful teachers. I have seen many changes in education throughout the years, but none quite compares to this year. This year, I did not get all my time with my precious students. A part of me has felt broken because we have not been able to return to our classroom. However, through this experience I had to give myself, my students and their parents grace. This has been a learning experience for us all. I have had to be forced out of my comfort zone to create videos of me teaching and trying to create fun, yet meaningful lessons that my students can complete independently at home. I have had to balance all of this while also teaching my own children. In return, my student’s parents have been grateful and supportive while continuing their child’s learning at home. Teaching through e-learning, I have been extremely blessed to work and collaborate virtually with some of the best educators. While this is not how I wanted our school year to end, I have been grateful for this experience. Teaching has always been my dream job. As a first year teacher, I’ve only just begun my teaching journey and this is not how I imagined closing out the school year. However, I have been encouraged to see every teacher really together to continue to provide the best education for our children. I am grateful more than ever for my colleagues. We truly are a team! We build off each other’s strengths, shared ideas, and compiled resources to create virtual lessons and assignments. The transition to distance learning has taught me more about technology than I ever thought I’d know. It was definitely a challenge and steep learning curve at the beginning when I was learning google classroom and simultaneously trying to teach my students and families how to use it. Thankfully, the overwhelming feeling of being a google help desk lessened each week as the students learned to navigate google slides and turn in their assignments. Google meets with elementary students are an adventure. It warms my hear to see their smiling faces and hear their sweet voices. The screen is a constant swirl of activity. I miss the random hugs, stories, celebrating loose teeth, and aha moments. My heart hurts that we said goodbye that last day with no warning, preparation, or idea it would be the last time we were together this year in a classroom. Being a quarantine teacher has impacted my teaching career for the better. Grace, flexibility, and collaboration quickly became the running themes of distance teaching. I am very fortunate to be a teacher! I have been able to work from home and continue to pay my bills. I terribly miss my morning hugs, my students’ sweet faces and “you can’t make this stuff up” things they do and say during a school day. I am thankful for the wonderful support I have had from my administration, my grade level team, office staff and my amazing parents.

Take time to thank a teacher. These unprecedented times are opening all of our eyes to many things we’ve always taken for granted. From veteran teachers to first year teachers, they are doing the best they can with what they have been dealt. Our teachers love our children and miss them.

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Telemedicine

By Sanat Dixit, MD, MBA

& the Blockbuster Video Experience

Movies. Seems like we’ve all been streaming lots of movies recently because of the lockdown. On Demand. Rent and watch now. Download and watch later. Sheltering in place has been good for digital media companies. (We have to stay entertained to not go Covid-crazy.) Now recall what the experience of renting a movie was like, not even twenty years ago. You went to the corner Blockbuster, walked the aisles and sifted through hard plastic DVD boxes or (if you were really old-school) VHS cassette tapes; looking for a copy of Gladiator or that movie where Tom Hanks kept talking to a volleyball. Our movie selection experience centered around driving, parking, sifting, waiting, eyeballing microwave popcorn, paying, driving back and hopefully remembering to return the movie in 48 hours. It was what we expected – it was normal, and quite frankly, it stunk. Blockbuster was a huge, $8.4 billion dollar business but then Reed Hastings started a company to redefine the video rental market in 1997. They had a simple idea – make video rental convenient, and skip the store. They had no idea how much they were about to redefine the new normal. Some people would say this is a great comparison to telemedicine and the “typical” venue of healthcare. This is almost true, but not quite. COVID-19 has starkly reshaped what’s normal in healthcare. Social distancing bred a near complete standstill of most hospital operations. Clinics and physician offices saw a drop in patient visits. (Waiting rooms became less popular than Nick Saban loitering at Toomer’s Corner.) But, in reality, doctors and patients still needed to see each other. In a moment that can be considered monumentally novel, the Centers for Medicare & Medicaid Services slashed the red tape associated with telemedicine visits, enabling access and ensuring reimbursement for services previously not covered. The scope of technology approved to allow virtual visits between providers and patients was also expanded; allowing for Facetime and Skype to be used for video chats, at least temporarily. What is telemedicine, exactly? Simply put, it’s a way of sharing health information and providing care using modern telecommunication devices, when the doctor and patient are not physically together. The most commonly used is video

chat, but other examples include use of secure messaging and remote patient monitoring. I think of it as a supplement to the traditional doctor visit, not a replacement. I’ve used virtual visits in some way, shape or form for the better part of 6 years. I quickly learned that most of the sales pitches around telemedicine centered around technology solutions geared to hospitals, like robots that made hospital rounds, and less around allowing physicians to provide better care. I started my first telemedicine company in 2014 with a focus on managing avoidable hospital readmissions from nursing homes and rehab facilities. (One in four nursing home Medicare patients were readmitted to the hospital and those readmissions cost Medicare in excess of $11 billion in 2011 alone.) We discovered the most valuable element wasn’t the technology, it was the ability to keep the onsite nurses and offsite doctors connected. Empowering front line care staff allowed for better patient care. Patients liked being looked inon by their doctors; while their family members found it reassuring. What we also discovered was that even though we were solving a significant healthcare problem, the nursing homes didn’t want to adopt the service because the status quo was good enough. (It wasn’t.) I also used telemedicine as a neurosurgeon to help triage offsite patients at community hospitals where a neurosurgeon wasn’t readily available. This enabled us to provide more appropriate care closer to home for most patients, who most definitely did not need to be airlifted 100 miles from home to have me say they wouldn’t need surgery. The democratization of tele-health came out of necessity; but the services have been available for many years. Many health plans offer tele-health visits through established provider platforms like Teladoc and American Well. Many large health systems offer their own tele-health services for things like front line triage of acute stroke patients. The promise of increased access and improved efficiencies fostered an uptick in telemedicine companies; offering up everything from generic HIPAA compliant video chat platforms, to well funded startup companies offering direct-to-consumer healthcare services. Patient focused telemedicine has also become associated with technology - and that is both a good and bad thing. Many of you may

COVID-19 has starkly reshaped what’s normal in healthcare.

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have already had your first telemedicine encounter, running the gambit from being a great visit to a frustrating placeholder until you could physically be seen in the office. The reality is telemedicine is not about what device, app or gadget you’re using. It’s about allowing patients and doctors more direct access with each other, and about delivering a better healthcare experience. By the time you read this, we will hopefully be well past the peak of the COVID curve. Everyone has been clamoring for a return to normalcy. Hospitals and physician clinics may return to something close to normal, but it will never quite be the same. The pandemic forced the system to adapt and evolve. Another spike in cases may be on the horizon very soon. We discovered there were some unique benefits and efficiencies to telemedicine and it’s not going away. Let me say that again - IT’S NOT GOING AWAY! Before the COVID pandemic, we ran a pilot at SportsMED using telemedicine to interact with post surgical patients. We found patients enjoyed the convenience of a virtual visit, stayed more engaged with their post operative care plans, and described a better experience overall. We’re working on the next phase to minimize wait times and improve access to our providers. (I cannot imagine anything more frustrating than taking time off work and wasting 4 hours of the day, to have a 5 minute check-in with your doctor.) Some people still want the status quo, because it’s familiar and waiting is what they’ve come to expect. I would argue if you’re spending 4 hours in a waiting room to see a doctor, maybe neither one of you is doing it right. Not every telemedicine visit is going to be the same. Some providers will use it more effectively than others. Done poorly, it adds little value - sort of like putting a drive thru window in a video store. Done correctly, it becomes a game changer for healthcare. Then again, some things will never change - some doctors will expect patients to wait to see them, and some patients won’t feel comfortable unless they are seen in a hospital or clinic for every healthcare visit. Things evolve and tastes change, especially when something like Netflix comes along and shows us how much easier and better it can be to accomplish certain things. Blockbuster Video declared bankruptcy in 2010. Netflix grew to an enterprise value of over $201 billion because they delivered what was really important to their customers improved access and offered a better experience. Nowadays, no one should settle for the Blockbuster experience from 20 years ago, even in healthcare - especially in healthcare.

Dr Dixit is a neurosurgeon with SportsMED Orthopedic & Spine Center. He is the founder of two tele-health 1companies. He enjoys movies but always paid a late fee when renting DVD’s at Blockbuster.

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Fitness


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Jamal’s St ry By Valeria McConnell

Jamal’s Helping Hands, Inc. Poised to Fight Rare Disease One Resource at Time

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eurofibromatosis (NF) 1 stopped being a rare disease to me after my son, McKinley Jamal Thomas was diagnosed with this rare disease at the age of nine. There are an estimated 7,000 rare diseases in the world. In the United States, approximately 25-35 million Americans are living with NF1. The Orphan Drug Act of 1983 defines a rare disease as a condition that affects fewer than 200,000 people. What about my one person…Jamal? Most parents would ask this question after receiving such devastating news about their child. Unfortunately, healthcare providers and parents struggle to answer the multitude of questions that come after diagnosis. An adequate amount of medical research and treatment information are often non-existent - keeping rare disease obscure and unknown. The journey with Jamal began with finding a nearby specialist that understood his condition and could help educate me enough to consider effective treatment options. NF is a genetic disorder that causes tumors to grow on the nerve tissue. There are three (3) types – NF1 usually appears in childhood; NF2 and NF3 appear in early adulthood. NF1 did not prevent Jamal from achieving his goals, as he graduated from the University of South Carolina with a Master’s in Social Work and a certificate in Drug Addiction Studies. Jamal was an extremely special person who never met a stranger. His people map spanned from doctors to pastors to toddlers. On March 28, 2017, the world lost Jamal at the young age of 31. Scripture tells me that God will make beauty out of ashes, thus Jamal’s Helping Hands, Inc. was birthed to help other families affected by rare disease. Our journey, while challenging,

made me resourceful, knowledgeable and resilient in championing the fight against rare disease. On November 20, 2017, Jamal’s Helping Hands was incorporated with the vision of creating a non-profit organization to enhance the quality of life for patients, with chronic illnesses or rare diseases, and their families. Families like mine. We provide clientfocused support to patients and their families by providing a variety of services and educating them about resources readily accessible in their surrounding community. These services include, but are not limited to providing caregiver information, educational workshops, outreach and awareness, emergency care scholarships, lodging assistance and other resources in an effort to make the experience of rare disease easier. These include: • Healthcare Coach helps patients and families navigate the daunting healthcare system to get quicker diagnosis and effective treatment. • Support Groups welcomes caregivers to participate in a collaborative and supportive environment based on trust, understanding and empathy. • Educational Workshops deals with a variety of important topics such as critical questions to ask doctors, how to balance work and caregiving and finding resources. • Financial Assistance to families to pay for medical appointments, diagnostics and travel to out-ofstate specialists. Jamal’s Helping Hands, Inc. is linking our hands together with each community to help fight rare disease one resource at a time. We will win with Hope, Help and Hands. Please join us in this fight.

Providing hope & help to your health care

“Our journey, while challenging, made me resourceful, knowledgeable and resilient in championing the fight against rare disease.”

If you would like more information on Jamal’s Helping Hands, Inc., visit JamalsHelpingHands.org. You can also find them on Facebook at @JamalsHelpingHandsInc

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Finding Ourselves.. NO MATTER THE SEASON By Elisa Brooks

We are smack dab in the middle of a season most of us did not expect to find ourselves in. Life continues in the middle of a pandemic … but at the same time, life is not the same. Have you felt that way? I often go for walks outside. The sky is still blue, the birds are still chirping, the grass is still growing, and life at that moment feels “normal.” And then I return to my house and my four kids are home when they would normally be at school, I livestream my classes from my living room instead of teaching inside the gym, and friends that I spent time with in person, I now connect with over the phone. And I often wonder, who am I in the middle of this? What am I supposed to be doing? What am I not supposed to be doing? Can I thrive, even in a season of unknowns? Yes. Absolutely yes! I can and you can. There are lots of ways we can continue to become the person we long to be. Ways to continue to grow relationships with others and to thrive, in any season. I want to share one simple thing that has helped me immensely in my personal life to experience abundant life - both in “normal” seasons of life and even in this unprecedented time. Quit dying to the wrong things. You read that right. Quit dying to the wrong things. Do you ever feel like you are juggling five million things? Have you ever wanted five minutes of silence but it seems like you can’t find it? Do you ever say

“yes” to things, when on the inside you were wishing you could say “no”? Do you truly enjoy the things that you do each day? We often walk along the pathway of life, adding things to our to-do lists, adding events to our calendar, responding to more emails and more texts, but we are left feeling unfulfilled. Even resentful. If you can relate to any of that, it might be because you are dying to the wrong things. Geri Scazzero, in her book The Emotionally Healthy Woman says it this way: “You die to the wrong things when you set aside or devalue activities that cause your soul to feel fully alive (music, dance, writing, art, astronomy, outdoors); when you ignore important relationships; when you care for others to the detriment of yourself; and when you fail to honestly state your preferences, always deferring to others.” In my own personal life, I realized a few years ago that I I felt constantly exhausted. Occasional migraines, which I have dealt with since college, became regular occurrences each week. I felt like every request from family, friends, and church were obligations I had to fulfill and I was saying “no” to nothing. I was dying to the wrong things. My body was giving me a wake-up call with the migraines. I had four children under the age of 11. I rarely set aside time for myself. I love to read … but I never gave myself time to read. (continued on p.28)

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

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HIGH TECH PAIN RELIEF By Jacqueline Makowski

It was exhilarating and heroic work. No other group of people can say they have taken off from and landed on a naval aircraft carrier. United States Naval Flight Officer Tony DeRossett is one of the elite few. Tony served his country traveling at speeds greater than 1,300 miles per hour in the cockpit of the world’s fastest fighter jets. Tony logged more than 3,000 hours of rigorous flights, which over time took a substantial toll on his spine. The continual jarring force of flight maneuvers ultimately compromised the discs and vertebrae in his spine resulting in severe back and neck pain.

“MANY PEOPLE DON’T REALIZE THE STRAIN IT TAKES ON YOUR SPINE WHEN YOU’RE UP THERE, TWISTING AND TURNING DOING YOUR JOB,” TONY SAID. “THE LION SHARE OF MY BACK AND NECK INJURY CAME FROM PULLING G’S.” Tony would routinely catapult from 0 to 150 miles per hour off aircraft carriers at times pulling upwards of 7-Gs or 7 times the force of gravity humans are normally exposed to when on Earth. For perspective, astronauts experience a maximum G-force of approximately 3G’s during a rocket launch. While active duty, Tony received a lumbar spinal fusion for his back pain, as well as a cervical fusion for nerve damage in his neck and arms. The

surgeries allowed him to continue flying for a few years but the pain never completely dissipated. Tony retired from service but continued to work as a defense contractor. Unfortunately, Tony’s pain persisted leading to an early retirement. Tony consulted with Dr. Ronald Collins at Tennessee Valley Pain Consultants and Huntsville Hospital who developed an individualized plan of care. Dr. Collins is an anesthesiology and pain management physician specializing in the minimally-invasive treatment of common spinal, nerve and joint conditions. Dr. Collins diagnosed Tony with Degenerative Joint Disease and offered non-surgical modalities including spinal injections and nerve ablation. The treatments provided relief initially but his pain continued to return. Dr. Collins recommended trialing an innovative therapy called neuromodulation, which controls pain through a small implanted device called a neuro-stimulator. The stimulator acts like a pacemaker for the spine disrupting pain signals traveling between the spinal cord and the brain. “Impulses travel from the device to the spine over thin insulated wires called leads,” Collins said. “The leads deliver mild electrical impulses to an area near the spine interrupting pain signals.” Neuromodulation offers individualized pain relief where patients control the settings to meet their unique needs. “For the appropriate patient, a stimulator can provide long-term therapy for chronic pain conditions and can help reduce the need for oral pain medication,” said Dr. Collins. Dr. Collins coordinated with Dr. Thomas Kraus, (continued on p.32)

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by Belinda Maples, M.D.

Remember to Vote Tuesday July 14th

PAID FOR BY TUBERVILLE FOR SENATE INC. 31

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anesthesiology and pain management physician also at Tennessee Valley Pain Consultants, to trial Medtronic’s new Intellis stimulator. “Unlike most medical procedures, patients are able to try this technology first,” Dr. Thomas Kraus said. “The trial helps patients experience how well the neuro-stimulator relieves their pain during different daily activities.” The trial allows patients to receive stimulation therapy for up to 10 days by using an external stimulator mimicking the actual treatment. “It’s important to know the trial is available,” Tony said. “The first good night’s sleep I got, I was sold.” A few weeks later, Dr. Kraus implanted the permanent device. Implantation is similar to the trial with leads placed near the spinal cord and is an outpatient procedure. “With the stimulator, I’ve had a tremendous improvement in pain and my quality of life,” Tony said. “I have more confidence because [my back] doesn’t hurt.” Tony’s stimulator works off Bluetooth technology and is paired with a small wireless handheld device. This allows patients like Tony to increase or decrease stimulation for personalized pain relief. The Intellis system also has an adaptive technology which automatically adjusts as patients change positions such as from sitting to standing. Tony has also been able to reduce the amount of medication needed since the neuro-stimulator was implanted. He offered to share his story to help others. “I’ve improved markedly since starting care at Huntsville Hospital and Tennessee Valley Pain Consultants,” Tony said. “I was miserable for a long time, and I didn’t need to be.” Dr. John Roberts, anesthesiology and pain management physician, also with Tennessee Valley Pain Consultants implanted the first Intellis stimulator in the state at Huntsville Hospital in October 2017.

Tennessee Valley Pain Consultants offers immediate appointments for patients with acute and chronic pain. Call (256) 265-7246 to schedule an appointment with an expert in anesthesiology and pain management. For more than 20 years, Tennessee valley Pain Consultants and Huntsville Hospital have been the regional leader in nonsurgical pain relief services. The practice has the area’s only team of double-board certified physicians in anesthesiology and pain management with more than a century of combined experience. tnvalleypain.com (256) 265-7246

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

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

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Roslyn Richardson, RN, & Amy Stephens, RN

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


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

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

In an emergency, call 911.


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

By Larry M. Parker, MD

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

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Be Still My

Beating Mind By Kari Kingsley, MSN, CRNP

T

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

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

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


“I began to realize the encouraging fact that I had been meditating all my life.” I encountered a brief meditation... walking outside on a warm spring day as the sun warmed my pale winter skin… the smell of knockout roses in the front yard filling my nostrils. I began to savor these moments. Life gives us gifts of moments like these throughout the day. These strong mind-body connections fuel the soul. Now it’s your turn. Close your eyes. (Ok, peak long enough to keep reading). Take a deep breath in. Now a lazy, fullrelease exhale. Don’t judge your breath. Don’t judge your thoughts. Acknowledge them. Accept them. For every negative attitude, replace it with a positive attitude. Or 2. Or 20. Ok, don’t be an over achiever. As your mind wanders, gently acknowledge the thought and re-center your focus on your breath. Deep breath in, and allow your exhale to fully release. The beauty of meditation is that you can’t fail. Meditation is your time. If your brain is flooded with thoughts and emotions, come back to the present moment and concentrate on your breath. When I meditate, I picture a blue sky. Each cloud that floats by is an individual thought. I acknowledge the cloud as it floats into view and then as it floats out the periphery. If you enjoy this short exercise, try a guided meditation that will teach you how to train your mind to let those negative thoughts and emotions pass through your mind without attaching to them or help you work through trauma or paralyzing fears and emotions. I still stumble and pick myself back up on my meditation journey. Life is hectic and somedays the thoughts in my head are really, really loud. The more I practice meditation and mindfulness, the easier it becomes to put the kindergarteners and hamsters down for a nap.

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

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NAVIGATING THE

World of Dieting By Tara Vardaman, MS, RDN, LD

As many of you know, trying to diet comes with a lot of confusion and frustration. But it doesn’t have to be that way. Many diets that are heavily promoted today are what dietitians consider “fad diets”. They offer quick results with dietary changes that are almost impossible to maintain long term. These fad diets also often lead to the yoyo effect – weight loss and gain that continues to repeat without any last effect of continuous weight loss. The key to dieting is to actually not “diet” at all. Achieving great health comes down to simply making dietary and lifestyle modifications that you can sustain for life. Consuming a diet that is full of fruits, vegetables, and unrefined grains, as well as lean proteins in moderation will provide your body a large variety of vitamins and minerals that are needed for the body to function properly. Additionally, consuming a highly plant-based diet helps to reduce the risk of developing chronic health conditions, and can even help with the treatment of many health conditions (heart diseases, high blood pressure, diabetes, high cholesterol, etc.). Now I’m sure as you read the words “plant-based diet” I lost some of your attention. The truth is, you do not have to become vegetarian or vegan, but consuming a diet that has a strong foundation of whole, plant-based foods is likely to drastically reduce the intake of refined sugar, total cholesterol, saturated fats, and sodium, all of which have been linked in some way to increasing the risk of developing the health conditions outlined above. In addition to diet modification, lifestyle modification is the other major component to achieving great health. This includes everything from physical activity to where and how you eat your food. Lifestyle modification can be broken down into three categories. The first lifestyle modification category is physical activity. It is recommended to engage in a minimum of 30 minutes of moderateactivity (brisk walking, biking, sports, etc.) 5 days a week, while also participating in resistance exercises (Pilates, weights, yoga, boxing, etc.) at least 2 days a week.

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The best way to achieve physical activity modification is to set SMART (Specific, Measurable, Attainable, Relevant, and Time-based) goals or yourself and gradually increase your activity level each time you reach your goal. The second lifestyle modification category is mindful eating. Mindful eating essentially means that you are putting primary focus on your plate while eating. This involves ensuring that you are in a minimally distracting environment while eating. This includes avoiding visual distractions such as screens (TVs, phones, tablets, computers), books, and even eating while driving. Additionally mindful eating also focuses on staying in tune with your body and its hunger level throughout the eating process. Ideally, you want to start eating when you start to become hungry (not when we are starving) and stop eating as soon as your hunger has resolved. The idea behind mindful eating is that it will help prevent over eating. The third lifestyle modification category is eating habits. Eating habits play a huge role in how much we eat at meals. Due to the fast-pace culture that we live in, many of us tend to eat fairly quickly. The reality is, eating quickly often results in overeating due to the delayed signaling from the stomach to the brain to let us know that we are full. To help slow down the eating process, follow three simple steps: Take small bites, chew foods thoroughly, and set down utensils between each bite. As you can see, achieving great health takes work but it doesn’t have to be overly complicated. Consuming a diet that is focused on whole-foods, engaging in physical activity regularly, ensuring that you practice mindful eating, and modifying your eating habits will help you achieve the health you want and deserve. It is also important to remember that results are not going to appear overnight. It takes time, sometimes a lot of time. Be willing to find gratitude in the smallest achievements, as those small achievements are what lead you to your greatest success.


“LET FOOD BE

THY MEDICINE

AND MEDICINE BE THY FOOD”

– HIPPOCRATES

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