late summer 2017
know the facts from A-E
skin cancer HAIRhealth
...how to get it healthy and KEEP it healthy
dealing with spine and extremity pain
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Inside Medicine | late summer 2017
FEATURES Pain Interrupted Moving forward through it all
Skin Cancer Know the facts from A-E
Dry Needling Options to treat pain
7 10 28
CONTENT Stand Tall Good posture is essential for good health
The Hero Fund Generosity helps those in need
Imagine a World The space race and its link to cancer research
L at e S u m m e r 2017 C O N T R I B U T ORS
Martha Campbell Pullen, Ph.D. Kimberly Waldrop, MA D Kishore Yellumahanthi, MD, MPH Nancy Washington Vaughn Nemil Shah, MD Larry Parker, MD Jill Homan Karen Fox, CRNP
Michael Beuoy, PT, Cert. MDT Traci McCormick, MD Bradford Meythaler Daniel Alexander
Pat Ballew Tiernan Oâ&#x20AC;&#x2122;Neill Kaki Morrow Chad Hobbs, PT, DPT, COMT Lisa Layton Andy John King S A L E S & M A R KETING
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Dear Readers– Summertime…we seem to let our routines slip. Bedtimes are later and early morning wake ups aren’t so early. Our schedules slow down with less on the calendar, our eating habits even change, and
getting back on track
our days often run together. Most of us let our children and ourselves enjoy the laziness and ignore looming deadlines, chores, and academic studies.
But, as quick as the bird flies, it’s time to go back to school! This
means we are destined to fall back to our timelines, daily rituals, and of course, school work. It’s a great time to rework what we’ve let diminish over the summer and get on track.
In this edition of Inside Medicine, we have some very helpful
information to guide in creating new routines, eating habits, and healthy reminders. Dr. McCormick has given us some great guidelines for helping children eat well. It is so important to feed our children to aid towards their success. Healthy eating and food is on everyone’s minds and she has provided us with such valuable information. We also have a wonderful editorial on children’s sleep routines and how important they are. Back to school time is the perfect opportunity to implement these recommendations.
Creating new and healthy habits can also mean just taking care
of yourself and loved ones. Lisa Layton has provided us with a story about Katherine Jones. Katherine was diagnosed with type 1 diabetes at only seven and a half months old. Read her story and you’ll see how it made her into a strong and healthy young lady who is beginning her senior year in high school!
This edition is also packed full of other useful information. Mak-
ing sure you have good posture, details of Hepatitis C, and aging in place are just a few of the expert articles highlighted in this issue.
As always, our prayer with Inside Medicine is to help our com-
munity and show a love for our Savior. We are always looking for new content and features. Please contact us if you ever have an idea for a story or want to be included in our magazine. We love hearing from you and appreciate your support!
The Road to Pain Relief Starts Here. Precise Pain Relief for: Back & Neck Pain Nerve Pain and Sciatica Knee and Hip Pain Shoulder Pain Discogenic and Radicular Pain Shingles Pain Cancer Pain
Non-Surgical Solutions to Restore your Active LIfestyle.
Team of Double-Board Certified
Anesthesiology & Pain Management Physicians Ronald Collins, M.D.
Morris Scherlis, M.D. Roddie Gantt, M.D. John Roberts, M.D.
Thomas Kraus, D.O.
Inside Medicine | aug-september 2017
Patient Spotlight: Martha Campbell Pullen, Ph.D. Have you ever met someone who leaves you thinking, “How do they do it all?” Martha Pullen, a north Alabama native and entrepreneur since age 14, moves in one direction – forward. Martha, a leader in the heirloom sewing industry, turned her passion of sewing into a multi-million dollar company, hosting a television program on PBS, founding Sew Beautiful magazine and leading conventions locally and globally. Travel was a way of life for Martha until 2013 when she began experiencing intense back and radicular leg pain. The pain prevented her from sitting for more than 30 minutes at a time and began to significantly inhibit her work and lifestyle. “I was afraid to drive or board a plane,” Martha said. “The pain was completely affecting my way of life and ability to travel for my business.” Refusing to let pain limit her, Martha went to Tennessee Valley Pain Consultants at Huntsville Hospital for an evaluation. Martha saw anesthesiologist Dr. Ronald Collins who ordered an MRI of her lumbar spine revealing spinal stenosis. Spinal stenosis is a common spinal condition where there is narrowing of the spinal canal often presenting with radiating leg symptoms. Dr. Collins recommended a series of lumbar epidural steroid injections as well as physical therapy for her condition. Epidural steroid injections are a non-surgical treatment option for patients experiencing neck and back pain and are particularly beneficial for treating radiating pain. It was determined Martha was not a surgical candidate, which made injection therapy her pathway for pain relief. Dr. Collins pin-pointed the spinal level producing her pain using real-time fluoroscopic x-ray guidance and injected a steroid-anesthetic bathing the painful nerve with soothing medication. “Patients suffering with back and neck pain like Martha can find relief with non-surgical interventions such as injection therapy,” Dr. Collins said. “Our goal is to treat patients with a minimally invasive approach.” Martha was able to return to business travel almost immediately after receiving her first injection. She has continued traveling across the country and globe with a new focus – teaching entrepreneurship and resilience. “It was miraculous,” Martha said. “Literally, the next day I was able to get back on a plane and continue my business. One block will relieve my pain completely for 3-4 months and sometimes up to one year.” Martha’s most recent venture is authoring the book G.R.A.C.E. (God. Resilience. Action. Creativity. Enthusiasm.) Keys to Entrepreneurship. Martha personally experienced the importance of resilience after suffering with back pain. “You conquer by continuing,” Martha writes in her book. “Behind every great success story are a dozen stories about preserving through difficult times.” Pain relief is transformational for many patients who suffer with persistent spine and extremity pain as Martha did. Nearly 100 million people in the United States suffer with chronic pain – more than those living with diabetes, heart disease and cancer combined. Due to its subjective nature, pain is often difficult to measure but important to address. Pain serves as the body’s “warning signal” for a problem requiring attention. “Our goal is to treat the pain at its source,” anesthesiologist Dr. Morris Scherlis said. “This often involves injections to precise pain generators and can markedly improve a patient’s quality of life.” Tennessee Valley Pain Consultants provides the area’s most experienced and advanced non-surgical treatment options for common spinal, nerve and musculoskeletal conditions. The practice has five double board-certified anesthesiology and pain management physicians with more than 80 years combined experience. Visit tnvalleypain.com to view educational animations on conditions and treatments provided.
Inside Medicine | late summer 2017
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The Junior League of Huntsville Gives Back and Why You Should Too by Nancy Washington Vaughn Junior League of Huntsville, 2017-18 President
“What is the essence of life? To serve others and to do good.” – Aristotle Have you volunteered recently? The question is not a typical conversation starter in our society, but perhaps it should be. Volunteerism is common in our community as many individuals give their time and energy without monetary compensation. It is common knowledge that volunteerism makes an immeasurable difference in the lives of others. But did you know that you are helping yourself by giving back to our community? Volunteering has been shown to lower stress and boost selfconfidence among other health benefits. While is it important not to lose sight of the fact that the volunteerism strengthens our community and improves the lives of beneficiaries, one cannot overlook the studies concluding that those who give support through volunteering experience greater health benefits than those who receive support through these activities. Studies have found that those who give social support to others have lower rates of mortality than those who did not, even when controlling for socioeconomic status, education, marital status, age, gender, and ethnicity. The numerous benefits of volunteerism on one’s health include, but are not limited to: • Decreased risk of depression because volunteering with and for others increases social interaction and helps build a support system based on common commitment and interests—both of which have been shown to decrease depression. • Increased enjoyment of a sense of purpose and fulfillment and self-confidence. • Increased ability to stay physically and mentally active in a meaningful way. A study revealed that volunteers increased their brain functioning. Volunteer activities get you moving and thinking at the same time. • Reduced stress levels. By enjoying time spent in service to others, you’ll feel a sense of meaning and appreciation— both given and received—which can be calming. • Increased experience of happiness from a release of dopamine in the brain. Helping others has a similar effect on the release of dopamine as vigorous workout. There are numerous ways to volunteer and support volunteerism in the Greater Huntsville community. One way is to support volunteerism is to help The Junior League of Huntsville, Inc. (JLH) achieve its charitable and educational mission. The Junior League of Huntsville. Founded in 1949, JLH has developed exceptionally qualified civic leaders who collaborate with various community partners to identify Huntsville/Madison County’s most urgent needs and address them with meaningful and sustainable solutions in order to enhance the quality of life in our community. JLH’s mission is that it is “an organization
of women committed to promoting voluntarism, developing the potential of women, and improving communities through the effective action and leadership of trained volunteers.” JLH members perform approximately 50,000 volunteer hours each year and the League has donated more than $2.5 million to our local community. JLH is part of the Association of Junior Leagues International which is one of the oldest, largest, and most effective women’s volunteer nonprofit organizations in the world including more than 150,000 women in 291 Leagues in four countries. JLH’s current projects are related to its community impact focus area of improving family literacy in our Huntsville/Madison County community. The projects include activities throughout Madison County such as hosting Family Literacy Nights at designated Huntsville Housing Authority communities, hosting college readiness seminars and awarding college scholarships for female high school seniors, planning enrichment activities for pre-school students at the Downtown and Northwest YMCA Early Childhood Education Centers, and volunteering with students in Madison County’s inaugural Summer Adventures in Learning Program at elementary schools in Huntsville City, Madison City, and Madison County. Individuals and companies can support The Junior League of Huntsville’s impactful community projects by: • contacting JLH to request volunteers for events or shortterm projects (https://www.jlhuntsville.com/sos/) • making a 100 percent tax-deductible charitable donation to the 2017-18 Annual Giving Fund (https://www.jlhuntsville.com/system/donate_summary/) • purchasing nutritious fresh apples in elegant gift baskets or bulk orders of crates for delivery to your home or office to support JLH’s 46th Annual Apple Annie Fundraiser (online ticket sales will be available on August 14th at www.jlhuntsville.com) • making a 100 percent tax-deductible donation to sponsor a school, grade, or classroom to provide Pre-K, Kindergarten and First Grade students in each Huntsville City, Madison City and Madison County public elementary school a fresh apple on JLH’s 46th Apple Annie Day in October • becoming a 2017-18 Corporate Sponsor of JLH • requesting information about JLH membership To obtain additional information about The Junior League of Huntsville’s community projects, public events, fundraisers, sponsorship opportunities, and/or membership please visit www.jlhuntsville.com, email email@example.com or call 256881-1080. Please don’t forget to ask your friends, family, and colleagues – “have you volunteered recently?” Dietz, N., Grimm, R., and Spring, K. (2007, April). The Health Benefits of Volunteering: A Review of Recent Research. Retrieved from https://www.nationalservice. gov/pdf/07_0506_hbr.pdf. Id. Parsons, T. (2009, December 24). Brain Benefit for Seniors Who Volunteer. Retrieved from http://www.futurity.org/brain-benefit-for-seniors-who-volunteer/. Giving Back Helps Others – And You. Retrieved from http://createthegood.org/ articles/volunteeringhealth. The United Way of Madison County’s Volunteer Center of Madison County maintains an online list of local volunteer opportunities.
Inside Medicine | late summer 2017
There are several types of skin cancer. The three common types of skin cancer are:
Skin cancer occurs as a result of uncontrolled growth of abnormal cells. Skin cancer occurs when mutations or errors occur in the DNA of skin cells. Often this is the result of exposure to UV radiation either from sunshine or tanning beds. These mutations in turn cause the cells to rapidly multiply and form malignant tumors. Skin cancer is the most common cancer in the US.
One in five Americans will develop skin cancer in the course of lifetime.
by D Kishore Yellumahanthi, MD, MPH
Basal cell carcinoma Squamous cell carcinoma Melanoma Basal cell carcinoma (BCC):
Epidermis is the top layer of the skin. The epidermis has four layers. BCCs are abnormal, uncontrolled growths that arise in the skinâ&#x20AC;&#x2122;s basal cells, which line the deepest layer of the epidermis. It is believed that long-term sun exposure over the lifetime as well as occasional extended, intense exposure (typically leading to sunburn) combine to cause damage that can lead to BCC. The risk factors for the development of BCC include, intermittent intense sun exposure (as identified by prior sunburns), radiation therapy, immunosuppression, a fair complexion, red hair and a positive family history of BCC. The clinical presentation of BCC is variable. For instance, it can present as open sores, red patches, pink growths, shiny bumps or scars. It has the least potential to spread from the primary tumor site. However, that does not mean it should be taken lightly as the treatment in the advanced stage may need a large excision that can be disfiguring at times. Given its variable presentation, it is often not easy for a common man to diagnose them by looking at them. Therefore, any new spot or bump or any other lesion on the body, should be brought to the attention of a physician immediately.
Squamous cell carcinoma (SCC):
Inside Medicine | late summer 2017
SCC in an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skinâ&#x20AC;&#x2122;s epidermis. It is the second most common skin cancer. It is caused most commonly due to chronic sun exposure. Anyone with a history of substantial sun exposure is at increased risk although people with light hair, fair skin and blue, green, or gray eyes are
at highest risk of developing the disease. Usage of indoor tanning beds is also a risk factor for SCC. The number of women under 40 years diagnosed with SCC is on the rise and it is largely believed due to their greater use of indoor tanning. Unlike BCC, in about 0.5 -5% of cases, it can spread and can become fatal if untreated. Similar to BCC, it can also have varying appearance. One clue to differentiate between the two, although not absolute, is often the skin around an SCC reveals telltale signs of chronic sun damage such as wrinkles, loss of elasticity, age spots, or broken blood vessels.
This is the most dangerous form of skin cancer. It arises from melanocytes, which are pigment producing cells present in the basal layer of the epidermis. Most melanomas are black or brown in color. However, they can also be skin colored, pink, red, blue or purple. Melanoma also has various morphological/clinical presentations. Melanoma is caused by intense, occasional UV exposure more so in genetically predisposed individuals. Besides genetic predisposition, the strongest risk factors include light complexion, light eyes, blond or red hair, heavy freckling, the occurrence of blistering sunburns in childhood, a tendency to sunburn easily and tan poorly. If melanoma is diagnosed and treated early, it is almost always curable. However, if it is not recognized early, it can spread to the other parts of the body and can lead to death. Therefore, it is very important that it is diagnosed early.
Melanoma can occur either in an existing mole or can present as a new lesion. It is very important for everybody to know their skin very well and to recognize any changes in the moles. Look for the ABCDE signs of melanoma.
A B C D E
Asymmetry: When symmetrical, if you draw a line through the middle, the two sides match. On the other hand, if you draw a line through a mole, the two halves do not match, it means it is asymmetrical, a warning sign for melanoma. Borders: A benign mole has smooth, even borders, unlike melanomas. The borders of an early melanoma tend to be uneven. Color: Most benign moles are all one color — often a single shade of brown. Having a variety of colors is another warning signal. Diameter: Benign moles usually have a smaller diameter than malignant ones. Melanomas usually are larger in diameter than 6mm, but they may sometimes be smaller when first detected. Evolving: Common, benign moles look the same over time. Be on the alert when a mole starts to evolve or change in any way. Any change — in color, shape, size, elevation, or another trait, or any new symptom such as bleeding or crusting — points to danger. Noticing one or more of the above, would warrant an appointment with a physician.
(continued on p. 12)
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What are ABCDE of melanoma?
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Skin cancer and color of the skin The general misconception is that people with dark color skin are not at risk of skin cancer. It is important to know that skin cancer can occur in people with colored skin as well, although their overall incidence among them is far lower than that among Caucasian population. Studies show that African Americans and other ethnic groups often have more advanced disease of melanoma at initial diagnosis and higher mortality rates than Caucasians. Also squamous cell carcinoma that tends to spread is more common among dark skinned individuals. Therefore, while it is true that skin cancer is much more common in lighter-skinned individuals (Caucasians), it tends to be more deadly among individuals of color.
Prevention of Skin cancer Sun protection plays a key role in prevention of skin cancer. Listed below are some of the skin cancer prevention tips. • Seek the shade, especially between 10 AM and 4 PM. • Avoid tanning and never use UV tanning beds. • Avoid Sunburn • Cover up with clothing, a broad-brimmed hat and UV-block- ing sunglasses. • Use a water resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher every day. • Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating. • Examine your skin head-to-toe every month. Scalp and nails also need to be examined carefully. Make it a habit to ask your hair dresser at the time of your haircut if any spots are seen on the scalp as scalp melanomas carry a bad prognosis. • See your physician every year for a professional skin exam.
In summary, skin cancer is the most common cancer in the US. BCC is the most common type of skin cancer and it is usually localized. However, it needs to be treated early to prevent wide spread excision which can look disfiguring at times. SCC is the second most common skin cancer and it is both locally destructive and has a potential to spread to other organs. Melanoma is the most dangerous type of skin cancer causing death invariably if not treated. Remember, ABCDE rule of melanoma. It is to be remembered that people of all skin types are at risk of skin cancer, though naturally dark-skinned people are less likely than fair-skinned people to get skin cancer. Therefore, it is very imperative for people with all skin colors to practice sun protection. Sun protection plays an essential role in prevention of skin cancer. Any new skin lesion(s) or changes to any existing lesion(s) needs to be brought to the attention of your physician immediately. Reference: 1. http://www.skincancer.org 2. Melanoma in Non-Caucasian: Jonathan Stubblefield BS and Brent Kelly MD Surgical Clinics of North America, 2014-10-01, Volume 94, Issue 5, Pages 1115-1126 3. Text book of Andrew’s Disease of the skin
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in Medicine by Nemil Shah, M.D.
It’s clear that Amazon’s meteoric rise didn’t happen by mistake. Jeff Bezos in his “Day 1” letter to shareholders outlines the importance of executing an unparalleled customer experience. By treating each day at Amazon as his first day, he has been able to create a platform for all sorts of independent retailers and services while passing the savings along to us, the consumer. Amazon makes accessing virtually anything, convenient! Amazon’s marketplace, true to it’s name, enables natural selection through the survival of the fittest. Why can’t we treat every day as our first day in practice in medicine? Competition fundamentally reduces costs while improving quality. Instead of arguing that Amazon monopolizes the retail industry, we should look at it as a platform that has transformed the retail industry. It reduces the barrier to entry for independent retailers and enables access to consumer-reviewed products which we otherwise may have never even known about. Amazon’s competitive e-commerce marketplace emphasizes quality in the customer experience and the online retailer experience. Quality care, or the lack thereof, in the healthcare system needs an “AMAZONing”: improvement in quality while reducing costs. Unattached and non-relational patient care is becoming a standard in the healthcare industry. There appears to be a shift from a once sacred doctor-patient relationship to one in which there has been a growing trend of patients who have determined the doctor-patient relationship is not a good use of their time. The growth of retail clinics, convenient care options, and telemedicine has enabled patients the opportunity to find care when they need it most: when they are sick! Independent clinic operators and private practice physicians should ask themselves why convenient care options are growing instead of giving up on their careers and practices. It’s obvious, these services exist in part because of the poor patient experience in healthcare. How many times have you called your doctor’s office and waited 10-15 minutes on an automated telephony system only to be told by the secretary “sorry please come in tomorrow or next week”? How many times have you had to wait to get an appointment, wait in the waiting room, wait in the clinic room, and been completely exhausted after completing your appointment? How many times have you been referred out to another specialist, lab/imaging, and/or ancillary service and faced similar waits and wasted time?
Inside Medicine | late summer 2017
The â&#x20AC;&#x153;doctorâ&#x20AC;? appointment experience has been terrible for years. Today, we are experiencing a boom in on-demand care services addressing that problem. Greater access to care through new models, however, is stressing an already-stressed healthcare system. Greater access means greater utilization of care away from the once sacred doctor-patient relationship. Without the tools to facilitate convenience, primary care practices now consist mainly of elderly patients with multiple medical problems who need more support and attention. The younger, healthier, and more tech saavy patients are seeking episodic and convenient care options. The system needs a great re-balance of the patients to ensure the future quality of care, but how? Providers NEED the RIGHT tools to adapt to the new healthcare landscape in order to stay competitive. Practice operators NEED to RECAPTURE and RECONVERT patients while reducing the barrier of high real-estate costs and marketing expenses. What is the solution? A competitive marketplace platform that provides an unparalleled patient care experience while enabling physicians reduced barriers and greater opportunities to access new and existing patients: ApproXie Share your thoughts with me on twitter @nemils or @approxiehealth or visit us at approxie.com
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Inside Medicine | late summer 2017
Practice the ABC’s of Good Posture
by Larry Parker, MD
As an orthopaedic spine specialist, I can tell you that your posture is essential to your health. Good posture helps reduce back and neck pain, minimizes your chances of needing spine surgery, and enables you to live an active lifestyle. But how can you learn to practice good posture? It’s as simple as ABC.
Experience good posture
Spine specialists use the term sagittal balance to describe a patient’s spinal alignment or posture. The best way to learn good sagittal balance is to experience what it feels like. Here are the ABCs that I teach my patients to help them experience the feeling of good posture:
• Begin standing up with your hands by your thighs—slowly arch your lower back and elongate your stomach muscles. • Gently pull your belly button towards your spine. In this position you should feel your lower back muscles, upper torso, and shoulders aligning over your heels.
• Rotate your shoulders outward so that your thumbs are pointing away from your body. • At the same time, draw your shoulder blades together. Adding this step should allow you to feel the muscles between your shoulder blades.
• With your neck muscles relaxed, look up until your ears line up over your shoulders. • During this step it’s vital that you relax your jaw and breathe through your mouth and nose. After step C, you should feel your elongated stomach and lower back muscles, the strong muscles between your shoulder blades, and your supporting neck muscles. This is the feeling of good posture.
Identify poor posture habits
On top of experiencing good posture, you can protect your spine by identifying your poor posture habits. Here are some of the posture issues I see at my practice: • In today’s world of smart phones and iPads, from a young age we spend countless hours staring down at devices with our necks flexed forward and shoulders slumped. This practice is so widespread that it has led to an epidemic of back and neck pain, or “text neck,” amongst children and teenagers. • As we grow older, we enter the workforce and spend untold hours—with few breaks—sitting at our desk while staring at a computer. This unfortunate habit deconditions our postural muscles and stiffens our spines. • Towards retirement, the cumulative effect of decades of poor posture may result in postural kyphosis, or a permanent flexed-forward posture. A flexed-forward posture comprises quality of life by limiting function, inhibiting balance, and increasing the risk for spinal fractures and chronic back pain.
Make posture a good habit
You can quickly improve your posture by practicing the ABCs several times a day. If you feel that you need more personalized instruction and strengthening exercises, a physical therapist can evaluate your posture and provide you with additional instruction. Remember that good posture can’t prevent all health problems. If you experience severe back/neck pain or numbness in your arms/legs consult with a spine specialist— these may be symptoms of spinal stenosis or another condition. Take a break right now and practice your ABCs. Good posture can go a long way towards keeping your spine happy and healthy for a lifetime. 16 16
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Eric used a voice computer to speak to a United States Senate hearing— ultimately helping to convince Congress to approve a National ALS patient registry to gather critical data on ALS patients.
by Jill Homan
President, Deep Target
he baby pictures hanging in the hallway reminded me of my own toddler – big smile, chubby cheeks, tiny creases at his wrists and ankles to connect his plump hands and feet … the picture of health. My mind flashed to that day my co-worker and friend stood in my office, chin quivering and voice cracking as he explained to me that the diagnosis was an “atypical form of ALS”. ALS? My mind raced as my then-mentor and CEO further clarified that ALS was “Lou Gehrig’s Disease” and that there was no cure. I recall feeling numb as my mind tried to process that diagnosis, what this family was about to experience, and the last few months leading up to this news. Now, here I stood … looking at these hallway photos and remembering Eric. Eric, was an 18-year-old honor student with perfect SAT scores in Math and Science, had a Georgia Tech academic scholarship in hand, accolades too numerous to list for his musical talents, and an invitation to play in the Georgia Tech Symphonic Band. His speech had suddenly begun to slur, prompting college interviewers to ask him to repeat himself. I recalled my friend asking me if I had noticed and me chastising him for being too hard on Eric … pointing out that he was just a teenager, not a seasoned executive. We both decided it was the laziness and haphazardness of a teen, ready to be done with high school and move on to an amazing college experience …. That was wishful thinking. Eric was one of the youngest people ever diagnosed with ALS and he would end up battling this imprisoning disease over the next ten years, twice the expected lifespan of a person living with ALS. Eric would leave a lasting impact on many over the next ten years. Eric, along with his parents Marcia and Stuart Obermann, 18
Inside Medicine | late summer 2017
would go on to become tireless advocates for people suffering from ALS. Even after losing his ability to speak, move or even breathe without assistance, Eric used a voice computer to speak at the United States Senate hearing – ultimately helping to convince Congress to approve a National ALS patient registry to gather critical data on ALS patients. Eric also influenced Senator Richard Shelby to champion ALS Research – leading to the eventual acquisition of over $100 million in funding. Eric’s motivation and initiative also helped with the formation of the ALS Association Alabama Chapter and the eventual opening of the Crestwood ALS Care Clinic, an ALS Association Treatment Center of Excellence. The Crestwood Clinic allows ALS patients to see multiple medical disciplines all on one clinic day. Patients have access to a neurologist, physical therapist, registered dietician, speech therapist, respiratory therapist, and social worker. Consultation is also available by referral with other specialists, including pulmonologists, gastroenterologists, ENTs, and psychiatrists/psychologists. ALS patients who are registered with the ALS Association Alabama Chapter may visit the clinic by appointment. Fast forward now seven years since Eric’s passing, my chubby toddler is now 18 and getting ready to leave for college. Indeed, Eric influenced how we raised our son Reid – teaching us to cherish each moment and to realize we are not promised tomorrow. Eric influenced our entire family and taught us that some causes are much greater than ourselves. Eric’s tremendous impact in his short time here serves as motivation for me to continue to keep up the fight for
those living with ALS. I serve as Secretary of the Board for the ALS Association Alabama Chapter, raising funds and awareness and promoting research to find a cure for this terrible disease. Eric’s influence over my thinking and actions continues. My current role in an exciting local tech company has given me another opportunity to question where else we can add value to our community. DeepTarget is a local FinTech (Financial Technology) company that enables banks and credit unions across the U.S. to connect, engage and cross-sell to their account holders using business intelligence and digital marketing. Today, more than 260 DeepTarget digital marketing solutions are in use by credit unions and banks across the country. By automating the use of customer information, these solutions deliver targeted product offers and pinpointed one-to-one messaging to banking customers through mobile and online banking, web and email - wherever, whenever and however they bank. Our mission is being further fueled by financial institutions getting outstanding results in the form of leads and new loans or other transactions by using our solutions, and those still looking for easier and smarter ways to connect to their diverse customer base in a way that is both personal and relevant. We are fortunate to have our base in the wonderful technology and innovation hub of Huntsville and see this as a real competitive
advantage towards driving our accelerated growth. As I said earlier, Eric’s influence continues. It is now serving as a catalyst for me to develop our new DeepTarget Cares program - one where our team works within the Huntsville community to do what we can to make a difference, with an objective to grow our span of care and influence as our company and team expand. .................................................................................................... At HudsonAlpha Institute for Biotechnology right here in Huntsville, scientists are applying their extensive expertise in genomics to untangling ALS and other neurodegenerative diseases in the hopes of identifying better treatments for these conditions. To advance the research into ALS and other neurodegenerative diseases, HudsonAlpha created the Memory and Mobility Fund as part of the scientific advancement fund. “HudsonAlpha is uniquely positioned to identify new ways to prevent and treat ALS. Our experience and expertise, along with our scientific approaches, are providing new hope for patients and families,” said Rick Myers, PhD, HudsonAlpha president and science director.
To learn more and contribute, visit: hudsonalpha.org/memory-and-mobility-fund
Inside Medicine | late summer 2017
} HEALTHY LIVING
by Bradford Meythaler
Aging-in-Place Guide: How to Stay in Your Home in Later Life The number of Americans who first grew up with rock ‘n’ roll, astronauts and McDonald’s is off the charts. The late 1940s through early 1960s were marked by a boom in the U.S. economy, suburban living and especially, babies. Lots of babies were born during this time period— some 76.4 million notes the U.S. Census Bureau.
These boys and girls who lived through the Cold War and cold cuts on Wonder Bread® are now aging individuals who almost all agree on one thing: living in their own home later in life. Nearly 90 percent of the nation’s aging baby boomers want to age in place. The American Association of Retired Persons (AARP) reports that 75 percent of adult children and 69 percent of the parents think about the parents’ ability to live independently as they get older. But how will these aging seniors remain comfortable and safe at home? What proactive steps can help safeguard everyday activities for older adults inside and outside the home? “As loved ones age, certain conditions like visual changes and weaker muscles can affect balance, or some diseases and medications can cause cognitive issues,” said Bradford Meythaler, President of Right at Home Huntsville. “When seniors face health concerns as a result of aging, their risk of falls and injuries escalates, and sometimes their home itself is hazardous. This is why it’s essential to assess regularly a senior’s health and anything in the home that might be a safety concern”. To reduce potential home hazards for older adults, Meythaler recommends the free Aging-in-Place Guide developed by Right at Home with Dr. Rein Tideiksaar, a leading gerontologist and geriatric physician assistant who specializes in fall prevention for the elderly. The Aging-in-Place Guide helps senior adults and their families spot home safety concerns and create an individualized plan around the elder’s functional abilities, including getting out of bed and bathing. The guide includes a checklist of risks for home accidents and tips for making a home safe again if health or environmental factors arise. (continued on p. 23) 20
Inside Medicine | late summer 2017
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} HEALTHY LIVING (continued from p. 20)
For more information
about home safety for older adults and to
receive a copy of the
Aging-in-Place Guide, contact 256-585-3140
The safety solutions can be as simple as adding brighter lightbulbs and more light fixtures to solve inadequate lighting. Adding carpet tape can smooth out curled carpet edges. For more extensive fixes, the guide outlines home modifications and remodeling such as installing bathroom grab bars, widening doorways and enlarging rooms. The Right at Home resource also highlights home-monitoring technology that is becoming more user-friendly and affordable to protect seniors at home and provide families with greater peace of mind. These secure-at-home options include updating the home with smart auto-set devices to simplify daily tasks such as opening or securing windows and doors, turning off appliances, and lowering countertops and shelves. Typically, older adults accept only two or three modifications to their home at a time, so Meythaler advises that families create a priority list and together work from that. “Sometimes, a simple adjustment like removing clutter from pathways or changing out hard-to-grasp doorknobs with handles is an easy fix and all that is needed to protect a senior at home,” said Meythaler. “The Aging-in-Place Guide identifies specific home hazards and clear-cut solutions. It’s also important to include the elders in health and home safety conversations and to give them a choice of the best living space options. With the right planning, living enjoyably and safely at home is fully possible for most of America’s seniors.” ................................................................................................................................. About Right at Home Founded in 1995, Right at Home offers in-home companionship and personal care and assistance to seniors and adults with a disability who want to continue to live independently. Local Right at Home offices are independently owned and operated and directly employ and supervise all caregiving staff, each of whom is thoroughly screened, trained, and bonded/insured prior to entering a client’s home. Right at Home’s global office is based in Omaha, Nebraska, with franchise offices located in 45 states nationwide and throughout the world. For more information on Right at Home, visit About Right at Home at http://www. rightathome.net/about-us or read the Right at Home caregiving blog at http:// www.rightathome.net/blog. To sign up for Right at Home’s free adult caregiving e-newsletter, Caring Right at Home, visit http://caringnews.com. About Right at Home of Huntsville The Huntsville, Alabama office of Right at Home is a locally owned and operated franchise office of Right at Home, LLC, serving the communities in Northern Alabama. For more information, contact Right at Home of Huntsville at www. RAHHSV.com, 256-585-3140 or by email at firstname.lastname@example.org.
Improving the Quality of Life for Those we Serve
Inside Medicine | late summer 2017
} HEALTH FEATURE
by Dr. Michael Dohrenwend
Board Certified, Gastroenterology Center for Digestive Health
Karen Fox, CRNP
Hepatitis C...Know the facts not the myths...not only can people with Hepatitis C be treated, they can be cured. Hepatitis C is a blood borne disease that was identified in 1989. Prior to 1989 it was labeled non A non B viral Hepatitis. Hepatitis C is a contagious disease caused by the Hepatitis C virus. The Center for Disease Control (CDC) estimates 2% of the US population or 3.5 million individuals currently have Hepatitis C in the USA. Most do not know they have the disease. The virus can be present/active for decades with little or no symptoms. According to the CDC, baby boomers are the largest group at risk, 1 in 30 have Hepatitis C. Baby Boomers are individuals who were born between1945 - 1965. Nine months after World War II ended more babies were born in 1946 than the prior year. In 1965, 3.4 million babies were born, that is 20% more babies born than in 1945. This was the beginning of the baby boom and in 1964 the birth rate began to taper off. In 1964 there were more than 76.4 million baby boomers in the USA, making up 40% of the population. The most accepted explanation for the baby boomer generation is families were confident after the war to start a family. They believed in the future and prosperity of our country. Why are baby boomers the highest risk group diagnosed with Hepatitis C? According to the CDC most baby boomers were infected in the 1970’s & 1980’s. During these decades infection control standards were not the same standards as we have today. Hepatitis C virus is spread through direct contact with infected blood. This means blood to blood transmission, such as having a cut with blood exposed and touching another person’s cut with blood exposed that is infected with the Hepatitis C virus. Most people with Hepatitis C contracted it through shared needles, snorting cocaine, sharing razors, toothbrushes, tattooing and body piercing if strict hygienic precautions were not taken. Prior to 1990, blood was not tested for the Hepatitis C virus, therefore receiving a blood transfusion prior to 1990 is a risk factor. History of HIV is also a risk factor. Keep in mind baby boomers are the highest risk group, however any one with high risk behaviors are at risk of contacting the Hepatitis C virus. Intravenous drug use is a significant risk factor, unfortunately IV drug use is on the rise. According to World Health Organization (WHO), 13 million people globally inject illicit drugs. The estimated global prevalence of Hepatitis C in people who inject illicit drugs is 67%. The CDC reports more people die from Hepatitis C than from HIV infection. Hepatitis C is NOT transmitted with sharing utensils or casual contact such as hugging, shaking hands or sneezing. The risk of spreading Hepatitis C during sex is low (3% over 20 years in monogamist couples with unprotected sex). Hepatitis C is a virus that affects the liver. It can cause acute or chronic liver disease, ranging from mild to serious liver disease. It tends to be worse or accelerated in persons with moderate to heavy alcohol use. According to the WHO approximately 71 million people globally have Hepatitis C. Approximately 24
Inside Medicine | late summer 2017
399,000 people worldwide die annually from Hepatitis C, mostly from cirrhosis or liver cancer. Cirrhosis is extensive scarring of the liver. Hepatitis C is the leading cause of liver cancer and liver transplantation. Hepatitis C is diagnosed with a blood test. Ask your health care professional if Hepatitis C screening is for you. A positive Hepatitis C test doesn’t mean the virus is active, it does mean you were infected at some point. Remember it takes only one exposure to be at risk. Most people do not know exactly when they were infected. Hepatitis C antibodies remain in the blood once a person is infected with the virus for life. Another special blood test, Hepatitis C RNA is then ordered to see if one is currently infected with the virus. According to American College of Gastroenterology (ACG) approximately 15-25% of people infected with Hepatitis C spontaneously clear the virus without treatment. According to ACG, symptoms can include fatigue, abdominal discomfort, nausea or itching. Once a patient develops cirrhosis, symptoms are more prominent and can include jaundice (yellowish color of the skin), weight loss, abdominal swelling, vomiting of blood. The virus is slowly damaging the liver over years to decades. Untreated Hepatitis C can lead to liver cancer and even death. The goal of Hepatitis C treatment is to clear the Hepatitis C virus. Prior to starting treatment the health care specialist will spend time discussing Hepatitis C and develop a plan of care. Today’s Hepatitis C treatment has less side effects and is easier to take than treatment from years prior. The end goal is sustained virologic response (SVR). In other words Hepatitis C virus is cleared after treatment. Hepatitis C is treated by a specialist, such as a Gastroenterologist, Hepatologist or Infectious Disease Doctor. These health care professionals have been trained and have the knowledge to best treat and manage Hepatitis C. The first step prior to treatment is to order specific blood tests to confirm active Hepatitis C. An abdominal ultrasound is also ordered to assess the liver status. After careful review of blood test, ultrasound, current medications the specialist will come up with a treatment plan. Direct Acting Antivirals (DAA) are medications currently used to treat Hepatitis C. These medications are taken by mouth and have less side effects than prior treatments. Average treatment last 8-24 weeks, depending on the lab results, liver status and prior history of any treatments. Treatment holds 90-100% cure rates. Currently there is no vaccine for Hepatitis C. In summary it is important to discuss Hepatitis C with your health care provider. Get tested if you are at risk. If you do test positive for Hepatitis C, there is a cure with a high cure rate 90100%. The major barrier why most people avoid discussing Hepatitis C with their health care provider is the social stigma of having Hepatitis C. Also avoid high risk factors that increases risk of contracting the Hepatitis C Virus. Don’t let this prevent you from getting treatment, preventing liver cancer or liver failure. Know the facts, it can save your life or a love one’s life. If we can be of help with any questions or screening for Hepatitis C please contact our office. 256.430.4427
Inside Medicine | summer 2017
EATING DISORDERS CAN HAPPEN TO ANYONE.
Inside Medicine | late summer 2017
Please know you aren’t alone. I am certainly a textbook example of all the stories you read and hear about teenage girls battling an eating disorder. I come from an affluent, two parent family with one older sister. My dad was a hardworking mechanical engineer and my mom was the idealistic housewife and mommy. My mom was super supportive and also super controlling; but at the time, I never saw her as such. She was my best friend and my favorite confidante. We lived in a nice, two story home in the suburbs of Birmingham. I went to school from preschool to high school graduation with the same classmates in the same school system. I was a straight A student, and by birth, slightly a perfectionist. I was also a part of the popular crowd. Just a typical, normal teenager with typical normal teenage issues. During my junior year of high school, I realize now, I was finding my way through the angst of growing up. I watched my childhood friends change and develop and I struggled to keep up. I didn’t like the idea of losing my adolescent naivete’. I didn’t like the changes and I didn’t appreciate having to break out of my shell and become an adult. I felt I was not in control of anyone, myself, or my body. Either a teacher, a friend, or my parent seemed to dictate who I was and where I was going at all times. The summer before my senior year, I accidentally decided to “get fit”. I wasn’t necessarily overweight but I saw myself as pudgy and was becoming insecure. I was on the cheerleading squad so I was expected to maintain an athletic build. So, watching what I was eating was not something completely out of the blue. I started small….when my friends ordered French fries, I would refrain and say I wasn’t hungry. I began packing a lunch for cheer days and for lunch during my senior year. I ate a plain turkey sandwich, a few pretzels, and maybe a jar of peaches….every day, for about 10 months. I would eat a small bowl of cereal for breakfast, and typically, a somewhat complete dinner (at least in front of my parents).
Obviously, I started to drop weight, and drop weight, and drop weight. With an active schedule and my finding something I could finally control, my 5 ft 6 in frame depleted to 100 pounds. Along the way, I would get tons of compliments and encouraging words about how great I was looking, etc. It helped me to continue down the dreadful spiral. I never ended up hospitalized like many others do, but my mom did take me to the doctor and then to a counselor. She could read between the lines and knew what we were headed toward. I did not want to talk to someone about my problems and resolved to promise I would start eating more. Well, I did start eating more, which lead me to my battle with bulimia. All four years of college, I was constantly fighting the urge to eat what everyone was eating and then go throw it up. After a six year fight, in all, I truly decided that for me, the only way to get rid of my problem was to hand it over to God. He was the only one who could definitely take away the burden and demon of my eating disorder. Anytime I felt like I needed to throw up, or skip a meal, I would literally cry out to God (often times silently in my head) for Him to help me. Most days, this is the only way I would make it through. Many people are predisposed to eating disorders and other mental illnesses. Some people are just wired to have them. You can find help with prescriptions and counselors, but I truly believe my absolute way to recovery was with GOD’s help. He is the best medicine! Now, as a 36 year old mother of 3, I still have days I find myself struggling. And still, the only way I pull myself through, is with my Lord’s help. Please know you aren’t alone. Please know others deal with and hide problems just like you have. Whatever it may be, “Trust in the Lord with all your heart and lean not on your own understanding.” Proverbs 3:5
**According to the National Association of Anorexia Nervosa and Associated Disorders, 95% of all eating disorders affect children between the ages of 13 and 25. For help and further information, you can call the National Eating Disorders Association or visit their website at www.nationaleatingdisorders.org
Call our toll-free, confidential helpline 1-800-931-2237
Monday - Thursday from 9:00 am - 9:00 pm and Friday from 9:00 am - 5:00 pm (EST)
Inside Medicine | late summer 2017
} HEALTH FEATURE
Dry Needling by Michael Beuoy, PT, Cert. MDT
pain should not be allowed to control your life In a society where prescription pain medication is under scrutiny, other options to help manage pain need to be explored.
Inside Medicine | late summer 2017
Pain affects us all at some point. Many reasons for pain exist, but often the soft tissue that we are made of plays a significant role in the discomfort that we feel. This tissue includes our muscles and the connective tissue, or fascia, that hold us together. When these tissues are dysfunctional, they do not move appropriately and can restrict circulation. Tissues that do not get enough oxygen have a difficult time healing and can create limitations in motion and our ability to move or perform normal tasks that we do daily. Many options for pain relief are available. As a physical therapist, we are trained in a variety of manual techniques, corrective exercises and modality treatments to help ease pain. One such treatment that is not as well-known is called dry needling. This is a treatment performed by a skilled, trained physical therapist that involves inserting a small, solid needle into the dysfunctional tissue to release trigger points. The insertion of the needle has a local effect on the tissues around where it is inserted. It also creates a systemic response, causing the release of endorphins by the brain to give an overall analgesic effect. The result is decreased tissue tightness, increased circulation, improved mobility and pain relief. Dry needling can be performed on acute injuries such as hamstring strain or ankle sprain, but it is also effective at helping with chronic pain issues. The frequency and number of treatments necessary varies for each patient. Some patients get relief of pain with a single session, while others require multiple needling treatments combined with other physical therapy interventions to see maximal improvement. The length of the session and the number of needles used will depend on the area and number of structures that are to be treated.
The most common question about dry needling is “Is it acupuncture?” The same needles are used to perform both, but the structures being treated are different. The second most common question is “Does it hurt?” This varies from person to person. Most patients report a deep ache while the treatment is being performed. Some patients report not feeling the needle at all. Localized soreness can be reported in the hours following the treatment, but that is usually minimal and resolves by the next day. The risks associated with dry needling are few and the incidence rate of these risks is very low. These should be discussed with the patient by the therapist that is to administer the treatment prior to the initial session. “Does my insurance cover it?” This depends on your specific policy. Many insurance companies are covering the procedure, but several do not. Cash options are available if the treatment is not covered under your plan. Patients dealing with pain have often tried many forms of treatment to seek relief. Maybe it is difficulty with running a marathon. Maybe you’re unable to play with your children or grandchildren. Or maybe, you deal with constant pain. Regardless of your situation, pain should not be allowed to control your life. In a society where prescription pain medication is under scrutiny, other options to help manage pain need to be explored. Dry needling can be one of those options.
Michael Beuoy PT, Cert. MDT Partner/Director TherapySouth Huntsville 256-513-8280
Inside Medicine | late summer 2017
your GenE•erosity MAKEs IT POSSIBLE to help those in need Jim Wall has struggled with back problems for more than 20 years, but just ignored the pain and accepted it as a part of life. “My sister used to tell me I had the ‘back walk’ and my wife used to tell me I walked around the house like Frankenstein,” said Jim. “Those were probably early symptoms.” In addition, Jim had swallowing issues – even with the tiniest amounts of food–and balance problems. Little did he know, there was a larger issue at hand.
Taking action After the death of his wife in 2007, Jim decided it was time to take control of his own health, and he began his search for a diagnosis at Emory University in Atlanta, Ga. He saw nearly ten different doctors. “I went to Emory for my back problem and I saw a bunch of different specialists in the neurology department. I saw swallowing specialists, balance specialists and a lot of other specialists. You name it, I saw it.” Jim was diagnosed with primary lateral sclerosis or PLS. Similar to ALS, PLS is a type of motor neuron disease that causes muscle nerve cells to slowly break down, causing weakness in your voluntary muscles, such as those you use to control legs, arms and tongue. “It mainly affects the muscle tone in the lower half of the body,” he said. “It also affects swallowing and anything connected to the neurological system. The prognosis is long-term and you never get better but in most cases, it isn’t fatal.” 30
Inside Medicine | late summer 2017
PLS explained most of Jim’s symptoms, but not all of them. He also didn’t know what caused his disease, or if it could potentially affect other members of his family. Nine years later, Jim moved back to his hometown of Huntsville, Ala., where his sister, familiar with HudsonAlpha and teaches Project Lead the Way classes at Bob Jones High School, suggested he visit Smith Family Clinic for Genomic Medicine. “She always thought that I had something similar to what my grandfather had,” said Jim, “So she thought it was probably genetic. That’s when I decided to contact the clinic.” Smith Family Clinic, powered by HudsonAlpha, Children’s of Alabama and UAB Medicine, is located on HudsonAlpha’s campus. The clinic uses whole genome sequencing to diagnose rare, undiagnosed and misdiagnosed disease. “These individuals have often gone to physicians all over the country with the question, what do I have?” said David Bick, MD, a clinical geneticist and the medical director for Smith Family Clinic. “One thing that we always try to do is use the simplest possible test to reach an answer. We ﬁnd, however, that approach, while it can solve some of the cases, doesn’t solve all of them. That’s why we use whole genome sequencing, which is a test that allows us to examine all of the genes at once to help those individuals ﬁnd a diagnosis.”
Whole genome sequencing is a comprehensive test, but it is so new, it isn’t often covered by insurance. Cost was an issue for Jim. He knew he needed the test. Now… how to pay for it?
He found his answer through the Hero Fund. The right diagnosis, thanks to your “gene-erosity” The Hero Fund was established to provide ﬁnancial assistance to qualiﬁed Smith Family Clinic patients who need access to genomic medicine. Thanks to an anonymous donation to the HudsonAlpha Foundation, patients have the opportunity to ﬁnd answers without the ﬁnancial burden. “When I’m able to call someone back and let them know that they’re approved, it brings tears to their eyes,” said Carol Aiken, clinical operations administrator for Smith Family Clinic, “because they knew they needed to have whole genome sequencing, but the ﬁnancial means were not within reach. I can’t express to you in words what it means to make that phone call.” After two decades of unexplained symptoms and appointments with countless specialists and clinics, Jim ﬁnally had a complete answer. “Dr. Bick diagnosed me with spastic paraplegia type 7 (SPG7),” said Jim. “The symptoms are very similar to PLS but there was one symptom that had no explanation...slight hearing loss. So it was nice to ﬁnd
out exactly what was wrong. Without the Hero Fund, I would have never gone through this and found out the true diagnosis.” Although there are currently no treatment options for SPG7, or any other form of hereditary spastic paraplegia, Jim said he is just happy to have an answer. “I’ve accepted the fact that I am never going to get better, but it does get me a little clarity to know what it exactly is,” he said. “I just wish I had this done ten years ago.” “We named it the Hero Fund because in our world, those individuals who have these rare conditions really are ﬁghting that problem every day,” said Dr. Bick. “They are the sort of day-to-day heroes of what we are doing so when we ﬁnd answers for these patients, it’s one of the greatest satisfactions of working here at the clinic.”
Your donation could make a huge difference in someone’s life.
Give to the Hero Fund today
Inside Medicine |
late summer 2017
Making sense of it all HOW TO MAKE SENSE OF MEDICAL STUDIES IN THE NEWS Tips from cancer.org It’s not uncommon to turn on the news or browse the web and find headlines promising exciting news about cancer or another medical condition. Headlines like these make it seem like a miracle cure is just within reach: • Breakthrough in cancer research could spawn new treatments • The Promising Cancer Cure That’s Not Available to Americans • Exciting blood test spots cancer a year early • Cancer: The mysterious miracle cases inspiring doctors Many stories like these are based on medical studies, but they often exaggerate benefits, minimize risks, ignore relevant information, or just plain get it wrong. According to the watchdog organization HealthNewsReview, on average media news story about health care interventions merits a score of just 55% out of 100: a failing grade. Answering these four questions help you better judge health care claims you may come across:
1. Did the study involve people? Research studies often start in a lab where scientists develop and test new ideas. If an approach seems promising, it may be tested on animals, often mice. But an approach that works well in the lab or on animals doesn’t always work well in people. Clinical trials are studies that test whether a treatment, device, or other medical strategy is safe and effective for people. Clinical trials are conducted in a series of phases that build on one another, and are designed to answer certain questions. Earlier phases are to find out if a treatment is safe, if it works, or what its side effects are. Later phases test whether a treatment is better than what is already available and may lead to approval by the US Food and Drug Administration (FDA).
According to the watchdog organization HealthNewsReview, on average media news story about health care interventions merits a score of just 55% out of 100: a failing grade.
Inside Medicine | late summer 2017
Only some trials are designed to test the things that matter most to people: whether a treatment helps people live longer, or improves their quality of life.
2. How many people were involved? In general, the earlier the phase of a clinical trial, the fewer people are involved in the testing. The most trustworthy scientific evidence comes from a later phase clinical trial that involves hundreds or thousands of people. Some studies – called case studies – are as small as just one person. News stories about an individual’s successful outcome are interesting and exciting. But they don’t tell us much about the treatment being studied or how it will work in most people.
3. Does the story jump to conclusions? Many studies are observational. They look for a link between a behavior and an outcome. For example, in some studies, people who drank red wine were less likely to die from heart disease. But no one knows if the benefit came from the wine or from something else the wine drinkers had in common. Maybe they also ate more vegetables, or exercised more. Just
Tips for searching online
because two things happen at the same time doesn’t mean one caused the other. The only way to know for sure would be to conduct a randomized, controlled study, in which two groups of people were treated the same except for the one factor being studied.
4. Does the story add up?
Numbers can be used to make a result sound more impressive than it really is. For example, a story might say that taking a certain drug lowers your risk of stroke by 50%. That sounds very impressive. But if the risk of stroke among the study population was only 2% and the drug lowered it to 1%, that’s less impressive. And if the drug is expensive or has side effects, taking it may not be worth it to you.
A good online search can help you find answers to your questions and connect you with people and resources to help when you need it most. But a bad search can get you wrong or outdated facts, medical information that may not apply to you, or even worse, an invitation to be scammed when you’re most vulnerable. •
Look for trustworthy and reliable websites as your sources. Sites affiliated with groups you already know and trust are often the best places to find quality medical information. This includes nonprofit organizations, government agencies, major medical organizations, and prominent academic health centers. Check with the Health on the Net Foundation (HON). HON is an organization based in Switzerland whose mission is to guide people to useful and reliable online medical and health information. Participating websites must agree to abide by an ethical code of conduct, which covers things like authorship, documentation of materials, and sponsorship of the site. Be suspicious of websites that make claims of “miraculous cures” or “secret ingredients” only available from one company, sites that feature stories of people who have had amazing results from a product without showing clear scientific data, and sites that make it hard to connect with the person or business running the site. Such sites may contain information that is not based on careful science and may deliver misleading information in order to sell you a product.
When it comes to finding out reliable, trustworthy medical information – especially if it’s because you have a health-related problem – your best bet is always to talk to a health care professional who can examine you, your health history, and your unique medical situation.
Inside Medicine |
late summer 2017
Helping kids avoid
ChildhoodObesity by Traci McCormick, MD
As the mom of five kids, this is a subject very close to my heart and close to the hearts of millions of others. One out of five children is obese and many more are overweight. We are seeing diabetes, high blood pressure, and the start of heart disease at younger ages than ever before. This generation of children is expected to be the first generation ever to have a shorter life expectancy than their parents. It doesn’t have to stay this way. There are things we can do to reverse this health crisis. Let’s start with how we can shape young children’s tastes so they will naturally choose to eat healthier foods.
Breastfeed as Often and For as Long as Possible Let me first say—fed is best! I never want to see a new mom struggling to feed her baby and feeling like a failure if she needs to formula feed. I was one of those moms. Five kids and I could never get the hang of breastfeeding. Despite multiple consults with lactation specialists, breastfeeding was always extremely painful for me. But I gave it a go, pumped for as long as I could, then eventually had to switch to formula. With that said, breastmilk is the absolute best nutrition you can give your baby. The longer and more exclusively you breastfeed your children, the greater the health benefits. Serve Fresh or Frozen Baby and Toddler Food When toddlers eat fresh food, they learn what real food tastes like. They learn to enjoy the flavor and texture of real food, and they are more likely to reject salty, sugar-sweetened junk foods. Babies do have an inherent sweet-tooth that should be satisfied with real fruits, like bananas. Graze on Grow Foods Children should be taught to graze on small portions of real food, eating 6 small meals through the day. By doing this, they learn what it feels like to eat “enough” without overfilling their stomachs. Did you know that your child’s stomach is about the size of their fists? Portions don’t need to be any larger than this. Avoid the Terrible Threes There are three artificial additives you should always avoid serving your children. They are high fructose corn syrup, hydrogenated oils or trans fats, and any color additive with a number symbol attached to it (e.g. blue #1, red #40, etc.). Serve Nutrient-Dense Foods Your child’s diet should consist of lots of “grow foods”. These are fresh foods or packaged foods that have undergone minimal amounts of
processing. Young children that are served nutrient-dense foods from an early age learn to prefer these foods.
Model Healthy Eating Habits Studies show that children tend to develop food preferences and eating habits similar to their mothers. Shape, Don’t Control Studies show that rigidly restricting children’s access to certain foods focuses more attention on these foods and increases children’s desire to eat them. Rather than restricting what your older children eat, you should provide your child with opportunities to make wise choices, and direct and redirect behavior in ways that help your child learn to be in charge of himself. Surround Your Child with Nutritious Foods Make healthy food readily accessible to your children. Keep a bowl of fresh fruit on the counter or place a plate of fresh veggies out as snack food. Expose Your Child to a Variety of New Foods It is normal for children to be averse to new foods, but you can help them accept new tastes by starting to introduce new foods early. And if your child won’t eat something the first time, don’t give up! Studies have shown that most children will accept new foods after repeated exposure—usually between 10 and 20 times. Enjoy Happy Meals Make mealtime a special time for family. Create a friendly, pleasurable atmosphere around the table. This will help your child establish healthy feelings about mealtimes. Advice for Parents with Older Kids What about those of you that feel like you’ve missed the boat? Your children already eat poorly and won’t touch a vegetable to save their life. What are you to do? First of all, remember that you are the parent and you get to make the decisions about what food is allowed in your house. Second, know that your children will grumble and complain and probably eat less during the transition to healthier food—but they will come around. Third, be proud that you are shaping their future eating habits and helping them prevent heart disease, diabetes, high blood pressure, cancer, and a whole host of other chronic diseases.
Inside Medicine | late summer 2017
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} LIFESTYLE FEATURE
with Daniel Alexander
Just like in any aspect of health, communication is the key for being understood and to receive the proper treatment. And when it comes to the health of our hair, our being able to openly communicate and be understood by our hairdresser is the key to leaving the salon looking and feeling our best. In the beauty industry, the consultation is the most important part of the service, and surprisingly, it is also the most neglected part of your service. Ask yourself, when is the last time someone complimented your hairstyle? If it has been a while, could it be a lack of communication with your hairdresser? Are you getting a thorough consultation with a clear understanding of your options and the health of your hair?
It has been a very long time since I felt like I met someone who just “gets” me, especially when I can’t even pinpoint those very characteristics in which make me who I am. But sometimes, there are just people who do. Many of Daniel Alexander’s clients would agree with me and feel this same way. He has a talent at getting to know people and helping to achieve their own style. Daniel is a genius at blending them together. When I interviewed Daniel, who recently opened the newest location of DanTera Spa, I discovered the passion that went into a day on the job with this color expert. He began his career in 1994, when a friend convinced him this would be a quick way to earn a decent living. Little did Daniel know he would have one of the greatest influences as an instructor early in his pursuit. His 9 months of studies quickly became a lifetime of continuing education and the reason he would halt his dream of becoming an engineer. After 22 years, and many times wondering if this is what he’s supposed to be doing, he always comes back to a resounding YES! Almost like an architect who requires time to access a property or site, returns to the drawing board several times, and delivers the wow factor days, weeks or even months later, Daniel constantly thinks and tweaks his art. Daniel: Yes, it’s like after doing color on someone’s hair a couple of times… I am constantly thinking about them when I discover or run across a certain look, allowing me to know what I want to do and the result I plan to deliver.
What about change?? Can clients trust you to change their look? Daniel: There are a percentage of my guests that there is no changing them. There are others where all I would have to say is
“I saw this new style, and it made me think about you.” That is usually my approach when I am ready to change someone’s hair. Sometimes, I might for example randomly ask a blonde if they ever thought about being a redhead; or I might ask them if there is a color that they’ve ever dreamed of having but too afraid of doing it, and get the conversation going that way. Daniel has been with DanTera Spas for 6 years. He helped the Madison location and now has two Huntsville locations. He believes in being the education director because in his words, “Education is what really drives a salon and that is what is lacking in the industry, especially in the consultation part of hair. I am transparent when it comes to this topic and I will tell anyone this. The industry needs to focus on communicating with the guests and creating a vision for their guests to actually engage. That is what the owner, Teresa, and I talked about first. We actually talked for about 6 months before I came to work for her. We started small. I was teaching classes in Madison a couple of days and working in Huntsville the other days. After about two years, it got too busy for me to keep going to Madison. I had to stop that and just go for meetings and education. After another two years…putting me with the company 4 years… we started looking at property to bring a second DanTera location into Huntsville. It took us about two years to make that happen, and that is where we are now.” DanTera has definitely made a name for itself. Their primary focus is the experience and they strive to make it great for guests. If the guests don’t feel it is great, they do what they can to make it that way. (continued p. 38)
Inside Medicine | late summer 2017
(continued from p. 37)
Daniel wants his clients to feel comfortable and secure, and have a wonderful experience, no matter what...
Daniel: Let me say this about experience. There are over 200 salons in Madison County. You chose to come here, so you are doing me the favor; not me doing you a favor. The least I can do is to make it convenient for you. I realize everyone has a life outside of here, and hair is an important part of it. That is kind of why we wanted to do the experience side, and that is why we made education such a huge thing in the company. It’s a requirement. That is why we set our standards high. It’s because people, like yourself, who have a busy life, don’t need their hair to be busy also. This needs to be the relaxing part of the day. It needs to be stress-free, where you come in the salon and exhale.
Daniel uses his time with clients wisely. Before he even begins
to work on your hair, he completes a consultation. He wants to know about your lifestyle, how you treat your hair and take care of it, and even how you feel about your hair. He wants to know what brought you to him and how you wear your hair. For every problem you have, Daniel will look for the answer to help. Dry hair? Color fading? Oily hair? The needs he takes care of comes from what the customer seems to need. Daniel: Beautiful hair always begins with healthy hair! You need to feel a difference when you leave our salon and your hair should be in better shape than before you walked in. We use Aveda coloring and recommend their products. When you go home, you have to be willing to take care of your hair and look forward to your next visit with me. I treat the process not necessarily one hair cut or color. I want my clients to get compliments on their hair. That’s my ultimate goal.
Inside Medicine | late summer 2017
5 things to keep healthy hair 1) Use a professional shampoo and conditioner no matter what. 2) If you don’t have to shampoo your hair every day, don’t. You need to maintain the acid mantel and it takes 24 hours for an adult to regain it after you shampoo your hair. You don’t want to put your hair in a state where your scalp thinks its dry all of the time and produces an overabundance of oil. You will feel like your hair is oily all of the time, so you have to shampoo it more often. You are just creating a bad cycle with that. If you find yourself in that, you are actually going to have to go a couple of weeks with oily hair to get everything balanced out. Therefore, if you could go 48 hours without having to shampoo your hair, it would be best. 3) Don’t color your hair at home. Color is a lot on your hair. You’ve got what is called natural remaining pigment in hair that is affected. If you are paying $6-10 for your color, then that is what you are getting out of it. We actually custom formulate many hair colors to every individual. 4) Don’t over style your hair. Don’t over flat-iron; don’t over curl your hair. If your hair is getting damaged, do something about it! 5) Have a consistent hairdresser that you can communicate with that you understand and understands you. This is a big one, and it may take a little while to find one.
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} HEALTHY LIVING
…and Good night! 1. Aim for a bedtime that allows your
child to get at least 9 to 11 hours of sleep. If your child is not going to bed early enough, start moving bedtime up two weeks prior to the start of school, if possible. Move it up 15 to 20 minutes every few days.
2. Set a regular sleep schedule. Your child’s
bedtime and wake up time shouldn’t vary by more than 30 to 45 minutes between weeknights and weekends.
3. Start scheduling a regular wake up time one week before school starts.
4. Create a bedtime routine – yes, even The National Sleep Association recommends school age children (6-13) get between 9-11 hours of sleep per night while teenagers (14-17) should aim for 8-10 hours a night. Back to school time typically means back to our regular routine time. This includes afterschool activities, weekend events, and most importantly, bed time routines. During the summer, most of us drift from the normal and allow our children to go to bed later and get up when they want. But, with the new school year starting, it’s important to back the bed time up to ensure children get the recommended hours of sleep they need to function properly. Studies indicate when children do not get enough sleep behavior problems increase. This includes ADHD symptoms, mood swings, and hyperactivity. It also seems to lead to over eating and obesity. So, getting enough sleep should decrease these things and help create a happy, healthier student/child! Sara Lappe, MD with U.S. News and World Report has eight recommendations to help you and your child become school ready and sleep fulfilled.
Inside Medicine | late summer 2017
for older children – that is calming and sets the mind for sleep.
5. Turn off electronic devices at least 60 minutes prior to bedtime.
6. Avoid caffeine and sugary drinks, particularly in the second half of the day.
7. Help your child get ready for sleep by making sure he or she is getting enough physical activity throughout the day. Aim for at least one full hour of physical activity. Outdoor play, particularly in the morning, is helpful because exposure to natural light helps keep your child’s circadian rhythm in sync.
8. As with many habits, it’s essential to
set a good example by making sleep a priority for yourself.
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IT’S NOT TOO LATE by Pat Ballew, 2015 Mr. Alabama
Do you want to live a longer, healthier, and happier life? Of course you do! Who wouldn’t want to experience all the joys and beauties of life for as long as possible.
What are some ways to better improve your health and fitness and hopefully extend your lives a little longer? The first thing I recommend is to write down a fitness goal. Don’t just think of one, actually write it down and put it somewhere you will see every day. Once something is written out it seems to become much more attainable. Additionally, you will hold yourself more accountable when you actually read and see your goal each day. Start with a simple goal. Little changes over time create greater change in the end. After you have your goal written out, decide how you will go about getting it done. This is the fun part! Yes, I said fun part. It typically involves some sort of activity or workout regime. When people think of working out they instantly picture being in a gym lifting weights or on a treadmill running to the beat of their favorite music. Well my friends, fitness can be so much more than that. Mother nature has provided us with the ultimate adult playground. There are unlimited outdoor activities that not only elevate your heart rate, but also allow you to spend time with your friends and family. Spending time with loved ones is something that none of us do enough of these days. We are all guilty of burying ourselves in technology. Go for a swim, play a game of kick ball, ride your bike around the neighborhood. All of which are simple and effective ways to burn calories and build your cardiovascular stamina while building a great foundation for improving your health. It doesn’t have to be complicated, in fact, anything that gets you moving around can be used as exercise. Lets get out of the house and get back to experiencing life. I challenge you to pick some outdoor activities and give them a try. What do you have to lose? Just don’t sit on the couch and let this beautiful life pass you by. Our time on this earth is limited enough. Lets stop doing things that make our time here even shorter.
You hold the power to creating the life you live. I believe in you!
Inside Medicine | late summer 2017
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Why is my doctor requiring me to see them for my
prescription refill requests? by Tiernan O’Neill There are many reasons why patients call their doctor. However the majority of those reasons fall under two categories, a) they wish to schedule an appointment or b) they are calling to request refills on their medication without scheduling an appointment. The former is relatively straight forward, but the latter can often be a source of confusion and conflict when requests are denied and patients are required to see the doctor. Although not necessarily an administrative concern, it is the clerical staff falling directly in the line of fire of patient frustrations. It is important as always to keep in mind rarely does staff relay unauthorized information from the doctor nor do they make independent decisions. More times than not they are simply following the physician’s (and their employer’s) protocol and/or direct orders. But I’m sure many patients might be interested in the reasons behind such decisions. And they often fall in one of the four categories below. 1) All medications have the potential for SIDE EFFECTS. This should not necessarily come as news to people, but perhaps it is overlooked too often. Such side effects are usually provided by the pharmacy or covered by the physician when medications are first prescribed. Furthermore, these potential side effects are often detailed through all of the direct to patient commercials or even class action lawsuits surrounding nearly every medication out there. Side effects can appear anytime, regardless if a patient has been stable on them for some time and often require blood tests to determine. As well it is too often overlooked that all medications hold potential serious side effects; and this includes controlled substances, non-controlled, over the counter products and yes even so called benign nutritional supplements. 2) When a doctor prescribes any medication, whether controlled or even those that can be readily available as generic version over the counter, that doctor is assuming HEALTHCARE RESPONSIBILITY. Which means any party ranging from insurance companies, legal authorities, or even the patients directly will assume the physician is taking responsibility for their care. This responsibility, once accepted, can be assumed to include not only the medication or condition being treated, but also the patient’s overall or unrelated health conditions. If a physician blindly accepts this responsibility and neglects to care for their entire patient there can be serious repercussions for not only the physician but the patient as well.
Inside Medicine | late summer 2017
3) By encouraging the patient to see the physician for prescription refills, the physician can also create what we will call the OH BY THE WAY phenomenon. Too often patients can be narrowly focused on their specific interest or condition, while they casually ignore other health care issues they may be experiencing. For a classic example, a male patient desires to have their erectile dysfunction medication filled. But during office visit they might add “oh by the way” I have this mole that has been problematic and possibly cancerous for some time. By the doctor eyeballing and communicating with their patients, they can often perceive or be informed of potentially serious health conditions which may have been ignored or oblivious to the patient for some time. 4) Ultimately prescribing medications falls under what is known as PHYSICIAN PRIVILEGE. With each encounter, prescription, health concern the physician is attaching their medical license to that patient in question. Now individual physicians may follow different standards by which they monitor and refuse to fill medications without seeing the patient, it is hard to fault the physician for taking an active approach towards their relationship with the patient. In fact, many physicians I am familiar with that will blindly refill medications without seeing the patient admittedly do so because they feel their schedule and office are too busy to accommodate all of the combined acute and chronic patients on a daily basis. Given the moral and legal ramifications explained above, any physician may rightfully be expected to determine their own prescribing habits and how they maintain their prescribing license. I would say all of the above explain reasonable grounds for what your physician determines as to your refill requests. But I also encourage all patients to have discussions with their physicians as to their reasoning; open communication is a cornerstone of a healthy and effective physician-patient relationship. Too often I have witnessed and heard patients complain of such scenarios to general office staff and never mention their concern once to the physician. This is always a conversation that should happen one on one during a visit deemed necessary by the physician. -Tiernan O’Neill, Panacea O’Neill Medical Group
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by Kaki Morrow Development Manager of Distinguished Events for the American Cancer Society
a world free of cancer... a world where no one ever has to hear the news of a life-changing cancer diagnosis. Imagine if a cancer-free world was a reality.
In 1947, the first successful chemotherapy treatment for cancer was discovered by American Cancer Society-funded researcher Sidney Farber, MD. He demonstrated that aminopterin, a compound related to the vitamin folic acid, produced remissions in children with acute leukemia. Aminopterin blocked a critical chemical reaction needed for DNA replication. That drug was the predecessor of methotrexate, a cancer treatment drug used commonly today. Shown above in 1961, Farber also served on the Society’s board as president. Below,the image of Dr. Farber, the photo of the Saturn V first stage (S-1C). This stage was assembled at the Manufacturing Engineering Laboratory at NASA’s Marshall Space Flight Center. With assistance by the Boeing Company, the manufacturer, this first stage was assembled using components made by Boeing in Wichita, Kansas and New Orleans. Finally, the image to the right shows former American Cancer Society grantee Brian Druker, MD. Druker reported stunning success in treating chronic myelogenous leukemia (CML) with a molecularly targeted drug (Gleevec), launching a new era of molecularly targeted treatments. In 2000, the first use of molecularly targeted therapy to treat cancer was successful.
What does the Space Race have in common with cancer research? More than you might think.
At a quick glance, the link between sending a man to the moon and curing cancer might be an easy one to overlook. We live in a country that sent a man to the moon, and this city’s history is so intricately intertwined with the defining moment on May 25, 1961 when President Kennedy challenged the country to put a man on the moon before the decade was finished. At that point there wasn’t a clear course of action to get there, just an undeniable willpower to unite to make it happen. Many technological advancements that had not even been imagined yet had to be made before this challenge could become a reality; from the development of the Saturn V rocket to entire computers and the method for manned orbital rendezvous. This was all new territory, but members right here in our community, the “Rocket City,” banded together to turn what was once science fiction into an undeniable actuality. Like the Space Race and the Moonshot so many decades ago, a cancer-free world is also possible. We, again, as a community and as a nation can achieve the seemingly impossible, and while treatment has come a very long way, the fight is not over, yet. On a daily basis, there are people right here in our community involved in the fight against cancer. Whether it’s the fighters on the front lines, the caregivers and physicians, or even the community activists who directly support the mission to save and celebrate lives, no one walks alone in the fight against cancer. Here in Huntsville, on August 19th under the rocket at the US Space & Rocket Center, the American Cancer Society will be honoring those who are involved in the fight against cancer at the Belles & Beaus Ball. Join the American Cancer Society in imagining a world that is free from cancer, and join us in doing what it takes to make this a reality. Meet the honorees. >>
formerly Summer Lights Celebration
MISS ANUSHA ALAPATI
MR. BILL BILLINGSLEY
MRS. TERESA CHAMBERS
DR. BETH FALKENBERG
DR. RAY FAMBROUGH
Meet the honorees...
This year, the Belles & Beaus Ball event committee knew that they wanted to recognize leaders in this community that have been involved in the fight against cancer. While survivors and fighters are on the front lines of this fight, many others make up the cancer community. Physicians, caregivers, and community activists, too, all have valuable stake in the fight. Photos by Steve Babin
MRS. KARA HOWARD
MR. HANK ISENBERG
MR. DEVYN KEITH
DR. RACHEL KRUSPE
MRS. KIM LEWIS
MR. DONNY MALEKNIA
MR. CHIP MOORE
MRS. JEANNE MOORER
DR. BO RIVERA
MR. CHRIS RUSSELL
DR. CAROLINE SCHREEDER
MR. MATT SCHUSTER
MRS. LISA WILLIAMS
MRS. KELLEY I n s i d e ZELICKSON Medicine |
l a t e MARC s u m m e rZELICKSON 2017 47 DR.
Join the fight at the American Cancer Society’s
Saturday • August 19, 2017 • 6:00pm BellesandBeausBallHSV.org
OH MY aching... by Chad Hobbs, PT, DPT, COMT
Aches and pains often seem like a fact of life, but all too often they begin to limit our activities, our ability to perform our household or work tasks, and even impact our mood and happiness. The good news is that help is available. Regardless of what stage in the “ache and pain” process you are in, there are many great options to help you get things back in order. One great option that many of us have heard of, but may not really understand is physical therapy.
Why should I try Physical Therapy? Physical therapists are the movement specialists in the healthcare industry. It is their job to assess your movement and how it affects your pain. Pain can change the way you move. This incorrect movement can increase your pain by producing excess stress on the body, causing it to break down and start hurting. It can become a vicious cycle where pain causes incorrect movement which leads to more pain. The physical therapist’s job is to do a thorough evaluation of your movement and determine what is moving correctly and incorrectly and how that affects or is caused by your pain. The best treatment is one tailored to your weakness and deficiencies. In most cases, correcting improper movement will eliminate your pain, or at the very least, significantly decrease your pain and improve your ability to function. Physical therapy is a great option for many conditions. While we often associate physical therapy with rehabilitation after a surgery, physical therapists have the ability to help with multiple conditions. Physical therapy is a great option for any musculoskeletal issue (i.e. neck pain, shoulder pain, etc.), however; some physical therapists can also treat many other conditions, such as headaches, vertigo, dizziness, TMJ/TMD, balance issues or unsteadiness, weakness, tendonitis and even plantar fasciitis.
Why should I try Physical Therapy again? Many patients have had an unsuccessful bout of physical therapy in the past. This can often be the result if the treatment was not customized to the patient’s specific problems,
Inside Medicine | late summer 2017
or the painful area was treated but their improper movements were not corrected. For example, if every patient with neck pain gets the same ten exercises to treat their neck, then the treatment is not being tailored effectively to get the best result. Or, if a patient has low back pain which was treated previously, but treatment neglected to correct a stiff arthritic hip, the low back pain may not resolve or the pain will likely return. Physical therapy can be highly specialized and customized to your specific condition and it should be. If physical therapy did not work the first time, it is worth trying again with a treatment plan that is personalized to your specific needs.
What is Manual Physical Therapy? With manual physical therapy, the therapist uses a handson assessment to determine your physical dysfunctions, whether it be stiff joints, muscle spasms, or poor muscle recruitment patterns. This assessment then allows the therapist to decide what treatments and exercises will be most beneficial. A specific customized plan involves the use of manual techniques, like joint mobilizations and soft tissue release, to treat limitations, such as muscle and joint stiffness, to correct movement. These treatments typically offer patients some immediate relief and allow them to tolerate specific exercises that help produce and maintain long-term corrections.
What should I expect from Physical Therapy? There are many things that make a great therapy experience, but the following list should be included in your experience. • A thorough evaluation consisting of a history, medical review, and hands on physical exam • An explanation of the findings of the evaluation and the treatment plan moving forward • Hands on techniques performed by the physical therapist • Specific exercise program consisting of exercises with reps, sets and number of times per day along with an explanation of what the exercise is accomplishing • Re-evaluation by the physical therapist each visit which assesses movement, so treatment can be adjusted or modified based on the patient’s response to the last visit. • Detailed discharge plans. Once therapy is over, the patient should know what to do to progress activities and how to respond should the patient experience a flare-up or symptom regression.
If you are having any of these aches and pains, you should discuss physical therapy with your physician, as it may be a great option for you. In the state of Alabama, you also have the ability to go straight to a physical therapist for an evaluation. Physcial therapy treatment cannot begin without the approval of a physician, but you can get a full assessment from a therapist and have that to discuss with your physician. Understanding what options are available enables you to make better choices for your body. Physical therapy is a great tool to assist with maintenance and management of your overall wellness. ............................................................................................... Chad Hobbs PT, DPT, COMT is the Director of Operations and partner at the local physical therapy company, Focus Physiotherapy. Chad graduated with his Doctorate of Physical Therapy from Belmont University in Nashville, TN. He currently holds the position as the Federal Affairs Liason on the Alabama Physical Therapy Association and is a current board member on the Alabama Board of Physical Therapy.
Our therapists provide highly specialized treatments based on a thorough hands-on assessment. We provide very specific manual techniques and exercises to facilitate quick and complete recovery.
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A Diabetes story
Through Faith and trust, KATHERINE jONES found her new normal by Lisa Layton
Imagine being a parent of a seven and a half month old baby who, until now, had been a normal, happy, healthy baby. We would all count our blessings for that, but now imagine everything changed in what seemed like an instant. Your baby becomes fussy and eating habits change, as most do when babies are possibly coming down with something. Eventually these symptoms turn into soaked diapers, labored breathing, low grade fever, throwing up and weight loss. As a parent, you would know something was terribly wrong, but as the parent of an infant, type 1 diabetes would not likely cross your mind as something you were facing. This was the story for Katherine Jones’ parents. At seven and a half months old, Katherine became the youngest baby in Huntsville to ever be diagnosed with type 1 diabetes. Seventeen years later and starting her senior year of high school, Katherine is a beautiful, energetic and active young lady full of life and spirit and has been living with type 1 diabetes since before she can remember. She knows no way of life other than one of hospitalizations, needles, blood checks, constant monitoring and at times excruciating headaches that affect her ability to carry on normal activities of other of girls her age. According to the Mayo Clinic, many of the approximately 15,000 children a year who are diagnosed with type 1 diabetes, show classic symptoms of extreme thirst and hunger, frequent urination, behavioral changes, weight loss and fatigue, to name a few. Infants experience these symptoms, but obviously, with their limited communication, oftentimes the severity of their symptoms may go unnoticed or just present as a virus that needs to “run its course”. It becomes a guessing game for parents and doctors alike until the proper urinalysis and blood tests are performed. Once these labs are completed, a definitive diagnosis can be made within an hour and at that time, urgent treatment becomes vital. When Katherine was diagnosed, she spent 3 nights in the Pediatric Intensive Care Unit and 2 nights on the Pediatric Floor, both at Huntsville Hospital. When the time came for her to be released from the hospital, her mom Kristy was nervous about taking her home. “I remember taking her home and I was scared to death literally to walk in the door; worse than having a newborn for the first time. I really have to keep her alive now and I don’t know what I am doing, “ Kristy said. She described the first night home as feeling like she was being thrown into the deep end of a pool with no life preserver or swim lessons. They were not just counting carbs, they were “chasing numbers” trying to provide her nutrition and keep her blood sugar at a safe level. They did all this while trying to maintain
Inside Medicine | late summer 2017
a normal environment for their three year old toddler son as well. Less than 1% of all children diagnosed with type 1 diabetes are diagnosed in the first year of life, and if current trends continue, the incidence of type 1 diabetes in the pediatric population will have increased by 23% by the year 2050 as stated by the CDC. Soon after beginning their “new normal” as parents of an infant with diabetes, Raymond, Katherine’s dad, walked in with bags of medicine from Medical Arts Pharmacy. Kristy said she had no idea what to do with all of the medicine, even though the family spent an extra day in the hospital just learning about Katherine’s care, which involved mixing two different kinds of insulin. Raymond and Kristy practiced giving each other saline shots so they would be ready when the time came to administer the real insulin to their baby multiple times a day. After several months, however, they realized they needed to make a change and inquired about a more suitable medical regimen for Katherine. At fifteen months, Katherine became the youngest baby in the state of Alabama to be placed on an insulin pump. An insulin pump is a small device about the size of a cell phone that administers “rapid acting” insulin. It has an internal computer that is controlled by a screen with buttons. This device pushes insulin into your body through a thin plastic tube. Kristy said she had little velcro pockets to attach the device to Katherine’s onesies. The new method of treatment lessened the need for multiple shots a day. Kristy said it was a more convenient and accurate way to maintain Katherine’s blood sugar at a healthy level. Additionally, it was a better way to manage her diabetes as she grew, completed pre-school and started kindergarten. As many parents were sending their children to kindergarten for the first day, waving goodbye, Kristy found herself spending hours with the school nurse reviewing details about how to safely care for her daughter. Sending Katherine to school full time was as much about fear and trust as it was about the nostalgia of sending her to school for the first time. Katherine said she started caring for herself around six or seven years old. It was then that she temporarily discontinued use of the pump and went back to her routine of insulin shots. After some time, she began using what is known as the Omnipod System. It is a small lightweight tubeless pump that is wireless and is controlled by a “bluetooth like” device that tests her blood sugar and communicates with a pod which contains approximately three days worth of insulin. The pod is attached to either an arm, a leg or the abdomen. Once the hand held device interacts wirelessly with the pod, a proper amount of insulin is released in the body. This system is what Katherine uses today and it allows her to swim, shower, and carry out her daily activities with minimal inconvenience. Despite the added advantage this new technology has provided Katherine, the hope for a cure is still something that weighs heavily on her. While there is still no cure in sight, Katherine has participated in HudsonAlpha’s DNA mapping in order to better understand the mutation that results in early onset diabetes. The mapping also studies the correlation between headaches and diabetes that at times rob her of some quality of life. She does this in hopes to one day get some answers that will
be useful in finding a cure. In the meantime, as her mom says, “she’s still got to get up everyday and live every moment doing what she has to do to stay alive.” Katherine is now starting to plan the next major step in life as she looks at colleges. This is an exciting time, however Kristy still has a hard time thinking about it. “Being a good parent requires knowing when to push and when to back off, when to help and when to let them make mistakes and then being strong enough to watch them go”. This is something the Jones family will face when sending Katherine to college. Her life has been a preparation for the day when she is totally self-sufficient and her work with HudsonAlpha hopefully will help make the transition to total independence an easier one. Being a normal teenager requires much more of Katherine than many of her peers. Good health is often taken for granted, but she can never take it for granted. She is very thankful for her good days and battles through the not so good days. Sometimes when a child is diagnosed with a medical problem, especially one that has no cure, a portion of their innocence is taken. To get through life requires a huge amount of trust and faith to walk a path one would never choose. Kristy says out of their family, if anyone could handle something like this, Katherine is the one with the strength to do it. The Jones’ do not understand why God chose them to carry this, but their faith assures them that one day they will know and understand the answer, and by that time, it’s fairly certain Katherine will have found a way to make a difference in someone’s life. Little does she know, she already has.
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Development Hebrews 5:12 says, “You have been believers so long now that you ought to be teaching others. Instead, you need someone to teach you again the basic things about God’s word. You are like babies who need milk and cannot eat solid food.” The author here in Hebrews is speaking to followers of Jesus and it doesn’t take a scholar to see the main idea: Christians ought to experience development until they are able to teach others what they believe. When my son first began to play baseball, I volunteered to help coach. Because of this, I was required to attend a little league baseball-coaching clinic prior to the beginning of the season. The instructor at this clinic was very knowledgeable and did a super job teaching the fundamentals of baseball. He spent two hours covering the basics of the game so many of us grew up playing. Do you know what new knowledge I left with by attending this little league baseball workshop? Absolutely None. I didn’t learn a single new thing. Why? Like many who grew up playing baseball, I’ve known the fundamentals for most of my life. And not only have I known the fundamentals, but I’ve had the opportunity to put them into practice and even help others to understand the game. Christians, your church leaders are waiting on your maturity so that more people can experience discipleship. Our churches are full of long time believers who have yet to teach, serve, and lead because they would rather sit under the teaching of the basics they’ve heard over and over again. It’s time to experience development! Spiritual life doesn’t end with a decision or baptism. That’s when our development begins and the discipleship of others depends upon it. Think with me: Can you imagine coaching a varsity baseball team and having to teach every player at every practice the basics of the game they desire to play? In a word: Frustrating. You could never field a team to actually play, because they only experience the knowledge of the basics over and over instead of development. Hear God’s Word: “You have been believers so long now that you ought to be teaching others.” Enough of the milk! People cannot benefit from immaturity. (And by the way, an unwillingness to step out faith towards discipleship or leadership is immaturity). Practice obedience, actually learn what you believe, surrender your will to the Lord, and for goodness sakes be willing to share your faith so that it will benefit someone else! Andy John King Campus Pastor Lindsay Lane East
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