Inside Medicine

Page 1

fall 2016

CANCER

blessed me BREAST CANCER AWARENESS

allergy season

Weight

upon My Shoulders

...a husband and father’s story

$4.95 US


OF HAMPTON COVE



features &

CONTENTS

Sharing with Purpose

Inside Medicine | fall 2016

Vol u m e 1 , Issue 1 C O N T R I BUTORS

Kari Kingsley, MSN, CRNP Amber Davis, R.N.

FEATURES Weight Upon My Shoulders Story of triumph and tribulation

Cancer Blessed Me The testimony of faith at unfortunate times. How blessings came to one family during the most unlikely circumstance.

In a heartbeat A mother discovers her daughter has a congenital heart disease

16 32

CONTENT Seasonal Allergies Our environmental conditions can impact our respiratory system

Stop...in the name of love!

11

40

When to know it is time to find comfort in your home

John Johnson, M.D. Belinda Maples, M.D. Matthew Clayton, M.D. Paul J. Fry, M.D. Jarrod Roussel, PA-C Bobi Jo Creel, MSN, CRNP

30

Jackie Makowski S A L E S & M ARKETING

How early screening can save a life

Death is coming

Shelly Rich, R.N., LBSW

Kelly Reese, Co-Owner

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C H I E F E D I T O RIAL WRITER

Kimberly Waldrop, MA G R A P H I C DESIGN

Karen Gauthier P U B L I SHER

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

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

We Support the Cause


} FROM THE PUBLISHER

Dear Readers–

Walk The Jubilee

In September 2015, my husband was diagnosed with cancer. I immediately became the cheerleader for our family’s lives. I had no idea blessings could or would derive from what was thought to be an unfavorable circumstance. As a wife and mother, I knew at the time my husband would have to embrace the most difficult challenges ahead. I was determined to advocate not only his story but also the medical providers who had long since cared for the patients and families that encountered these very circumstances for decades. A diagnosis of cancer makes you really think about your life. How much time do we have left? What things do we want to accomplish? Let’s make the most of our time here on Earth. My husband and I began to write our bucket lists. The more I composed a list of my own, the more I found myself passionately desiring the execution of these tasks. The list is compiled of exquisite adventures to the most ordinary things: to walk a Jubilee with my father along the eastern shore, picnic in the vineyards of Napa Valley, work for my community, author a book. Most of all, I want to raise my five wonderful children in a Christian, loving home. In order to face the ugliness of cancer head on, and to continue living our lives to the fullest, our family needed answers and help from the medical community. Luckily, we had a network of medical professionals in our reach. But I began to realize there are other families that suffer the same news or illnesses daily with no one to rely on for immediate affirmation. This revelation left me broken. I decided to tackle an aspect of my bucket list and become an advocate for our community. I know this magazine is God ordained and HIS hand is all over it. I, along with the other members of the “Inside Medicine” team, have pledged to serve out this role with the goals to deliver today’s most advanced medical treatments. We hope to provide an intricate reference to medicine. It should give anyone seeking medical information the highest quality of resources and a diverse selection. We hope to pave the Valley’s referral source to medical landscapes among our community and help anyone seeking this type of information.

Kelly Reese


DISK

artificial

Replacement by John Johnson, M.D.

Neck pain is one of the most common medical problems, affecting eight out of ten people at some point during their lives. With today’s advancements in surgical technologies, spine surgeons are now able to perform minimally invasive procedures resulting in better patient outcomes.


} SURGICAL TECHNOLOGY

MINIMALLY INVASIVE One medical procedure on the cutting edge in spine surgery is artificial disc replacement. Artificial disc replacement is an alternative to traditional spine surgery procedures such as bone grafts and disc fusion. Similar to a knee replacement, artificial disc replacement substitutes a mechanical device for a damaged disc in the spine. The implanted device imitates the normal function of the degenerated disc by restoring motion to the spine. Artificial disc replacement is typically performed on patients with cervical disc herniation and/or osteophytes (bone spurs) which compress adjacent nerves of the spinal cord. Damaged cervical discs are most common between the C4-5, C5-6, or C6-7 levels of the vertebrae. Symptoms may include radiating arm pain, arm weakness or numbness accompanied with some degree of neck pain. There are several potential benefits of a cervical disc replacement over cervical fusion. Disc replacement surgery can reduce recovery time, allowing patients

to return to their normal activities much faster. Disc replacement surgery preserves the normal disc space height and movement between the vertebral bodies. The preservation of motion may potentially decrease the long term risk of adjacent level disc degeneration. The most important predictor of success with an Anterior Cervical surgery is the selection of appropriate patients for surgical intervention. If you or a loved one is suffering from neck pain, education and treatment of this problem is available through SportsMed’s Spine Center Orthopaedic and Neurosurgical physician partners.

John Johnson , M.D. Orthopaedic Spine Neuro at SportsMED 4715 Whitesburg Drive Huntsville, AL 35802 256.881.5151 www.sportsmedalabama.com

Inside Medicine | fall 2016

7


When should I have

surgery?

by Matthew Clayton, M.D.

As an orthopaedic surgeon specializing in total joint replacement, I am asked often to tell patients when they should undergo surgery. I think this subject is something with which many patients tend to struggle. Indeed, deciding to undergo a major surgery should be a well informed and thought out decision. Each person that presents to an orthopedic surgeon is coming because they are in pain and looking for relief. Often times this relief comes in the form of conservative treatments. For my patients, many of whom suffer from arthritis of the knees or hips, these conservative treatments may consist of oral anti-inflammatory medications, injections, or physical therapy. I always encourage patients to maximize their utilization of these conservative measures. This approach may extend the time before needing a major surgery for months or even years. Unfortunately, these conservative treatments may lose their effectiveness with time. As the disease of arthritis progresses, the cartilage within a joint is worn away until bone begins rubbing against bone. This results in severe joint pain and stiffness, which may worsen to a point that daily activities become difficult. Eventually, patients often find that their painful arthritic joints dictate to them what they are able to do. I often hear that my patients say that they will not shop in stores that do not have parking available by the door, or will not fly because they can’t move easily through the airport. I have also noticed that these limitations do not only affect the patient suffering from arthritis, but they can also rob their families of many opportunities to enjoy spending time together. If you find that you are identifying with these limitations, I would suggest to you that it is time for treatment. This treatment should begin with a full evaluation by a physician who can accurately identify the cause of your pain. If indeed arthritis is the cause of your pain and limitations, the conservative measures noted above should be attempted. If these treatments have not provided adequate relief, then this is the time to consider surgery. Joint replacement surgery has two major goals: to relieve pain and restore function. Total joint replacement is a procedure that can give a patient back their mobility and therefore has one of the highest rates of patient satisfaction in all of medicine. So, if you find your painful joints are ruling your life, now is the time to discuss treatment, armed with the knowledge that if surgery is required, you can reclaim your mobility and get back to living the life you want to live.


Four Convenient Locations to Serve You

Orthopaedic Surgeons H Cobb Alexander, M.D. Kendall Black, M.D. Beatriz Garcia-Cardona, M.D. Matthew D. Clayton, M.D.

Huntsville 256.881.5151

Dale Culpepper, M.D. Brett Franklin, M.D. Eric W. Janssen, M.D. Troy A. Layton, M.D. Jack W. Moore, M.D. Randall Tindell, M.D. John H. Walker, M.D.

Spine Surgeons Neurosurgeon/Physiatrists Curt Freudenberger, M.D.

Podiatrists

Javier A. Reto, M.D.

Angela L. Hampton , D.P.M.

John Johnson, Jr., M.D.

Robert Ocampo, D.P.M.

Kristina Janssen Donovan, D.O.

Milton W. Sterling II, D.P.M.

Ryan Aaron, M.D.

www.sportsmedalabama.com

Madison 256.464.8200 Athens 256.230.9607 Decatur 256.306.0800


Finding the Problem with

ALLERGY TESTING by Kimberly Waldrop, M.A.

Allergies‌that word we often hear when we are dealing with headaches, scratchy throats, and itchy eyes. Sometimes an over the counter medicine helps aid in getting through the seasons and problems. Other times, a doctor is needed to give something stronger to combat the illness. Allergies affect more than 50 million people in the United States alone. Doctors are available to help decipher what allergies exist in order to accurately treat them. Allergy testing can be performed by an allergy specialist as skin tests or blood tests. These tests can be performed on adults and children. Most often, a skin test is used unless a patient suffers from a skin condition, is taking medicine that can interfere with testing, or is worried for a severe reaction from the skin testing. Also, for younger children and babies, a needle prick may be easier than the several skin pricks used in skin tests. A skin test is performed on the patient’s back or forearm. A drop or suspected allergen is pricked or scratched on the surface of the skin. Many allergens are tested at the same time. A reaction typically appears within 20 minutes but can take up to several hours after the skin testing. The skin test is not necessarily painful but positive reactions cause annoying (sometimes itching) red bumps. Thankfully, the itching and bumps are usually gone in a few minutes or hours. From the results of the allergy test, the allergy specialist can determine what type of treatment is needed. Medicines are given by mouth or via injections. There are also new treatments that involve immunotherapy.


} HEALTH FEATURE

SEASON

by Kelly Reese

allergies

It has often been said that a person who suffers from eczema will also suffer from asthma. Well, there was truth in this for us.

Seasonal allergies affect nearly the entire population which resides beneath the peaks of some well-known mountains. Green Mountain towers the southern portion of our community, providing a beautiful landscape of rich colors. Monte Santo Mountain, the most central border to our hill-topped valley, is the home to some our finest communities. Yet, we all reside in what has been known or learned to be a factor to the painful symptoms of our environmental allergies, The Tennessee Valley. I’ll find myself reaching for a tissue, yet denying any reality my drainage may have a relative correlation to the air in which I breathe. My children suffer from allergies and have since they were young. My daughter was only a few weeks old when she started developing skin rashes and irritations that soon grew into a severe case of eczema. It has often been said that a person that suffers from eczema will also suffer from asthma. Well, there was truth in this for us. However, the asthma seemed to begin as our eczema trials disappeared. We had filled many lobbies of specialists with laughter, tears, fears and the unfortunate outbursts of a mother at her wits end with two children suffering from painful, irritating, itchy conditions that I hope we as parents don’t accept merely for a place we like to call home. After trying every prescription and over-the-counter medication known for relief without success, I desperately began to wonder if a solution could ever be found. Then suddenly, she grew out of it! Yes! Now, what do I tell my child whom I had convinced over time that her eczema made her special? I had always tried to comfort her by explaining that everyone was made special; and in this case, her skin made her special. Little did we know, this part of her description would disappear and quickly replace itself with her airways that would keep her home nearly an entire month from the school year. As mothers, we become desperate when we cannot meet the needs of our children. The sense of delusion can betray us of our initial assessment of timely encounters. Just like the moment you arrive at the hospital in hopes to get some sort of relief for your child, you realize that you have forgotten the very symptomatic sequence of events needed to help diagnose the issue. The same occurred with the pulmonologist who needed accurate information to best treat my children for their symptoms. I then discovered the phone would create a diary if I would just take a picture at the pediatrician’s office. Needless to say, my phone’s photo library is now full of these similar events to help with my children’s allergy patterns. I have often thought about what I haven’t tried and what else in our circumstance can be done in a considerable manner. We are just a few of the many people suffering with the same issues. Our daughter has now been under the care of a pulmonologist for over a year. Since his specialty is to understand and treat her type of condition, his management plan has helped her to significantly improve. He regularly monitors her symptoms and recommends treatment that allows her to live a normal healthy life. Inside Medicine | fall 2016

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TO THE YOUNG GIRL THINKING OF

Becoming a Nurse... (a note to myself at 17) The world will speak at you in many ways. You will read how the medical world is full of red tape, rules, ratios and never ending charting, but there are a few things they are missing. The world needs good nurses called into the profession; and you, girl, can make a difference. Here is what no one tells you...

by Bobi Jo Creel, MSN, CRNP

12

Inside Medicine | fall 2016

No one tells you that you will be scared– Of the pressure. Of messing up. Of not knowing something. Of doing the wrong thing. Of letting down your medical team. No one tells you this will make you a better nurse. No one tells you the ways patients will affect you– With their struggles. With their stories. With their faith. With their determination. With their fight. No one tells you this will make you fight harder. No one tells you there will be days when your faith becomes shaken– When you don’t think you can. When you don’t know what to do next. When you just want to walk out of the patient’s room. When you think, “Why am I here and how do I fight harder for this life?” No one tells you that you will start to believe in you. No one tells you that patients and families will change you– With their harsh words as they are at their worst. With their loss as if it’s your own. With their happiness in the successes of small daily battles. With their joys in new beginnings and the

miracle of life. No one tells you that your character will strengthen through empathy and grace. No one tells you how your coworkers will influence you– To want to be a part of a work family. To understand sometimes all there is left to do is pray. To learn to be a better listener and supporter. To realize that you are not in control. To realize who is. No one tells you that you will learn another side of the meaning of love. No one tells you that you will have days when you feel the fragile flicker of mortality– When a patient gets better and then back to worse in the blink of an eye. When you code a patient for the first time. When you have your hands on a chest praying for that life to stay grounded. When that life breaks it’s earthly chains. No one tells you that you will, in these moments, recognize that there are two types of patients–those who should be able to be saved, and despite all medical resources, aren’t. Those that shouldn’t have a chance to survive, and by divine medicine, do. No one tells you that you will go to church in a patient’s room– When your patient just needs to talk or hold your hand. When your patient’s family members want answers you don’t, and won’t ever, have. When you and your team have exhausted


all efforts and you gather around the bed and pray...and cry. No one tells you you will find your beliefs in those walls because you finally understand He is never far away. No one tells you of the days when– You find peace in your calling. You finally see why you are in this role. You realize that you are a tool and an avenue for great work to be done. You understand that you are human and your best IS good enough. You believe. No one tells you that you’ll look back at your journey with a heavy heart at the ones who branded it and are no longer with you, of the ones who stay with you for all the best reasons, or the days when you felt like you were right where you needed to be. No one tells you that when you are doing what is your calling, that it is all that matters and, most importantly, all that ever will. No one tells you that you will find peace in your work because it is far more than just a job. No one tells you that sometime later you will look back at how it all started, with tears in your eyes, and realize– That the days of doubt were trials and you passed, not always prettily, but you did it and you have built character as a result. That the positive far outweighed the negative. That the days of not knowing your purpose are over. That you are the mother, daughter, sister, and spouse you are because you endured. That the pieces of all these experiences you have carried with you now quilt your being. And, lastly–that even on those long days and nights over the years when you felt your heart breaking and healing, that those on this adventure with you saved a piece of you as well. You’re journey is not over, it has only begun; the trail is merely better marked now as a result of your experiences. It can only make your footprints clearer for those who travel along it with you and for those who follow after you.

M

otherhood by Kelly Reese The blessing of childbirth is often described as a natural thing. Textbook examples are available to describe a beautiful moment between mother and child, medical professionals, and fathers. My experience with childbirth should also be described as natural even though it did not go as perfectly

as planned. Like many mothers, I found myself in the operating room for a caesarean delivery. My natural “thing” turned into something that didn’t seem so natural because of what society had placed in my thoughts. Prior to my experience, I thought the only way to give birth would be through the “natural” process.

Fast forward, three children and three caesarean deliveries later, my

view on “natural” is not the societal normal. In the world today, we allow the majority to determine what is expected and what is natural. But, my view now sees an abdominal incision as a normal, natural process.

Society should tell us that it is in fact the ability that God has allowed us

naturally to bear children and delivery them via different options. Because of HIS plan, we are able to work miracles with HIM and many babies are born. HIS plan, along with medical intervention, has helped births as well as infertility issues. The societal “natural” way to conceive children sometimes needs medical intervention through advanced procedures.

Although pregnancy and birth are achieved by different means, both

are still blessings of motherhood. What a great medical testimony of helpful interventions that aid us in a way to carry out the responsibilities we are called to do. No one is a better mother for how they conceive or how they have given birth. Our medical society is working hard to find a way to overcome the obstacles which many face beyond their control.

Inside Medicine | fall 2016

13


KIDNEY

STONE by Kelly Reese

The pain from a kidney stone can take you to your knees. Besides tooth pain, it is said “the pressure from a kidney stone is the closest thing to the pain of child birth.” Many times, it comes on with no symptoms to prepare you. Some people are just unlucky and seem to be susceptible to developing kidney stones. Often times, it may be from various other factors. Specialists have concluded the primary factors that cause kidney stones include dehydration, excessive caffeine, loss of fluids, intake of dark liquids, diets rich in salt and protein, and inherited conditions. What we put into our body is as important as what the kidneys remove. We rely on our kidneys to take away waste products from our bodies. It is a strenuous and important filtering job performed by our kidneys. Besides staying away from the obvious, drinking clear liquids, such as water, can help contribute to healthy kidney function. If there aren’t enough clear fluids flowing through our system to help break down chemicals and minerals that we ingest, kidney stones can develop. Good kidney function is also needed to allow our body to fight the infection and bacteria we come in contact with. Again, it is through the failing attempts of the kidneys to work appropriately that lead to kidney stones. Obstruction of the kidneys occurs when a stone has developed and becomes lodged within the ureter. This blocks urine flow to the bladder. When our kidneys 14

Inside Medicine | fall 2016

don’t work correctly, we feel it! Symptoms seem to be most present in a patient’s lower back. The bacterial infection caused by the blockage may also show up in the form of a fever. Another symptom, hematuria, is the presence of blood in the urine. Once symptoms occur, a diagnosis is needed. Kidney stones can often be detected by a simple X-ray of the abdomen. A urine sample is usually used to determine if there is an infection, but follow up blood work can give an analysis of kidney function. Present symptoms that are non-conclusive may indicate a concern for further evaluation, such as an intravenous pyelogram (IVP). If the kidney has blockage due to a stone, the dye will not be able to pass, causing the kidney to appear large. Finally, a CT scan may be performed to detect urinary stones with more sensitive imaging. This information will help the urologist indicate the best form of treatment. There are several procedures available that do not require a traditional open surgery. Treatment options are usually based on size, location and number of stones involved. Shock Wave Lithotripsy (SWL) is a non-invasive treatment where an energy source generates a shock wave directly at the stone within the kidney or ureter. This treatment acts in dissipating the stones into small fragments. Some stones (cystine, calcium oxalate monohydrate) could remain resistant to SWL, requiring another treatment. Larger stones (generally greater than 2.5 centimeters) are also known to break into pieces that can still block the kidney. The stones located in the lower portion of the kidney will also have a decreased chance of passage. Another treatment option is Ureteroscopy (URS). This procedure involves the use of a very

small, fiber-optic instrument called a ureteroscope. This allows the urologist the capability to access to the ureter or kidney stones visually through the ureter via the bladder. Once located visually, a small basket-like device will grasp the stone for removal. In the event a stone is too large to remove, a spark-generating laser probe or air-driven (pneumatic) probe can pass through by way of the ureteroscope and the stone can be fragmented. The final treatment option is percutaneous nephrolithotomy (PNL). PNL is the treatment of choice for large stones located within the kidney, not suggestive for SWL or URS. The main advantage of this approach is that only a small incision (about one centimeter) is required in the flank. The urologist will place a guide wire through the incision. Under fluoroscopic guidance, the wire is placed within the kidney and directed down the ureter. A nephroscope is then passed into the kidney to visualize the stone. Fragmentation is done using an ultrasonic probe or a laser. Because the tract allows passage of larger instruments, suction or grasp of stone fragments can be removed. This procedure results in a higher clearance of stone fragments than that of a SWL or URS procedure. It is encouraging to know the pain of a kidney stone can be treated. With medical technology, these non invasive treatments are highly suggested. If you or a loved one suffers from kidney stones, it is encouraged that you seek a urologist or nephrologist for the appropriate treatment for your condition.



Weight

upon my

by Dawson Willford

O

n July 7, 2016 at 12:13 AM my wife was dying. She just had an emergency C-section and went into shock. I stood by her head while she was bleeding out and remembered every fight we ever had and the things I never did for her. I couldn’t let her know how scared I was. I stood in front of my wife saying my final good bye! What do you say to someone knowing it’s going to be the last time you talk to them? I tried so hard to comfort her and tell her everything is okay. I tried to smile and pretend that it’s all part of the operation. They called a code blue and people started rushing into the room. She was shaking so much!!! I kissed her and asked God “please don’t take her home.” I thought about all the times I missed church at Way of Life. I thought about how to tell my new family the bad news. So much was going through my mind that I had no time to enjoy my son. I had to be strong for my family. I had to put the weight upon my shoulders and walk with this load of having my wife pass in the operating room. I didn’t know what to say. I didn’t want to pray because I thought God would shun me for not being a good Christian. I was so sorry and asked God if somehow he could just hear this last request. I was rushed to a different room and waited for about 10 minutes. Jackie finally showed up and my heart was so so so so heavy with grief. I wanted to pick her up and carry her out of the hospital as if everything would be fine. I wanted to leave and have this nightmare be over! I stood with Jackie for about 3 minutes and the worst happened. She lost about 1 litter of blood in a couple seconds. I didn’t say anything, I was so scared. I just looked at my wife and couldn’t utter a word. I wanted to say I love you and tell her it’s okay. I wanted to help her as much as I could. I wanted to stop everything and start all over again. I knew she was dying in front of me. They called another code blue! This time my heart stopped. I thought why didn’t I pray every night! Why didn’t I love her like God has loved me! I died in that room! I truly died! I didn’t know what to do again. I watched helplessly as they tried to save my wife. People were running and pushing me farther away from her. She finally uttered a word and it was like the room went silent. She asked for some water and I knew she was leaving earth. They took me and my newborn son to another room. As we were walking I saw my mom and family. I wanted so hard for someone to hold me. I wanted someone to carry me like a kid and tell me it’s gonna be okay. I didn’t want to be a man anymore. I wanted

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Inside Medicine | fall 2016


} FEATURE

shoulders to cry! I wanted to cry out to God and ask him why! I stood by my family for about 2 minutes looking at everyone and holding back all of my emotions. My mother asked me “How is Jackie?” I almost lost it and cried like a baby. I just shrugged my shoulders and said I don’t know yet. I was lying, I knew she was in really bad shape. I wanted to run back in the room and hold her but I had to take care of my son now. He had to be given antibiotics to prevent an infection from starting. After about 5 minutes I asked the nurses if I can go see my wife and they reluctantly said yes. The hallway to where my wife was is about 40 yards. I walked about 5 yards and started crying alone. I couldn’t keep up this persona for much longer. I was scared to walk back and hear the news. I wanted my dad to comfort me! I’m still his little boy! I had around 30 something yards to walk and God spoke to me. Gabriel my son I love you more than you can imagine. I heard you and I was there! I saw the c section. I helped the doctors find the problem. I saw when she hemorrhaged and made sure they caught it really quick. I was waiting for you in this hallway when you wanted your father. It’s okay to call on me. I will always love you. Just as you asked to save your wife. I’ve been asking my father to save yours. I walked with more love in my heart for everything in that moment. My wife and son are doing great and will be discharged Sunday. If you see me at church don’t ask me where I have been. Just say I’m glad to see you’re home!!’

Inside Medicine | fall 2016

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} FEATURE

Don’t KNOWYOURPLAN just Sign Sign here, initial here, sign on the dotted

of the upmost importance. It is necessary

you ever “signed your life away” and then

in legislation, and in our benefits. Our

line, initial where it is highlighted...Have looked back not even sure of what you

were putting your John Hancock on?

Most people in today’s world are busy.

by Kelly Reese

Over scheduled and over demanded, most of us have too much going on to pay at-

tention to the smaller details. Sometimes, this makes things get overlooked or completed incorrectly. We become hasty, ir-

rational, and impulsive. We want to get it done and move on to the next thing. This

occurs when we make a large purchase, open a business, sign our children up for things, and even at the doctor’s office. We

just trust what we are signing and turn it in without hesitation. Often times, this

quick behavior results in us missing out on something important. It makes us break

that we know the changes in our co-pays, employers expect us to read policies and

agree, with signature. Reading and knowing how things have altered is just as important as knowing that we are covered

under the insurance blanket. Referrals and medical emergencies will arise. We need

to have a clear understanding of our cov-

erage and authorizations before we need to utilize our benefits.

Insurance companies generally have

a large amount of information available with easy accessibility. Read and re-read

your insurance policies. If you feel you

don’t clearly understand, it is encouraged

for you to ask questions and get answers. Don’t sign until you are clear on all facts!

rules we don’t want to break or owe more money than we want to owe.

We need to stop, slow down, and

READ! Paper after paper, we need to

make sure we know what we are signing. Medical records and insurance papers are

Inside Medicine | fall 2016

19


Insurance Financial Responsibility by Tiernan O’Neill

Medical insurance is often times a touchy subject. It is difficult to navigate and sometimes difficult to understand. From the perspective of health care providers, all balances following care and treatment of an individual is ultimately the responsibility of the patient. Since even before the inception of the Affordable Care Act (ACA), providers have found it extremely difficult to navigate around the insurance billing world. Insurance companies refuse to provide a clear and detailed map of covered services. They never commit to any sort of coverage stance, always referring to their pre-service statements as “not being a guarantee

of coverage or benefits.� This situation is further complicated by the wide array of insurance plans and companies patients expect providers to accept. And not all of these companies provide up to date, convenient or even standard methods of coverage verification. Finally, the ever changing landscape of billing codes and subsequent coverage determinations has also been extremely challenging; especially for smaller operations with limited resources. Since the inception of the ACA, it has been commonplace to see plans change frequently and most importantly deductibles and patient costs increase substantially each year. When you couple this fact with the above, it is easy to see why patient financial responsibility has increased over the years. While we can empathize with how complicated these factors can be to the average person, it does not change the critical problem medical practices have seen. It is a dramatic increase in their

outstanding collections. Patients are failing to accept responsibility for the plans they chose for themselves; many of whom are becoming more and more frustrated to be paying higher premiums for lesser coverage in a sluggish economy. Of course, the insurance coverage guidelines are rather dense and complicated but patients are actually provided with far more tools and information than is being provided to the medical professionals. Further, an interesting dilemma is encountered by physicians whereby they are trying to provide the health care they were trained and obligated to provide without financial restrictions. Given the factors detailed above and including the private business of medical care in this country, it is not surprising as insurance coverage changes and patient financial responsibilities increase, more and more medical facilities will have the right to shift the burden of understanding coverage to the ultimate responsibility of the patient.

ridgeline construction residential / commercial

roofing & exteriors

256-325-1345 20

Inside Medicine | fall 2016


Surgical Sterility by Jarrod Roussel, PA-C

The surgery date has been set. Many thoughts may come to mind such as making provisions for work and family during the procedure and the recovery. The surgeon has discussed the potential risks, which includes the risk of infection. This is one fear many patients face, because they are unfamiliar with the events surrounding their surgery that are specifically designed to prevent infection. Personal health and habits are the first defense against infection. Eating a healthy diet full of fresh fruits and vegetables helps provide the body with the materials it needs to combat harmful bacteria. Other obvious mitigating factors include quitting tobacco products and consuming alcohol in moderation or avoiding it altogether. Proper control of certain conditions such as diabetes is also very important, because if not controlled, these conditions can increase infection risk. Prior to entrance into the hospital, many patients will cleanse their skin with an antibacterial soap such as Hibiclens. Within an hour before surgery, the patient is given an intravenous dose of antibiotic with subsequent doses for the next 24 hours, to further prevent infection. Once a patient is anesthetized and properly positioned for surgery, the skin is cleansed with an iodine containing cleanser such as Betadine.

When the surgical site is prepared and draped, an iodine embedded, adhesive plastic film is placed directly to the skin. This provides further antisepsis, plus it traps anything on the skin underneath the plastic film. There are alternatives if a patient has a sensitivity to iodine. The surgeon and all people assisting with the surgery scrub their hands and forearms with surgical soap prior to entering the OR. Each person then puts on a sterile full-length, longsleeved gown and gloves. Equipment in the OR suite is either cleaned or covered with a sterile plastic cover if it cannot be cleaned. Sensitive electronic equipment such as a microscope or fluoroscope generally will require covering. All OR staff are trained in proper sterile technique to prevent transfer of bacteria to the clean surfaces. There is a general, high level of awareness in the operation room, especially with the surgical technicians who assist with the instrumentation, to ensure that the sterile field around the incision and the surgical tools is maintained. Surgical instruments are thoroughly cleaned between every case. This first includes an enzymatic spray onto the used instruments before they leave the OR suite. When they reach the decontamination area, the instruments are manually scrubbed clean and then sent through

a mechanical washing machine. Next, they are packed in trays or individual packages and placed in an autoclave, which sterilizes at high temperature and pressure so that no viable genetic material remains. Following surgery, the incision site is kept clean and bandaged by the inpatient nursing staff. The patient will be instructed regarding wound care upon their discharge from the hospital. Procedures and policies have been developed over the years to ensure the highest possible protection from infection. While the risk can never be completely eliminated, it has been significantly reduced making surgical infection risk safer than ever.

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healthy

Eating ON A BUDGET

Can you really eat healthy on a budget? Absolutely! Following these tips will help you stick to your budget while eating healthy. The most important tip is to plan a 5-7 day menu and create a shopping list in advance. When planning your menu, browse through the weekly ad from your local store and choose meals which call for ingredients that are on sale. Then make sure you stick to your grocery list while shopping. “Saving money at the supermarket doesn’t mean giving up nutritious foods.” says Jill Weisenberger, MS, RDN. Choose less expensive meats such as chuck or bottom round roast which has less fat and is cheaper than sirloin. Learn to incorporate whole grains and beans! Whole grains such as brown rice and quinoa along with pinto or black beans is a tasty and inexpensive way to add fiber and protein to your diet. The more you can replace meat with beans, the more money you will save. “You can cut food costs by eating more meals at home and by making sure you feature healthy foods such as whole grains, beans and vegetables.” says Elaine Magee, MPH, RDN. Another great tip is it’s always smart to buy frozen produce or produce that’s in season. Frozen produce is just as nutritious as fresh produce. It’s available year round and is cheaper. With these simple tips, everyone on a budget can make healthy eating a reality for their family.

by Keri Matherne

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GetCPRcertified by Kimberly Waldrop, M.A.

Imagine walking through the mall, minding your own business, when you hear someone yelling for help. You turn around to see a young woman bent down next to an older man. The woman is crying for help and shaking the man, who seems unresponsive. Immediately, you are hit with the urge to provide assistance, nobody else is doing anything. Your brain starts working overtime… trying to remember anything you can from that medical care class you took in high school. Maybe you can pull out some memories of CPR training…how to find a pulse…should you call 9-1-1 first??? The best thing we all can do is become certified in CPR training. Since that medical care class in high school, recommendations for performing CPR have been revised. The training keeps you updated and will also enable you to be comfortable actually helping and reacting in a crisis situation. It can also protect you by being covered by the Good Samaritan Law. You can receive training at local hospitals, fire departments, and even online.

www.nationalcprfoundation.com

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The HudsonAlpha Institute for Biotechnology hosted the eighth annual Tie the Ribbons luncheon to a sellout crowd of 1,400 on September 22 at the Von Braun. The event raises funds and awareness for the Breakthrough Breast and Ovarian Cancer Research Team, a group of scientists committed to the goal of using genomic science and HudsonAlpha’s state-of-the-art technology to make new discoveries in breast and ovarian cancers. Through collaborations with scientists around the nation, the team is working to find biomarkers that lead to earlier, more accurate diagnoses and new pathways for more effective and targeted treatments.

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Faculty Investigator Sara Cooper, PhD, gave an update on the team’s latest research at the event. “The problems we’re trying to tackle are very personal,” said Cooper. “When I see my friends and family facing cancer, it makes me feel ever so slightly better to say I’m working on solving it.” Attendees also heard from Kimberly Strong, PhD, HudsonAlpha faculty investigator and director of the Ethics and Genomics program. Strong gave an update on the Information is Power initiative, a unique initiative launched in October 2015. Thanks to a generous sponsorship from Redstone Federal Credit Union, the initiative will now offer free breast and ovarian cancer risk genetic testing to 30-year-old women and men who reside in Madison, Jackson, Limestone, Marshall and Morgan Counties. HudsonAlpha is collaborating with genetic testing company Kailos Genetics, a HudsonAlpha associate company. “We’ve processed test kits for close to 400 30-year-old women,” said Strong. “Overall, around four percent of the tests have been positive, which means there is a mutation in one of the genes linked to breast and ovarian cancer.” The genetic screening tool was created by Kailos. It screens for mutations in the well-known BRCA1 and BRCA2 genes, as well as additional genes linked to other cancers. “It is our goal to make genetic testing available to all people,” said Troy Moore, chief scientific officer of Kailos Genetics. “Understanding what’s in one’s DNA can help people and their doctors make more informed health decisions.” Phase two of Information is Power will begin October 29, 2016, at which time 30-year-old men and women who reside in the five counties will be able to order a free test kit. To learn more, visit: www.hudsonalpha.org/information-is-power.

About HudsonAlpha: HudsonAlpha Institute for Biotechnology is a nonprofit institute dedicated to innovating in the field of genomic technology and sciences across a spectrum of biological challenges. Opened in 2008, its mission is four-fold: sparking scientific discoveries that can impact human health and well-being; bringing genomic medicine into clinical care; fostering life sciences entrepreneurship and business growth; and encouraging the creation of a genomics-literate workforce and society. The HudsonAlpha biotechnology campus consists of 152 acres nestled within Cummings Research Park, the nation’s second largest research park. Designed to be a hothouse of biotech economic development, HudsonAlpha’s state-of-the-art facilities co-locate nonprofit scientific researchers with entrepreneurs and educators. The relationships formed on the HudsonAlpha campus encourage collaborations that produce advances in medicine and agriculture. Under the leadership of Dr. Richard M. Myers, a key collaborator on the Human Genome Project, HudsonAlpha has become a national and international leader in genetics and genomics research and biotech education, and includes more than 30 diverse biotech companies on campus. To learn more about HudsonAlpha, visit: http://hudsonalpha.org/.

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Comfort

...in your own home

Death is Coming by Belinda Maples, M.D.

The hospice philosophy focuses on a death with dignity without pain or suffering. There comes a point in time when a treatment is worse than the disease, when medications and procedures do not help and physical and emotional suffering is not relieved. Many people find death is too disturbing to discuss and therefore avoid talking about it. Talking openly about death and dying may be considered disrespectful and some believe that it will lead to despair or even accelerate the process of dying. Some patients fear that entering hospice care represents that they have been given up on, hastens death 26

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or shortens one’s life. This is misconception and studies demonstrate a 100-day survival advantage with end stage heart failure patients. Such attitudes in the general public can cause delayed treatment with palliative care services and increase the amount of suffering. Discussions on death, palliative care, and hospice need to be made early in any terminal disease process between a patient and their health care provider. Hospice care provides medical care and support to patients with a life limiting illness and focuses on quality of life rather


} FEATURE

than curing the illness. The hospice philosophy focuses on a death with dignity without pain or suffering. The care and treatment provided are based on the patient’s and family’s goals and values. This holistic approach focuses on symptom management, support, and assistance by way of communication and providing coordination of care. Hospice is appropriate when patients are entering the last months to weeks of life and when decisions are made to stop disease modifying therapies and focus on maximizing comfort and quality of life. The World Health Organization has identified the most common conditions that require palliative care for adults and include dementia, cancer, cardiovascular disease, cirrhosis, COPD, diabetes, HIV/AIDS, kidney failure, multiple sclerosis, ALS, Parkinson’s disease, stroke, lupus, rheumatoid arthritis. and drug resistant tuberculosis. An individual is referred to hospice when the life expectancy is less than 6 months and it is especially important if the goals of care are comfort, being at home, and staying in control. This timeline is difficult to estimate in advanced illness due to effective new therapies, psychological reasons to maintain hope, and the clinician’s overly optimistic desire to cure disease. It becomes easier to predict death when the end is closer and usually less than 3 weeks. These individuals can benefit from hospice care as long as they continue to exhibit a decline consistent with the progression of the disease process. Many symptoms are demonstrated in the last phase of life. These can be disturbing to family members and health care providers alike. A decrease in heart function and blood volume leads to diminished or increased heart rate, low blood pressure, cooling in the extremities, discoloration of the skin, and loss of peripheral pulses. Families cannot rely on vital signs alone to determine impending death. Infections and febrile episodes are among the most common acute complications by terminally ill patients and may represent the end. Neurological changes such as decreasing levels of consciousness leading to coma, delirium with confusion, restlessness, agitation, and day to night reversal may also occur. Moaning, groaning, and grimacing may accompany the delirium, but may be misinterpreted as uncontrolled pain. Some will have hallucinations that involve deceased individuals from the past and make references to “going home” or dying. Breathing may become shallow and labored with periods of absent breathing where family members perceive this pattern as holding her breath or breathlessness. Breathing difficulties may be reduced with oxygen through a nasal cannula or face mask and bedside fan may relieve the sensation of being short of breath. The buildup of saliva and secretions may lead to gurgling, crackling or rattling sounds with each breath, which is sometimes referred to as the death rattle. This can lead to inability to rest, worsening shortness of breath, coughing spells, predispose to infections, and increase distress to family. Proper positioning, cleansing the mouth with sponge sticks, and suctioning to clear secretions are appropriate for short term benefits. As patients near death, they spend more time in bed or a chair and one of the most significant milestones of functional decline is the loss of ability to independently transfer from bed to chair. Assis-

Family is encouraged to stay with patients to improve comfort and safety and one on one sitters may be needed.

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tive equipment with lifts, wheelchairs, and hospital beds become necessary since patients become at high risk for falls and serious injuries. Education regarding transfers, turning, changing, feeding, and other personal care issues may be given to caregivers to ensure safety for the patient and themselves. Family is encouraged to stay with patients to improve comfort and safety and one on one sitters may be needed. Call buttons, bells to alert caregivers, and bed alarms may help respond to needs promptly. Cushioning on beds will improve comfort and reduce risks for skin breakdown and pain. Some aspects of personal hygiene such as bathing or help with toileting may be socially uncomfortable for some family members and home health aides may become a major resource. Decreased oral intake is common in the dying process with impaired swallowing due to severe weakness, increased sedation or metabolic disturbances. Family members exhibit distress when the patient becomes unable to take food and fluids orally and do not want their loved ones to “starve” or become “dehydrated”. There is no evidence that improving caloric intake with feeding tubes or intravenous nutrition will improve strength, energy, functional state, or prolong survival. Case reports support the view that dehydration actually reduces distressing symptoms like choking and drowning sensations, less cough and chest congestion, decreased urinary incontinence/ bedwetting due to decreased urinary output, less swelling in arms and legs, less abdominal discomfort from bloating, vomiting and diarrhea due to decreased GI fluid. Loss of sphincter

control in the last hours of life may lead to urine or stool incontinence. This can be managed with absorbent pads or urinary catheter may be placed to reduce frequency of changing bed linens, clothes and reduce demand and distress to caregivers. Weight loss leads to loss of fat behind the eye and causes the orbit to fall within the socket. The eyelids may not be able to fully close and they appear to be asleep with their eyes open. It is often observed that a familiar voice, touch, and music have a calming effect on dying patients. Family is often encouraged to comfort their loved ones, express their thoughts, and touch their loved ones, even though they cannot communicate response back. After all, touch and hearing are thought to be the last senses to be lost in the dying process. Care for the actively dying patient should be redirected from procedures and other aggressive treatments to an emphasis on reducing suffering and improving comfort. Many patients in the terminal stages of a serious life threatening illness die in settings where they do not receive care designed to address suffering in the last hours/days of life. Patients require careful symptom management and families need support and coaching as death approaches. Hospice medicine focuses on preventing and relieving suffering and supporting the best possible quality of life for patients and their families facing serious illness. Ì



STOP

...in the name of love!!! Everybody has heard of mammogram screening for breast cancer. Everybody has heard of Pap smear screening for cervical cancer. Everyone probably knows about screening for colon and prostate cancer. What you might not have heard about is screening for lung cancer. Why is this important? Lung cancer kills more men and women than any other type of cancer. It accounts for 27% of all cancer deaths–more than deaths from cancers of the breast, prostate, and colon combined. Yet, until recently, there was no screening test for lung cancer. Being diagnosed with lung cancer is scary. However, lung cancer does not have to be a death sentence. In 2011 the National Lung Screening Trial reported that individuals who were screened for lung cancer with a low dose CT scan had a 20% lower risk of dying from lung cancer than those individuals who were screened with a standard chest x-ray. This study was finally proof that early detection of lung cancer can result in increased cure. For lung cancer screening to be effective, it is important that only those persons at high risk be screened. High risk is defined by age, years of smoking, duration or years since the person may have stopped, as well as by other possible exposures. Simplified – anyone between 55-74 who has smoked the equivalent of 30 pack years is at high risk (# of packs you smoke per day times # of years smoked = pack years). If someone who has smoked at least 30 pack years has quit smoking within the last 15 years, that person is still at sufficient risk to be screened. Additional risks may also play a role. If a person

is 50 or older, with at least 20 pack years of smoking and any other exposure or factor that adds to their risk such as a previous malignancy, radon exposure, or asbestos or other occupational exposure – he has sufficient risk to be screened. The program involved in the screening is important. Clearview Cancer Institute launched its lung screening program in 2012 after seeing the devastating effects of diagnosing lung cancer in its later stages. We really felt we had a mission and obligation to the community to make lung cancer screening as universally accepted as mammography is for breast cancer. We were joined by our colleagues involved in the diagnosis and care of patients with possible lung cancer, as well as the Huntsville Hospital Health System. With support and effort of all and additional funding from the Russel Hill Cancer Foundation and the Alpha Foundation, we developed the Southeast Lung Alliance. This is a program dedicated to increasing the awareness of Lung Cancer Screening and supporting tobacco cessation as the mainstay in prevention of this most lethal disease. In our community hundreds of your family, friends, and co-workers have already been screened and, yes, some have had their lives saved by finding a unsuspected cancer early enough to be cured. If you or any of your loved ones smoke – stop! But whether you stop now or not, enroll in a screening program for early detection of lung cancer. It could save your life or the life of the one you love.

For more information, go to www.selungalliance.org or www.clearviewcancer.com or discuss lung cancer screening with your physician.

by Marshall T. Schreeder, MD , MPH Clearview Cancer Institute

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cancerblessedme My husband is my hero. He is everything I hope and wish to be. I go about my typical day with ambition to commit to my responsibilities, complete my tasks, and distinguish the importance of the 20 additions piled on throughout my day’s work. I work, and struggle, and almost collapse after a full day of my work and my family. Not Brandon, he’s a different story.

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by Kelly Reese

He has this amazing way to manage our large family while making it look easy. He gets more done than I ever could, pulling it off with ease and control. I like to sit back and watch him, longingly, in the moment. He pulls off a typical day with grace and precise abilities, while pleasing everyone around him. He has it all together and displays his heart in everything he does. From the outside looking in, I think our family looks pretty normal. A family of seven, most days, going to school and work and extracurricular activities. Trying our best at doing life. But, there is something different about us. The difference is, we are fighting CANCER. You would never guess the one in our family that is being attacked by this awful illness is our strong hold. It is Brandon that has to endure the illness. Like the rest of his normal days though, Brandon makes cancer look good. In fact, I think he makes it look really good. From the moment he was diagnosed, Brandon has been the one reminding me this circumstance does not define us. It can never take away our belief that God will protect us. Brandon is ready and willing to deal with this full force with the grace and ability he uses to deal with everything in his life. He has already endured things most people never experience, especially at his age. In the recent past, Brandon and his siblings experienced the loss of their mother, their father, and their brother. One thing after the other, Brandon has pulled through. Right down to being given a treatable, but incurable diagnosis of cancer. If there is mercy in the world, my husband is a walking testimony of it. This is not a mercy that takes away the trials but allows you to radiate an image of Christ through our Heavenly Father’s love, who has covered us in peace without understanding. Brandon has exemplified a man who is fearful of his Heavenly Father, trusting in His word. The only way he can walk his journey is to know his mighty Savior has “blessed” him with a disease so he can lead others to walk in His peace. All the while praying they do not have to walk in his shoes. He would never wish cancer upon anyone. Yet, now that he is living with the illness, I believe he would never give it back. Especially if that meant losing what he has come to learn…the people who have shown their love and the continued support through prayer and ministry that we continually receive without asking. The diagnosis has lead Brandon to undergo a bone marrow biopsy, 5 surgical procedures, a seizure, 6 immunotherapy treatments and countless doctor visits with numerous specialists. Without his faith, none of us could deal with it. I have come to realize anyone who doesn’t believe or trust in the Lord would feel scared, angry and confused. Brandon’s childlike faith has helped me understand we aren’t fighting this alone. He continues to be the leader of our family, and carry us along on his tough journey. One day, I had the privilege to accompany my husband to his lumbar puncture. I say “privilege,” because that is what it is; it is a privilege he is here and more so that he would want me to be the steward by his side. The procedure was being used to test whether or not he could have a brain virus caused by his cancer. As we drove toward the hospital, with natural nervousness to a spinal tap, my husband asked, “Kelly, what if the test results are positive


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(...cont’d from pg. 32)

for the brain virus?” Like anyone these days, I answered with, “Honey, let me see what Google says”. Typically, I have refrained from additional medical information unless provided by our oncologist. But in this moment, I was weak and divulged. Immediately, tears ran down my face (faster than shower water in a new faucet). My heart ached as I read the words before me. My husband could potentially have a brain virus that 50% die of or become disabled within months. I began to cry. My immediate response was to then dial our pastor on the phone. Brandon noticed the tears on my cheeks and he knew I was terrified. Quickly, and without a second thought, he says, “Baby, it is nothing; and if it is more, we got this. God has this”. Wow, just wow. As always, he did it again. He brought me back to the place I need to be. To remember we are all in God’s hands. There’s nothing we can’t handle with Him by our sides. At all of his treatments and doctor visits, I still sit with him as the proudest wife. My husband continues to be a blessing to us and everyone around him. He deals with his life’s ups and downs, and his daily routine as he always has. It took his cancer diagnosis to get me to understand where he takes his mind to all the time. His illness has become a part of our story. A story that no matter how it ends up, if God calls him home or if he lives out a longer life, we will forever be changed for the better. We hope to share our journey, to help others know whatever you are faced with today, it is nothing God can’t help carry you through. Our peace comes from HIM!

Keep it CLEAN! Most of us can recall some childhood memory of a cut or injury. Someone around us probably told us to “keep our boo boos clean”. We probably didn’t realize it then, but these small “boo boos” could have become infected. This keep it clean advice follows us into adulthood, passed on from our parents to our children. Over the years, our availability of disinfectants have changed from a mere soap bar to a soap dispenser to the now available gel form that doesn’t even require water.

It basically seems we have reduced the steps to sanitary requirements.

The way we are heading, one day we may no longer take showers and rely on some form of fabric that is approved to be a safer, more efficient form of cleanser. It would save time, water, and probably money. But, would it be best for us? It makes us question how we keep things clean, for sure!

Nothing can replace the scrub and rinse of soap and water. When I

was deep in my clinical rotation in college working through the surgical unit of the hospital, we had to literally clean our hands for nearly five minutes. From finger tips, under our nails, and all the way to our elbows, we had to scrub and rinse. It was most important that all things remained sterile and clean from any contamination. Even now, nurses come into public schools to teach children how to wash their hands. Keeping germs and bacteria away from open wounds and “boo boos” is even more important.

Even more important, is keeping surgical supplies clean and sterile. If it

is so important to keep ourselves clean on a “normal” day, or with the slightest wound. Imagine the method of cleaning a surgical instrument!! Commercial, oversized sinks are readily available to rinse, scrub, rinse(repeat), dip, soak, and so on until you make your way through the washer and then on to the autoclave. The autoclave is a device that is massive in size with several racks to hold various instrument trays used in surgery. The individual trays are specific to each type of surgery. In many cases, the surgeon will also have his own tray to ensure what he needs during surgery is available.

In addition to keeping the utensils clean and sterile, the patient undergo-

ing the procedure is also scrubbed down with the most powerful antibacterial liquids there are. The surgical patients are also screened appropriately to make sure they are low on any risk factors that can lead to infection.

Surgeons are absolutely ready to “keep boo boos clean”!

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beyond the skin by Paul J Fry, MD

If God had only made us with transparent skin? When there is a pain or dysfunction, all one has to do was look at the problem. Alas, as we know, the skin is opaque, a barrier to observation. Doctors have used the physical exam and history to determine possible diagnoses. Much of a doctor’s education, a college degree followed by four years of Medical School, is devoted to learning the science, anatomy, and pathophysiology of the disease process. The year following Medical School, the intern year, is mostly devoted to refining the art of the physical exam and history. The next three to five years, and depending on the specialty, sometimes up to six or seven years, is devoted to specialization within the medical field, learning further how to diagnose and then treat any disease that may exist. Despite the years of training, doctors would still be basically guessing, albeit an educated guess, what is occurring wrong beneath the skin. There must be a better way. How can we peer below the skin surface and actually see the disease? Beginning with the discovery of X-Rays by Wilhelm Roentgen in1896, doctors have been able to see beyond the skin, into the body, and improve the accuracy of their diagnosis. Through the years many other discoveries have paved the way for further forms of imaging. The first imaging was by X-Rays, basically a high energy radiation. These X-Rays pass through the body exposing film on the other side. Early on only the very dense structures such as bone could visualized. Objects that didn’t belong such as metal could also be seen. [As a side note, it was at Davidson College, my Alma Mater, where the first documented use of X-Rays were used as a diagnostic tool to visualize, amongst other things, a .22 caliber bullet.] To see structures other than bone [and bullets], various metals were introduced into the body such as iodine in the blood and barium in the GI Tract. With the advent of computers these X-Ray images could be digitally manipulated, the rudimentary explanation of Computed Axial Tomography, CT, and Digital Radiography, DR. Over the years other forms of energy have been used to image the body. Sonar, first used in underwater naval applica-

tions, was refined to see not just below the surface of the water but the surface of the body. Ultrasound has had many many uses, none as important as its use in Obstetrics. Magnetic Resonance Imaging, MRI, is a computer manipulation of data obtained from the body utilizing strong magnetic fields and it’s interaction with electricity. Some 120 years following the discovery of X-Ray, Radiologists and other Medical specialties have amongst their arsenal for diagnosis: X-Ray, DR, Fluoroscopy, CT, MRI, Ultrasound, Doppler Ultrasound, Nuclear Medicine, Single Photon Emission Tomography (SPECT), Positron Emission Tomography (PET), Angiography, Duel Energy X-Ray Absortometry (DEXA), and now Molecular Imaging. Individuals trained to actually perform these studies are Radiologic Technologists. This requires two to four years to master with vigorous certification and credentialing criteria. The medical specialty devoted to imaging is Diagnostic Radiology. Radiology is a four year residency following one’s intern year. This is followed by one to two years of further fellowship sub-specialization. The radiologist helps supervise the performance of imaging, interprets the results, and then communicates with the patient’s doctor the results of the studies. The radiologist is available for consultation with a patient’s doctor concerning the proper imaging to order, the implications of the results, and if needed any imaging guided treatment that can be offered. Though the skin remains opaque, it is no longer a barrier to visualization of what is occuring beneath its surface. Medical Imaging and it’s specialist, the Radiologist, can supplement the history and physical and provide the medical practitioner a more accurate diagnosis. With more accurate diagnoses, better treatment can ensue improving the health care of the patient. Dr. Fry is a Board Certified Radiologist, a partner in Radiology of Huntsville (ROH). ROH provides radiologic services at multiple facilities throughout the Tennessee Valley including Huntsville Hospital and Crestwood Medical Center. He currently serves as the Imaging Medical Director at Athens-Limestone Hospital.

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Understanding the risk of Diabetes 36

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According to the American Diabetes Association, diabetes is the 7th leading cause of death in the United States. The prevalence of the disease is growing by the day. In 2012, it was estimated 9.3% of Americans were living with diabetes. It is believed the number has increased significantly in recent years. If this many people are living with this epidemic, we all need to be concerned with risks that come along with a diagnosis. The range of problems that can occur include heart disease, blindness, loss of blood circulation that can lead to amputation, and many more


...someone living with the disease can just as well develop other health problems despite following every rule they are given.

health issues. Diabetes doesn’t have a certain cause, it can just be a family history of the illness. Just as someone can be given a diagnosis, even if they don’t even eat sugar; someone living with the disease can just as well develop other health problems despite following every rule they are given. My grandmother was unfortunately one of these people. She was diagnosed with diabetes long before I was born. My memories of her are so precious. But, I always remember the fact that she never ate as much cake as anyone else, she always kept a good watch of her blood sugar, and she was an avid walker so she kept in shape. At one point, she had to move closer to my daddy so he could help take care of her. He even arranged for her to have assistance in her apartment. One day, a day etched deeply in my thoughts, I walked in from sleeping over at a friend’s house. The look on my daddy’s face said it all. My grandmother had fallen, had undergone surgery, and

then developed an infection due to her procedure. Because of her diabetes, she was unable to heal normally. It was, and still is, hard to understand how diabetes could lead to her death, even though she was so good at taking care of herself and her illness. My grandmother still lives in my heart and my mind. Every time I overindulge in ice cream and the memories of her, I am reminded we are often dealt a hand we just have to deal with. Like her, we should do everything in our power to take care of ourselves and finish a prescription, get ample vitamins and sunlight, and watch what we eat and drink. There is only so much we can do to avoid risks, but we need to take every precaution anyway.

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by Amber Davis, R.N. Hypertension does not discriminate. It affects around 70 million people in the United States alone, and that number does not include the undiagnosed cases. Many people go years without getting their high blood pressure diagnosed. Sometimes, this is due to the fact that hypertension often has no symptoms at all. Some people are unaware of this diagnosis until they reach a hypertensive crisis. This is a condition where your blood pressure reaches such unsafe levels, it’s extremely hard to control and often requires hospitalization. Hypertension that goes untreated can lead to many serious health issues such as a heart attack, stroke, aneurysm, heart failure, and kidney damage or kidney failure. When hypertension causes thickening and hardening of your artery walls, it is a condition called atherosclerosis. The longer that high blood pressure goes untreated, the worse the damage can become. Your age, race and even family history play a major role in this health risk. Therefore, it is important to know your family history and risk for hypertension and heart disease. Knowing this will help make you aware and hopefully push you to educate yourself on the risk factors for high blood pressure. Remember, you know your body better than anyone. If you think something is not right, or you haven’t been feeling well lately, do not just push it aside! Get in to see your doctor, or the next time you could be going to the emergency room for something much more severe! It is very important to be informed on possible health issues in which you are at risk. Therefore, here are some risk factors for hypertension.

Do any of these apply to you? Age – The older you are, the higher the risk. However, you can be diagnosed with high blood pressure at any age. Being young does not exclude you. Family history – If you have a history of hypertension or heart disease in your family, then you are at risk. It does tend to be a hereditary condition. Overweight and lack of physical activity – The healthier you are, inside and out, the less risk you will have of hypertension. Tobacco and alcohol – The risk of hypertension can increase for those who consume higher levels of alcohol and tobacco products. Sodium – High levels of sodium in your diet may increase your risk of hypertension. Stress – Stress can cause your blood pressure to temporarily spike. Over time, this could play a role in long-term hypertension.

We all need to be more informed about hypertension. So many people have this medical condition; yet, so many people understand nothing about it. Hypertension is sometimes hard to control and hard to manage. Compliance with your medications is the first step in getting your hypertension under control. Yes, medications can have side effects, but that is just part of it. The risk of heart damage and/or disease significantly outweigh the risk of side effects from medication. However, discuss this with your doctor. He may need to adjust your medications and try something new if there is a great concern. Open the lines of communication with your doctor and be honest on how you are feeling. Do not let this condition go untreated. This is your life, live it well!

Reference High Blood Pressure (Hypertension). Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/definition/con-20019580. Accessed August 8, 2016.

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in a

heartbeat by Shelly Rich, RN, LBSW

Why are newborns not being screened for CHDs when 1 in 110 newborns are born with a CHD?

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Inside Medicine | fall 2016

November 16, 2015,

started like any other typical day, off to school and work for everyone. By mid-day, a text came from Rachel, our 13-year-old, saying, “I don’t feel good. I think I am getting sick.” By midnight that night, she had a low grade temperature. The next morning, she stayed home from school, and when she woke, she felt nauseated. She soon became unconscious, turned gray in color, and her hands drew up. We quickly called 911.Upon the arrival of emergency responders, she was alert and talking. In the emergency room, several labs were taken and tests were performed. The visit concluded with a diagnosis of vasovagal syncope, or fainting. Due to this diagnosis, a routine follow-up visit was scheduled with cardiology. November 24, 2015, we presented to the pediatric cardiologist for our “routine” follow-up appointment. An electrocardiogram, a test to monitor the electrical rhythm of the heart, was performed. An echocardiogram (ECHO), an ultrasound that produces images of the heart, was performed as well. And then, all in a heartbeat, everything changed. The cardiologist proceeded to tell us that the good news was the syncope or fainting was due to a vasovagal response and nothing to do with her heart. He said this was common in young teenage girls. Very uncommon, however, was the fact that the echocardiogram revealed a Sinus Venosus Atrial Septal Defect (SVASD) with Anomalous Pulmonary Venous Connection (APVC) or a large hole between the two upper chambers of her heart with 3 pulmonary veins in the wrong location. What?! How could this be? Never had there been even a mention of a heart murmur! We sat frozen and numb at what we had just been told. He said an ASD is one form of Congenital Heart Disease (CHD) and that this birth defect would have happened about the second week of gestation. A CHD is defined as a problem of the heart’s structure that is present at birth. There


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are various forms of CHD, some considered critical, which means they have to be repaired soon after birth, and others that are just as serious, such as this one, but do not require immediate repair. CHDs are the most common birth defect. The cardiologist went on to explain to us that ASDs are a common CHD, but not often found until adulthood. He also stated the most common ASD is the Secundum ASD, and it often does not require surgical intervention because it can sometimes close on its own. Rachel, however, had the rarest form of ASD, Sinus Venosus Atrial Septal Defect with Anomalous Pulmonary Venous Connection. This would require open heart surgery to repair. We sat speechless and in total shock. How could this have been missed? According to multiple cardiologists, if she had not fainted and presented to the ER, this would have went undetected until her mid 20’s or early 30’s, but by then her heart and lungs would have been damaged. Left undiagnosed until adulthood, this could lead to right heart failure, arrhythmias, stroke, and pulmonary hypertension. My question then became, “Why are newborns not being screened for CHDs when 1 in 110 newborns are born with a CHD?” I was given a couple of answers, but one answer was dominant. Money and availability of technicians to perform ECHOs was the number one answer among 5 cardiologists. How can the cost of an ECHO be more important than the damage that is created by an undiagnosed CHD left to rear its ugly head in adulthood? The second answer was that some states perform newborn screenings using pulse oximetry. Pulse oximetry estimates the level of oxygen in the blood by using sensors placed on the skin. While pulse oximetry detects some CHDs it does not detect others. ASDs are one of those it does not detect. Currently, Alabama does not require pulse oximetry as part of the required

newborn screening. Rather the Alabama Health Department provides guidelines and asks hospitals to “partner with us to voluntarily implement CHD screening in the newborn nursery.” Again, how can this be? In a country where the American Heart Association is so large and active, how can there be no set standards? We have Heart Walks, Jump Rope for Heart, and many things to raise awareness of other heart diseases, but not this. There needs to be change! According to the Center for Disease Control (CDC), “no tracking system exists to look at the growing population of older children and adults with heart defects.” Currently, researchers have only estimated the number of older children and adults with CHD based on healthcare databases in Canada. Once again, how can this be? It is just unacceptable. More must be done to record the incidence of CHD and to identify them earlier to avoid irreversible, costly, long term effects. Because, all in a heartbeat, it could be your child, your grandchild, or even yourself !

Littlemendedhearts.org Alabama Department of Public Health Adph.org Center for Disease Control Cdc.gov


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

OUR PHYSICIANS

Ronald Collins, M.D.

Morris Scherlis, M.D.

Roddie Gantt, M.D.

John Roberts, M.D.

Thomas Kraus, D.O.

Call (256) 265-PAIN (7246) or visit tnvalleypain.com for more information.

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

Sciatic and Neuropathic Pain Facet Pain Peripheral Neuropathy

Cancer Pain Shingles Pain


Pin Point Pain Relief Advanced Pain Management techniques focus on nonsurgical pain relief

Nearly 100 million people in the United States suffer with chronic pain – more than those living with diabetes, heart disease and cancer combined. This statistic has garnered considerable attention from the healthcare community. Due to its subjective nature, pain is often difficult to measure but is important to address. Pain serves as the body’s “warning signal” for a problem requiring attention. The most common conditions treated by pain management specialists include low back and neck pain, neuropathic pain, pre-and postsurgical pain, cancer and shingles-related pain. Many patients will experience acute pain which will resolve within 6 months. For patients whose pain does not improve, many develop chronic conditions and suffer with a reduction in their mobility, range of motion and overall quality of life. “The Pain Management specialty is designed to work with primary care physicians to diagnose the underlying cause of pain and determine an effective treatment plan,” says Ronald Collins, M.D., DAAPM, anesthesiology and pain management physician with Tennessee Valley Pain Consultants. “Many people can achieve pain relief without surgical intervention.” While prescription medication can be effective when utilized as part of a treatment plan, there are many advances in nonsurgical interventions available for patients. Patients suffering with pain in the spine, extremities or nerves can often benefit from a less invasive option – injection therapy. Whether used for diagnostic or therapeutic benefit, injec-

tions including nerve blocks are commonly used for treating both acute and chronic pain. Pain Management physicians utilize advanced techniques under x-ray guidance to pin point pain and relieve it. “Our goal, besides managing pain with appropriate medication is to try and change the pain at its source,” says Morris Scherlis, M.D., DAAPM, anesthesiology and pain management physician with Tennessee Valley Pain Consultants. “This often involves injections under fluoroscopy to specific and precise pain generators.” Nerve blocks relieve pain by interrupting the transmission of pain signals to the brain. Common blocks include cervical and lumbar epidural steroid injections for neck and back pain relieving both site and radiating pain. Under x-ray guidance, the physician injects a mixture of steroid and anesthetic into the epidural space, bathing the painful nerve root with soothing medication. Many patients experience significant relief from only one or two injections. Injections are also very effective for sacroiliac joint pain which is often caused by arthritis in the joint where the spine and hip bone meet. The steroid medication alleviates pain by reducing swelling and inflammation. In addition to spinal conditions, nerve blocks are also extremely effective at relieving acute Shingles pain as well as postherpetic neuralgia, the residual nerve pain lasting for several months to a year. Injection procedures are typically done Inside Medicine | fall 2016

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in an outpatient setting using light sedation. For some patients, a minimally invasive procedure known as facet radiofrequency is performed to disrupt nerve signals. Radiofrequency can be performed in both the neck and low back. During this procedure, a physician inserts a needle-like tube into the spine under x-ray guidance to the irritated medial branch nerves. A radiofrequency electrode is inserted through the tube to heat and cauterize the nerve blocking pain signals. Patients usually experience full relief within 30 days and enjoy lasting benefits. For pain that is unresponsive to a conservative approach, spinal cord stimulation is among the most advanced technologies in the pain management field. “These implanted devices act like pacemakers for pain and can help to significantly reduce a patient’s discomfort by inhibiting painful impulses sent to the brain,” says John Roberts, M.D., DAAPM, anesthesiology and pain management physician with Tennessee Valley Pain Consultants. Spinal cord stimulation has a high success rate and is less invasive than other surgical options. Since every patient’s pain is unique, it is important to seek an experienced board-certified pain management physician offering a multidisciplinary approach to pain relief. by Jackie Makowski Tennessee Valley Pain Consultants 201 Governors Drive, Suite 400 Huntsville, AL 35801 256.265.7246 tnvalleypain.com

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Common Procedures for Pain Relief The following procedures are performed with real-time x-ray guidance. Epidural Steroid Injections: Administered in the epidural space of the spinal cord to relieve inflammation secondary to spinal disc problems or pain associated with pinched nerves. Trigger Point Injections: Performed on site of muscle pain improving blood flow and reducing pain. Selective Nerve-Root Blocks: Utilized to diagnose the specific source of nerve root pain and for therapeutic relief of low back pain and/or leg pain Facet Joint Injections: Performed for temporary joint pain relief and in preparation for more long-term treatments such as facet radiofrequecy.

Other Procedures Facet Radiofrequency: Utilized to help patients with chronic low-back and neck pain and pain related to the degeneration of joints typically from arthritis. Physician precisely inserts a needle precisely delivering heat to a specific nerve disrupting the pain signals transmitted to the brain. Pain relief may last for several months to a year. Spinal Cord Stimulation: Performed for patients with nerve root damage or failed back syndrome who have not responded to conservative treatments. This procedure involves implantation of a small, rechargeable device releasing electrode signals to the spinal cord, replacing pain with a more pleasant sensation.



TALK IS CHEAP A few moments in your life are you able to go back and relive with such clarity that you can remember what you were wearing, what your hands were touching, or how the air smelled. Traumatic events have a way of permanently marking synapses in the brain that survive Alzheimer’s and even amnesia. Perhaps this is why our Post Traumatic Stress patients are so challenging to treat. Many friends have told me over the years that they can remember exactly what they were doing when the planes hit the World Trade Center. I remember my grandmother telling me what she was doing the moment she found out Pearl Harbor was bombed. For me, I’ll never forget the moment I learned my younger brother, Ben, had committed suicide. That day is burned so deeply into my memory that it will probably be there with me until I die. Dressed in scrubs, seeing my 7th patient of the afternoon, sipping cold coffee, I picked up the phone and learned that he had shot himself in my backyard garden, using the revolver I kept for safety in my night stand. Physical torture was more welcome than the squeeze put on my heart in that moment. Recently laid off from his job and grieving over a close friend’s death, Ben had moved in with me. Falsely, I felt a sense of security that he was under my roof, and I could watch him. Not all suicide victims present with the classic warning symptoms: hopelessness, excessive sadness, withdrawal, changes in appearance, dangerous behavior, or plans to get their affairs in order. Ben was acollege-educated, well-dressed, handsome, charismatic person up until the day he died. This can make acceptance as hard as not recognizing the warning signs. Suicide leaves more questions than answers, and closure is almost completely out of the question. If you are lucky, you are ableto find peace and move forward. Florence Nightingale once told us, “I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.” My dad would say it more directly: “Talk is Cheap.” Ben and I were blessed to have two supportive parents, but anytime I would begin

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Inside Medicine | fall 2016

by Kari Kingsley, MSN,CRNP

spouting typical teenage delusions of grandeur, my father had an earnest way of reminding me that our actions speak louder than words. It is easy in modern times with the constant bombardment of political lobbyists or incessant infomercials, all promising a better life, to forget the truth in that statement. Talk is cheap; so cheap, it’s free. At times, you would pay not to hear it. Rather than talking about what we can do to combat the staggeringly high (and ever increasing) incidence of suicide, I began to feel it was time for action. Be kind to those around you; something as simple as not jumping into the gossip at work, or doing something for someone else without getting something in return. These are easy behaviors that we sometimes forget. Since my brother passed away July 24, 2012, the outpouring of love and support has been astonishing. For a long time, I survived on the kindness and love of others. From the moment he died, I knew I would never be able to move forward unless I could find some form of good to come out of my family’s darkest moment. I was humbled to have been approached by the American Foundation for Suicide Prevention to chair their annual “Out of Darkness” Community Walk in Huntsville to raise awareness and support for suicide victims. The event is set to take place, Sunday, November 6, 2016 at Ditto Marina in Huntsville. This is the way I plan to move forward. I encourage each of you to find yours. If you are blessed enough to have not suffered a devastating tragedy, please don’t wait for one like I did to feel the need to make a difference. Volunteer. Cut an elderly neighbor’s grass. Call your parents. Join a charity. Do something instead of Talking…because, talk is cheap. As Florence Nightingale reminds us, actions speak louder than words. We get one life. All that is left after we are gone is the mark we leave. I want my actions to speak volumes.


WALK TO FIGHT SUICIDE OUT OF THE DARKNESS Community Walks Suicide Prevention Starts With Everyday Heroes Like You. Register Today.

North, AL Out of the Darkness Community Walk Presented by:AFSP Alabama Chapter November 6, 2016

Ditto Landing Marina - Huntsville, AL Contact:Kari Kingsley (CarolineEkingsley@gmail.com) Registration Time:2:30 PM Walk Time:3:30 PM

afsp.org/walk


ADHD My son is smart

Have you ever considered therapy for you or your children? Read Jennifer’s story and maybe you can relate. When I found out I was pregnant for the first time I was so excited! My personality is one that always wants to be prepared, in control and a planner. I naturally read all the books to educate myself and my husband so we could be the best parents to our first son. I talked to all my friends about what delivery would be like and what it was like to care for a newborn. I was confident with what kind of mom I was going to be and had the “I got this” kind of attitude. Deep down I was scared! What if I wasn’t ready? What if I mess up? What if I miss something? 48

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My son is now about to turn 9 and boy have I learned so much since then! I think my story is like so many other moms who live day in and day out wanting the best for their kids. When Chris was 2 years old my mommy instinct put up a red flag. Chris was not even making sounds or even babbling. Of course I googled and the word, “autism” immediately popped up. I began paying more attention to things and realized Chris did not have many of the descriptions. I talked to my doctor about it and he said that autistic kids can’t point. Chris could point though! I felt relieved. 4 months later he started to say 20 words in a day and I felt like he was making up for lost time. Still I felt something was off. We called him our “runner”. I would see little boys standing nicely with their moms in the grocery store and wonder when will Chris be like that? Here I am chasing after him in the frozen food aisle. He would want to touch everything and get into everything. My husband would always say he is just a “boy” and he is fine. In preschool they would joke with me about how distracted he would get and how he was very smart.
 Fast forward to Kindergarten. I believe this is where those “ mommy instincts” or red flags started to pop out more. He was having a hard time staying on task and staying focused. His grades were good and academically was right where he needed to be. But, his behavior was subpar at best. His teacher said she could tell he fights so hard to not make wrong choices but his impulsiveness always got the best of him.

 In April of 2014, when Chris was 6, I felt enough was enough. The “he is just a boy” phrase had expired and I was tired! I was tired of getting bad reports at school, I was tired of yelling at him at home for not sitting still and to stop being so “wild” and I was tired of feeling like I was failing him!! I called my insurance company to find out what services they offer and what doctor was covered. I found out that my insurance only covers a psychologist with a PH.D. I was told that there were only 2 doctors in the Huntsville area. We chose our doctor and made our first appointment. I was excited to go, I think so many people are afraid of psychologist, but not this girl! I wanted answers, I wanted help. No one gives you a manual on parenting. I didn’t have time to read books and surf the web. I wanted face to face contact. I think I cried the first 6 visits talking about how I felt Chris was not your “typical” boy and how we had gone through so

many daily struggles together. I cried over thinking I wasn’t a good mom and how maybe my kid just needed a good spanking and more discipline. I cried over all the times of “looks” I got when out in public or how many times he did something he wasn’t supposed to do in school. I will never forget one of her first questions to me was “tell me 3 positive qualities about Chris”. I was not prepared for that question at all. I thought I was here to talk about all the stuff going wrong. That moment was eye opening to me. I am a positive person by nature. I try to find the positive in any negative situation except for this one. Therapy has been life changing for me, my son and our family! We go every 3 months now to check in and talk about different behaviors or different ways to parent and help our son excel in life. I learned positive reinforcement techniques, different ways to talk to Chris when it came to discipline and most importantly how to love my son for who he was and how we turn the negatives into positives.
 I’m sure your wondering what his diagnoses was and what was wrong with him. The answer is... nothing! He is an impulsive, has a hard time sitting still, high energy boy who wants nothing more than to be loved and accepted by others. For insurance purposes, he is “labeled” with attention deficit/hyperactivity disorder. I knew our Doctor was a great fit for us when she said she does not care for labels. For me, therapy is about asking for help when you need it, not being in denial about who our kids are and love them the way they are. I’m a parent who doesn’t have all the answers but I can sleep well at night knowing that my husband and I are doing everything we can to give our son the best version of us and experiences in life. My son is smart, he loves making others around him laugh, and he has a sensitive warm and caring heart. Parenting is hard but with a little extra help it can be great. Don’t look at therapy as a negative thing. It can take such a weight off your shoulders. It has helped our son, and our family, tremendously! Now, can you name 3 positives about your son or daughter?

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HudsonAlpha expands Information is Power initiative HudsonAlpha, Kailos Genetics and Redstone Federal Credit Union team up to bring free breast and ovarian cancer genetic testing to North Alabama

HudsonAlpha Institute for Biotechnology announced today that it will extend its unique breast and ovarian cancer genetic risk testing initiative Information is Power for another year. The announcement was made at HudsonAlpha’s annual Tie the Ribbons luncheon to support breast and ovarian cancer research. Information is Power is a collaborative effort between HudsonAlpha and genetic testing company Kailos Genetics, a HudsonAlpha associate company and developer of the genetic screening tool. The initiative was set to wrap up in October of this year, but thanks to a generous sponsorship from Redstone Federal Credit Union, the initiative will be extended and expanded. Free testing will be available through October 2017 to 30-year-old women and men who reside in Madison, Jackson, Limestone, Marshall and Morgan Counties. Redstone Federal Credit Union said sponsoring the initiative was important to them because of the positive impact that it will have on the community. “We understand the importance of being knowledgeable about your health and risks to your health,” said Joseph Newberry, President and CEO of RFCU. “We also understand that for many in our community, access to such information can be challenging. This is Redstone Federal Credit Union’s way of helping to build a healthy and strong community and we are happy to do it.’’ The test screens for mutations in the well-known BRCA1 and BRCA2 genes, as well as additional genes linked to other cancers. If you are 19 or older and reside in the five counties included in the initiative, the test will be available at a reduced cost of $129. “This type of testing is traditionally done in a context where a person has a family history of cancer, and this initiative makes testing available to people in the community regardless of family history,” said Kimberly Strong, PhD, HudsonAlpha faculty investigator and director of the Ethics and Genomics Program. “Now with Redstone’s support, we are able to offer free testing to 30-year old women and men in the surrounding counties as well.” Kailos said offering free testing to residents in five counties is one step closer to achieving their goal of population-wide genetic testing, which would allow everyone to have access to information about their genes. “Our mission is to give people insight into their genetic data to help them make smarter, more informed decisions for their health,” said Troy Moore, chief scientific officer of Kailos Genetics. “Now that we’ve started to see the life changing impacts of the Information is Power initiative, we are excited to give even more people access to these benefits by extending that opportunity not only for another year, but to all 30-year olds in North Alabama.” Phase two of Information is Power will begin October 29, 2016, at which time 30-year-old men and women who reside in the five counties will be able to order a free test kit. To learn more, visit http://www.hudsonalpha.org/information-is-power.

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About HudsonAlpha: HudsonAlpha Institute for Biotechnology is a nonprofit institute dedicated to innovating in the field of genomic technology and sciences across a spectrum of biological challenges. Opened in 2008, its mission is four-fold: sparking scientific discoveries that can impact human health and well-being; bringing genomic medicine into clinical care; fostering life sciences entrepreneurship and business growth; and encouraging the creation of a genomics-literate workforce and society. The HudsonAlpha biotechnology campus consists of 152 acres nestled within Cummings Research Park, the nation’s second largest research park. Designed to be a hothouse of biotech economic development, HudsonAlpha’s state-of-the-art facilities colocate nonprofit scientific researchers with entrepreneurs and educators. The relationships formed on the HudsonAlpha campus encourage collaborations that produce advances in medicine and agriculture. Under the leadership of Dr. Richard M. Myers, a key collaborator on the Human Genome Project, HudsonAlpha has become a national and international leader in genetics and genomics research and biotech education, and includes 32 diverse biotech companies on campus. To learn more about HudsonAlpha, visit: http://hudsonalpha.org/.

About Kailos: Kailos Genetics is a trusted provider of personalized health information. Addressing unmet needs of healthcare consumers and their families is Kailos’ primary reason for being. With its proprietary and robust DNA sequencing enrichment and laboratory information system, TargetRichTM, Kailos helps make personalized medicine affordable and accessible for everyone through the PraxisTM test. Founded in 2010, and based in Huntsville’s HudsonAlpha Institute for Biotechnology, Kailos is committed to providing a simple, trusted and affordable way to help individuals understand what’s in their genes. To learn more, visit www.praxiscanhelp.com/about-kailos. About Redstone: With more than $4.4 billion in assets, Redstone Federal Credit Union is the largest member-owned financial institution in Alabama and Tennessee and one of the 25 largest federal credit unions in the nation by assets. Based in Huntsville, Alabama, Redstone Federal Credit Union serves nearly 388,000 members. Chartered on November 28, 1951, Redstone Federal Credit Union has proudly served its members in the Tennessee Valley area for 65 years and has 25 conveniently located branches across North Alabama and Tennessee. Redstone Federal Credit Union provides a level of service that is not generally available at other financial institutions through its philosophy of - People Helping People.

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NOT ASKING TOO MUCH by Kimberly Waldrop, M.A.

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines: “Aerobic Activity. Get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity. You can also do a combination of moderate and vigorous activity.”

That sounds like a lot...150 minutes???? Goodness, do you know what that is? That’s 2 and a half hours…a week…that’s NOTHING!! That’s less than one whole Lifetime

Movie. That’s less than one episode of the Bachelorette!! Surely we can fit in 2.5 hours of exercise in our routine, per week!! Now, that’s not to lose weight or anything. This is just a recommendation to stay “active”. We’ll cover getting healthy and losing weight later.

So, how can we make sure we get 2.5 hours of “moderate aerobic activity” in our

weekly routines? Take an afternoon walk. Even if only 10-15 minutes a day…we can

make sure we do our 2.5. Go for a bike ride, take a swim, hike the hills around your neighborhood, turn on some music and dance, race your kids back and forth down the

driveway, etc. As busy people, we may have to work our family into our 2.5 hours, or do our moving and grooving while the kids are at dance or tumbling.

Get creative and get going!! You’ll be so glad you did!



Early detection is your best protection.

Dr. Hoyt A. “Tres” Childs, III Dr. Noel C. Estopinal Dr. Elizabeth Falkenberg Dr. Harry James McCarty III Dr. Traci Cole McCormick Dr. John Francis Gleason, Jr.

256.327.5800 | www.ccchsv.com