Page 1

winter 2016

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features &

CONTENTS

Sharing with Purpose

Inside Medicine | winter 2016

Vol u m e 1 , Issue 2 C O N T R I BUTORS

Neeta Kohli Dang, M.D. Wanda Mullins

FEATURES Look & Feel Your Best What’s New at Center for Women Healthcare?

Let’s Get Physical The Importance of your Annual Physical

A Family in God’s Will How adoption blessed a loving family

9 20 40

CONTENT New Hip Anterior Hip Replacement, a New Surgical Approach

Alzheimer Q&A Advancements made towards a cure

Shingles Treating the pain of shingles

22

Case Pattisson Tiernan O’Neill Ben Macklin Nick Cochran, PhD Myrna Brandon William Mitchell, M.D. Marcia Mierez, DO

38

Cody J. Robinson, MS, MPH, CSCS Tobin Fisher, M.D. Sunita Puri, M.D. Randall Moreadith, MD, PhD

43

Stephanie M. Burrell, M.D. Jarrod Roussel, PA-C Anne Jewell Kim Aaron Brittney Satterfield Matthew Clayton, M.D. Jackie Makowski John P. Cimino M.D., FACOG S A L E S & M ARKETING

Kelly Reese, Co-Owner Julie Pack 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

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.

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


} FROM THE PUBLISHER

Dear Readers– Many challenges come with beginning something new. Like anything NEW, the excitement is there, but so are the fundamental responsibilities.

a season to reflect

The NEW in us...whether a NEW car, relationship, job or new home... will eventually become seasoned or considered old. But what fascinates me is the newness in my life as I become whole, whole and complete in Him and not in myself. The older I get, the more youthful and forgiving my heart becomes. I had an opportunity to share a few words at the launch party (the NEW magazine...) for Inside Medicine. I talked about Huntsville, the surrounding area that we have, its opportunities and the possibilities that present themselves in our market; but, I did not include the meaning and heart behind my passion for this magazine. God had given me a calling; God provided our family with the best medical professionals; and, God allowed this publication to happen. I now have an understanding of how faithful He is, in all things. When needs are spoken, our community comes together to form a unity. We show up when someone asks, and we pray when someone is in need. As a united force, we together can share our stories. Through sharing our testimonies among peers, strangers and colleagues, the NEW “in giving” of our wise and spiritually maturing walk can spread a youthful, joyful and inspirational fulfillment only Christ alone can provide. For me, Inside Medicine is that. It is a unified effort to bring a connection among community providers and patients with human interest stories that share our life from a side of understanding. We will one day leave this place we call home and go to a NEW beginning, a Joyous One. Knowing that Satan is real, I only hope my work here on earth was of such good intent to not allow him any victory. God saved my husband, not just from cancer, but he saved him from himself. Allow God to take your pain and heal your heart. Let him lead you in your path, so that you can develop a stronger and more trusted relationship with Him, our heavenly Father. And lastly, let’s remember that anything NEW we plan in our lives should always include His plan and His will.

Kelly Reese


} HEALTHY LIVING

by Ben Macklin

Feet are the workhorse of our bodies and an important part of a happy, healthy lifestyle. Our feet work hard considering the weight and stress we put on them every day, but we continue to give them very little respect. The average adult takes 4,000 to 6,000 steps per day. That’s enough steps to walk around the earth four times during your life. With 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments making up the foot and ankle, it’s easy to see how approximately 80% of people will experience a foot related problem at some point during their life. However, most foot related issues are the result of neglect and lack of awareness for proper care.

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Inside Medicine | winter 2016

Basic foot care takes very little effort and can be easily incorporated into your grooming routine. • Wash your feet daily to prevent fungal infections. Be sure to get between the toes as this area is more susceptible to infection. • Moisturize your feet to prevent cracking, but DO NOT put lotion between your toes. • Do not soak your feet. Foot soaks can break down skin and actually cause damage. • Trim your toenails straight across versus rounding the nail or cutting the sides to prevent ingrown toenails. • Examine your feet periodically. Make sure there are no cuts or red areas. • Tend to cuts and scratches immediately. After cleaning the wound, use a mild ointment and cover the site with gauze and a bandage. Be sure to change the bandage often. • If you have numbness in your feet from diabetes or nerve damage, examine your feet daily. • Smooth corns and calluses with a pumice stone while the foot is still damp. Rub gently, only in one direction, and treat the site gradually. There are a number of problems that can affect your feet, including: foot odor, cracked skin, fallen arches, corns, bunions, calluses, ingrown toenails, fungal infections, strains, sprains, fractures, and more. Of all the potential problems our feet encounter, heel pain is the number one complaint. Heel pain is typically the result of repetitive stress on the foot


These simple exercises can help your feet and ankles stay happy... caused by biomechanical problems (flat foot) and wearing improper footwear. Plantar Fasciitis, heel spurs, and heel fissures (cracked heels) are some of the primary causes of heel pain. Heel pain can often be prevented or treated conservatively. “Daily stretching can prevent heel pain, and good supportive shoes can prevent over 40% of future heel problems,” notes Milton Sterling, DPM, Podiatrist at SportsMED Orthopaedic Surgery and Spine Center. Preventing and managing heel pain can be accomplished by making simple modifications to your daily routine. • Proper footwear can help absorb shock and provide additional cushioning to take pressure off the heel. • A daily calf stretching routine can take pressure off the heel and relieve pain. • Wear well-fitting, activity specific shoes. • DO NOT go barefooted. • Avoid flip flops, high heels, and pointy toed shoes for extended periods of time. • Custom orthotics can help correct biomechanical issues and prevent foot, knee, and lower back pain. • Diet and exercise also play a key role in preventing foot pain. Dr. Sterling adds, “B complex vitamins accompanied with exercise can decrease neuropathic pain that affect the foot.” As we age, foot related issues tend to worsen. If foot care does not seem important now, it will be. Showing your feet a little respect and some TLC will carry you a long way in life.

Foot Stretch 1. Sit with knee straight and towel

looped around involved foot.

2. Gently pull on towel until stretch

is felt in calf.

3. Hold 10 seconds. 4. 5 repetitions, 2 times per day.

Calf Stretch 1. Stand with involved foot back, leg straight,

forward leg bent.

2. Keep heel on floor, turned slightly out,

lean into wall until stretch is felt in calf.

3. Hold 10-20 seconds. 4. 5 repetitions, 2 times per day.

Calf Raises 1. Balance on involved foot, using

something sturdy to help you balance.

2. Rise up on your toes, then lower back

onto your heel.

3. 20-30 repetitions, 2 times per day.

Heel Stretch 1. Standing with only the ball of the

involved foot on stair, push heel down

until stretch is felt through arch of foot.

2. Hold 10-20 seconds. 3. 5 repetition, 2 times per day.

Inside Medicine | winter 2016

7


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Inside Medicine | winter 2016


} HEALTH FEATURE

What’s New at Center for Women’s Healthcare?

Dr. John Cimino is an OBGYN with over 15 years experience as a specialist in women’s health. He provides comprehensive healthcare for women in all stages of life. As an active triathlete and marathon runner, he also enjoys promoting increased physical fitness amongst his patients. Dr. Cimino encourages his patients to exercise and “be active”. When asked about their exercise plan, many claim that they “just don’t have the energy”, but they know they need to lose weight. Dr. Cimino has observed in many of his patients that very often just dropping that initial 10-15 pounds and making healthier dietary choices gives them the energy and the desire they need to get more active. Therefore, Dr. Cimino has added several weight loss options to his practice which have been effective in “jump-starting” the weight loss process while making the transition to a healthier lifestyle. He partners with each patient to provide effective, medically supervised weight loss, which when combined with hormone therapy as necessary, nutritional recommendations, and an exercise plan yields successful long-term results. Many patients report that they feel better and have more energy than they have had in years! Very often, patients who are making a commitment to transition to a healthier lifestyle simply want to look and feel their best. Dr. Cimino also offers non-invasive facial rejuvenation services including botox and facial fillers. These appointments can be scheduled at your convenience by calling our office. Dr. Cimino’s office is conveniently located in Huntsville with frontdoor parking and minimal wait time. He and his staff strive to maintain life-long patient relationships and make every effort to meet the individual needs of each patient. Now accepting new patients - call 256-882-1717 to schedule an appointment.

Inside Medicine | winter 2016

9


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} FEATURE

Injury Awareness and Treatment

We, as parents, teachers or coaches, need to be aware of who is the best to evaluate these young but serious up-andcoming athletes...

The spotlight on overuse injuries has covered the nation with awareness. But what truly defines the responsibility? For 7-year old Sophia, her spotlight debut was going to bring her quickly to understand recovery. While performing in a competitive cheer exhibition to start off her all-star competition season, she broke her arm on stage on film and on count. In that very moment, the spotlight was on her, and her injury was in the presence of everyone. Sophia’s parents had been so supportive of her dream to one day cheer on a college football field. Little did they know that when they enrolled in such a competitive sport, she would be on her way to outperforming many collegiate-level cheerleaders at her very young age. Now, this dream was suddenly put on hold due to an injury, which came unexpectedly! Thankfully, local orthopaedic specialist Dr. Buckley of The Orthopaedic Center (TOC), who specializes in pediatric care was able to get Sophia back to what she loved most in a short amount of time. Dr. Buckley was accustomed to seeing pediatric and adolescent injuries. As an expert who is fellowship trained and board certified, treating injuries of all types has shaped his patient practice. He knows an overuse injury when he sees one. But he would also tell you that injury is a risk we all take with anything we do. Fortunately, he and other orthopaedic specialists at TOC are here for our community when these emergencies happen. Although all injuries are not avoidable, the spotlight should be focused on identifying the ones that can be prevented. Unfortunately, Sophia’s arm was one of those that could not have been prevented. Most often, injuries come with warning signs. Aches and pains that are persistent are an example and should be evaluated and not always just shrugged off as part of the training. But what about those serious athletes that are elementary or middle-school age that suffer greater injuries to bones and still-developing joints? We, as parents, teachers or coaches, need to be aware of who is the best to evaluate these young but serious up-and-coming athletes and at what point should these issues be addressed with primary care physicians or orthopaedic specialists? The Orthopaedic Center has over 30 orthopaedic specialists, and pediatric and adult Sports Medicine is their understanding. They specialize in orthopaedic care for children, high school athletes, families and senior patients. They use the latest technology in orthopaedics to diagnose and treat everything from sports injuries to fractures to knee pain to scoliosis. All TOC doctors are board certified and fellowship trained. Their teams of surgeons collaborate with physical therapists, athletic trainers and other providers to deliver the highest quality, specialized patient care for you and your family. Customized treatment plans are designed to get you back to work and play as quickly and safely as possibly. They take a conservative approach to treatment, but when surgery is necessary to replace a broken down knee or hip joint or repair a fracture to even the youngest of athletes, you can rest assured you’re in the very best surgical hands. If you are interested in learning more about TOC’s personalized treatment regimen, visit their website at www.visittoc.com.

Inside Medicine | winter 2016

11


It is 5am, and you have been vomiting constantly for over 4 hours. Do you rush to the Emergency Room (ER), or do you wait and go to an Urgent Care (UC) facility at 8am? The choice may seem simple but there are factors to consider that will dictate the most appropriate location to receive the best care. If you have been vomiting the food that you ingested last night from a backyard barbecue or a fast food restaurant, then an Urgent Care is the best place to handle your current condition. However, if you are vomiting blood, it is imperative that you go directly to the Emergency Room. During this age of instantaneous information, individuals often find it difficult to spend hours sitting in an ER waiting to be evaluated. Others do not want to go to the ER and often prefer an UC because of the high cost associated with an ER. Also, some people refuse to travel via ambulance to the ER, even when it is deemed in their best interest to do so, due to cost. With the rise of so many Urgent Care facilities, which were born out of a need to stand in the gap between the Emergency Room and the Primary Care Providers (PCP) office, the UC is often seen as a convenient choice to save both time and money. But does the UC fit the needs of everyone needing urgent or emergent healthcare? Unfortunately, the answer is no. The UC will not be able to service all needs and there is still a role for the ER to play. The UC model was designed to relieve the pressure of an ER overrun by conditions that can be handled outside of the ER. For example, a sore throat with a mild to moderate fever (Temp= 99.1 to 100.9) has no place in the ER. Visiting the ER with a sore throat will cost you time and money which would be dramatically less had you gone to an UC. However, if you are experiencing a sore throat with a narrowing of your airway and have difficulty breathing as a result with or without a high fever (Temp=101-104), please proceed to the nearest ER immediately. The difference in the location of care is often determined by the severity of your symptoms. It is important to know where to go to access the best healthcare for yourself which can save time and money. From a clinical standpoint, as an Urgent Care Physician, I am poised and ready to assist you with your healthcare needs and remain equipped to handle a host of conditions: simple fractures; sutures; upper respiratory infections (bacterial or viral); atypical chest pain (ribs or musculoskeletal); sore throat; allergies; sinusitis; sexually transmitted infections; abdominal pain; dizziness (vertigo); and motor vehicle accidents (without head injury). However, I cannot and will not be a replacement for the ER. If you are having slurred speech, facial droop, mental confusion, and/or an inability to move a body part, go to the ER immediately as these are signs of a potential stroke in progress. Time is brain tissue! If caught within a 3 hour window, meds can be used to try to eliminate a clot and reduce symptoms post stroke. If you are having chest pain or shortness of breath, and have had cardiac or severe pulmonary issues, go directly to the ER and contact your Car14

Inside Medicine | winter 2016

diologist/Pulmonologist. Time is heart tissue! You have a better chance of survival from a Heart Attack (MI) if you go to the ER and get diagnosed and treated within 6 hours. Pulmonary Embolisms (lung clots) may not give you hours before your ultimate demise. If you visit the UC with cardiac chest pain, you will likely be sent to the ER. This approach will cost you time and money as you will be charged for the visit to the UC and then charged again at the ER. Even if the UC is equipped with tools to identify a cardiac event or the possibility of a clot in the lungs, the office is not equipped to handle these emergencies in the UC and will have to send you to an ER directly. In addition, your mode of transport will become costly as it is likely that an ambulance will take you to the ER as it is unsafe to drive or even be driven to the ER due to your condition. The only way to avoid transport via ambulance is to sign your life away via an Against Medical Advice (AMA) form. The AMA form is a costly venture as well in that it places your life and your healthcare consequences in your hands and relinquishes the physician caring for you of all accountability. I recall pleading with a few patients to go to the hospital via ambulance in an effort to save their life only to have to discuss and fill out the AMA form and pray to God that they survive the journey and get the advanced level of care that they require in time. In addition, while Urgent Care physicians are equipped to handle acute healthcare issues that can be taken care of by the Primary Care Provider who may not be present in the office, we are not a replacement for your PCP. We often work on shifts and work different schedules and in some cases different offices at any given point and time. Therefore, we will not be the best option for managing your continuity of care if you have serious chronic illnesses that require monitoring. But we can stand in the gap for your PCP, if they are out of the office or unavailable to you, to handle any Urgent or Primary Care needs as they arise acutely. While UC physicians are equipped to handle most acute care needs or even PCP tasks, we cannot be a replacement for the ER and should not be accessed for serious illnesses or conditions. So, if you have chest congestion and difficulty breathing or a cough and cold symptoms, stop by the UC for treatment, but if you have acute shortness of breath and/or chest pain associated with extreme fatigue, go to the ER immediately. If you have acid reflux, stop by the UC, if you have right lower quadrant abdominal pain and your appendix is still in, go to the ER immediately. If you have dizziness along with an ear infection, stop by the UC, but if you have dizziness with new onset of a severe headache that woke you out of bed and felt like a thunder bolt exploded in your head, go to the ER immediately. As a Family Practice Physician who is now practicing solely as an UC physician, I pray that this article allows you to prosper and be in good health, but when this is not the case, I hope that you will access the appropriate location for the level of care you require. by Marcia Mierez, DO | Highway 53 Urgent Care


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T

A Mother’s

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by Dr. Sunita Puri

MedCare + 8075 Madison Blvd., Suite 106 Madison, AL 35758

he clock read 3 a.m., and I was finishing a 24-hour shift in a remote rural emergency room when Millie came in with her child wrapped in a blanket. She was reluctant to place him on the bed. I asked her if I could peek under the blanket. When I pulled the blanket away, I saw unseeing eyes and dysmorphic facial features, but Millie smiled and looked at her son, Michael. The boy had mild respiratory distress. I touched his cheeks and said, “Michael, we will take good care of you.” Millie relaxed and allowed him to be examined. He was wheezing and had a respiratory rate of 25 per minute, with mild retractions. Other vital signs were within normal limits. Pulse oximetry was 96% on the room air. Millie sat on the bed, holding Michael’s hand and watching every move I made. Michael was treated with an aerosolized bronchodilator, to which he responded. A chest x-ray revealed right lower lobe pneumonia. When I told Millie that Michael needed to be hospitalized, the color drained from her face. She shook her head and said, “No.” I asked her to tell me more about her son. Now 14 years old, Michael had been diagnosed at age 1 with Hurler syndrome. I had noted the characteristics of this rare syndrome when Millie placed him on the bed. Michael is now three feet long and had profound growth and mental retardation. Originally, Millie was told that he would live only a few years. She refused to entrust his care to an institution. For 14 years, she had loved this child into living and observed the smallest changes in his behavior as indication of how to take care of him. It was obvious that Millie knew more about caring for Michael than anyone else did. I respected her wish to take Michael home, and we agreed to treat Michael with antibiotics as an outpatient. Since then, I have seen Michael twice for similar illnesses; we treated him and released him into his mother’s care. As a seasoned medical professional, who may be unaware of the family dynamics, we often feel our judgment is right, particularly when a child with special needs is involved. This year, Michal will celebrate his 17th birthday. I can only admire this super mom who gives all her time and energy to taking care of this youngster. Had Michael been placed in an institution and deprived of his mother’s care, he might not have lived for 17 years.

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Inside Medicine | winter 2016

Sometimes, only mother knows best.


} FEATURE

MDVIP

by Tobin Fisher, MD

When I was asked to write this article, my first thought was, “sure, why not?”. As the deadline loomed closer my thoughts changed to, “Why did I think this was a good idea”? The truth of the matter is, I wanted to write the article to give an alternative perspective to an area of medicine that is misunderstood by most patients and the general population. I want to try to answer the question of why I transitioned my practice from a traditional one to a concierge model. The answer is complicated and I am not sure I can give a sufficient one. The many other physicians who have this type of practice would probably give different answers to this question and we all probably have different reasons for doing it. Certainly, some may have done it at the lure of greater profits but I really do think (at least I hope) that those are the vast minority. Hopefully, a brief overview of all the thoughts I went through will lead to a deeper understanding of why a physician would do this because they want to be a better doctor. A good place to start would be to explain why I wanted to be a doctor in the first place. To make a long story short, I liked it. I know that makes no sense, how would you know you liked doing something before you did it? But for me, that is how it was. Every step of my training led down a path that made me feel more like the person I wanted to be. So flash past medical school and residency and now I am working doing what I always wanted to do. I was there to see someone when they were worried and scared and reassure them they were fine. I was also there so see someone and their family when things were not fine. Things were hectic but I always tried my best to take care of the issues and problems patients brought to the office; both the ones they stated and

the ones that were there but often not stated. Things were going well. Then, through time, things started to change. More and more the care I wanted to give was interfered with or dictated by a third party such as insurance or new Federal Regulations. There was usually a way to still get what the patient needed but that took time, and in the current medical system time is not something you often have. Along with this, the pressure to see more and more patients was very high. Suddenly, I was not doing what I had always wanted to do. The increase in volume and the decrease time spent on patient care led led me to something I was no longer enjoying. This was no longer the type of medicine I had started out wanting to practice and something had to change. Around that time my partner and mentor, Dr. Garber, was looking at a new type of model-concierge medicine. He had started looking at other options as he had the same concerns I had. Concierge medicine has been seen as many things. Some things that are said about it are true and some are not. For me it signaled a way to get back to my original goal: taking care of my patients to the best of my ability and having the time to do just that. I cannot describe how guilty and how often I questioned my decision to change my practice while I was going through the process. Even now, I often wonder if it was the right thing to do. It is very difficult and sometimes painful for families to make the choice I was now requiring of them (pay the fee to stay in my practice or find another physician) and I hope they know I do understand that. But in the end, I felt this was the best option. So was it the right choice? That is a near impossible question to answer. I do still have guilt. I admit I do still question whether or not it was the right decision. But I also feel staying on the path I was on would not have led to a fulfilling practice. I think the patients that stayed with my practice would say it was the correct decision. But in the end, I guess I did the best I could to stay true to what it was I started out trying to do which is be the physician to my patients I wanted to be.

Inside Medicine | winter 2016

17


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} FEATURE

financial responsibility

by Tiernan O’Neill

Can you imagine going into the grocery

sicians around the country are starting

fice. There are virtually no offices I know

store and telling the cashier to bill you

to adopt a stricter financial policy. Re-

of that will not be willing to work out pay-

later? It just doesn’t happen like that,

cent trends include collecting 100% of

ment plans with patients. Typically, this is

does it? The healthcare industry is pos-

charges at the time of service and even

reserved for patients who are open, hon-

sibly the only industry left where people

more are requiring patients to leave

est and upfront with the situation; con-

feel they should be allowed to receive

methods (credit card) of payment on file

versely you will find little assistance when

services well before they pay for them.

for future collections. While physicians

you ignore bills, refuse to answer contact

For some unknown reason, and for

offices understand additional financial

attempts, or are less than truthful.

some time now, it seems people have

charges can be burdensome to many

been accustomed to paying the medical

individuals in the present economy,

responsibility for your financial obliga-

community well after they receive ser-

those same individuals must recog-

tions. They are a direct result of your

vices. Or sometimes, not paying at all.

nize these services and personnel have

choices of the insurance you selected,

It is so important for the future of

costs. When the costs aren’t met due to

the appointment you scheduled to see

health care in this country that patients

lack of payment, these services could

the doctor you requested and the choice

meet their financial responsibilities.

be abandoned in the future.

of seeking medical treatment for your

This includes payments and charges at

There is a way to meet halfway! Pa-

ailments. Ignoring or not meeting these

the time of service but also any subse-

tients must take their financial responsi-

bills is unfair, unwarranted and unwel-

quent bills determined by the insurance

bility seriously and physician’s will work

come. If patients continue to abuse the

company’s response to the physician’s

with the billing. If there is a hardship or

system they will soon find themselves

office billing.

inability to pay for such services there

without well intentioned doctors, staff,

are many alternatives or solutions.

facilities or means of treatment.

65-70% of family physicians are

currently claiming financial hardship.

With declining insurance payments,

dures prior to it being performed when-

physicians have frequently began to of-

ever possible and discuss necessity or

fer more services and additional conve-

cheaper alternatives.

niences in their office as new sources

of revenue and to attract new patients.

which will reasonably cover the expens-

Often, by the physician offering services

es you typically see in any given year.

and bypassing traditional large scale

facilities (such as hospitals) they have

nity resources that exist to aid those in

been able to save patients money as

financial hardship.

well. However, these services require

an investment of capital in staffing and

to the physician and the physician’s of-

The main point to remember is take

First, inquire as to the cost of proce-

Second, find a health insurance plan

Third, actively search for commu-

Last and most important, be upfront

resources. Physicians are left in debt when patients receive services and do not subsequently pay for them. This negatively affects all operations and services a physician can offer in the future. In response to the lack of pay outs, phyInside Medicine | winter 2016

19


The Importance of your Annual Physical by Stephanie M. Burrell, MD N AL Family Medicine, LLC

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Inside Medicine | winter 2016


Preventative Services (per age group) It’s 07:30a.m., and I’m dropping off “Big Baby”…at Infiniti for a maintenance appointment. (Yes, I’m referring to my car. No jokes, please.) I am religious about doing this. I want to try as much as possible to “catch problems” before they cause an “epic” breakdown. It’s great because the technician tells me if he or she recognizes any problems that need to be addressed and how soon they should be taken care of. Things that should be monitored as well as those things that serve as warning signs are brought to my attention. I am given the opportunity to ask questions about different things that I may have noticed since my last visit like…why does this warning light about tire pressure keep appearing? Yes, you may have guessed where I’m going with this… Similarly, a patient’s yearly physical is a time when the patient and physician can discuss and explore a patient’s concerns and complaints, if there be any. The physician can update the patient on screening tests (whether laboratory or imaging) that are recommended for his/her age group. Vaccinations may also be discussed. In return, the patient can update the physician on his/her health status since their last appointment. Concerns can be addressed and if not diagnosed and treated on that very day, a plan of action can be developed. I have had several encounters in which major health problems were discovered during the time of the physical. What does a physical entail? It’s simply a headto-toe check of the major organ systems-i.e. skin, cardiac, etc. Physicals are covered by most (not all) insurance plans. Schedule your physical on or near your birthday–you won’t forget it! So, do you maintain your vehicle? Well, maintain your body too, after all, it is far more important!

20’s: 30’s: 40’s: 50’s: 60’s:

Baseline labs/BP checks (yearly) Full body skin exam Self breast exam (monthly) WWE (Pap and in-office breast exam) yearly Booster Tdap (every 10 years) Influenza Vaccine (yearly) Mammogram for high risk women Mammogram Colonoscopy DEXA Scan (bone density) Zostavax (shingles) vaccine Pneumovax (pneumonia) vaccine Prevnar (pneumonia) vaccine

Preventative Services (per age group) 20’s: 30’s: 40’s: 50’s: 60’s:

Baseline labs/BP checks (yearly) Full body skin exam Booster Tdap (every 10 years) Influenza Vaccine (yearly) Baseline labs/BP checks PSA and DRE for men of ethnicity Colonoscopy PSA and DRE for non-ethnic men Zostavax (shingles) vaccine Pneumovax (pneumonia) vaccine Prevnar (pneumonia) vaccine

(Tables to right should serve as a guide and is not all inclusive; an individual may require other services based on his/her past medical and family history) Inside Medicine | winter 2016

21


} SURGICAL TECHNOLOGY

A NEW SURGICAL APPROACH for YOUR

NEWHIP by Matthew Clayton, M.D.

It is estimated that 27% of the population above the age of 45 years old will display evidence of hip arthritis on x-ray. Hip arthritis is a common problem that often results in pain and stiffness of the hip. Most people will experience this as pain in the groin or buttock muscles. These symptoms result in limitations that drive patients to seek treatment from medical professionals. Treatment for hip arthritis can be as simple as oral medications or injections. However, a significant number of patients do require surgical intervention, often in the form of total hip replacement. Fortunately for the patients that do require surgery, there is a new surgical approach that is changing the field of hip replacement. The direct anterior approach total hip replacement offers less post-operative pain with a faster recovery. This procedure has been discussed nationally in publications like the Wall Street Journal and even on CBS News. These news outlets are showing interest because this procedure is truly changing the way medicine is practiced. This innovative surgery is now being performed for patients here in Huntsville. Total hip replacement has classically been performed through what is referred to as a posterior or direct lateral approach. Both of these surgical approaches to the hip require that muscles and tendons be cut to access the hip joint. The direct anterior approach allows the surgeon to work between muscles, rather than cutting them. This is much less traumatic for the patient, resulting in less pain after surgery. The surgeon also uses x-rays during the procedure to ensure that the implants are appropriately sized and positioned to recreate the patient’s natural anatomy. With all of these advantages, why is this not the standard of care for hip replacement surgery? The truth is, many surgeons were not taught this approach during their surgical training and it can be technically challenging to learn and implement. For these reasons, it is important to find a surgeon that performs a high volume of these procedures. In the hands of a well-trained hip surgeon, patients in the Huntsville area can now regain their mobility and get pain relief after a hip replacement faster than ever before.

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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


The HudsonAlpha Institute for Biotechnology is a nonprofit research institute, but also has more than 30 for-profit biotech companies on its campus. One company in particular is Serina Therapeutics, a pharmaceutical company that has developed a proprietary, patented polymer technology for drug development. Using this Randall Moreadith, MD, PhD President and CEO of Serina Therapeutics

technology, the company developed a oncea-week injection, called SER-214, which may not only reduce the amount of needed treatments, but it may also become an alternative to levodopa—a common Parkinson’s drug which causes a well-known side effect associated with the disease.

How common is Parkinson disease in the U.S.? As many as one million Americans in the US are presently diagnosed with Parkinson disease, and approximately 60,000 new patients are diagnosed every year. It is one of the most common and debilitating neurological diseases in the US and worldwide, with as many as 10 million patients worldwide.

If a family member has Parkinson disease, what is the likelihood that I will also receive diagnosis? Most patients who are diagnosed with Parkinson disease have the non-familial form of the disease, which means they do not have a genetic predisposition to developing the

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Inside Medicine | winter 2016

disorder. Only about 5 % of Parkinson disease is inherited. That means 95% of the patients who are diagnosed, generally at an age over 50, do not have an identifiable genetic link to developing the disease. There is much work being done to identify genetic links to the disease, and in the future it may be possible to diagnose the disease with a genetic test before one even begins to develop signs or symptoms of the disease.

What types of treatment options are available? There are many treatment options for patients with Parkinson disease, both pharmacological – meaning drugs – to nonpharmacological such as dance and exercise, and finally even surgery. The most commonly prescribed drug for Parkinson disease is levodopa given as an oral formulation


in combination with another drug that inhibits the breakdown of levodopa before it can enter the brain. Once levodopa enters the brain, it is converted to the missing chemical in the brain that leads to the disorder – dopamine. Dopamine is a neurotransmitter that is required for normal coordination … if it is deficient, then one begins to develop the common manifestations of the disorder including tremors, bradykinesia and gait disturbance such as imbalance. There are other drugs that act like dopamine in the brain – we call those dopamine agonists. Commonly employed dopamine agonists include rotigotine – which is available in a transdermal patch, and ropinirole and pramipexole, which are available as oral drugs. All of these drugs can be used to control the symptoms in Parkinson disease, but like many drugs, they have side effects including nausea, somnolence, pathologic gambling, onset of involuntary motor fluctuations known as dyskinesia, and hypersexuality. Other classes of drugs include those that prevent the normal metabolism of dopamine by inhibiting the enzymes that convert dopamine to its metabolic end products in the brain (MAO-B inhibitors), as well as those that inhibit it’s breakdown in the blood (COMT inhibtors). Finally, if the options described above do not provide symptomatic relief, then surgical options are available including an intestinal catheter that delivers levodopa continuously into the small intestive, and an invasive procedure known as deep brain stimulation (DBS). The latter approach involves implantation of electrodes within the brain that provide tiny pulses of electrical stimulation that can provide dramatic improvements in some patients – but there can be complications with the surgical procedure. The intestinal catheter and surgery are generally reserved for patients with significantly advanced disease.

ritation and itching, and it can fall off if you sweat. There are chemical components in the patch that can also cause an acute allergic reaction. SER-214 goes into the blood directly following the injection – no shaving, no skin irritation, no significant side effects, and it delivers rotigotine continuously over a one-week period. There is no product like this right now, and we are in Phase I development now in Parkinson disease patients.

Have you started clinical trials? We are in the earliest phase of clinical development now known as Phase I. Our Phase I study is being conducted in Parkinson disease patients, and you can read more about this on our website at www.serinatherapeutics.com. On the website, you can pull down a fact sheet as well as the entire description of the trial on ClinicalTrials.gov site.

How far away are we from a cure? That is a great question, and it is the mission of organizations like the Michael J Fox Foundation who want to achieve that. We may be years away from curing the disorder, but in the meantime there are effective treatment options that are available to control the symptoms of the disorder while we work diligently to find a cure for this very common and often debilitating disease.

What is SER-214? SER-214 is an injectable candidate drug that can be taken just like you take an insulin shot, except that you would take it once a week. We programmed this pharmacokinetic profile using our polymer drug platform, which allows drugs to be delivered as a single injection. The drug attached to the polymer is rotigotine, which is a known safe and effective drug that can be delivered as a transdermal patch on a daily basis (Neupro). The advantages of SER214 over the patch are significant – you have to shave your body to apply the patch, it often causes significant skin ir-

Inside Medicine | winter 2016

25


by Anne Jewell President, Cox Associates, Inc.

long-term care

and Your Future

Former First Lady

Rosalynn Carter

said it first:

“There are only four kinds

of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

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Inside Medicine | winter 2016

Rosalynn Carter was perhaps the first public figure to champion the cause of those Americans— now more than 65 million — who care for those who are older, chronically ill or disabled, or live with special needs or mental illness. Long Term Care (LTC) is pervasive in today’s world. More than 50% of all Americans will need long term care in their lifetime. LTC includes a wide range of medical and support services for people with

cognitive disorders, prolonged illness, degenerative conditions, or the result of trauma or accidents. If these numbers make you think that long term care affects older individuals, you are correct. But younger people also need to consider long term care as part of their overall risk-management plans because accidents and illnesses prey on younger people, not just the aging. To better understand, think


} FEATURE

of LTC as not only medical care but also “custodial care.” This can involve providing assistance with activities of daily living such as eating, dressing, bathing, transportation or supervision of someone who is physically or cognitively impaired, or both. Long term care can be provided in many settings including your own home, adult day care programs, assisted living facilities and nursing homes. The need to make plans for Long Term Care coverage is real, and there are many reasons to consider products that offer such coverage. Most importantly among these is to preserve your independence and freedom of choice to stay at home or move to a specified care facility. LTC coverage removes the burden of your care from your family members, it can preserve a spouse’s standard of living, it can preserve and protect assets. Longer life expectancy and rising health care costs are trends that will continue to increase the value of a good LTC plan. And the list goes on.

As Clint Eastwood might say, “Are ya feeling lucky?” We’d rather say, “Isn’t it smart to do a little planning... just in case.” .......................................................................................................

So what’s your plan for living a long life? Into your 80s or 90s? Maybe even longer? Today, long term care is the greatest uninsured risk Americans face. Planning now - while you are younger and still in good health–is a critical step to protecting your financial Independence, your retirement assets and your future choices.

I urge you to call for a no-cost consultation as an

opportunity to learn more about the potential risks, costs, and options available. Anne C. Jewell | 256-533-0001 Some data provided by the American Association for Long Term Care

Inside Medicine | winter 2016

27


He Cares For You

Early one morning, I decided to stop at a store to pick up a few items. While walking in the parking lot, I noticed a little sparrow on the ground attempting to fly but could not. One of its feet was stuck on a piece of sticky candy. After putting my items in the car, I bent over and gently pulled its leg free. In an instant, the sparrow took to flight and disappeared. Many of us will face challenges as we go through life with illnesses such as Cancer, Diabetes, Hypertension etc. Don’t allow fear or doubt to cripple you. Like the sparrow, never give up. Go forward each day on the wings of faith. Jesus has invited you to “cast all of your cares on Him because He cares for you” 1 Peter 5:7. There is nothing too hard for God. The prophet Nahum reminds us that “the Lord is good, a refuge in times of trouble” Na 1:7. Even when we cannot see Gods hand we can trust His heart. –Myrna Brandon


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by Kelly Reese

What drives this community of determined and successful residents begins with the foundation.

The city of Huntsville and its surrounding areas of Madison County have strived in so many ways over the past years, everything from exceptional healthcare and medical research to advanced military technology and defense contractors. This one growing city and surrounding county can make anyone from the North Alabama area proud to call this region their home. However, are you aware of a region just minutes from this popular area, just a short drive westward on Highway 72 and Interstate 565 that is sometimes overshadowed by its big brother to the east? This area is Limestone County. It is full of rich commercial farmland as well as successful livestock and poultry companies. Its abundance of small businesses is an example of family-friendly communities living the American dream. These are not just your stereotypical “mom-n-pop” restaurants or corner stores, yet there will always be a special place in my heart for these warm and friendly atmospheres. These diverse selections include law firms, accounting firms, medical offices, insurance agencies, financial and banking establishments, computer and network companies, and many other professional businesses. These are the specialty and trade skill companies such as manufacturing plants, machine shops, and graphic arts and design companies that make up the landscape of this thriving community. What drives this community of determined and successful residents begins with the foundation. The foundation begins at a very young age. This foundation is our Limestone County School system. LCS produces many of the finest graduates in the state of Alabama. It has top-notch teachers who are dedicated in helping the students of this area reach their upmost potential, either in advanced education for those who are led to pursue careers such as engineering, healthcare, finance, and law, or advanced technical skill areas such as graphic arts, machinists, and master mechanics. Limestone County now leads the state in jobs creation, due in part to the school system’s commitment to workforce development and its partnership with the Limestone County Commission. Much of Limestone County’s education improvement is due to the hard work and leadership of its Superintendent of Education, Dr. Tom Sisk. He has dedicated his life and career to providing the best educational system for his community. Moving to the eastern portion of Limestone County after leaving his native roots of the Mobile area after 17 years with the Baldwin County public school system, Dr. Sisk and his wife, Jennie (who I must add is a former educator herself ), have influenced the residents, students, and business owners of this county in a very positive way. He has brought many innovative ideas with him and continues to build upon the foundation and improve the quality of academics, athletics, and other school organizations in Limestone County. One of his more recent initiatives has allowed us to gain access to a higher level of advisors for our students through the virtual school offered to anyone from anywhere in our State. Yes, this is now possible right here in this community, in Limestone County. Dr. Sisk has already surpassed the expectations of many, and he is setting the educational goals for his community even higher. With an increasing population and economic growth, Dr. Sisk is positioning the Limestone County Schools to not only meet the needs and challenges of the economy, but to drive it even higher and further stimulate its growth.


Smells

So good by Neeta Kohli Dang M.D.

“Jason” suffered from recurrent sinus infections for years. We discussed surgery on a few occasions, and eventually decided to proceed. Surgery confirmed severe disease and the sinuses were carefully and thoroughly cleaned. After months of regular follow-up and more treatment, Jason joyously announced that he had regained his sense of smell. Imagine our delight when he started bringing in absolutely delicious homemade cakes to the office. Their quality would have put a seasoned baker to shame. As well, his family was thrilled to have Dad in the kitchen again making delicious food with wonderful aromas. Alas, what about our low calorie and cholesterol diet? FAT CHANCE – cakes like these don’t walk into your office every day. Jason and I have since become good friends and I wish him continued good health and success. SINUS disease is rampant in the United States affecting millions of children and adults. It is estimated that approximately 150 per 100,000 people in the general population are affected by chronic sinusitis. The incidence appears to be increasing every year with the disease becoming more common in patients with AIDS, common variable immune deficiency, diabetes, polyps, and severe allergies. There are about 20 million physician visits in the United States each year for chronic sinus issues. We usually have eight fully developed sinuses with bilateral frontal, sphenoid, maxillary, and ethmoid cavities. Acute symptoms may include dull mid-facial pain, frontal headaches, thick discolored postnasal drainage, nasal congestion, sore throat, poor sense of smell, bad breath, dental pain, and fatigue. A variety of organisms can be responsible for sinus disease. These may include viral, bacterial (Staphylococcus aureus, Hemophilus Influenza, Moraxella catarrhalis, Strep pneumoniae, Pseudomonas aeruginosa, anaerobic bacteria), and fungi (Aspergillus, Alter32

Inside Medicine | winter 2016


naria). Initial treatment includes appropriate antibiotics, steroids, cortisone nasal sprays, decongestants, and saline nasal rinses. However, in patients with recurrent sinusitis an underlying etiology needs to be determined. This may include environmental allergies, structural changes (as evident on CAT scan), polyps, immunodeficiency, ciliary dysfunction, bony spurs, and chronic mold exposure. CAT scan of the sinuses is considered the gold standard to evaluate individual sinus cavities in more detail and assess ostiomeatal units as well as transitional spaces. Further options include surgical intervention with endoscopic sinus surgery. No longer do we use external excisions or extensive nasal packing. There is no facial bruising or swelling, and patients can often return to work within a few days. Balloon sinuplasty is a new technique that is becoming increasingly popular and very helpful in selected individuals. This procedure can also be performed in our office utilizing state-of-the-art equipment including a stereotactic computerized navigational CAT scan that allows access to diseased and obstructed sinuses in a safe and effective manner. Balloon sinuplasty is especially helpful in older patients who may prefer to undergo the procedure under local anesthesia rather than receiving general anesthesia at the hospital. Untreated chronic sinusitis can sometimes lead to serious complications with extension of

disease into the orbit and intracranial cavity. Fortunately, these cases are very rare. Patients with asthma often note significant reduction in the severity of their disease when chronic sinusitis is appropriately treated. We strive to provide compassion along with exemplary medical and surgical care. Should you or your family wish further evaluation, please feel free to contact our office so that we may recommend a tailored plan of management to suit your ear, nose, and throat concerns. ................................................................ Neeta Kohli Dang M.D. F.R.C.S (C) Huntsville Ear, Nose, and Throat Physicians, P.C. www.huntsvilleearnosethroat.com 256-882-0165 285 Chateau Drive, Huntsville, 35801 ..............................................................

Sinus disease is rampant in the United States affecting millions of children and adults. It is estimated that approximately 150 per 100,000 people in the general population are affected by chronic sinusitis.

Dr. Neeta Kohli-Dang is a board-certified otolaryngologist and a Fellow of the Royal College of Physicians

and Surgeons. She has been practicing in Huntsville for about 20 years with regional and international patients. She was selected to participate in a national multi-centric study involving chronic sinusitis and balloon sinuplasty with subsequent publication regarding its efficacy.

Inside Medicine | winter 2016

33


} HEALTHCARE NEWS

by BY CHASE PATTISON Chief Commercial Officer at ENTRADA

Over 50% of physicians now report

having at least one symptom of burnout.

A study of almost 8,000 surgeons found that

major medical errors correlated strongly to a

surgeon’s degree of burnout.On patient outcomes,

physician burnout is associated with lower patient satisfaction and longer post-discharge recovery time. In other words, burnout can make clinicians less effective.

The Advisory Board. “Physician burnout is becoming an epidemic. How do we stop it?” April 21st, 2016

Increasing federal regulatory and compliance burdens, alongside the requirements to adopt and “meaningfully use” cumbersome EHR technology, is killing productivity and making physicians rethink their career choices. In fact, 55% of surveyed physicians would not recommend medicine as a career to their children or their friends . Many doctors are choosing to retire earlier, and those who don’t have already (or plan to) reduce access to their services by reducing the number of patients they see. All of the unintended consequences of further detaching physicians from patient care is not yet known, but thought leaders from across the industry are starting to focus on how to reducing the new challenge in healthcare - physician burnout. Here are five tips to avoid physician burnout in your practice:

1. Reduce clicks and screen time. It’s easier said than done, but obsession over reducing the clicking, scrolling, and typing in an EHR can make a major difference to a physician’s work satisfaction. In fact, engaging with the EHR, particularly EHR documentation, is routinely cited as the number one driver of physician satisfaction. Automated templates, delegating EHR responsibilities, and dictation and speech-to-text solutions are just a few tools you can use to reduce the time physicians must spend staring at the computer screen. 2. Put the lives of patients in the center of your workflow. For every hour physicians spend face-to-face with patients, they spend two more hours at the end of every day documenting what they discussed into the electronic health record. Make sure that crucial time physicians get to spend with patients is maximized. Providing small details about the patient prior to the visit - such as a patient photo, clinical data, and notes from a prior encounter - can enable physicians to spend more quality time with their patients.

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Inside Medicine | winter 2016


Caregivers, get your groove back. 3. Design your patient notes with what matters first. The massive amounts of data now being captured in the EHR has created a new phenomena of “Note Bloat,” where quality narrative about the patient is buried in page after page of indecipherable data points, an overwhelming task for physicians to even understand the true patient story. By redesigning your document templates with a cover page with the most important information (e.g. HPI, Physical Exam, Assessment, and Plan) makes a better looking document that can actually be read and understood. 4. The rest of us are mobile, and physicians should be too. The mobile revolution has transformed every major industry in the US, accept for healthcare. Physicians are almost always required to be at their desk in their office to complete any necessary EHR tasks. Investing in a handful of mobile solutions can vastly improve productivity as physicians can now find new times to be productive. Imagine being able to respond securely to your nurse while you are at lunch with your spouse or being able to finish up some documentation work on the commute home. 5. Communicate with your physicians, and make sure they are heard! Nothing irks a physician more than feeling like their opinions aren’t being heard and valued. Many clinics don’t have the necessary feedback loops and communication channels to gather physician input, leading to many doctors believing they are “on their own” to fight the uphill battle of practicing medicine in the new era of EHRs, Meaningful Use, ICD-10, MACRA/MIPS, and so on. Make sure your practice has recurring meetings with not only administration and physician leadership, but also with employees throughout the practice.

Regain time to focus on what matters most with speech-driven clinical documentation. Learn more at www.entradahealth.com

Inside Medicine | winter 2016

35


} SURGICAL TECHNOLOGY

New Intraocular Lens enhances options for cataract patients Enjoyable splendor of the holidays fills the city of Huntsville as

we bring in the New Year. Our community is lit with elaborate décor and elegant sounds of cheer; both which are captivating

to the audience. But to those millions of Americans suffering

from cataracts, enjoying the beauty of our finest celebrations is nearly impossible.

Cataracts are a very common condition. By age 80, more

than half of all Americans are affected by the problem. Individuals under the age of 65 help account for the nearly 4 million cataract surgeries that are performed yearly.

Dr. Mitchell is known for always staying on the cutting edge of technology in the area of cataract surgery, using the most modern techniques available today. He was the first physician in Alabama to offer the Tecnis Symfony Intraocular Lens.

New on the market this year is the TECNIS® Symfony

lens made by Abbott Medical Optics. After Abbott won

FDA approval in July of 2016, Dr. William Mitchell with Maynor & Mitchell Eye Center became the first Surgeon

in Alabama to perform this state of the art procedure. Dr. Mitchell expresses, “The Symfony lens is an entirely new de-

sign, a revolution to our generation of intraocular lenses. A lens providing seamless, day-to-night vision, high-quality

vision, extended depths of focus and demonstrates a low incidence of halo and glare compared to other corrective surgeries for cataracts. The Symfony is our market’s first lens

offering the patient to see both distance and up close. My patients with active lifestyles can enjoy their vision without the hassle of corrective lenses.”

The Symfony lens also enhances colors and is available

to a wider range of patients than other multifocal lenses. Dr. Mitchell has experienced the patient benefits of utilizing this new technology.

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Inside Medicine | winter 2016


ROUTINE EYE CARE • RARE EYE CONDITIONS • COSMETIC PROCEDURES • GLAUCOMA TREATMENT • CORNEAL REFRACTIVE THERAPY

Robert Maynor, M.D.

Michael Salter, M.D.

Jennifer Martin, O.D.

William Mitchell, M.D.

Brian Baxter, O.D.

We are proud to welcome Dr. Michael Salter to our exceptional team of doctors!

Call us today to SEE what you’ve been missing HUNTSVILLE: GUNTERSVILLE: 256.533.0315 256.582.1211 www.maynorandmitchell.com

Dr. Mitchell and his staff are dedicated to the families in our community. Don’t let blurriness, glares, or difficulty of seeing

bright lights hinder the enjoyment of your holiday season. Bring in the New Year with a new lens that will allow you

to appreciate the lit streets and homes in our community. A “symphony” to consider.

To find out if you’re a candidate for this newest available

cataract surgery, contact the office of Maynor & Mitchell Eye Center.

Maynor & Mitchell Eye Center www.maynorandmitchell.com 256.533.0315

Locally owned, we proudly serve our community with fast, friendly, professional service and the highest quality medicines and health products.

Visit us today!

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Medication reviews Diabetes products & services Email & text refill reminders

200 W. Market St | Athens, AL 35612 | 256.232.3811 M-F: 7:30 AM - 7 PM | SAT: 7:30 AM - 5 PM | SUN: 9 AM - 5PM Inside Medicine | winter 2016

37


Alzheimer disease Q&A with Nick Cochran, PhD

A

ll neurological diseases are interconnected. At HudsonAlpha Institute for Biotechnology, scientists are using cutting-edge technology to better understand neurological diseases, such as Alzheimer disease and frontotemporal dementia. While some advances have been made in treating the symptoms of these conditions, it is critical that we learn more about the genetic factors involved in these devastating and debilitating diseases. Above: Live cells from human skin cells that have been grown in the lab as neurons. Watching the cells while they are alive provides valuable insight, such as reaction to treatment.

Photo credit: Nick Cochran, PhD Above right: Nicholas Cochran, PhD, is a postdoctoral fellow in the Myers lab at HudsonAlpha where he investigates the genetic risk factors or causes of neurological diseases.

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Inside Medicine | winter 2016

Finding answers about one neurological disease may lead to answers about many of them. To help speed discovery, HudsonAlpha has established the Memory and Mobility Fund (M&M Fund) to support new projects and continue existing work in a variety of neurological diseases. One project in particular aims to sequence the genomes of more than 1,500 patients with Alzheimer disease and frontotemporal dementia.

How common is Alzheimer disease in the U.S.? More than five million Americans have Alzheimer disease. Every 66 seconds, someone new is diagnosed with the disease. If a family member has Alzheimer disease, what is the likelihood that I will also receive diagnosis? Estimates for this vary widely, and it is likely because the answer depends largely on the age of onset for the family member. For example, if your sibling or parent had Alzheimer disease and was diagnosed between ages 65 and 85, risk of a diagnosis with earlier onset Alzheimer disease is lower for you. However, if family members happen to have onset before age 65 in multiple generations, it’s a good idea to contact a neurologist and/or geneticist, because this is rare and could have a very strong genetic component.


} FEATURE

What types of treatment options are available? There are currently two treatments for Alzheimer disease. Neither addresses the underlying cause of the disease. Both can “plateau” progression for about 6 months. Together, they can delay nursing home placement by about two years, so they do have a measureable benefit, but there is a lot of room for improvement.

What advancements have been made so far in Alzheimer disease at HudsonAlpha? At HudsonAlpha, we have been positioning ourselves to analyze whole genomes for Alzheimer disease and other types of dementia. The word “analyze” is important here because there are a few other places that have been sequencing whole genomes for Alzheimer disease and other types of dementia, but the expertise at HudsonAlpha is really top-notch for analyzing the whole genome, and not just the part coding for proteins. The other thing we’ve gotten off the ground recently is cultures of human brain cells – neurons, as well as supporting cells. We’re not doing anything scary to get the human brain cells – we are simply using cells that were re-programmed from an adult’s skin cells. Having this type of culture available allows us to mimic the types of genomic changes we find in patients, which can help provide evidence for or against a given genomic change being associated with disease.

How is studying the genomes of Alzheimer patients going to advance our knowledge of the disease? With science we can never guarantee anything going in, but what we can do is position ourselves for success as well as possible given what’s worked well in the past. So, we’ve done that with Alzheimer disease and related dementias by selecting a group of samples from patients that are highly likely to have one underlying cause of their disease. Specifically, these are earlier onset and/or atypical cases of Alzheimer disease and frontotemporal dementia. Earlier onset cases are more likely to be strongly genetic. We could learn a few different things from these data. One critical thing is that we could find new genes that have variants that cause disease. This is critical because it’s only by knowing what genes have variants that cause disease that we can take any kind of rational approach for therapeutic development. Another key set of observations we could gain from these are identifying biomarkers of disease. We will be making measurements of immune response, which has come into the limelight in the research field recently as being very important.

How far away are we from a cure? Often what people really want to know is how close we are to effective therapies, which can be almost as good as a cure. The first key idea is that prevention is going to be the name of the game. There has been a lot of work lately showing that the most effective therapies in development are performing the best in people who have very mild symptoms. This is probably due to the fact that based on work done recently, we now know that the underlying disease process starts decades before symptoms. So, if we can target that process before symptoms, that would be even better and screening tools are in active development (and some are already approved) with the hope of doing just that. For Alzheimer disease, I would speculate if we could get to two or three effective therapies, targeting underlying disease process, we could make an impact on prevention that is very tangible. Some of these are close to completion, and more and more will read out over the next 5 to 10 years.

What other neurological disease research is happening at HudsonAlpha? We are doing and have done quite a lot of work in different neurologic diseases, from childhood intellectual disability and developmental delay, to major depression and schizophrenia, to other adult-onset neurologic diseases like Huntington disease, Parkinson disease and ALS. I think we gain a lot of synergy by doing this, because while these are distinct diseases, we can often learn things about one disease from another, both from commonalities and differences between them. Inside Medicine | winter 2016

39


A Family

by Kim Aaron

in God’s will

Ryan and I have been married for almost 14 years. Within those 14 years, we have learned a lot and grown a lot… We were married Ryan’s first year of medical school. I remember a conversation we had before we walked down the aisle in which we acknowledged the fact that half of all marriages end in divorce. We realized that his school and training were going to be a difficult road to travel for us both. We made a decision that we would always strive to keep God at the center of our marriage and the center of our lives. Abundant life is in Him, and if left to our own efforts we would likely not make it. With that said, we have not always succeed in this because we are only human. We have made our share of mistakes. But, the Lord has been faithful to gently pursue us back to His will during those seasons. 40

Inside Medicine | winter 2016


} FEATURE

We also discussed early on that as a physician we would be blessed with much. We know that all good things come from Him and that we are “blessed to be a blessing”. We decided in those early years that it would be our prayer that the Lord would lead us to use those blessings for His glory and for His purpose. We did not know then, it would be through adoption that we could serve out this plan.

Adoption is not a fairy

10 years ago, when I was pregnant with our first child, we heard a

tale. It is full of loss,

sermon on James 1:24. It was that day we first heard His call to adopt a child.

pain, and grief. But,

For a long time we tried to talk ourselves out of adoption with thoughts like “maybe God really didn’t call us to do this”….”We can fulfill the call to care for the orphan in other ways”….”this is too hard, maybe we are not supposed to do this”. These were all lies to keep us from doing the Lord’s will. After a season of running, The Lord brought us both to the same conclusion at the same time that adoption was His will for us. We pursued our options, and over the years everything fell into place. Adoption is not a fairy tale. It is full of loss, pain, and grief. But, our God is greater than all of these and He is a redeemer. Our baby girl’s story is heartbreaking from the beginning. She is definitely our miracle. She was born weighing 2.2 lbs and fought for her life for several months. By His amazing grace, he brought us together and completed our family. On December 14, 2015 we met our beautiful daughter and we arrived home with her on American soil on Christmas Eve of last year.

We are now working at being a family. A family in God’s will. We have

three beautiful children, Sydney Ann is now nine, William Michael is seven, and Gabriella Rose is our two year old miracle from China. We realize they are each a gift from the Lord. Adoption is now a big part of our “story”. The main lesson I have learned in our journey is that I can fully trust God and His plan for my life. You can trust God and His plan for your life! He is our creator and our Redeemer and He gave His only Son that we might live! Believe me when I say that a God like that can be trusted. So when He leads you to do something, do it and fear not for He is with you! Another lesson that I have learned is that God’s ultimate goal for the Christian is to make us holy, not happy. Please do not misunderstand me when I tell you this, I do believe that He wants us to be happy, but this is not His ultimate goal. His ultimate goal is to transform us into His likeness. As I look back, I can be thankful for the tremendously joyful times and the painful ones, for He is still working on us to make us more like Him.

our God is greater than all of these and He is a redeemer.


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


} FEATURE

If you have had chicken pox, the Shingles virus – a painful blistering rash–is already inside you. With one in three people expected to develop Shingles in their lifetime, the healthcare community is focused on treatment and prevention. After chicken pox resolves, the virus known as varicellazoster remains in the body lying dormant inside nerve cells near the spine. The virus is suppressed by the immune system, but life factors such as stress, illness and aging increase the risk of the virus remerging as Shingles. Shingles is a blistering rash accompanied by severe burning, shooting pain which can last up to 30 days. For one in four patients like Sue Potee, the pain will persist even longer.

by Jackie Makowski

“One quarter of Shingles patients will develop postherpetic neuralgia and suffer with long-term nerve pain,” said Dr. Roddie Gantt, anesthesiology and pain management physician with Tennessee Valley Pain Consultants. “The earlier postherpetic neuralgia is treated the better the outcomes will be for resolving nerve pain.” Sue and her husband were traveling out of the country this spring when she developed a painful burning rash. While she received the Shingles vaccine, Sue knew her nerve pain was consistent with Shingles. “I had the Shingles vaccine and thought it couldn’t happen to me,” Sue Potee of Meridianville said. “The pain was so unbearable that I went to an emergency room overseas. I was prescribed medication to help with breakthrough discomfort but it never relieved the constant shooting pain.” Unfortunately for Sue, the pain persisted upon her return to the United States and while the rash had mostly resolved she was still suffering with severe penetrating pain. “A friend recommended Tennessee Valley Pain Consultants for a nerve block,” Sue said. “Dr. Gantt performed the procedure and I felt immediate relief.” Sue received a therapeutic nerve block performed to alleviate acute

Shingles pain and postherpetic neuralgia. Pain management specialists inject a corticosteroid through an epidural injection precisely targeting nerve pain. The Shingles rash typically stretches from the back around to the front of the body on one side. However, it can also occur on one side of the face, neck, chest, hands and leg. Epidural steroid injections can be performed in the cervical, thoracic and lumbar spine depending on the presentation of the rash. Therapeutic injections for Shingles pain are done in an outpatient setting with little to no downtime. “The best defense for shingles is the Zostser vaccine which is recommended for people 60 years and older,” said Dr. Thomas Kraus anesthesiology and pain management physician with Tennessee Valley Pain Consultants. “While it doesn’t prevent shingles it can reduce a patient’s risk by 50 percent as well as the severity and risk of complications if the virus does occur.” Tennessee Valley Pain Consultants offer appointments for patients with Shingles pain, both acute and long-term, within as little as two business days. “Nerve pain associated with Shingles can be very debilitating,” Dr. Kraus said. “The nerve blocks offer immediate relief bathing the nerve with medication helping patients like Sue.” Inside Medicine | winter 2016

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Infant loss is such a sad topic. It is hard to find the goodness when you hear these words. But, praise the LORD, there can be goodness within the sadness. I have much gratitude to God for allowing good and bad things to happen within the last few years. My story is like many others. I am finding strength in my pain, living my life through my sadness, and making the unbearable become bearable. The only way I can do this is with my relationship with God. I was almost 18 weeks pregnant with my second child, a baby boy, when I was told at a routine obstetrician checkup that my baby’s heart had stopped. With a broken spirit, I was sent home to wait until my scheduled induction. That was the longest, worst three days ever. The day of the induction is such a blur. The doctors started my labor early in the day and I finally delivered the baby early that evening. A fifteen hour labor led me to see him, to feel him. He was perfect. He had ten fingers, ten toes. He was supposed to be healthy, but he wasn’t. We had an autopsy that concluded nothing was wrong. Heartbroken doesn’t even begin to explain how I felt. My family gave him a funeral, and then we tried to get on with our lives. The pain in this actually gave me strength to go on. I believe I am blessed to have seen him, to feel the pain in delivering him and then to tell him goodbye. These emotions were and are so real, as was Dalton. Fast forward through rounds of tests and even a exploratory surgery to make certain I didn’t have a medical condition. Again, everything came back normal and I was told I had a healthy body. For two years, I struggled with so many emotions. I held tight to my “heart healing” daughter but longed for the brother we lost. Along the way, my only hope was found in my Savior. The most important thing I did was make sure my relationship with Him was strong. A little over two years from the date I lost my baby, I delivered a healthy “rainbow baby”. He has helped heal my heart more than I can describe. I realize, through this journey, everything is a blessing in disguise. God doesn’t allow things to happen to us but for us. The pain I endured with my loss is definitely hard to handle. But, GOD is there!! He is here!! The closer I am to Him, the easier life is to face every day. I can actually talk, love, trust, and obey the One and Only that holds my sweet baby. I encourage any woman feeling the sadness of infant or child loss to think this way. The closer you are to God and the better the relationship you have with Him, the closer you are to your lost loved one. God is the One who is walking with you through your circumstance, and He is also the One holding your baby for you until He is ready to call you home. I encourage you to find the hidden blessings, find the closeness to God that seems unreal, and look at the loss as an honor. My heart goes out to anyone going through such pain. I love you and I’m truly praying for you all!!

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} HEALTHY LIVING

A SELF AFFIRMING JOURNEY

A weight loss approach grounded in simplicity

.............................................. We understand the frustrations of being overweight and feeling that it’s a losing battle. At Arize Clinic many of our clients tell us that we are their last hope. They

BODY LEVERAGE

Let your body’s metabolism do the hard work by releasing fat and using that fat for your daily calorie needs. Then use your experience with us to manage your weight and health going forward.

EXPERT NUTRITIONAL SUPPORT

Benefit from weekly follow up sessions with our nutritional consultants, to provide you with support, nutritional guidance and tailoring the program based on what works for you.

JOURNEY SUPPORT

Once you achieve your weight goals you aren’t alone. While you will use your experience with us to manage your weight and health going forward, you can schedule weekly bi-weekly or monthly follow up to keep you on track.

have tried every diet imaginable and everything has

Our Food Supply

failed them. It’s understandable because the success

Our busy lives have us eating man-made “non-foods” that are processed, chemical filled, calorically dense and nutritional deficient. The foods we eat today have been purposefully engineered to taste good and get quickly converted into body fat so we eat more. We know our car would run poorly with the wrong type of gasoline or something other than gasoline. The same is true of our bodies. When we put the wrong type of food or nonfoods into our bodies, our weight and health suffers. Real food looks the same as when it came out of the ground, walked the earth or swam in the ocean. Fact: 120 years ago the average American consumed 1012lbs. of sugar per year. Today Americans consume more than 165lbs. of sugar per person each year.

rate with traditional diets, where you are eating less than what your body needs, is less than 5%! Traditional weight loss is a slow, painful and repetitive event.

The Arize Clinic Weight Loss program is NOT traditional! The Arize Clinic Program is a revolutionary way to lose weight quickly, safely and naturally. We do it through metabolism-boosting natural supplements, a nutritionally dense meal plan of whole foods and finally expert nutritional support and guidance. The Arize Clinic Program is not just about losing weight. It’s about maximizing weight loss, regaining your health and gaining the knowledge to keep it off. What starts as an event becomes an amazing, self-affirming journey! The Arize Clinic approach to health is grounded in simplicity: a solid nutritional based of whole foods, a balance of positive mental and physical activities and awareness and gratitude for your life journey. The Arize core program has four elements for rapid, healthy weight loss and on-going weight health management.

WHOLE AND NATURAL

Use our all natural FDA registered metabolism-boosting supplements and follow our scientifically designed whole foods meal plan, made up of nutrient dense fruits, vegetables and lean meats. 46

Inside Medicine | winter 2016

Traditional Diets Traditional diets are defined as any diet that has you eating fewer calories than what your body needs. When you go on one of these diets your body’s survival design will respond by slowing your metabolism so it can function on fewer calories and eventually the amount of calories you are eating. This makes you feel like you have no energy and slows your weight loss. As your body does not want to release fat, it will begin converting (eating) your lean tissue (muscle) into calories to provide additional calories. A traditional diet will always keep you hungry, because you aren’t getting enough calories, you will have no energy, and your metabolism and muscle mass will be reduced! With a decreased metabolism and less muscle mass you will gain weight easier after traditional diets and it will be harder to lose weight in the future. Fact: Sugar, Fat and Salt all trigger low grade addictions and chemical responses in the brain that make us eat more.


Lose up to 1 lb. per day naturally– eating real food, no diet pills, no exercise required.

I love this program.The first week was a little tough, but once I got used to it, it wasnt bad at all. I lost 9 pounds in the first ten days! – Tammy

I was so tired of dieting, being hungry and exhausted. Something had to change! I decided to try Arize because I knew someone who did the plan, lost 35 pounds and has kept it off for 3 years. I feel so much better! – Sandy

The Arize Clinic program is designed to be a journey because it works for you and not a diet event because it doesn’t. At our clinic, all-natural is more than a term — it is a commitment to excellence. We take great pride in providing the highest quality, all natural, FDA registered supplements that make sense for your weight-loss, health maintenance needs and goals.

Call or Click Today to get started! 256.533.4700 | www.arizeclinic.com


} HEALTHY LIVING

Seriously, why does the most important practice we know to be true have to be so difficult? Why does it take so much time and why aren’t there more private options?

home sweat home

In-home fitness training and private yoga instruction are in fact an option in Alabama!

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We all know it. Physical activity is considered to be among the strongest tools to decrease the risk of death from heart disease, stroke, colon cancer, and diabetes. Sadly, approximately 45% of adults fail to exercise sufficiently enough to achieve health benefits, with 80% not even meeting the government’s national physical activity recommendations for aerobic and muscle strengthening. If you’re reading this then you’re clearly someone who stays abreast of the latest health news and works diligently to live a healthy lifestyle. Therefore you know for a fact that fitness and proper nutrition are among the most important items to maintain in your daily walk. But why don’t we do it? The CDC states that, “300,000 deaths each year in the U.S. likely are the results of physical inactivity and poor eating habits.” What really gets in our way of daily exercise? For professionals, it’s most commonly the lack of time. Do you really have 2.5 hours to lose by driving to the gym, completing a rushed workout, showering, and then getting back across town to your next appointment only to discover that your core temperature is still up and you are perspiring in front of your colleagues or patients? Maybe it’s the aggravation of having to exercise in public. The last thing you need during your day is to feel judged by the individuals that seem to live at the gym, or having to wipe off the residual sweat left behind by your treadmill predecessor. Seriously, why does the most important practice we know to be true have to be so difficult? Why does it take so much time and why aren’t there more private options? Plus, there is the constant battle of motivation to elevate your heart rate after a difficult and stressful day at work. You’re exhausted! Will working out not just make you more tired?


Save Time. Thankfully, there is an alternative. In a world of saturated YouTube workout videos and diet plans, there remains a personalized touch that is tailored precisely to your goals and your body’s needs! A friendly face to knock on the door with equipment in-hand to guide and motivate you through your next workout. In-home fitness training and private yoga instruction are in fact an option in Alabama! Yes, you can roll out of bed, turn on the news, and sip through your first cup of coffee in time to hear the doorbell, “That must be my trainer.” You answer the door to your accountability partner, “Good morning!” and walk over to lace up your shoes while your personal trainer sets up the equipment for the session. A little banter about weekly news and upcoming family events while going through the warm-up and stretch routine. Now it’s time to focus. The trainer leads you through a 30-45 minute workout, inching you closer to your fitness goal. You notice your strength is much better, flexibility has improved, and getting up and down on the floor is a piece of cake. Before you know it several sets have already been knocked out and your “To Do List” for the day comes to mind as you go through the cool down portion of the workout. A handshake followed by a thank you and the trainer concludes with, “Great job! Have a wonderful day and I’ll see you on Thursday!” A quick glance at the clock on the way to the bedroom and you realize it’s just now 6:30am with plenty of time to get ready for work. That’s truly what many in-home training sessions look like. You have saved time, maintained privacy, and were held accountable to work hard toward your health and fitness goals. How great was it that you did not have to drive to the gym, especially now that winter is here. That is definitely concierge service at its finest. If this sounds like a great option for you, search for your local team of in-home personal trainers or yoga instructors and schedule a free workout to see if this is a perfect fit for you!

Train at Home.

We specialize in training those who are chronically busy with no time to make it to the gym. HomeFit provides you with the personal attention of a professional fitness trainer or yoga instructor in the comfort of your own home or office. Personal Training Private Yoga | Nutrition Group Exercise | Corporate Options

Ready to get started? Schedule a FREE personal training session to give us a try!

855.934.3834 email: info@homefitconsulting.com

www.homefitconsulting.com Inside Medicine | winter all 2016

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Christmas Reflections taken from the WORD “STABLE” …What a COMFORT! As I woke up from the fog of surgery, I heard snippets of my surgeon’s voice telling my husband how things went. He said one word that triumphed all other words,” STABLE”. “She was ‘stable’ through the whole process.” Fears vanished into air, and I knew that I could go on into my medicated state at rest with the world. Chuck told me he was able to get updates through the surgery by phone from the nurse, Lauren. She told him 3 hours into the process that everything was stable. So, ‘stable’ was not new news to him. He knew how things were all along until he hit about 3:30 and there was not any more news until late that evening. That must have been hard! I am happy to be on the other side of surgery and now with Christmas just behind us too, I can sit and contemplate a few things… with the computer on my lap, fire in the fire-place and my favorite blanket on my lap (Thanks, Kim! And of course my Dad for the coffee!). So, back to the word ‘stable.’ Being a teacher, I love words, and I love the use of words. I even love puns on words; I just can’t help it. The word ‘stable’ hit me… ‘Stable’ can be 3 parts of speech; a noun, a verb, and an adjective.

‘Sta-ble.’ 1. Noun: a building by which domestic animals are sheltered and fed. 2. verb: to put or keep in a stable, to dwell in (… hmmm, let’s keep this in mind) 3. adjective: firmly established, not changing or fluctuating, steady in purpose, firm resolution not subject to insecurity or emotional illness

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by Wanda Mullins

I remember all of the stories and “possibilities” that swamped my thoughts the months before surgery. I was reminded of them again the hour before they began to cut me open as the parades of professionals came to speak to Chuck and me. It was really un-nerving. But, they have to give the info. They were so professional and so great! I had a couple of options: I could panic and run, or I could trust the physicians that are knowledgeable in their field and rest, knowing that they know what they are doing. I chose the latter. In fact, I hardly got out the door on the way to surgery, and I was out like a light. Now, being on the other side of surgery and on the other side of the calm, beautiful day of Christmas, I still have “stable” on my brain. Every time I get up, I have that word wobbling around somewhere... “alright now…Stable...Stable…you can do this…stable...one foot in front of the other...” When they removed the tumor, they also took the balance mechanism in the right side of the brain, so I have to be able to compensate as time goes by. I will never forget the first time I went to get up. It was a grand trip to the bathroom. Yes, a major success! Everything seemed unsteady, insecure and fearful. Every time I got a “new” nurse, I had to explain to her that it was okay for her to stay in the bathroom with me. Just the comfort of her voice, her touch and her presence really helped! It moved me along, for a lack of better words, ha-ha! I couldn’t resist! Now, I could have been very prideful and pushed her out, but the comfort of knowing she was there was priceless.


That’s it! That is like the ‘stable.’ My nurse, physically with me. Our God, physically with me and us! His voice… “Do not be afraid…I am here…I love you…You are going to be alright!” He is God, Emmanuel… God WITH US! I want so much for God to stay IN my world WITH me. Don’t you? The ‘stable’ of life can be a very prideful place. We want to do it all on our own. We want to think that we do not need anyone or anything. As I reflect, I can just sit back and close my eyes in beauty, because I did not resist her help or her loving care. She did not force me to receive her help. It just beautifully came, and I received. I know I could turn on the TV at any moment and get back to the chaos of the world. It will not stop. Satan knows he is on a timeline, and he knows it is getting shorter. He wants to steal your STABLE. He wants to put you in a place of PRIDE, so you are so unable to receive what is offered in the STABLE. I can’t think of a better way for a true King to come into the world than through a low, humble STABLE. He is HIGH and LIFTED UP! He has come to breathe the beauty of life into the stench of DEATH, conquering it FOREVER! Thanks for letting me contemplate my new word. How I loved hearing the word ‘stable’ just coming out of surgery from the lips of my surgeon! How I love peering into the ‘stable’, living in a world that is nothing but…and finding my God right here with me, through the power of the resurrection and the Holy Spirit. “Take Heart…for I Have overcome the WORLD! ~John 16:33. That is straight from the Healer’s lips, the Greatest Physician of all. Now, that is STABLE!

Wanda Mullins was diagnosed in 2013 with Acoustic Neuromas, which are benign slow-growing tumors in the brain. She has had a long but blessed journey through the diagnosis, surgery, and continued recovery of her condition. More information regarding her testimony and journey can be found at www.underthebrainbow.com

Inside Medicine | winter 2016

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Are We Flicking Lit Matches Into Hayfields? by Jarrod Roussel, PA-C

Recently, I went to a continuing medical education conference where several speakers spoke about treatment updates in internal medicine. One speaker that specifically caught my attention discussed risk classification in cardiac disease. He talked at length about what constituted the different classes and about which medications and treatments were best for each. It was clear that he was intelligent and that he knew his subject very well. As I listened, it occurred to me that the academic side of medicine has become extremely adept at acquiring and analyzing data. We can perform studies with thousands of participants and account for multiple variables so that we can be absolutely certain that the outcome is reliable. But can we truly be certain? While the lecturer spoke, I began to wonder if we have a blind spot, at least in part, within this behemoth* we call “modern medicine”. During my medical training, we received very little instruction on nutrition and how it relates to nourishing and sustaining the body. I have learned more about the healing properties of food throughout the years since my graduation. I started thinking that our lack of understanding of nutrition and our poor “food” choices contributes, sometimes heavily, to the pathology causing cardiovascular disease. The very disease this doctor was trying to control with medications. I say control, because nothing he mentioned would actually reverse the disease process; it is only modern medicine’s attempt to “contain the flames” so to speak. I had this mental imagery come to mind while I listened to the lecturer that gives an analogy for what I feel we are doing, at least as it relates to this lecturer’s topic: A person is standing on the edge of a dry hayfield lighting matches and flicking them into the dry straw lying on the ground. As small fires begin to develop, there is another person, a fireman, a few feet away analyzing these fires. The fireman is measuring the height of the flames, the diameter of the area on fire, the number of flames burning at any one time, etc. He then creates a protocol to adequately extinguish the fires to

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prevent the entire field from being ruined to nothing but ash. If there is one fire less than 3 inches in diameter, he will simply stamp it out by foot. If the fire is greater than 3 inches and less than two feet in diameter and there is only one area on fire, he will use a thick wool blanket to smother it; if there is more than one area on fire, he will use a carbon dioxide fire extinguisher. We want to avoid using water because that could ruin the hay or interfere with harvesting it. If the diameter is greater than 2 feet and there are multiple fires, use a fire hose. If the whole field is ablaze, pray for rain! As a healthcare provider, I feel like we are doing this very thing with our patients. One might suggest this is our purpose. Managing the risks is what we are supposed to do. While this is true, wouldn’t it be easier to simply tell our fire starter to stop flicking lit matches onto a dry hayfield? I understand that this analogy is an oversimplification. People are far more complex than this, but I think the lesson still stands. Most will acknowledge that they don’t do the basic things they need to keep themselves healthy: exercise, proper nutrition, sufficient sleep, etc. By integrating these technically simple strategies into our daily routine, I believe that we could eliminate many of the health woes that plague people as a whole. Healthcare resources would be conserved by reducing the amount of medications required, of surgeries needed, etc. Our workforce would serve with greater vitality. People would experience greater satisfaction and add years to their lives. Medicine has inarguably made many great strides to serve the well-being of humanity, and we need to continue that momentum. However, we should never forget the basics either. We all need to educate ourselves on specific health benefits of nutrition, and then implement them. Simple choices made today will have lasting benefits for a lifetime. * something enormous, especially a big and powerful organization.


Inside Medicine Winter 2016  
Inside Medicine Winter 2016