Smart Living featuring Anthony Lanier II

Fall 2018 $3.00 Value

Savannah’s Anthony Lanier II powers through obstacles as an NFL pro

Numbers in the Teens Healthy choices are more crucial for a young person’s health than their body fat measurements

L i v e smar t .

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Inside Cover

A Word from the President & CEO Paul P. Hinchey

There’s a bit of folk wisdom,

generally attributed to Mark Twain, that says “it’s not the size of the dog in the fight, it’s the size of the fight in the dog.” Anthony Lanier II has not only carried this wisdom with him throughout his life, he’s applied it. Since high school, he’s overcome mental and physical tests to become an NFL pro. Now he’s ready to take on a new challenge as he heals from an injury this season. Throughout it all, Lanier II has maintained great focus on his health. Learn more about this young man’s journey from Jenkins High to the pros in this issue.

Working hard, raising a family, being a good citizen—these aren’t the things that make headlines, go viral on YouTube or trend on Twitter. But they are what make our rural communities the life blood of this country. Our rural neighbors deserve the same high-quality care as everyone else.

In this issue, discover that when physicians provide that care to rural communities, it is rewarding for everyone.

Please enjoy this edition of Smart Living, and also feel free to share any comments you have with us on our Facebook page at facebook.com/StJosephsCandler.

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Ask A Magnet Nurse

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Live Life Smart Home Community

Access to high quality care is improving for patients in small towns and rural areas

Numbers in the Teens Healthy choices are more crucial for a young person’s health than their body fat measurements

That’s Your Cue

Infants can give non-verbal signs of hunger, even before they cry

Features

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Safety First

Savannah’s Anthony Lanier II powers through obstacles as an NFL pro

Lean Defensive Machine

Savannah’s Anthony Lanier II gains power and respect playing defense for the Washington Redskins

Cover photo courtesy of Washington Redskins

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SafetyFirst First

nyone who enjoys a good Do-It-Yourself project at home can feel a great deal of satisfaction from a job well done. It takes sweat and maybe some tears, but it shouldn’t draw any blood.

Practicing precautions with power tools can save you from a trip to the doctor’s office or the emergency room

Unfortunately, from what Jeff Kenney, MD, has seen, projects taken on without putting safety first have caused all kinds of injuries. As medical director of the St. Joseph’s Hospital Emergency Department at St. Joseph’s/Candler, Dr. Kenney implores all woodworkers, craftsmen, and DIY warriors to protect themselves before jumping in to the next project.

Precautions for using woodworking machines, saws, and other power tools: • Wear safety glasses or goggles (welders will need a special mask) • Wear hearing protection • Use gloves when handling wood (but remove when your hands are near rotating blades or other moving parts that might catch the bulky fabric) • Tie back or secure long hair or a long beard • Do not wear loose clothing or accessories that could get caught in the machinery • Clamp or secure work pieces when drilling or milling • Keep your work area well-lit, clean and clutter-free “Protective eyewear, typically with three millimeters of polycarbonate, can make potentially devastating injuries almost entirely preventable,” Dr. Kenney says. “Hammering, cutting, or grinding metal are the most common causes of a metal projectile puncturing the eye.”

Most tools have precautions or warning labels printed on their body in some way. Dr. Kenney emphasizes that careless operation of tools can also lead to injury. A nail gun is just one example.

Daniel Cobb, MD

Jeff Kenney, MD

“More than 80 percent of nail gun injuries happen because the operator had a finger on the trigger,” Dr. Kenney says. “This is most common when the gun is set to bump-trip mode, where if the operator is holding down the trigger, the gun fires a nail as soon as its nose bumps against a surface—like your knee! Set the nail gun to sequential mode instead and keep your hand off of the trigger when you're carrying it.”

Even tools without sharp blades or other obvious hazards need to be used cautiously.

“Pressure washer injuries are becoming more common,” Dr. Kenney says. “Most of the ones I've seen involve the hands and feet due to improper footwear like flip flops, or ill-advised use such as rinsing yourself off. Depending on the strength of the water stream, it is possible to cut the skin and even remove flesh.”

Most people, including hobbyists who have created shops in their garage or shed, are aware of at least some of these precautions. But when immersed in getting a project done, not everyone heeds them.

“Balance your enthusiasm with patience and common sense,” Dr. Kenney says.

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Smart Living Fall 2018

Savannah’s Anthony Lanier II powers through obstacles as an NFL pro

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hen Anthony Lanier II first played football at Jenkins High, he got creamed.

“My coach put me at defensive end, and at practice he sent some guys on me,” he recalls. After getting pummeled, the Savannah native got mad. His coach saw the anger in his eyes and told him to channel it through his opponents.

“Next time he sent them, I knocked all of them over,” he says. “Coach said, ‘That’s how you play football.’”

Today Lanier II wants to continue proving himself as a defensive end, even after a hip flexor injury took him out of play earlier this season and cost him his spot on the Washington Redskins roster. As a free agent this season, Lanier II will undoubtedly continue to channel the inner drive that surprised everyone, even himself, as a young player in Savannah.

Making the Grade

Lanier II actually didn’t play football or his other favorite sport, basketball, for his freshman and sophomore years at Jenkins because of his poor grades. It was a basketball coach, Gregory Oliver, who told him that not only would those grades keep him from going to college, but it would also stop him from living the life he wanted.

“I was frustrated, but I was determined to show him I could do better,” he recalls. He not only got his grades up, he impressed his coaches on both the football field and basketball court. He did the same at Alabama A&M, where another coach, James Wright, told him he should focus his energy, strength and speed on football exclusively. He took his advice, graduating early and then signing with the Redskins in 2016 as an undrafted free agent.

‘Kinda Small’

Lanier II admits to being a bit nervous and uncomfortable as a rookie in huge stadiums filled with screaming fans.

But he managed to recover an opposing team’s fumble in overtime on his first play of the season. The next year, he was determined to keep making an impact.

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Smart Living Fall 2018

NFL photos courtesy of the Washington Redskins

“I could run like a horse, but I was actually kinda small for my position,” he says. “But I’ve always been told, ‘It’s not the size of the dog in the fight, it’s the size of the fight in the dog.’ I worked out every morning at 6 a.m. I was the last to leave training at night. I worked a long time to build up strength and weight.”

One interesting fact about the 6’6”, 285-pound player is that he has about four to six percent less body fat than other players in the same position.

“I was at 15 percent in training, and that dropped to 13 percent once I started to play,” he says. “Along with working out, I turned over a new leaf with nutrition—staying with whole wheat, greens and veggies. This is not something players always tend to do. I had to train myself to eat healthier.”

Working Harder Than The Others

The mindset of making your own way, despite the obstacles, is one that he tries to share with young men in Savannah as well.

He has held an all-day football camp each summer for the past two years. Along with game fundamentals and drills, part of his program is to teach his campers about personal responsibility, respect, and drive, just as his coaches from high school onward have taught him.

“I tell these kids to keep God first, and to remember that somebody else is going to work just as hard as they do,” he says. “So they need to ask themselves, ‘What could I be doing that the other guys are not?’ Along with that, I remind them to listen to adults. When they are giving you advice, it’s not just to get on to you. They are doing it because they care.”

Do you wonder if body fat affects your son or daughter’s athletic performance, or just their life in general? Learn more about this topic on page 6.

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Smart Living Fall 2018

Access to high quality care is improving for patients in small towns and rural areas

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hen high school students get a check-up with Tricia Etheridge, MD, they may not realize that their primary care physician walked the same halls that they do now.

“I went to high school in this area,” says Dr. Etheridge, who practices Family Medicine at St. Joseph’s/Candler’s Medical Group – Ridgeland. “I moved away for my training, but I’ve been back here for almost twenty years, and in my current practice for fourteen. And there’s no place I’d rather be.”

Generations In the past, rural medicine has sometimes lagged behind urban and suburban areas in terms of technology and accessibility. Although this is changing for the better, the challenge it created has never affected what Dr. Etheridge finds most rewarding about where she practices—the people.

Tricia Etheridge, MD

“Most of my patients have lived in this community for generations,” Dr. Etheridge says. “The goal of family medicine is to take care of whole family units. Here, I am able to take care of not only the immediate family but also the extended family, from the great-great grandmother to the smallest child.”

Dr. Etheridge believes the unique connection she has to her patients is made possible by the rural environment in which they live.

“You are treating people you truly know from your church family, your school family, and so on,” she says. “In the same way, because they know me as an individual and not just as their doctor, I think they are more appreciative and receptive of their treatment.”

Access and Awareness

A patient’s trust is essential to Dr. Etheridge because, in some cases, she is the patient’s first step into awareness of true wellbeing. When she first began practicing in Ridgeland more than a decade ago, she noticed that many patients had chronic diseases that weren’t being managed, such as diabetes and heart disease.

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Smart Living Fall 2018

“By being here, I feel like I’ve been able to have an impact on my patients’ awareness of self-care,” she says. “They are learning to manage their diabetes, or even prevent it, or they are taking the right medications for their heart disease. And now people have access to their patient portal, and we are helping them become a bit more technologically savvy.”

For some residents, just Dr. Etheridge’s presence in their town helps with accessibility.

“I have a lot of patients who are small-business owners,” she says.

“They can’t close down for half a day to drive 45 minutes away to see a doctor. But they can run in and see me right here in Ridgeland.”

Willing to Grow

With all of these advantages to small-town life, one might assume that Dr. Etheridge prefers that things stay the same.

But like anyone who cares about their community, she hopes that it will grow in a steady, positive way.

“Now that we are making an impact in primary care, I do hope our area will grow enough to bring specialists here,” she says. “I would love for patients to be able to see a specialist in their home community.”

Dr. Etheridge also wants the perception of rural medicine by healthcare professionals to shift as well. She considers her staff a great example of how rewarding it can be.

“Many of the people in my practice have been here for more than ten years,” she says. “Patients can sense that they truly care about them, and we all enjoy that unique relationship. I know that people might not see rural communities as the most desirable place to live and work, but we’ve all had great careers—and great lives—here.”

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Smart Living Fall 2018

Healthy choices are more crucial for a young person’s health than their body fat measurements

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eenagers can often get obsessive about the thing that’s most often on their minds—themselves.

This self-focus, while exasperating to parents, is fairly natural and usually part of finding your identity as you grow into adulthood. It can become a concern, however, when it leads to an unhealthy perspective or harmful behaviors. One example sometimes seen in young athletes is a misperception about body fat.

BMI

Fred Harold, DO

Body fat is essential to the health of vital organs and body regulation, and having too little could actually be fatal. It makes up the body’s composition along with lean body mass—which is the combined weight of water, tissues, organs, bones, and muscle. A common problem that physicians see is people who have more body fat than they should.

“Too much body fat can be a significant risk factor for a multitude of pathologies, including heart disease, type 2 diabetes, and cholesterol issues,” says Fred Harold, DO, of St. Joseph’s/Candler’s Medical Group – Richmond Hill.

One quick way that physicians estimate a patient’s body composition is the Body Mass Index, or BMI. This is basically a calculation of a person’s weight to height ratio.

“A higher body mass index frequently indicates a patient’s weight is disproportionate with their height, which suggests a higher percentage of body fat than is recommended,” Dr. Harold says. “It may indicate a risk of becoming obese, which is a problem for many teenagers in this country.”

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Smart Living Fall 2018

The Whole Story Dr. Harold notes that while BMI serves an excellent role for general assessment, it does not always provide the full picture of certain individuals, including athletes who do a significant amount of weight training for their sport.

“BMI and other body fat measurements serve as barometers for level of fitness, however they often don’t tell the whole story,” Dr. Harold says.

“Also, some aspects of BMI, such as our sex and family genetics, are beyond our control.”

For this reason, Dr. Harold advises teen athletes—and really anyone who is concerned about their BMI—not to worry too much about one number.

“Instead, target the constituents that, if done correctly, almost always lead to a healthy BMI or body fat percentage,” Dr. Harold says. “Healthy food choices, physical activity, and adequate sleep—collectively, these offer a much better reflection of one’s health.”

Healthy Self-Awareness For athletes, a drive for better performance coupled with pressure from peers, parents, and coaches could lead to an unhealthy obsession.

“Excessive worry about body fat is a particular concern in female teenage athletes,” Dr. Harold says. “When an athlete’s workload exceeds their nutritional intake required for recovery, it predisposes them to disruption of the body’s hormonal signaling. This leads to what is known as the female athlete triad, commonly defined as disordered eating, menstrual irregularity and alterations in bone density.”

Further problems that arise from female athlete triad include depression, poorer performance and healing time, and even stress fractures. Besides being unhealthy, this can also hinder the athlete from playing the sport they were hoping to excel in. Dr. Harold reminds patients that discussions about their body fat are designed to help them make healthy choices, whether the issue is too much or too little.

“The BMI/body fat discussion is not meant to be discouraging to teenagers,” Dr. Harold says, “but rather a lesson in self-awareness. We want to intervene and help before the consequences of an unhealthy lifestyle occur.

By recognizing at-risk teenagers and promoting smarter choices, we can hopefully create a brighter future for all kids.”

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Smart Living Fall 2018

That’s Your Cue Infants can give non-verbal signs of hunger, even before they cry

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eeking expert advice on breastfeeding is a great idea. It can be a challenge for any new mom and even for moms who have been there before. Your doctor, nurses, lactation consultants, and yes, even friends and family, are ready to help.

When the question is when to breastfeed, one of the best experts you can consult is your newborn.

A baby’s hunger is well-tuned to his energy and nutritional needs, so he knows when it’s time for a fill-up. But because babies can’t use words yet, there are other signs they give to parents. These signs are known as cues.

Marybeth Milton, RN

“Feed as soon as the baby gives you a cue, and feed as often as the baby cues,” says Marybeth Milton, RN, a board-certified lactation consultant at St. Joseph’s/Candler’s Telfair BirthPlace.

Your baby is hungry when he or she: • Licks or smacks their lips • Brings their hands to their mouth/sucking on their fist • Moves their head back and forth, searching for the breast • Cries Crying is actually one of the later cues for feeding. If possible, try to respond to earlier cues so that your baby is not too stressed to breastfeed easily. On the other hand, don’t get too discouraged if you do happen to miss a cue.

“Breastfeeding is a journey,” Milton says. “It’s a new skill and it takes practice. Moms need to be patient, get plenty of rest in between feedings, and not be afraid to ask for help.”

Looking for more tips on how to be successful at breastfeeding? You can find them on our Living Smart blog at www.sjchs.org/breastfeeding-tips.

The Living Smart blog has new content every week, featuring tips and insight from experts on trending health topics such as women’s care, heart health, nutrition, family medicine, and more.

Visit us online at www.sjchs.org/living-smart.

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Smart Living Fall 2018

Down to the Marrow Does the idea of something soft hidden inside a hard shell make you think of the

natural sciences? Or maybe just Tootsie Pops? Either way that description fits our bones, which give our body structure and protect our organs. Inside these solid structures is something that is quite soft yet also quite powerful in the fight against disease. Take our quiz to learn more:

1. Bones are made of these main types of material EXCEPT:

4. One possible treatment for certain cancers and blood disorders is a transplant of healthy bone marrow cells to replace faulty or diseased cells.

A. Marrow B. Spongy bone C. Shell bone D. Compact bone

A. True B. False

C. Shell bone. Compact (also known as cortical) bone is the hard outer layer of bone. Spongy (also known as trabecular or cancellous) bone is found mostly at the ends of bones and, though porous, is not soft. The soft tissue on the inside of bones is called marrow.

A. True. With a successful donor match, certain patients can receive healthy cells through a transfusion that will create new red blood cells, white blood cells, and platelets.

5. A bone marrow transplant may be the best treatment option for:

A. Leukemia and lymphoma B. Sickle cell disease C. Multiple myeloma D. Certain inherited immune system disorders E. All of the above

2. The two types of bone marrow are called:

A. Alpha and beta B. Vascular and fatty C. Autologous and allogeneic D. Red and yellow

D. Red and yellow. Both types have blood vessels running through them. New red blood cells, white blood cells, and platelets are made in red marrow. Yellow marrow is mostly fat.

3. An injury to bone marrow is known as an osteoblast.

A. True B. False

B. False. Osteoblasts are a kind of cell that helps make new bones or rebuild broken ones. “Osteo” is the Greek word for bone, and is used in several medical terms that relate to bones. “Blast” also derives from a Greek word for growth.

E. All of the above. The transplant replaces unhealthy blood-forming cells, also known as stem cells, with healthy ones. In certain cases, a transplant can cure the patient.

6. Matching donors is more complicated with bone marrow than it is with blood types.

A. True B. False

A. True. Physicians must match donors based on their human leukocyte antigen (HLA) tissue type. HLA are proteins found on cells. They work as markers that show how each person’s tissue type is unique. If there is a basic match, additional testing will be needed to determine which donor matches the patient most closely.

Sources: St. Joseph’s/Candler’s Health Library at www.sjchs.org/health-library and Be The Match, operated by the National Marrow Donor Program, at www.bethematch.org.

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Smart Living Fall 2018

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November St. Joseph’s/Candler Calendar

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Mobile Mammography Reidsville 912-819-6800

Mobile Mammography Port Wentworth 912-819-6800

Cancer Support Group 912-819-5704

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Savannah Ostomy Support Group 912-225-4174

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Thanksgiving

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Prepared Childbirth Class (The Weekender) for expecting couples 912-819-3360

New events are added every day.

Please visit www.sjchs.org and click on “Events” for additional information.

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Look Good, Feel Better workshop presented by the American Cancer Society 800-227-2345

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Tea & Tour for expecting couples Mary Telfair Women’s Hospital 912-819-3360

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A Growing Number of Lung Cancer Patients Are Benefitting From Immunotherapy Laurie Luteran, BSN, RN, OCN Oncology Patient Navigator, Nancy N. & J.C. Lewis Cancer & Research Pavilion

Smart Living: As a patient navigator, you help guide lung cancer patients through their continuum of care. Have you seen any developments in treatment that may benefit patients?

Laurie Luteran: Immunotherapy is an exciting and fairly recent development in the treatment of non-small cell lung cancer. There are two types of lung cancer—small cell and non-small cell—but non-small cell lung cancer is far more common, accounting for about 85 percent of all primary lung cancers. Unfortunately, at the time of diagnosis, most patients present with advanced disease that cannot be surgically removed. For a long time, chemotherapy was the only systemic treatment available to prolong survival, but immunotherapy has emerged as a treatment option for certain patients.

Unlike chemo, immunotherapy is designed to make use of the body’s own immune system to fight cancer. Typically, your immune system works to defend your body against infections and cancer cells. Sometimes cancer cells avoid this by making what’s called a checkpoint protein, PD-L1, which works as a kind of blindfold, so to speak. It binds to T-cells, a type of white blood cell, making them unable to see the cancer cells. Checkpoint inhibitor immunotherapies work in turn by either binding to proteins on the T-cells or binding to proteins on the cancer cells themselves. In either case, this binding of proteins removes the blindfold, allowing T-cells to recognize and destroy the cancer.

SL: How do lung cancer patients receive immunotherapy? Is it similar to chemo?

LL: It’s similar in that the patient sits in a chair and the immunotherapy drug is administered through a vein in the arm or a port implanted in the chest. The treatment time varies with the type of drug, but typically patients will need a 30 to 60 minute infusion every two or three weeks. Generally, immunotherapy is well-tolerated by patients, but as with any drug, side effects may occur. Mild side effects include fatigue, muscle or joint pain, or itching. In some instances, more serious side effects can occur.

Not all patients are eligible for immunotherapy. Testing is done on a patient’s tumor to determine how likely he or she will respond to this treatment. As an oncology patient navigator, it has been very exciting for me to see these advances develop. Researchers continue to determine which patients are most likely to benefit, and more indications are being approved all the time.