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The Paper | Thursday, April 16, 2015
Dealing with pain
Physician shares insight into pain management By FARAH BOHANNON
fbohannon@clickthepaper.com
Dr. Tennent Slack, from the Northeast Georgia Physicians Group Department of Interventional Pain Medicine, spoke at the Braselton Woman’s Club April meeting where he discussed chronic back pain and what available to control it — everything from medications to therapies to surgery — that one in particular being a last resort. Slack said that chronic low back pain is extremely common, and a majority of heads nodded in agreement as he made that statement. It can be caused from anything, and Slack’s main purpose is to help others figure out the source of the pain and how to effectively manage it. “The number of adults in the United States who experience some kind of a chronic pain problem is roughly 100 million,” said Slack. “The United States population is around 300 million, so about one third of Americans are currently Slack experiencing pain.” A majority of the 100 million people dealing with chronic pain have problems in the spine, a very complex part of the human body — a jungle of bones, nerves, discs and more. Slack says a majority of people’s problems occur in the lower lumbar or sacral portions of the spine, what everyone refers to as the lower back. Spinal nerves that are irritated cause leg pain, commonly known as sciatic pain. The second major source of pain is arthritis originating from the spinal joints — stiffness can occur as well, which can be just as uncomfortable as extreme pain. Disc pain is also common since there are several nerves that run into them. As a person ages, the discs lose their shape, which can irritate those nerves — ouch. The last source of pain discussed was sacroiliac joint pain. “When the sacroiliac join is irritated, many people say they are experiencing hip pain,” said Slack. “It hurts to cross legs, walk upstairs, sit and stand from a sitting position. That and the other three sources of pain are where a majority of low back pain comes from. “Unfortunately, the course of low back pain is incredibly unpredictable, but my job is to do what I can to figure out where the pain comes from and how we can manage it appropriately,” he said. Slack said he constantly sees patients who complain about back, hip or leg pain that came about suddenly after never undergoing any problems, and want to know what caused it. He said it is difficult to find the cause most of the time because many of the cases are not due to a disc herniation or something of the like. Most of the time, pain is caused from disc degeneration that became symptomatic. It is important to understand that chronic back pain can be a “beast” as Slack said, also unpredictable and difficult to diagnose. After all, there is a lack of correlation between the spine and the complaint in many cases. Sometimes an MRI will not give the answers that one may be searching for — managing the pain, and not curing it is usually the only answer that is available. Luckily there are doctors who spend their
days researching and helping their patients find the pain management program that works for them. “The typical issue I see is degeneration,” said Slack. “Even I have it. When a patient comes to me with degeneration of the spine, we look at a management plan. There is no fix. The patients really do not like hearing that, but there is a way to manage their pain. There is no cure for diabetes, but it can be managed. The same concept goes for chronic back pain and degeneration.” Slack says in these cases, he makes a concerted effort to find out where the patient’s pain comes from to create the best management program — that way, he can figure out what to do other than administering and taking strong pain killers or medications such as Lortab, Percocet, Cymbalta, Methadone and even those that are over-the-counter. There are benefits to these, but if there is something else that can be done — great. Another important factor to consider is the specific patient’s pain perception. Different people feel pain in different ways, and that can be attributed to factors such as emotional state, genetics, mood/anxiety disorders or cultural background to name a few. It is a complicated phenomenon, but will never be forgotten thanks to doctors like Slack. Slack did mention he is not anti-medication, but activities like physical therapy, water aerobics, yoga, massage, acupuncture and chiropractic visits have all been very helpful in chronic back pain management. After all, medications do come with intense side effects and some even have the potential of being addicting. “Addiction to pain medications has become a huge problem in the United States, and unfortunately deaths from overdoses have risen significantly,” said Slack. “That is another lecture for another time, but it has gotten worse.” Patients must weigh the benefits and the side effects before making a decision on a pain management regimen. Slack says that he is all about “every tool in the toolbox” while treating back pain because nobody has the one answer. Everyone is different and handles pain differently, and pain management doctors like Slack are eager to help their patients find relief. To make an appointment with Dr. Slack, call 770-219-0023. About Dr. Slack Born and raised in Gainesville, he earned his bachelor’s degree in Physics at the Georgia Institute of Technology. He received his medical degree from Emory University School of Medicine, where he also completed a residency in Anesthesiology. He practiced Anesthesiology in Atlanta for 14 years before completing a fellowship in Pain Medicine at the Medical College of Georgia. In 2009, Dr. Slack returned to Gainesville to practice Pain Medicine exclusively. He is a member of the American Society of Anesthesiologists, the International Spine Intervention Society, the American Medical Association and the Georgia Society of Interventional Pain Physicians. Dr. Slack is board certified by the American Board of Anesthesiology in both Pain Medicine and Anesthesiology.
Second in a series
Court Appointed Special Advocate: A day in the life of a special volunteer A Court Appointed Special Advocate gets ready to advocate for their assigned foster child through the Juvenile Court System by first preparing a report for the Judge. The Juvenile Court Judge helped to start the CASA program here in Jackson, Banks and Barrow counties. Before each hearing, he wants a report with current information about the child and their family so he’ll have the background he needs to interpret the testimony he hears. The Judge will hear testimony from the Department of Family and Children’s Services (DFCS) case manager, possibly their supervisor, the parents and any other witnesses that the DFCS attorney and the parents’ attorney(s) want to call, just like in any trial. The CASA report has to be distributed to all the attorneys and the Judge and filed with the clerk several days before the court hearing. To write the report, the CASA relies on the relationship they have built with the child and the information they have gathered about the family and child to form recommendations in the best interest of the child. What does that mean? In training, the CASA learns that the best interest of the child may be different at different times during their stay in foster care. Thinking about best interest takes into account the child’s problems and concerns, what the child has told the CASA and what the CASA knows about the child. How is the child responding to being in foster care, to having their needs met? Has the child talked to the CASA about what the child thinks would be best for them? Most often, children in foster care want to return home, no matter how bad their home situation has been. The CASA, being a specially trained adult, realizes that the child’s wishes are important, but their wish to return home may not be the right choice for them at that moment in time. How are the visits going with family members? To make well thought out recommendations to the Judge, the CASA has to have current information about their family. Is the family making the changes needed to bring the child home so that child will be safe? Is the family receiving all the services that they need to make these changes? Before writing the report, the CASA has met with the parents and with the DFCS foster care case manager and others involved in services for the child and family
YOUR OUTDOOR BAR-B-Q PLACE!
Big Green Egg
Braselton Woman’s Club convening on May 6 The Braselton Woman’s Club will meet at noon on Wednesday, May 6, at Country Inn & Suites Hotel, located at 925 Highway 124 in Braselton, with Fern Meyer as guest speaker. A Georgia resident for 28 years, she moved from New Jersey in 1987 and to Jackson County in 2002. She is a wife of 40-plus years, mother of two grown children and a grandmother of five. After numerous careers, including customer service, pro shop owner, consignment store owner and high end decorative painter, she went to college for the first
time at age 55 and graduated from the Institute for Integrative Nutrition. Certified as a holistic health coach by the American Association of Drug Free Practitioners, she is also a wellness advocate and essential oil expert with doTERRA essential oils. She is in the business of promoting wellness with real food and natural medicine. Meeting admission is free and light refreshments will be served at no cost. Learn more by visiting the Facebook page at Braselton Woman’s Club, or call 706-654-9266.
to talk about the child’s case, to air concerns and to discuss solutions. The CASA will have met with the child’s teacher and reviewed school records. The CASA will have reviewed any pertinent medical records and have discussed them with medical providers. So the day of writing the report comes and with it the responsibility of setting out the facts and circumstances in the case that are important for the Judge to know. Following that, comes the recommendations. When the court hearing date arrives, the CASA knows that they are prepared, their report has been read and they are ready to testify if requested. There may have been a few sleepless hours when the CASA wonders if they are prepared as much as possible. Is their report as accurate as possible? Have they included all pertinent information? Luckily, CASA volunteers don’t bear this burden alone. Their CASA volunteer coordinator has been there to help them, to provide them with a sounding board, to read their report and to make suggestions to strengthen the report. The volunteer coordinator goes to court with the CASA volunteer. The CASA volunteer coordinator and volunteer are eager to hear what will happen in court and whether or not the Judge after hearing testimony will rule as they have recommended in the report. The Judge is always grateful for a well written report, and yet things don’t always turn out the way CASA hopes. The Judge has to make a decision based on the law and the testimony he hears. The excitement of seeing a child reunified with family or being present at an adoption makes up for the sometimes stressful preparation and work. The system is a good one, and allows community members who know their community to speak on behalf of one of the community’s children. Training opportunity New CASA volunteer training begins May 7 at The Tree House in Commerce, 6-9 p.m.; anyone who wants to know more about CASA is welcome to attend the first session. For more information, call 706387-6375 or go to www.piedmontcasa.org. Lift Up a Child’s Voice. A Child’s Life.
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Backdoor Roth IRA: Appropriate Or Not? This paid advertisement written by Jeff Cutter, Investment Advice by Scott Moore.
Last week I received a phone call from a very nice young woman, Stephanie. She is a faithful Moore Weekly reader who wants to stay financially fit. Stephanie wants to contribute to a Roth IRA. She is concerned about taxes rising in the future and she does not want to bear that burden. Smart gal. The problem is that she earns too much money to contribute to a Roth IRA. Stephanie asked her broker about any solutions available to her that will allow her to contribute to a Roth under her current situation. She told me that her broker advised her to do a “backdoor Roth IRA.” Hmmmm . . . not so fast. A backdoor Roth IRA can be a solution for investors who make too much income to qualify for normal Roth IRA contributions, and want to increase their retirement savings in taxadvantaged accounts. This is because with a Roth IRA your hard-earned money grows tax-free, and you are allowed to withdraw those funds taxfree in retirement (don’t forget, you do pay tax up-front in that you contribute with after-tax dollars because you don’t get a tax deduction when you make the contribution). Furthermore,
unlike traditional IRAs, there are no required minimum distributions for Roth IRAs and they can be passed on to one’s heirs. This allows the funds to grow tax-free over many years, and offers tax-free compounding and withdrawals. However, there are limits and complications involved with “backdoor Roth IRAs.” Stephanie’s broker advised her to begin a two-step process for her to create a backdoor Roth IRA. He suggested that she first, contribute to a (nondeductible) Traditional IRA because unlike a Roth IRA, a traditional IRA has no income ceiling for contributors. Next, after the funds clear, he suggested she convert the traditional IRA to a Roth IRA in order to never pay taxes again on her investments. He told her that since no time elapses between the contribution to the Traditional IRA and the conversion to the Roth IRA, there are no earnings on those funds and it is a non-taxable event, unlike if she were to convert pre-tax IRA funds, (tax deductible IRA money and earnings which have not been taxed yet) into a Roth IRA, in which case all gains are taxed on the conversion at current rates. Sounds great! Not so fast. Bring in the “pro rata tax rule.” The pro rata rule is the factor that can
complicate a backdoor Roth IRA, even if it otherwise sounds like it might be for you. This is how it works: if there are any pre-tax IRA funds in any other IRA (for instance, an old 401k that you have rolled over), the conversion of any contributions becomes a taxable event which will result in taxes being paid on the conversion. Generally you can’t convert just that nondeductible IRA contribution tax-free when you have other IRA funds. Stephanie was very surprised to hear this because she was told that since any contribution to a backdoor Roth comes from an immediate conversion from a nondeductible IRA, it is a nontaxable event. Although generally speaking that is true, there is a big exception: if you own any pre-tax IRA, including SEP and SIMPLE IRAs. If Stephanie owns IRAs with both nondeductible and pre-tax funds, then each dollar withdrawn (or converted) from any of her IRAs will contain a percentage of tax-free and taxable funds based on the percentage of after-tax funds to the entire balance in all her IRAs. She cannot just withdraw (or convert) the nondeductible IRA contribution and pay no tax. Stephanie also has about $95,000 of pre-tax IRA money being held in various accounts with her broker. And even though these funds
are held in separate accounts, the IRS looks at them as one IRA. So, let’s assume Stephanie contributes $5,000 into a nondeductible traditional IRA, and soon after converts that $5,000 into a Roth IRA, utilizing the backdoor Roth strategy. If Stephanie had no other IRAs, the conversion to the Roth IRA would be taxfree. However, since she has other IRA assets, well, we have a problem. The pro rata rule requires Stephanie to aggregate all of her IRA money that has not been taxed yet and views the $5,000 as a percent of the total IRA pool of (non-taxed) funds. The $5,000 converted to a Roth is considered 5 percent of her total IRA assets ($5,000/$100,000). Her percentage of pre-tax funds in her IRA is therefore 95 percent, and upon conversion of the $5,000, she will be taxed upfront on $4,750 of the $5,000. As you can see, the backdoor Roth is not as advantageous a strategy for Stephanie as it may be for others and I advised her against it. Given the benefits outlined above, backdoor Roth IRAs are certainly something to consider when you are charting your course for retirement savings. Specifically, if you have already maxed out other retirement
savings options, you are willing to leave the money in the Roth for at least five years, and you expect to be in a higher tax bracket in retirement than you are currently, it is something to consider. Folks, backdoor Roths are not for everyone, so if you do consider it, make sure you carefully contemplate all the ramifications. If you already have any traditional IRAs or can contribute to any other retirement savings vehicles, make sure to do the math to see if a backdoor Roth IRA is for you. I finished the call with Stephanie by advising her to make sure she seeks her retirement solutions from a retirement specialist. It could save her a small fortune. I advise you to do the same. For answers to these questions, contact Scott Moore 770-535-5000. In addition to being a fiduciary, Scott is an Ed Slott Master Elite IRA Advisor.
210 Washington St. NW, Suite # 106 • Gainesville, GA 30501 • 770-535-5000 • 12600 Deerfield Parkway, Suite # 100 • Alpharetta, Georgia 30004 • 678-566-3590 www.MooresWealthManagement.com Investment advice is offered by Horter Investment Management, LLC a Registered Investment Adviser: Insurance and annuity products are sold separately through Moore’s Wealth Management. Securities transactions for Horter Investment Management clients are placed through Pershing Advisor Solutions, Trust Company of America, Jefferson National Monument Advisor, Fidelity, Security Benefit Life, ED&F Man Capital Markets, and Wells Fargo Bank, N.A. This content is developed from sources believed to be providing accurate information. The information in this material is not intended as tax or legal advice. It may not be used for the purpose of avoiding any federal tax penalties. Please consult legal or tax professionals for specific information regarding your individual situation. This material was developed and produced by radical promoting and their editorial staff based on the original articles written by jeff cutter in the falmouth enterprise. This article has been rewritten for Scott Moore and the readers of the Moore’s Weekly Column. The opinions expressed and material provided are for general information, and should not be considered a solicitation for the purchase or sale of any security