HealthWatch April 2011

April 2011

North Georgia’s Health & Prevention Magazine

IN THIS ISSUE ar infections for children younger E than 2 need attention E ating apples every day really is good for your health, scientists say Rest is mandatory to combat shin pain Getting older, getting asthma

FEATURING See a doctor at the first signs of vertigo

Pages 12-13

Sunday, April 24, 2011

The Times, Gainesville, Georgia |

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See a doctor at the first signs of vertigo

By Lauren Blais

lblais@gainesvilletimes.com

It’s spring and you’re at the fair.

Everything is spinning and bright lights whirl around you, but you’re not on a ride. In fact, you’ve only just bought your tickets.

You’re experiencing vertigo, the feeling of movement while standing still. And it could be a symptom of a larger problem.

“It’s a symptom with multiple diagnosis,” Dr. Daniel Cobb with the Gainesville Neurology Group said.

There’s a difference between vertigo and light-headedness; a complaint of “dizziness” is vague.

Vertigo is identified as a sensation of the room spinning.

Doctors must figure out the kind of vertigo to determine its source and cause, and then, treatment.

A series of tests help determine whether the vertigo is peripheral, coming from the inner ear, or central, meaning it’s neurological or coming from the brain.

If you experience a brief onset of vertigo, it may be caused by benign paroxysmal positional vertigo, a wordy way to describe a sudden change in position. This is the most common kind, and is related to peripheral vertigo.

Peripheral vertigo sometimes occurs when the fluid in the ears, which gives us our sense of balance, thickens and becomes lodged in ear canals. While some fluid thickening is normal as we age, it could also be caused by a viral infection.

If the vertigo is peripheral, patients may become nauseated or have difficulty walking.

Symptoms may come and go, but they tend to be severe, Cobb

Scott Rogers/The Times Using a model of the brain and ear canal Dr. Daniel L. Cobb demonstrates to Byron Wiley where in the ear a type of vertigo occurs during a typical treatment at the Gainesville Neurology Group at the Guilford Clinics.

said.

A test that helps identify peripheral vertigo is the dix-hallpike maneuver. Cobb demonstrated with Byron Wiley, who also works with the Gainesville Neurology Group.

From sitting, Wiley was quickly brought to a lying position on the exam table. Cobb turned Wiley’s head to the side and held it for several seconds, watching his face.

“What I’m looking for is abnor-

mal movements of the eyes,” Cobb said. If doctors determine that the vertigo is peripheral, the patient may be referred to an ear, nose and throat specialist. He or she Please see Vertigo page 3

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Vertigo Continued from page 2 may undergo positional therapy, or receive medication.

Unlike peripheral vertigo, central vertigo can be chronic, or long-lasting.

“Peripheral comes and goes; central, it’s like it comes and never stops,” Cobb said.When seeing a patient that might have central vertigo, Cobb looks for other neurological symptoms such as speech problems, numbness and weakness in the arms or legs. It may be a sign that a stroke has happened or is about to occur in the patient. For this reason, Cobb recommends that patients experiencing vertigo for the first time see a doctor immediately, even if

it’s the weekend.

“It’s not something I would put off until Monday,” he said. Doctors may scan the brain to determine if a stroke has occurred or, less common, if a tumor is present.

Because issues in the brain are complicated, getting rid of the symptoms of central vertigo is not so easy.

“Someone who’s had a stroke and has vertigo, it’s harder to recover from that,” Cobb said.

In cases of peripheral vertigo, if treatments do not work then Cobb recommends that patients try to avoid triggers. Cobb said that no particular populations are more susceptible to symptoms of vertigo. In the case of central vertigo, patients as young as 20 or 30 may be having a stroke and not know it.

“Anyone who is having their first bout of vertigo should see their physician,” Cobb said.

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Sunday, April 24, 2011

Scott Rogers/The Times Dr. Daniel L. Cobb demonstrates a typical vertigo treatment for Byron Wiley at the Gainesville Neurology Group at the Guilford Clinics.

Sunday, April 24, 2011

The Times, Gainesville, Georgia |

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Ear infections for children younger than 2 need attention

By Robyn Abree

For The Times

Few creatures are as miserable as a small child with a raging ear infection. Emily Bailey of Flowery Branch has witnessed this five times since Bridget, her 3-year-old daughter, was born.

“A sick child is not a happy child,”Bailey said.“They are clingy and require lots more attention to comfort them through the sick times. I think it is sometimes harder on parents to see their little ones sick than it is for them to suffer through it.”

Bailey takes her daughter to the pediatrician as soon as symptoms strike, which is usually after what she calls “a persistent cold that doesn’t budge for at least a week.” Kathy Morse, a nurse practitioner at Pediatric Associates in Braselton, says Bailey is doing the right thing.

Parents should consult a doctor right away if a child aged 2 or younger has a high fever, pulls at their ears and cries when sucking or sleeping — classic signs of acute otitis media.

Because untreated ear infections can permanently damage hearing, Morse prescribes antibiotics to infants under 2 because they usually don’t heal as well on their own.

A new study highlights the wisdom of this approach.

Researchers from the University of Pittsburgh School of Medicine divided 291 children, all under age 2 and suffering acute otitis media, into two groups. One group was immediately given Augmentin (a common antibacterial drug), and the other received an inactive pill. After seven days,

researchers found that about three-quarters of infants in both groups had improved — they were no longer crying or pulling on their ears. This signaled that in the short run, antibiotic treatment didn’t make much difference.

The real benefits of antibiotic treatment showed up after 12 days when doctors checked kids’ ears for evidence that the infection was still there, even though symptoms had lessened. Of the 144 infants given Augmentin,only 23 still had signs of acute otitis media; of the 147 left untreated, infection persisted in 75.

Bailey says she sees noticeable improvement in her daughter’s symptoms after the third day of antibiotic treatment. She said that only on one occasion did the infection not clear after the first round of antibiotics so her Please see Ears page 8

The Times, Gainesville, Georgia |

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Sunday, April 24, 2011

Eating apples every day really is good for your health, scientists say

By Karen Kaplan

Los Angeles Times

An apple a day really can help keep the doctor away, at least for postmenopausal women,researchers said this month.

In a study of 160 women who ate either dried apples or prunes daily for one year, the women who ate apples saw their low-density lipoprotein cholesterol — the “bad” kind known as LDL — drop by 23 percent after six months. At the same time, their “good” highdensity lipoprotein cholesterol, or HDL, rose about 4 percent over the course of the study.

Women in the dried apple group ate 2/3 cup of the fruit each day.

Though the apple slices added 240 calories to their daily diet,

these women wound up losing weight — 3.3 pounds, on average.

These women also saw their levels of C-reactive protein (a measure of potentially dangerous inflammation) and lipid hydroperoxide (which can signal higher risk for cardiovascular problems) fall.

Researchers from Florida State University decided to put apples to the test because the fruit contains pectin, which improves the body’s ability to metabolize fat, and polyphenols, which dials back production of inflammatory molecules. At least, those effects had been demonstrated in animals.

Now they have some preliminary data that the same might be true in people.

The next step, the researchers said in a statement, is to expand

the study to women across the country to test whether the old adage holds up.

And it is an old adage.According to a website on the history of popular phrases, idioms and expressions, the idea that eating an apple a day could keep the doctor away can be traced to Pembrokeshire in southwest Wales. Nearly 150 years ago, a Welsh magazine called “Notes and Queries” published a longer version of the famous rhyme: “Eat an apple on going to bed “And you’ll keep the doctor from earning his bread.”

The results of the preliminary research were presented in a poster session at the Experimental Biology 2011 conference in Washington, D.C.

Sunday, April 24, 2011

The Times, Gainesville, Georgia |

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Rest is mandatory to combat shin pain

By Emily Perry

For The Times

Spring time in Georgia usually means cleaning out closets and dusting off ball gloves, running shoes and tennis racquets. Sports enthusiasts know all too well that the sudden welcomed opportunity for outdoor exercise can lead to injury.

One of the more common injuries, shin splints, most often refers to pain felt along the shin bone.

“Essentially, it is tendonitis and inflammation of the tendon,” said Dr. W. David Weiss of Specialty Clinics of Georgia in Gainesville.

Associated primarily with activities played on hard surfaces, such as basketball and tennis, shin splints are a common ailment for athletes who engage in sports with frequent starts and stops.

And almost always, shin splints are caused by overexertion.

Mignon Hooper, a Braselton resident, danced“en pointe”with the Gainesville Ballet Company for 14 years. Her time spent as a ballerina involved intense preparation before performances.

“We trained five to six days a week, four to six hours a day. In ballet, your body is in a lot of pain anyway, so you push through pain and you don’t really recognize physical pain,” Hooper said.

Studies have shown that shin splints account for 16 percent of runners’ injuries and more than 19 percent of high school track athlete injuries.

They were the most common injury reported in a national survey of ballet companies according to a 2002 report by Thacker, Gilchrist, Stroup and Kimsey, for the National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention in Atlanta.

Symptoms range from tenderness in the inner part of the lower leg to swelling.

“It felt like a sharp pain and it started with a tingling sensation and then I would rub my shin and I would feel the bumps on my shin from the muscle,” Hooper said.“The muscle will rip away from the bone and it makes these knots all the way up and down your leg.” Her injuries eventually led Hooper to give up dancing.

“When you get shin splints, it’s very important that you rest instead of progressing on,” said Christine Hurley, an avid tennis player from Flowery Branch.“I kept progressing on, I never rested. When you get shin splints it takes a good week or two to get rid of them. It takes rest. You can’t keep going and playing.”

According to the Federal Citizen Information Center, established to help federal agencies develop useful consumer information, there are three groups: children and adolescents, middle-aged athletes and women who are particularly vulnerable to sports-related injury, including shin splints. Others at risk for shin splints range from those who train in the military to people born with flat feet or rigid arches.

The chance of lower extremity injury can be reduced by choosing the proper foot wear.

“When I started playing (tennis) I didn’t know about shin splints,” Hurley said.“That’s what the doctor attributed it to; I was playing on a hard surface and I didn’t have the proper shoes. I had to try three or four pairs before I found some that had enough support.”

It is recommended that athletes prone to shin splints should buy shoes that offer good arch support with plenty of cushion in the heel area.

Treatment of shin splints can be done at home in most cases. Patients are encouraged to use the Rest, Ice, Compression and Elevation method to Please see Shin splints page 8

Tom Reed / The Times Dr. W. David Weiss checks the x-ray of a tibia for any indication of stress fractures or other sources of shin pain.

The Times, Gainesville, Georgia |

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Sunday, April 24, 2011

New procedure recommended for CPR

By Brandee A. Thomas

bthomas@gainesvilletimes.com

Although you are supposed to re-take CPR training at least every two years, there’s even more reason for you to brush up on your skills now.

In October, the American Heart Association released a statement changing their preferred order for administering cardiopulmonary resuscitation, or CPR. The goal of CPR is to help revive an unconscious person who appears to be suffering from cardiac arrest, meaning their heart has stopped functioning properly. Previously, administers were taught to check the victim’s airway, give

two rescue breaths and then begin 30 chest compressions.

The cycle was to be repeated until the victim regained consciousness.

Now, the heart association is recommending that the chest compressions be done first, followed by an airway check and rescue breaths.

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” said Dr. Michael Sayre, co-author of the new heart association guidePlease see CPR page 19

CPR training For more information about the Northeast Georgia Chapter of the American Red Cross’ CPR training schedule, visit www.negaredcross.org, email chapter@negaredcross.org or call 770-532-8453. The chapter’s office is located at 675 White Sulphur Road, Suite 230, Gainesville.

Sunday, April 24, 2011

Ears Continued from page 4 doctor had to prescribe a stronger dosage.

Although these results favor immediate treatment, they are unlikely to be the last word in an ongoing debate about whether ”watchful waiting” or immediate antibiotic therapy is a better approach to treat common childhood ear infections. Some say that the rush to prescribe antibiotics for every ear infection gives microbes too much opportunity to develop drug resistance.

But Dr. Jack Paradise, co-author of the University of Pittsburgh study, believes the argument for immediate treatment of infants under 2 is persuasive.

“In a very young child, the

Shin splints Continued from page 6 promote healing.

Weiss, who is an orthopaedic surgeon specializing in sports medicine, said if symptoms aren’t relieved within two weeks with rest and use of an antiinflammatory drug, medical treatment should be sought.

“I did use ice at first,” Hurley said. “I felt like somebody had taken electricity and just plugged it into each hip.

I would have shooting pain going all the way down through my toes. After about a month and a half, they completely went away.”

The condition usually does not lead to permanent damage and rarely is surgery required, Weiss said.

The Times, Gainesville, Georgia |

condition causes immense pain, and even if symptoms go away on their own, there still may be a lingering infection that can cause permanent hearing damage,” Paradise said. He added, “It is not the responsibility of the child to eliminate unnecessary anti-microbial treatment, it is the doctor’s.”

The real culprit in development of antibiotic resistance is not treatment of a single childhood ailment, but instead “antibiotics apparent in everyday life, from agriculture, cattle, chickens, and prescriptions for other respiratory problems.”

Gainesville pediatrician Eugene Cindea agrees with Paradise’s recommendations for treating ear infections in very young children, but gives more credence to the idea that using antibiotics in this way may contribute to drug resistance.

“Shin splints can be confused with other conditions such as stress fractures and exercise induced compartment syndrome, which will take longer to heal,” he said.

Even with proper pre-activity warm up and the right foot wear, knowing when to stop before causing injury can be a challenge.

Hurley plays tennis four days a week and has recently added jogging to her exercise regimen.

“Over time I can tell when I’m starting to feel like I’ve had too much,” she said.“One of the things the doctor told me at the time is that I may not need to play five days a week. I may need to play two on and one off and alternate like that.”

Hooper found it difficult to let go of her passion to dance in the ballet.“It’s a lifestyle. Because you’re committed to that lifestyle, it’s really hard to change because you’re fully committed.

“You’re going to do it no matter what,” she said.

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“Development of antibiotic resistance in children is certainly related to antimicrobial over-exposure,” said Cindea, who practices at the Longstreet Clinic in Gainesville. “Doctors must be careful and judicious in the prescription of antibiotics for ear infections. A physician should never treat a patient over the phone or prescribe medicine on the basis of symptoms before thorough examination.”

When a child has a mild ear infection or is older than 2, Cindea waits and watches to see if the problem spontaneously heals.

In fact, “85 percent of infections in children over 2 years old clear up on their own,” Morse said. For older children, she usually prescribes eardrops for pain and suggests acetaminophen or ibuprofen.

Waiting for an ear infection to

clear on its own can be agonizing for parents of a slow-healing child.“For us, watching and waiting has failed more times than it has succeeded,” Bailey said.

“When we take the waiting path, it’s usually a long road to recovery that takes twice as long than with antibiotic treatment.”

What parents really want to know, of course, is whether ear infections can be prevented. “I usually tell adults to marry someone with good genetics,” said Cindea. “Outside of good genes and taking their children out of daycare, there isn’t much they can do. Ear infections aren’t preventable.”

Robyn Abree is a Health and Medical Journalism student at the University of Georgia who writes on health topics related to Hall County as part of a program of instruction.

The Times, Gainesville, Georgia  |

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Sunday, April 24, 2011

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Sunday, April 24, 2011

An Advertising Supplement to The Times

Getting older, getting asthma

By Judy Graham

as chronic obstructive pulmonary disease or chronic lung infections.

Many of these individuals Asthma is often overlooked in smoked at one point. Exposure older patients, but why? to bad things in the environment We asked two leading experts to — cigarette smoke, moldy houses, weigh in. Dr. Charles E. Reed is a contaminated air conditioning sysformer head of the division of aller- tems, nasty workplaces — doesn’t gic diseases at the Mayo Clinic in just cause asthma, it causes other Rochester, Minn. Dr. Monroe King lung diseases. is an associate professor of medicine in the division of allergy and King: Older people who get asthimmunology at the University of ma tend to have fewer allergies.

South Florida and a consultant to The course of their illness is stormthe National Institute on Aging for ier — they tend to have more asthma and allergic diseases. This exacerbations of asthma, more hosstory represents an edited version pitalizations and the highest rate of of their remarks, made in separate death of any age group. That may interviews. be because older people’s immune systems aren’t as robust as younger Q: Can people get asthma for the adults. Also, older people tend to first time later in life? get more respiratory infections.

Chicago Tribune

Reed: Yes. Our epidemiologic studies in Rochester showed us that asthma can start at all ages, even in the elderly. At the same time, people continue to recover from asthma even after age 65.

We’re not sure exactly why, but we think it’s because something in their environment changes.

King: There are two peaks of asthma onset: One, in children and younger adults; the other, in people middle age and older.

Q: What about treatment of older adults with asthma?

Reed: Older adults often tend to have a poorer response to treatment. Also, they often have other conditions that can make it difficult for a physician to sort out all the details. Young people with asthma are all pretty much similar.

Older folks with asthma, each one is different.

King: Older people may also have more difficulty using asthma inhalQ: What distinguishes people ers if they have arthritis or probwho get asthma later? lems with coordination.

The asthma medications we use Reed: When older people get for older adults are the same. But asthma, they seem to have more because patients frequently have severe disease. When I reviewed co-occurring conditions and are the elderly asthmatics we saw at taking other drugs, there is more the Mayo Clinic — at least 1,000 risk of adverse reactions. a year — over 40 percent of them Take, for example, older people had irreversible lung diseases such with tremors. Asthma medicines

can increase tremors sometimes.

There are safety questions about some of the beta-agonists (medicines that help open the airways).

The FDA has a black box warning for those drugs that applies to everybody, but there are concerns that older people might be at greater risk, especially for heart troubles. Also, beta blockers and ACE inhibitors for hypertension can make asthma worse.

shown that women at menopause and older are three times more likely to be hospitalized as men with asthma. Women over the age of 65 are twice as likely to be hospitalized and twice as likely to die of asthma as men.

Q: What’s going on?

King: We don’t know if hormones directly affect asthma. But we do know that boys under the age of Q: I know there are gender differ- 12 have twice as much asthma ences with asthma. Is this true of as girls do. By age 20, girls have older adults? twice as much asthma as boys.This reaches a ratio of three to one by King: Yes. In studies by both the age of menopause. the Centers for Disease Control and the New York State Health Q: You mentioned that fewer Department, epidemiologists have Please see Senior asthma page 11

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Senior asthma Continued from page 10 older adults have allergy-induced asthma. Can you tell me more about this?

Reed: It’s really quite unusual for someone over the age of 40 to develop an allergy to something unless it’s something that they haven’t been exposed to before.

Yet, people still develop asthma in later middle age and beyond, even though they’re not getting allergies. This is called “intrinsic asthma” as contrasted to “allergic asthma.”

The cause of intrinsic asthma has not been established.The pathology and physiology is similar to allergic asthma, but the environment exposures and molecular processes that lead to airway inflammation have not been identified.

Q: Is getting an asthma diagnosis hard for older adults?

King: This condition is underdiagnosed, and patients don’t think of asthma as a disease older people can get. So, frequently older people attribute difficulty with breathing to aging. They just decrease their level of activity to accommodate it.

Q: What would you advise an elderly person who’s having problems breathing?

King: Have a pulmonary function test. And if your primary doctor can’t do one, get referred to a pulmonologist or an allergist who can.

Seniors and asthma Prevalence: Six percent to 10 percent of seniors may have asthma — a chronic inflammatory condition that affects airways in the lungs.

Symptoms: Coughing, chest tightness, shortness of breath, wheezing.

Diagnosis: Can be difficult, as asthma can co-exist with conditions that have similar symptoms, including chronic bronchitis, congestive heart failure, sinusitis, gastrointestinal reflux and chronic obstructive pulmonary disease.

Concerns: Drugs used to treat asthma can exacerbate osteoporosis. Drugs used to treat other conditions — betablockers, ACE inhibitors, aspirin, non-steroidal antiinflammatory medications — can trigger or worsen asthma.

Treatment: Eliminate environmental triggers such as dust mites or mold. Use medications to reduce inflammation and open inflamed airways.

SOURCE: American Academy of Allergy, Asthma & Immunology

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Sunday, April 24, 2011

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GAINESVILLE HEAR S E RV I C E S O F F E R E D

GAINESVILLE HEART AND VA S C U L A R G R O U P At Gainesville Heart & Vascular Group, we believe that the patient is the center of our practice. We are committed to providing the best possible care through diligent clinical evaluation and appropriate use of state-of-the-art technology. Guided by compassion for each individual, we strive to provide convenience and peace of mind to our patients by providing most services under one roof. Our ultimate goal — help our patients achieve a better quality of life.

• Adult Consultative Cardiology • ECG, Holter and Event Monitoring • Exercise Treadmill Testing • Echocardiography • Transesophageal Echocardiography • Stress Echocardiography • Myocardial Perfusion Imaging (Nuclear • Peripheral Vascular (claudication) Testin • Cardiac Catheterization (leg and wrist ac • Coronary Angioplasty and Stenting • Peripheral Vascular Angioplasty and Sten • Renal Angioplasty and Stenting • Pacemaker Implants • Loop Recorder Implants • Pacemaker and ICD Management • Anticoagulation Management • Lipid Management • Pulmonary Hypertension Testing

7 0 5 J e s s e J e w e l l P a r k w a y, S E , S u i t e 2 0 0 , G a i n

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Sunday, April 24, 2011

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RT AND VASCULAR GROUP Cardiovascular disease af fects

80,700,000 people in the United States.

• Coronary heart disease or disease in the blood vessels which supply oxygen to the heart affects 17,600,000.

• Myocardial infarction or a heart attack affects 8,500,000 people. There are 785,000 new heart attacks and 470,000 recurrent per year.

• Angina pectoris, chest pain or discomfort caused by reduced blood supply to the heart muscle, affects 10,200,000 people.

• Stroke or disturbance to brain function due to disturbance to the brain’s blood supply affects 6,400,000.

• Peripheral vascular disease or disease affecting the blood vessels of the arms and legs affects 10,000,000.

Scans) ng ccess)

nting

• Heart failure, the heart’s inability to meet the body’s demand, affects 5,800,000.

Risk factors associated with cardiovascular disease include age, diabetes, high blood pressure, high cholesterol, tobacco use and family history of cardiovascular disease. Symptoms associated with cardiovascular disease include chest pain, shortness of breath, arm/leg pain, loss of consciousness and fatigue.

We at the Gainesville Heart and Vascular Group specialize in prevention, diagnosis and treatment of cardiovascular disease. Established in 1994, the Gainesville Heart & Vascular Group, formerly known as the Gainesville Heart Group, is recognized as the first cardiology practice dedicated to the care of heart patients in Gainesville and surrounding areas.

Its founder, Dr. David P. Johnson is a Gainesville native who had a dream of providing full-time and full-service cardiac care to the community. He and his partners played an integral part in bringing the Open Heart Surgery program to Gainesville in 2002.

Our staff has a reputation of applying a personal touch to our care and cherishing the relationship we have with our patients. Our staff, including physicians, enjoys residing and being an active part of the Hall County community.

We would enjoy an opportunity to meet with you to prevent, diagnose and treat cardiovascular disease.

e s v i l l e • P h o n e 7 7 0 . 5 3 4 . 9 0 1 4 • w w w. g h v g . n e t

276255 4-24 em

Our office has a wide variety of services, including general cardiology consultation, electrocardiography, echocardiography/ 2-D Doppler, stress echocardiography, nuclear stress testing and ankle brachial pressure index. Our physicians are staffed round the clock, 365 days a year, at the Northeast Georgia Medical Center.

Cardiac catheterizations, including coronary and peripheral artery stenting, stress testing, transesophageal echocardiography and pacemaker devices are performed at the Northeast Georgia Medical Center.

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Sunday, April 24, 2011

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Sleep apnea no fun for sufferers or their kin

By Jeff Seidel

Detroit Free Press

Peter Manschot woke up in a hotel room and found his wife, Emily, sleeping in the bathroom.

“I felt really bad,”says Manschot, 63, of Novi, Mich.“She was curled up with blankets and whatever pillows she could scrounge, trying to make a bed out of the bath tub.”

It was the only place she could sleep because he was snoring so loudly.

Manschot’s snoring was a symptom of a much bigger problem.

He is among the estimated 18 million Americans with obstructive sleep apnea, a chronic condition in which the airway is blocked during sleep. It prevented Manschot from breathing and caused him to snore.

“Basically, I was waking up 30 or 40 times an hour,” Manschot says. Doctors evaluated him, and “they said on a scale of 1 to 10, I was a 12. They could hear me down the hall with the doors closed.”

The prevalence of sleep apnea is expected to grow with the rise in obesity and the aging population, because age and weight are two factors that increase the chances of developing the chronic condition in which the back of the throat relaxes and the airway becomes blocked.

For some, surgery can alleviate the problem. For others, the use of a continuous positive airway pressure (CPAP) machine opens up the airways and allows for more normal breathing during sleep.

Manschot was prescribed a CPAP machine — the most common treatment for sleep apnea.

The machine pumps air through a hose and into a mask that fits over a person’s mouth and nose, or just over the nose. The machine gently blows air into the throat, artificially holding the airway open.

“Now, I’m sleeping through the night and have been for years,” Manschot says. “I think it’s immensely benefited me.”

Emily Maschot is thrilled that her husband is now sleeping through the night — it means, she is, too.

“I think it has saved our marriage,” she says,“and maybe even saved his life.”

Untreated sleep apnea can increase the risk of high blood pressure, heart attack, stroke, obesity and diabetes.

Neither the CPAP machine nor surgery helped Tom Norgiel, 50, of Walled Lake, Mich.

For years, he’d searched for a way to get a good night’s rest.

He was diagnosed about eight years ago with moderate obstructive sleep apnea. Doctors tried to treat the problem with a CPAP machine, but he didn’t like using it. Some people find the masks uncomfortable and the machines too loud.

About five years ago, Norgiel had surgery to try to improve his breathing at night. Surgery usually involves shrinking, stiffening or removing excess tissue in the mouth and throat or resetting the lower jaw, according to the National Institutes of Please see Apnea page 15

Sleep apnea risks Sleep apnea is a chronic condition that requires long-term management. If left untreated, it can lead to increased risk of: • High blood pressure, stroke, obesity and diabetes • Heart failure, heart attack and irregular heartbeats • Having work-related or driving accidents Source: National Institutes of Health

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Apnea Continued from page 14 Health. “I had implants put into my mouth,” Norgiel says. “It supposedly makes your soft palate more rigid.”

But it didn’t help.

Then, Norgiel visited Dr. Bruce Luria, a Dearborn dentist who makes a dental device that looks like a mouth guard. The appliance forces Norgiel’s jaw forward slightly, pulling his tongue from the back of his throat and opening up the blocked airway.

“When I have that thing on, I don’t snore a bit,” Norgiel says.

“It’s like night and day.

“It’s made a huge improvement for me. I sleep a lot longer.”

The use of dental devices to treat sleep apnea is growing in popularity, according to Sheri Katz, the president of the American Academy of Dental Sleep Medicine, a national organization that provides training and resources for dentists and orthodontists who treat sleep apnea.

And that popularity is expected to surge even more. Beginning this year, Medicare is going to consider coverage for customfabricated dental devices to treat mild and moderate cases of sleep apnea — although a pay structure has yet to be determined.

Many insurance companies also cover at least some of the cost of these devices.

“If a patient is covered for CPAP, most insurance companies Please see Apnea page 16

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The Times, Gainesville, Georgia |

Apnea

Symptoms of sleep apnea One of the most common signs of obstructive sleep apnea is loud, habitual snoring, although not everyone who snores has sleep apnea.

Other signs to watch for : Sleepiness Morning headaches Memory or learning problems and not being able to concentrate Feeling irritable, depressed or having mood swings or personality changes A dry throat when you wake up

Continued from page 15 will cover oral appliance therapy under the right protocol,” Katz says. “It’s also covered for people who have severe sleep apnea and have failed to use CPAP.” For people who have no trouble with the CPAP treatment, the trend is moving toward smaller masks, lighter equipment and smaller machines.

“They seem to make them more attractive, so you don’t mind having them on your bedside table,” says Joy Lucas, who has been a sleep technician for nine years at St. Joseph Sleep Disorders Center in Auburn Hills.

Lucas says there are several variations of masks for the machines.

“We tried to figure it out once, and there were something like 180 different types of masks,” Lucas says. “Basically, there are three types: There is a mask that goes over the nose, there is a mask that goes in the nose, and there is a mask that goes over the nose and mouth.”

Different machines have different comfort features.

“One decreases the pressure as you exhale, or they might have heated tubing.”

Lucas says some women have apprehension about wearing the CPAP mask.

“Maybe it’s a little harder for women because it’s not very attractive,” Lucas says.“It just kind of gets in the way of things.”

As an alternative to CPAP, dental devices can be 90 percent effective for mild to moderate cases of

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Source: National Institutes of Health

What’s your snore score?

Answer these questions to find out whether you may have sleep apnea: 1) Are you a loud or regular snorer?

2) Have you ever been observed to gasp or stop breathing during sleep?

3) Do you feel tired or groggy upon awakening, or do you awaken with a headache?

4) Are you often tired or fatigued during waking hours?

5) Do you fall asleep sitting, reading, watching TV or driving?

6) Do you often have problems with memory or concentration?

Thomas Norgiel, of Walled Lake, shows off his BIPAP machine he used to help him sleep.

Norgiel suffers from sleep apnea and has tried many remedies to get a good night’s rest.

sleep apnea, Katz says, but there can be a downside.

“In more than half the cases, teeth can shift,” she says. And when that happens, the devices need to be altered or patients may need braces.

Luria makes dental devices only for patients who can’t use a CPAP machine.

“If you can wear the mask, wear the mask,” Luria says. “CPAP machines work phenomenally.

But not everyone can wear the masks. That’s how dentistry got involved in this.”

Luria says the dental appliances cost anywhere from $1,200 to $2,500. But all of them do the same thing: They move the jaw forward, pulling the tongue out of the back of the throat.

“It’s not like your tongue is hanging out of your mouth,” he says. “It’s just that the back of your throat remains open.”

If you or someone close to you answers “yes” to any of these questions, you should discuss your symptoms with your physician or a sleep specialist. Factors that increase the risk of having sleep apnea include being overweight or obese, having a large neck and having high blood pressure.

Source: American Sleep Apnea Association

The Times, Gainesville, Georgia |

Keep your toothbrush healthy

By Alison Johnson

Daily Press (Newport News, Va.)

Brushing (and flossing) is the best way to protect your teeth and gums — but not if your toothbrush is in bad shape. “Toothbrush bristles that are worn or frayed from use cannot effectively remove plaque, which is critical to maintaining healthy teeth and gums,” says Sebastiana Springmann, a dentist in Williamsburg, Va. Some advice: • Don’t cover up brushes between uses. Allow them to airdry instead. Bacteria and other organisms will grow faster on bristles kept in a closed, damp environment.

• Rinse them thoroughly. After each use, hold brushes under running tap water until you’ve cleaned off all remaining toothpaste and visible debris.

• Store them correctly. Place brushes in an upright position to best air them out. Also keep them at least 6 feet away from a toilet to avoid contamination with (yuck) airborne particles after a flush.

• Don’t share brushes. You’ll be swapping germs with the other user, which can make you sick. If you store more than one brush in the same container, keep their heads completely separated.

• Replace them often. Get a new brush at least once every three or four months, and after each time you’ve been sick, according to the American Dental Association,

or ADA. If bristles look worn or frayed, the brush needs to go.

Children may need replacements more often than adults.

• Consider disinfecting them.

Some dentists recommend soaking brushes in an antibacterial mouthwash such as Listerine for five minutes a day. You also can buy an ADA-approved sanitizer machine, which uses ultraviolet lamps or steam and dry heat to fry nearly all bacteria and viruses.

Just note: Studies to date haven’t confirmed a health benefit, and not all dentists believe frequent disinfecting is necessary.

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Full body scans needed to check for osteoporosis

By Shannon Casas

scasas@gainesvilletimes.com

As people age, a certain amount of bone loss is natural, but for some, that loss becomes too much and can develop into osteoporosis.

The problem means that bones are less dense than they used to be, leaving them brittle and at greater risk of fracture.

But how do you know whether you’re developing this problem?

Back pain and tenderness, height loss and a slight curving of the back are a few symptoms, according to a patient education pamphlet put out by the American College of Obstetricians and Gynecologists.

Risk factors include taking certain medications, personal history of fracture, family history of osteoporosis, poor nutrition, low body weight, lack of exercise and early menopause. Women are more at risk than men.

At about age 50, depending on risk factors, women should begin getting full body scans to determine if they have osteoporosis, said Regina Bennett, a radiological technologist and registered diagnostic medical stenographer with Heritage Obstetrics & Gynecology, which has locations in Gainesville and Braselton “It is the best diagnostic testing for osteoporosis,” Bennett said.

“The reason we do the spine, the hip, is because of the density, which is a coarser density; it’s a thicker density and so you want to make sure that that bone material is not being broken down.”

Dual-energy X-ray Absorptio-

metry is the most accurate test available, according to the American College of Obstetricians and Gynecologists. During the test, a patient lies down while a device scans the body. The test provides a T-score, which compares the patient’s bone density to that of a healthy 30-year-old.

A score of minus 1 to minus 2.5 means you’re at risk for osteoporosis; a score less than minus 2.5 means you have osteoporosis.

There are other scanning methods. Quantitative Computed Tomography tests the bone density of the spine and provides three-dimensional images, but it requires more radiation than the DXA. Quantitative Ultrasonography uses sound waves instead of radiation, but it is not as accurate as other tests, according to the American College of Obstetricians and Gynecologists.

Once you determine whether you have the disease, treatments include a variety of medications such as bisphosphonates, selective estrogen receptor modulators and hormone therapy, according to the American College of Obstetricians and Gynecologists.

What’s even better, of course, is preventing the disease. Getting enough calcium and Vitamin D is important, along with weightbearing exercises, such as step aerobics, brisk walking or games like tennis.

“There’s certain diet factors,” Bennet said. “Be sure you get your calcium levels, get your screening tests — some people are just predestined to it according to family history ... weigh all your odds out on that.”

Sara Guevara / The Times Dr. Holt Harrison, right, views a bone density scan with ultrasound technician Davita Sosebee April 15 at Heritage Obstetrics & Gynecology in Gainesville.

The Times, Gainesville, Georgia |

CPR Continued from page 7 lines.

“This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygenrich blood circulating through the body. Changing the sequence from A-B-C to C-A-B for adults and children allows all rescuers to begin chest compressions right away.”

Every five years, the heart association uses research from “resuscitation experts” to decide if any changes should be made to their guidelines for treating cardiac emergencies.

According to the group, when CPR is administered immedi-

ately after a person goes into cardiac arrest, their chances of survival are doubled, sometimes tripled.

The American Red Cross is responsible for training thousands of individuals each year in current CPR techniques.

Last month, the organization began offering what it has deemed “the next generation” of first aid and CPR training.

The Northeast Georgia Chapter of the American Red Cross, which includes Hall County, offers a number of CPR training courses throughout the year. The chapter offers training for professional rescuers and also for the average citizen. There’s even a pet first aid and CPR course.

A full class schedule and pricing list is available on the organization’s website.

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New treatment for lupus offers hope for sufferers

By Harry Jackson Jr.

neered an anti-antibody that seeks out and prevents one of the big, errant cells from producing more bad antibodies.

“It’s much more complicated than that, but essentially that’s how it works,” he said. “What’s important is we’ve had success at developing a targeted therapy for lupus so more and better targeted therapies will be available in the future,” Brasington said.

“This new drug is not perfect, but it’s the next step to improving people’s lives,” he said.

Indeed, Aton described her life before lupus as “Type A.” She has a bachelor’s degree in chemistry and a master’s degree in industrial hygiene and toxicology. She scrutinized health practices of companies, consulted for other

St. Louis Post-Dispatch

Lupus causes Elizabeth Aton’s left hand to tremble while an intravenous needle is placed into the top of her right hand.

She drives about 235 miles a month, round trip, from her home in Pittsfield, Ill., to St. Louis for a two-hour treatment that eases her lupus.

The treatment is brand-named Benlysta, generic name belimumab, developed by Human Genome Sciences and GlaxoSmithKline.

The U.S. Food and Drug Administration approved it March 12 to fanfare by supporters of lupus research. Benlysta is the first medication developed in 50 years exclusively to treat lupus.

About 1.5 million Americans have lupus, according to the Lupus Foundation.

Dr. Richard Brasington, professor of medicine and rheumatologist with Washington University School of Medicine, led the research in St. Louis that included Aton.

The medication isn’t perfect, he said. It stands to help fewer than half of the cases, he said. Also, it doesn’t work well on black people as a group, although some individuals have benefited. The reason remains a mystery.

The real triumph is that the drug was developed and approved, he said.

“It opens the door to pharmaceutical companies looking for better (medications),” he said.

That’s a breakthrough because lupus is a difficult condition to treat.

The Lupus Foundation of America defines lupus as an auto-

Richard D. Brasington, MD, is a professor of medicine in the Division of Rheumatology at Washington University.

immune disease — an immune system that attacks its own body.

It’s similar to rheumatoid arthritis where the immune system attacks the joints. But the foundation says systemic lupus, the most common form, attacks all of the other systems, including the nervous, cardiovascular, digestive, renal and skeletal.

Brasington said it’s difficult to corner because the condition comes from multiple sources within the immune system.

Doctors most often work to relieve symptoms, he said.

In the case of Benlysta, researchers learned that some of the antibodies that attack the person’s body are produced by larger immunity cells.

The drug companies engi-

companies, and sat on community betterment committees in St. Louis.

Her diagnosis in 1993 was the beginning of the end of that life.

Over time, the eye pain, joint pain, fatigue, paralysis, nausea and muscle pain became unbearable and hospitalized her two to three times a year.

By 1998, she had reduced her work to part time, working in research at Barnes-Jewish Hospital.

But that slowed eventually and she had to quit altogether.

“I liked being a competent person, and suddenly I was not,” she said.

Therapy during flare-ups included increased steroids, morphine Please see Lupus page 21

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Lupus Continued from page 20 for the pain. “I developed that buffalo hump on my back and osteoporosis from the Prednisone (steroid),” she said. “Bad as that was, it wasn’t as bad as the disease.”

The trial for the medication began in 2004. She doesn’t know if she had the medication or a placebo.

In 2005, she entered the “open label” stage, taking the medication at the dosage the drug companies recommended.

Her life has improved markedly.

The two-to-three flare-ups a year reduced to one every other year. She has reduced the use of steroid dosages by half. She’s moving around again with much less pain.

Aton recently got some good news. The study has been extended 10 years to keep an eye on the long-term effects on 40 people selected from those who were in the trials nationwide. That means she gets the drug for free.

That’s a good deal. The drug treatment will be expensive, as much as $35,000 a year. It’s a bioengineered antibody that’s slow and expensive to produce, Brasington said.

While Benlysta is available now, it won’t be in wider use just yet, Brasington said.

Because of cost, medical insurance companies “will still want patients to use other (medicines) and if they don’t work, then they can graduate to this,” he said.

What’s just as important, “... is that she’s getting her life back,” he said.

“This is humbling,” she said. “I

can’t do all the things I used to do, but it’s giving me a little more time.”

So she mentors graduate students working fellowships through the Semiconductor Environmental Health Association and performs some consulting.

“I’m having more fun with family and friends,” she said. She has 19 nieces and nephews.

“It’s fun watching the next generation and the generation after that — seeing that the family will continue,” she said.

Will the drug prolong her life, considering lupus shortens life by years? “We don’t know,” said Brasington. “That will take 10, 20 years to know.”

MORE INFORMATION ABOUT LUPUS Lupus Foundation of America: lupus.org Statement by Human Genome Sciences and GlaxoSmithKline on the FDA approval of Benlysta for treatment of lupus: alturl.com/i93gs Help paying for Benlysta: benlysta.com/copaybrochure.pdf Living Well with lupus, an online support group: alturl.com/6zvph

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Stimulus money stimulating shift to electronic medical records

By Bruce Japsen

Chicago Tribune

Jennifer Gomez sat at her doctor’s office after her appointment, waiting for a handwritten prescription. Minutes later, her doctor wondered why Gomez was still in the office.

What the 20-year-old Loyola University Chicago student didn’t know was that not only had the prescription been sent to the pharmacy, it also was ready to be filled.

“The prescription was at my pharmacy before I even walked out of the office, because everything is computerized,” Gomez said of her experience at a clinic run by NorthShore University HealthSystem. “I was surprised, expecting to wait.”

Gomez is among the first patients to experience the benefits of electronic medical records, as the nation’s health care industry moves from paper files to computerized records. The momentum is expected to pick up this year as federal stimulus money to help with the transition is starting to arrive at doctor offices and hospitals across the U.S. Already, hundreds of hospital operators nationwide, including the largest ones in the Chicago area such as NorthShore, have entered the digital age, allowing patients to access email alerts to remind them of appointments, request medical test results or easily connect with insurance companies, pharmacies and other key players of the health care system.

Industry observers project the digitizing of medical records

could save the nation’s health the efficient sharing of medical that if you give me your prescripcare system hundreds of mil- information. lions of dollars because it would “Most physicians will tell you Please see Medical records page 23 reduce or eliminate redundant testing and the occurrence of errors in patients’ files, among other benefits.

“If you are an emergency room doctor and you are trying to figure out what to do next, an electronic medical record may prevent you from having to do another” test, Dave Seaman, chief executive of Pronger Smith Medical Care, said of expensive procedures such as MRIs and other diagnostic imaging that can cost hundreds or thousands of dollars.

About 90 percent of the medical care providers at Pronger Smith, which has more than 60 doctors, physician’s assistants and nurse practitioners in Tinley Park and Blue Island and handles about 50,000 patients each year, have implemented electronic medical records, Seaman said.

As more health care systems adopt electronic records, consumers also should benefit from

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Medical records Continued from page 22 tions that you are on and show me your lab tests, that tells a pretty good snapshot of a patient,” Seaman said. “(Without electronic records), you’d have all these lab test results, and you would have them in 50 to 100 sheets of paper, if the patient even had them.”

The shift to electronic medical records has been in the works for years, but obstacles such as the cost of digitizing files and concerns about patient privacy have held back many hospitals and physician practices.

A key hurdle has been the doctors themselves. The physician community is highly fragmented, numbering in the hundreds of thousands, with more than 60 percent of office-based physicians in single or a small practice of four doctors or fewer, according to the American Medical Association. So coordinating implementation has been a battle.

These doctors also have been concerned about the affordability of information systems, which can cost tens of thousands of dollars for a small practice. The doctors also worry whether the systems will work and whether they can communicate with other computerized medical systems.

In 2009, Congress passed and President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health Act, which was part of the federal stimulus legislation known as the American Reinvestment and Recovery Act. The legislation aims to provide

more than $20 billion to get doctors and hospitals to use electronic medical records, computerized prescription systems and other health information technology.

And doctors for the first time are eligible to begin getting more than $40,000 in extra Medicare payments this year if they upgrade their health information technology. If doctors can’t demonstrate the “meaningful use” of certified electronic health record system by 2015, they face reduced Medicare payments, federal health officials say.

The financial support is paying off, the nation’s top health official said.

“In the last two years, the share of primary care providers using a basic electronic health record has gone from under 20 percent to nearly 30 percent,” Kathleen Sebelius, secretary of Health and Human Services, told hospitals and health systems in February at the Health Information and Management Systems Society annual meeting in Orlando, Fla. “When President Obama came into office, only two in 10 doctors ... used even a basic electronic health record system. Over the last two years, we’ve created unprecedented momentum behind health information technology.”

But challenges are expected to remain for smaller and solo doctor offices, analysts say.

“The initial startup and transition is difficult,” said Dr. Stephen Sproul, a family physician at Advocate Lutheran General Hospital in Park Ridge.

“You have to learn a whole new way of documenting your patient care and managing your patient interactions, and that change is difficult,” Sproul said.“You start to see a light at the end of the tunnel after about a year. Physicians have to be patient, but they will see results.”

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