A medical publication from Scripps Howard
Navigating Future What the top healthcare minds in Memphis see on the horizon.
NASA may have put a man on the moon, but we got kids to walk there and back.
In the past five years, the BlueCross WalkingWorks® for Schools program has encouraged Tennessee’s kids to walk more than 17 million miles. That’s 35 trips to the moon and back. Next, let’s take on Neptune. BlueCross BlueShield of Tennessee is for Tennessee. Committed to helping kids get walking and
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get healthy. Get involved at bcbst.com/impact. ©2011 BlueCross BlueShield of Tennessee, Inc. is an Independent Licensee of the BlueCross BlueShield Association.
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When the problem is pain, we’re here to help. Unlike other medical problems, pain can’t be seen or measured; like love, only the person who feels it knows. This makes the diagnosis and treatment of pain a true medical art where physicians must be experienced and knowledgeable, but also enthusiastic, persistent and dedicated. Ask your doctor and your friends about us.
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DECEMBER 2011 issue Welcome to the December issue of Good Health! We are proud of our cover story, as a distinguished panel of health care experts from differing perspectives gave us their insight into the evolution of health care. They have certainly given us some food for thought as we look into the upcoming medical challenges in the next decades. We also have information on exercise for seniors, life care plans for senior care, acupuncture for fat reduction and the basics of celiac disease, among several other topics. And the holidays are upon us! Let us all try to walk off what we eat, pace ourselves and indulge within some sensible parameters. I won’t think that 5 pounds is worth it come January, will you? Here are some tips to keep yourself in check that I found: 1. Eat a high protein meal for breakfast before heading to family or friend’s houses. You will feel fuller and be less likely to overeat. 2. Chew gum! Food doesn’t taste right and isn’t as easy to eat if you have a piece of gum in your mouth. This tip works especially well if you’re the one who is preparing the meal. 3. Serve raw vegetables for your snacks while waiting on your holiday meal instead of serving or munching on chips, dips, and heavy foods, eat raw veggies instead. 4. Drink plenty of cold or iced water between snacks and meals. Ice water causes your body to digest food differently and make you feel fuller. 5. Indulge! Allow yourself to snack, even if you are on a diet. The more you try to avoid certain foods, the more you’re going to crave them. Only take a small bite of each thing you want, instead of heaping it on the plate.
Ginger H. Porter
table of contents
Navigating the Future What Top Healthcare Minds in Memphis see on the Horizon by Ginger H. Porter | Photos by Donny Granger
Helpful Hints for Avoiding Holiday Depression
Swollen Ankles and Legs Memphis Vein Center
A New Approach to Hip Replacement OrthoMemphis
Non-surgical Liposuction Alternative Midtown Acupuncture and Wellness Center
Department Coordinator Chip Wiley Creative Director Jason Prater
A Home for Living and for Life Kirby Pine Retirement Community
VP Of Business Development Rob Jiranek Director Of Production & Printing Scott Binford
Lakeside Behavorial Health System
Fitness is Crucial to the Senior Population
SCRIPPS BC DEVELOPMENT
When Should You go to the ER? Saint Francis Healthcare
A Primer on Celiac Disease Memphis Gastroenterology Group, P.C.
Designer Tina Lovett Associate Publisher Elizabeth Williams Editor Ginger H. Porter Good Health Magazine, a monthly publication from Scripps Howard, serves as the medical crossroads where top local physicians bring patients the latest news about treatment, technology, and medicine. All rights reserved. Reproduction in whole or part without written permission is prohibited. Copyright 2011. For more information on advertising your medical practice in Good Health, contact Elizabeth Williams at 901.529.6502 or e-mail firstname.lastname@example.org 495 Union Avenue, Memphis, TN 38103 www.goodhealthmemphis.com
Margaret Metz, Family Cancer Center Patient Since she was diagnosed with advanced breast cancer in 2006, Margaret has Ridden a camel in Morocco, Bicycled through tulip fields in Holland,
Gone ballooning in France, Shopped for antique kimonos in Japan, Hiked on Roman roads in Tunisia.
what’s your story? www.familycancercenter.com 901.747.9081
It’s not what we treat, it’s who.
navigating the future
What Top Healthcare Minds in Memphis See On the Horizon by Ginger H. Porter | Photos by Donny Granger
it. More of us are going to have a responsibility for our own health. We are going to increasingly see financial incentives as well as employers incenting in different ways for their employees to lead healthier lives. And the government is trying to do that. Along with that, we are going to see financial responsibility increasingly put back on the individual. You are seeing a lot of that happen now with HSAs (healthcare savings accounts), various restructuring of benefits, high deductibles, copays, savings accounts.
Gary Shorb President and CEO, Methodist Healthcare Systems
Hospitals are buying up physician practices, surgery center, diagnostic centers and the like. Why and what does that mean for the patient? It means a couple of things. From a patient perspective, for years, the industry has been organized in silos. So we have had hospitals as one organizational entity, physicians having their own, professional corporations, and then surgery centers have been freestanding. Increasingly as we look at better ways to provide the customer with seamless care, coming under one umbrella makes a lot of sense. When you look at the most successful models indicated for highly cost-effective care and great clinical quality of care, you see ones who have put all outpatient services under one hospital umbrella like the Mayo Clinic. Like Johns Hopkins. They are all fully integrated. That’s where we are headed. Economic pressures are a big part of this. As payments get squeezed, you have to come up with different models of care. It’s all coming together in what you are describing. Practices are being bought, care is being consolidated. My view is optimistic. I think it is a good thing. We are all working together more, communicating more, focusing on many more quality indicators than we have in the past. What keeps you awake at night? The fear that the least able to pay among us get squeezed out of this system of healthcare that we have. That these financial realities coupled with the demands result in restricted access. So our collective goal has to be to find ways to keep that from happening. That’s part of the employment strategy. Right now, if you are a Medicare patient, finding a primary care doctor is a real challenge with our work in primary care as we employ primary care physicians, they are incented in a way that makes the patient’s insurance coverage or payor not a concern for them because they get paid the same
Gary Shorb no matter who walks in the door, whether it is a patient with no coverage or not. That improves access to care from a community perspective. It improves a primary care physician’s salary. It makes primary care a lot more attractive to residents coming through our training program. We are trying to move primary care to a place of more expansion, and I think employment is an effective way to do that. What else do you see coming? We’ve already seen this and I think we will only see more of
How are hospitals coping with reimbursement changes and other challenges we have mentioned? I see two things. We are becoming more disciplined about how we do things on the supply side of the health system world. We are moving toward more exclusive contracts for medical devices to achieve higher levels of discounting. That really wouldn’t have worked five years ago. The reality is now we have to do things like that to realize more cost savings. The other thing is just redesigning care. Thinking through how we educate patients on the front end to make them fully aware of their illness, what’s going to happen to them, when we would expect to discharge them, to educate them the right way, to make sure the coordination of care in the hospital is done in the most effective way to get their imaging right, to get them through the system and well as quickly as possible. We have a saying “make every day just like a Tuesday.” For instance, don’t have a patient who is here on the weekend and does not get physical therapy. That happens in every hospital. It’s that kind of health care work redesign we are putting a lot of time and attention into.
When you look at the most successful models indicated for highly cost-effective care and great clinical quality of care, you see ones who have put all outpatient services under one hospital umbrella like the Mayo Clinic.
service that is increasingly important in the future of health care, but in a place like Memphis where overall there is a shortage of primary care, there’s just very inadequate resources and the demand for those is only going to get greater.
Executive Director, Christ Community Health Center What do you see in the future as the next round of health care changes that are going to come? My perspective is dramatically impacted because we deliver primary care because of who we serve and where we are located. There is the good and the bad. The services we provide are the services that will be more greatly valued in the future. If health reform is implemented in 2014 as it is designed, in Shelby County there will be a fairly significant number of low income folks who have been described as uninsured who will immediately be covered by Medicaid, the TennCare program. With these people with limited financial resources, it unleashes their pent-up demand for service. They no longer have to defer their problems for lack of ability to pay. I look at it that it is great we deliver a
What are the most common concerns you see in your patients? We do a lot of pediatrics—about 30 percent of our visits are pediatric visits. We are doing a lot of well child care, upper respiratory infections, GI upsets, the things you would typically see in a pediatric practice. We also do a lot of prenatal care for a lot of young, single pregnant women who are poorly prepared to be parents. Complications with those patients tend to be lifestyle or social issues. Then we get to the adults we see which are 60 percent of what we do—they tend to be chronically ill and have multiple chronic diseases. The rates of obesity and diabetes, hypertension, etc. are really astounding. They tend to be people who have not had the benefits of preventive health care. Many of them work to survive week to week—to feed their children, to have a place to live, to remain safe. They tend to make their lifestyle choices that don’t help such as unhealthy food and very little physical activity and they just end up with really poor health. What is your biggest present-day challenge at Christ Community? Every day, we have dozens of patients, sometimes as many as a hundred patients that we can’t see. We have more demand for our services than we have the capacity to deliver. And we have six medical clinics --Broad Ave., Frayser, Third St., Orange Mound, Hickory Hill, and University Health Center--and three dental clinics--Broad, Hickory Hill and Third Street Dental Centers--plus a mobile clinic that goes to homeless shelters. For those patients we can’t schedule every day—they are either deferring care or going to hospital emergency rooms. Also, we just have increasing numbers of people who are uninsured. Over a three year period of time we have seen our uninsured patients increase from 30 percent to almost 40 percent.
If health reform is implemented in 2014 as it is designed, in Shelby County there will be a fairly significant number of low income folks who have been described as uninsured who will immediately be covered by Medicaid, the TennCare program.
Memphis is a place that due to the history and the concentration of poverty here that we really see the negative impact of healthcare being oriented to hospitals and tertiary levels of care. We see the negative consequences of that because we see the hundreds of thousands of people who can’t get health care. They drive the status of our community. At least health reform with different forms of payment and different structures holds some promise that more of our resources will be expended on people with the greatest need. I do have somewhat of a sense of optimism going forward. It took decades and decades to build the health system we have now. It will take decades and decades to build the health care system of the future that is focused on community based primary care.
James K. Ensor, MD
Germantown Wellness and Internal Medicine, Immediate Past President of the Memphis Medical Society What forces are at work for hospitals to be buying up physician practices diagnostic centers and surgery centers? Since 2000, Medicare has decreased the reimbursement to physicians every single year. So you have a 50 percent cut from what you were paid in 2000, but the other side is your office costs have gone up 40 percent, so you are getting really close to where your costs of your office are starting to exceed your revenue. In any other venue, you would raise your charges to handle the cost of your business. Healthcare is different. Reimbursement has been for doing in office procedures at the cardiologist to the point where it has been below the cost of providing the procedure. The problem is practices buy equipment not with cash but with a line of credit, so you are looking at the major groups in this city being bankrupted in a matter of months. Hospitals, realizing they were about to lose the cream of area doctors, jumped in and bought the practices, made them part of the hospital and in essence saved that from happening. Now, being part of the hospital, the cost of doing procedures has quadrupled in price because they are now based on hospital charges. Why is there such a shortage of primary care doctors? For the last five years, two percent of the graduating class at medical schools in this country has been primary care--defined as internal medicine, pediatrics, family practice, ob/gyn and general surgery. So you have 2 percent of 20,000 students in medical schools across the country to
accommodate primary care for millions of people. The students really have no choice in the matter. Medical loans now average a quarter of a million dollars or more. They may have altruistic opinions about doing primary care, but the reality is paying of this debt changes their direction. They tend to gravitate toward the specialties, which pay more. Also, now about 50 percent of your medical classes are female, which sounds good until you recognize that these young women may have more in mind for their lives than practicing medicine. They may decide to have a family. A study at UT found that for four female graduates of a private practice program, at 10 years you had one full time, two part-time and one had stopped practicing. So for four females, you get two practicing doctors in 10 years. So you have decreasing numbers of doctors coming out, increasing populations who need them, the shift in the demographic for what a doctor is, and we are set for the perfect storm. The TMA (TN Med Assoc) made comment this spring in their annual meeting in Nashville that in rural areas care will be rendered most by young men and women who are nurse practitioners. I walked into a hospital and saw my colleague on the phone, panicked. “Jim, I’ve got a nurse practitioner in the emergency room in over her head taking care of an aneurism and dissection.” That’s what is already happening. Independent care and practice by nurses out in some communities in essence are practicing medicine with no oversight. You have nurse practitioners doing epidural blocks by themselves. Their supervising doc is in Phoenix. I don’t know anyone that would feel that is a good level of health care. What you are probably looking at is a collapse before common sense begins to set in.
Medicare docs are terrified because they have been waiting for the government to fix these problems they promised to fix ten years ago and nothing has been done. This is one of the reasons docs have frozen their Medicare practices or stopped seeing Medicare patients all together. I think it’s tragic that’s the way this country treats its seniors, but that’s the way it treats its poor folks as well. We are making it impossible to buy insurance with all these regulations and we have done all these things to run the cost of health care through the ceiling.
Two main problems with government role in health care: We fail to take care of our brother and we keep trying to prove socialism works. People say what about Europe? There was an article that came out about a country just to the north of the U.S. that had the best health care available. It’s called Minnesota. The study took the various states of our country and compared them by size, demographics and resources, to the various countries in Europe. And they beat the Europeans every time in longevity, access, but no one is going to pay attention to that--because it is not within conventional thinking.
Where are all these market forces and legislation pushing us? In order to maintain this massive government that we can’t pay for, we are going to cut Social Security to our seniors and Medicare. The
In order to maintain this massive government that we can’t pay for, we are going to cut Social Security to our seniors and Medicare.
James K. Ensor
MERRY CHRISTMAS I CAN’T AFFORD THAT
Is There a Way Out? HAPPY HANUKKAH
NOT ANOTHER PARTY MISS MY FAMILY
I NEED A BREAK
Every year, over 21 million adult Americans suffer from a depressive illness. It’s more than just being sad or feeling down after a bad day. It is a complex state of mind that is felt all the time. It affects not only the individual but also those around them. It creates other medical disorders and can lead to thoughts of death and suicide. The holidays can be especially difficult. Don’t Suffer. Call us for help. Our trained staff of professionals is available 24/7/365.
I FEEL SO ALONE I NEED A DRINK I CAN’T FIND A JOB
I Feel Trapped
the sooner you call lakeside, the better it will be for everybody.
Helpful Hints for avoiding Holiday Depression It is no secret the holidays can be difficult. This time can be filled with parties, celebrations, and social gatherings with family and friends, but at the same time, it can be filled with sadness, self-reflection, loneliness and anxiety. The loss or absence of family and friends can create an increased sense of loneliness during the holidays. The recently bereaved are experiencing all their “firsts” without their loved one, and it seems Thanksgiving through New Year’s are especially low points. As early as late summer, retailers begin promoting the holiday season, and the burden of budgets, lists, a jammed calendar, decorating, cooking, buying and wrapping is on the mind. Anxiety and stress builds and weighs us down. We get easily overwhelmed. The stress of the holidays may cause people who do not view themselves as “depressed” to develop stress responses, such as headaches, excessive drinking, overeating and insomnia. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress and makes you more susceptible to colds. Overcommercialization and financial stress can peak right before the holidays and then show up again in January when the bills come in. Then again, some experience postholiday sadness after New Year’s/ January 1st, resulting from unmet expectations and disappointments from the previous year, coupled with stress and fatigue.
The holidays can be especially difficult. Don’t suffer. Call us for help.
Shortened winter days can also cause some change in behavior. Most people find they eat and sleep slightly more in wintertime and dislike the dark mornings and short days, which can be a trigger for a depressed mood. Relationships can also cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re put together for several days. Although there may be no statistical increase in depressive or suicidal thoughts during the holidays, most experts agree that this time of year, above all others, has the right mix of variables that contribute to feeling overwhelmed. The holidays weren’t designed to create lasting happiness but are just a brief moment in time to celebrate, in your family’s tradition, what is important to you. There are a variety of ways to approach November and December effectively. To create a lasting feeling of happiness, tap into your sense of purpose and meaning in life. These are more significant factors to happiness than the pursuit of pleasure. If you are involved in community or spiritual activities, you are more likely to have a greater satisfaction with life. A little depression or sadness during or after the holidays is normal…even the happiest of people have bad days. However, do not neglect yourself if your episodes become more frequent, more intense and more prolonged… contact your doctor or a counselor.
10 WAYS TO PREVENT “THE BLUES” 1. Learn to say no. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for lost time. 2. List all the things that need to be done, and if possible, delegate! If not possible, cut back. Prioritize important activities, then add them to your schedule…but spread them out over time to lessen the burden. Do not take on more than you can handle. 3. Try something new—celebrate the holidays in a new way. This especially applies to people who are grieving. Sometimes keeping everything the way it has been just magnifies the hole that is present without your loved one. In addition, it is normal to feel sadness and grief and express those feelings. 4. Keep up with holiday spending and make a plan to pay off those bills. Plan to put aside a little money to pay for next year. 5. Try to live in the moment and enjoy the present. Don’t be chained with someone’s unrealistic expectations (or your own). Be liberated by enjoying the now. 6. Limit your consumption of alcohol, since excessive drinking will only increase your feelings of depression. Don’t overeat. Overindulgence only adds to stress and guilt. 7. Surround yourself with supportive and caring people. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Set aside grievances until a more appropriate time for discussion. 8. Reach out to others. If you feel lonely or isolated, seek out community, religious or other social entities. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships. 9. Look at the blank calendar for the New Year – this is a clean slate. How to make the best of it is up to you. Take some time to think of your direction this year. 10. Get out. Just because the weather is cold and dreary doesn’t mean you were made to hibernate. Bundle up and get outside, even if it is just for a short time.
Lakeside Behavioral Health System has served the greater-Memphis area for over 30 years, and provides behavioral health and addiction treatment for children, adolescents, young adults and seniors in an inpatient, residential, day treatment and outpatient setting.
for a lifetime.
Maybe you have always wanted to try your hand at painting, but never had the time. Maybe you would love to take up water aerobics, but canâ€™t find an exercise partner. Perhaps you just dream of quiet mornings on your patio overlooking the natural beauty. Whether youâ€™re seeking a life of adventure, the amenities of a resort or simply a community where close friends are always nearby, Trezevant can make it happen. The Trezevant lifestyle is paired with quality health care and personal options that lead to a fulfilling life. Call us at (901) 515-2800 to schedule a personal tour at your convenience.
177 North Highland Street | Memphis, TN
www.trezevantmanor.org We are proud to be the only retirement community in the Memphis area that is fully accredited by CARF-CCAC.
Fitness is Crucial to the Senior Population
“Fitness is such an important part of our overall well-being,” remarks Rinnie Wood, Trezevant’s fitness director. “And, it is particularly important for seniors who are dealing with arthritis and related issues to stay active, stretch and increase circulation and flexibility.” Residents participating in “Steppin’ it Up” earned points for every activity, workout or class they attended throughout the week. Activities included an on-site ALS Walk, line dancing and Middle Eastern dancing, chair massages and demonstrations on new classes such as seated Tai Chi. The on-site ALS Walk held a particular significance for residents because Trezevant’s participation was in honor of John Elkins, Trezevant’s former fitness director who suffers from ALS. “We feel it’s important to raise awareness of this disease,” remarks Wood. “We are honored to be able to participate on behalf of my predecessor who did so much raise awareness of the need to remain active as a key
▲ Trezevant resident Jack Gordon poses with his wife, Mary Alice Gordon, and shows off his prize pedometer that he won in a drawing as part of Trezevant’s “Steppin’ It Up” fitness week.
source of wellness, a message that continues now at Trezevant.”
The week also included several educational talks by area health care professionals such as Dr. Patrick Toy, a physician with Campbell Clinic who discussed orthopedic issues commonly affecting seniors such as dealing with joint replacement. Trezevant offers health-related classes to help residents. One example of this is the new Gentle Arthritis Aquatics class taught on Saturday mornings by Trezevant’s director of resident services, Obie Sue Thomas. This course is taught in a therapeutic, heated pool to help keep joints loose and increase flexibility. “Classes like this aim to reduce the pain and stiffness associated with arthritis,” says Thomas. “These exercises help increase muscle strength while improving overall balance and coordination.” Thomas understands firsthand the debilitating effect arthritis can have on one’s overall health. “Becoming certified to teach these courses has helped me deal with my own symptoms – and it also allows me to pass that relief on to residents who take advantage of these classes and can reap the benefits they offer.”
▲ Obie Sue Thomas (right), Trezevant’s director of resident services, teaches a Gentle Arthritis Aquatics class to residents in a therapeutic, heated pool. Increasing flexibility and balance are two of the main benefits of the new Gentle Arthritis Aquatics class at Trezevant. Trezevant residents participated in their on-site version of the ALS Walk. Over 25 residents walked about a mile on the path around Trezevant in honor of John Elkins, Trezevant’s former fitness director who has ALS. ▲
During the last week in October, Trezevant held its annual “Focus on Fitness” week. This year’s event, themed “Steppin’ it Up” featured weeklong events and a friendly competition among residents for prizes and awards for the most active and most spirited participants as well as other daily drawings for fitness-related prizes such as pedometers and water bottles.
One important takeaway from this week-long event is how to help residents incorporate a fitness regimen into their regular routine. “While it’s important to have an annual event focused on fitness, it is even more critical for us to ensure that our residents have a fitness plan that improves their lives all year round,” says Wood. For that reason, Trezevant is continually ▲ Trezevant residents Madexpanding upon its fitness offerings. eline Jehl (left) and Lu Smith (right) pause for a moment on Currently, the community offers evthe trail to pose with fitness erything from water aerobics and director Rinnie Wood (middle) seated Tai Chi to walking and stretchduring the ALS Walk held at Trezevant during Trezevant’s ing courses. “Varying your workout “Steppin’ It Up” fitness week. can help you stay engaged and ensure that you stick with exercise for life,” says Wood. “What’s important is that we keep moving and stay in motion to increase our circulation, ▲ Trezevant residents enjoyed a Middle Eastern dancing demonstration with dancers of Desert Rose Troupe as part of the senior community’s “Steppin’ It strength, flexibility and overall abil- the Up” fitness week in Trezevant’s Performing Arts Center. Meredith Page, Desert ity to enjoy life, particularly in our Rose Troupe dancer and Trezevant fitness staff member, performed for Trezevant residents. aging years.”
Freedom. Our specialized joint team is focused on giving you back the freedom to participate in the activities you enjoy. Your care begins with our fellowship trained orthopaedic surgeons and physical therapists designing the optimal rapid recovery plan for you. We care for patients with a multitude of diagnoses for the knee, hip, shoulder, and elbow. Discover more about our team and how we can get you back to an active lifestyle by visiting us online at www.orthomemphis.com.
901.259.1600 www.orthomemphis.com Sports
6286 Briarcrest Avenue
A division of MSK Group, P.C.
Tim Krahn, M.D., Randy Holcomb, M.D., Michael Neel, M.D., Jared Patterson, M.D., and Kenneth Weiss, M.D. Fellowship Trained Surgeons
Foot & Ankle
Memphis, TN 38120 Bourland Holcomb Jameson Krahn Neel Cole Sorensen Dowling Murrell Weiss Deneka Heck Patterson Fletcher Giel Massey
A New Approach to Hip Replacement The most frequent cause of discomfort and chronic hip pain is arthritis. Arthritis is the leading cause of disability in the United States. In fact, it’s estimated that one in five people in the United States has some form of arthritis. Two thirds of the people who have been diagnosed with arthritis are under the age of 65. When medication, physical therapy and other conservative methods of treatment no longer relieve pain, total hip replacement may be recommended. Total hip replacement helps relieve pain and may allow patients to perform some activities that before were limited. Between 200,000 and 300,000 hip replacement operations are performed in the United States each year, most of them in patients over the age of 60. According to the American Academy of Orthopaedic Surgeons (AAOS), only 5–10 percent of total hip replacements were in patients younger than 50 in 2002. Due to limited life expectancy of the prostheses, doctors had traditionally advised to put off hip replacement operations as long as possible to prevent undergoing another replacement later. However, Americans rising expectations of quality of life have meant having surgery sooner. Less people are willing to tolerate years of pain or limited activity. Newer, more advanced technology means longer lasting prostheses. Experts are estimating that well over half a million hip replacements a year will be done by the year 2015.
connections, and through healing, the patient has a more normal gait with less limping. During surgery, the patient is positioned on the back versus laying on his or her side, propped up with
In traditional surgery, the surgeon makes an incision along the side of the leg to access the hip joint. The natural head (ball) of the femur (thigh bone) is removed during surgery. The remaining preparation of the femur and acetabulum (socket) involves reshaping to allow solid, accurate alignment of the hip components. The femoral stem is inserted inside the thigh bone, and the acetabular shell is inserted inside the socket of the pelvis.
Small Incision in Upper Thigh
Each patient is different and has different needs, so surgical approaches are chosen with those needs in mind. However, the direct anterior approach (from the front) for hip replacement is gaining in popularity. For the patient, there is reduced tissue trauma and less muscle damage, because an area is used where there is an interval—the muscle actually spreads apart. So, unlike other hip surgical approaches, there is no detachment of the muscles during surgery. The hip has more normal mechanics because you have not disrupted muscle
Risks are: bleeding, infection, scar tissue, dislocation, blood clots, and weakness. These are the standard risks for a hip replacement regardless of the type of procedure. With anterior hip replacement, one risk factor is lessened—the chance of sciatic nerve damage. Due to the positioning of the body on the back, the surgeon is not near the sciatic nerve.
I tell my patients that it is not wrong to do the surgery one way or the other. It’s just another technique to use. The direct anterior approach is gaining in popularity nationwide. Physicians are taking extra courses and visiting other physicians to learn the approach, which caught on in the United States in the 1990s. This technically difficult procedure has gotten easier due to new technology and modifications in hip replacement hardware. Refinements in stems of implants lend themselves better to the direct anterior position. All of these modifications mean a less invasive procedure for the patient.
Muscle Easily Parted to Expose Joint
special implements, in more traditional approaches. There is a smaller incision and less scarring, usually less usage of pain medication, a quicker return to function, reduced physical therapy requirements and a reduced dislocation rate. Most people are candidates for the surgery. Things that would make this approach inappropriate would be a previous hip surgery for a fracture with rods inside the bone, people with a hip malformation or hip dysplasia and then people with significant differences in leg length. In these cases, other surgical approaches would have to be used. Benefits of this approach to surgery include: the muscles aren’t detached from the bone as much, so there is an easier recovery and the patient gets a head start with physical therapy; an X-ray machine can be used during surgery to check the parts to see they are in best alignment; better conditions for leg length assessment during the procedure; decreased chance of dislocation because muscles haven’t been cut off at the hip joint.
D r. P a t t e r s o n is a partner of OrthoMemphis, a division of MSK group, P.C. He completed his fellowship in Adult Orthopaedic Reconstruction & Arthritis Surgery at the Florida Orthopaedic Institute. He is also a member of the American Academy of Orthopaedic Surgeons.
Non-surgical Liposuction Alternative Zerona is a revolutionary new weight-loss procedure that uses cool-laser technology to non-invasively eliminate fatty tissue deposits in the body. Available at Midtown Acupuncture in Memphis, the Zerona emits a low-level cold output energy that generates no thermal effect on the bodyâ€™s tissue eliminating any risk to the patient. Through a natural process of fat removal, the laser-released fat is safely removed and broken down, providing patients with a truly non-invasive, non-surgical procedure without side effects or downtime. The Zerona procedure involves exposing treatment areas to the laser, which encourages fat cells to release the fat into the body, where it is absorbed and eliminated naturally. We also offer lymphatic massage, a FAR-Infrared sauna and an ionic foot bath that help stimulate and detoxify your lymphatic systems. These additional services are important part of the success of the Zerona system. This process results
in the loss of weight amounting to significant loss of inches from abdominal and leg areas in particular. When combined with a healthy lifestyle, Zerona is a comparable alternative to liposuction, without the recovery time and side effects usually associated with surgical weight-loss procedures.
on your activities during or after the treatment process. Results are usually evident about a week after the treatment period is complete, with some individuals seeing a difference even sooner. There are certain medical conditions that are not a good fit for the Zerona, call Midtown Acupuncture for a consultation.
Zerona is scientifically-proven to be both safe and effective. Zerona is an excellent choice for those who want to lose a few inches but donâ€™t want to go through something invasive. The results speak for themselves. We are excited to be the first in Memphis to add this procedure to our practice. There is absolutely no pain associated with the Zerona procedure, which is one of the primary benefits of Zerona compared to other weightloss procedures. There is no recovery time since it is completely non-invasive and does not require healing. There are no limitations
The only FDA approved Laser Lipo treatment available in Memphis
REVEAL YOUR TRUE SHAPE IN TWO WEEKS
Memphis native Jessica Puckett brings the modalities of Acupuncture, Herbology, health coaching and mind-body wellness to Midtown Acupuncture. Jessica is a NCCAOM nationally board certified Acupuncturist and is certified to practice in Tennesse by the Tennessee Medical Board.
ZERO Pain ZERO Surgery ZERO Downtime
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Only Available at:
MIDTOWN ACUPUNCTURE & WELLNESS CENTER 917 S. COOPER MEMPHIS, TN 38104
(901) 272-2600 www.midtown-acupuncture.com
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The Eye Center offers a wide variety of eyewear. Here are just a few of our name brands: 1225 madison Avenue, memphis, tn in the heart of the midtown medical district 901.722.3250 • eyecentermemphis.com
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Swollen Ankles and Legs Vascular disorders affect more than 20 million Americans. The most common and treatable underlying cause of swollen ankles (edema) and legs due to venous insufficiency.
There are several causes for lower extremity swelling including venous insufficiency, heart failure, liver and kidney disease, and certain medications including calcium channel blockers and anti-inflammatory agents.
The veins in the legs are responsible for transporting blood up to the heart. These veins in the legs have valves that prevent the backward flow of blood within them. Venous insufficiency is resulted from these damaged valves in the superficial veins causing accumulation of fluid around the ankles and sometimes the entire leg. Most people suffer from various symptoms including swelling around the ankles, leg pains, and/or cramp both while standing and rest. Other factors include multiple pregnancies, standing for long hours, and previous blood clots.
â€œAfter living for years with the pain, discomfort and embarrassment of unsightly varicose veins, I was genuinely surprised at how fast, safe and effective the endovenous laser procedure is. I no longer experience burning, itching or swelling.â€?
This eliminates the venous insufficiency and varicose veins and is done in our office. A long plastic tube is inserted, under local anesthetic. Using ultrasound guidance, the laser fiber is inserted in the leg above the origin of varicose veins. Once the laser is activated, the laser closes off the leaky valves, improving the circulation and redirecting the blood throug normal veins. This whole procedure takes less than one hour. After the procedure, the patient can return to daily activities right away.
“I came to Memphis Vein Center and I had suffered from venous stasis for years. I’m a nurse and I had constant pain in my legs. After treatment with Dr. Arcot, my legs look really good with very little pain. I have already referred my sister to him. Great job, Dr. Arcot and all your staff!”
“My legs hurt all the time. They were tired and achy. I couldn’t keep them still when sitting. I had the Endovenous Laser Treatment done and my symptoms have improved. I would recommend anyone to Memphis Vein Center.”
Kishore K. Arcot, M.D., F.A.C.C., established Memphis Vein Center with the goal of providing quality vascular care in a relaxed and convenient environment. Dr. Arcot is a board-certified interventional cardiologist with 20 years experience in interventional cardiology and management of peripheral vascular diseases. He received his cardiovascular training at the University of California, San Francisco.
Show off your legs again with...
Varicose Vein Treatment Get dramatic results without drastic measures. Banish varicose veins without painful surgery and lengthy downtime.
• 45 minute procedure with no general anesthesia or hospitalization • Relief from swelling, pain, ulcers & discoloration • Covered by most insurance carriers • We also treat spider veins
Dr. Arcot was awarded Compassionate Doctor Recognition 2010 and Patient Choice Award 2010 on Vitals.com For a free screening, contact
6005 Park Ave., Suite 225-B Memphis, TN 38119
PHONE: 901-767-6765 FAX: 901-767-9639
Delta Medical Center
Speciality Services BARIATRIC
Come to our educational seminars to learn more about surgical weight loss options. Call 901-369-4662 at the Delta Wellness Center.
The New Hernia Center at the Delta Wellness Center. Call 901-369-4662.
Received a 5-star rating by Healthgrades. Call 901-363-3600.
Same-day and around-the-clock emergency eye services. Call 901-369-8610.
Delta Medical Center memphis
As a top specialty-referral hospital, we dedicate ourselves to being a center for excellence in providing surgery, a 24-hour emergency department, acute medical care, and behavioral health medicine.
A Home For Living and For Life
What is Life Care? Life Care means you will be taken care of for the rest of your life. It is guaranteed financial and medical security.
What is a Continuing Care Retirement Community CCRC? It is a special combination of housing, hospitality and wellness services, plus comprehensive health care in one location. What does “No Buy-In” and “No Entrance Fee” mean, and how do they relate to Life Care? Life Care is your guarantee that you will be provided with lifetime nursing care and your family will not be financially responsible should you require long-term care. It means you have a home for life, which differs from “no buy-in” or no entrance fee rental retirement communities which only offer monthly services. At Kirby Pines, Life Care provides security and financial peace of mind. If I choose to move out, is my entrance fee refundable? Kirby Pines offers an unconditional Guarantee of Satisfaction. This means 100% of the entrance fee paid is refunded if a resident wishes to leave during the first year of residency. We also help pay moving expenses. After the first year, the refund amount will depend on the individual plan selected. If it becomes necessary for me to move into assisted living or the rehabilitation and nursing home, will I ever be able to move back into an apartment or Garden Home? Absolutely. If your health allows you to resume an independent lifestyle, the first available apartment or Garden Home will be yours. May I bring my own furniture with me? Yes. Residents may furnish and decorate independent living apartments, Garden Homes, and assisted living apartments, to suit their own tastes. May I have guests? Of course. Your guests are welcome to join you in the Dining Room (guest meal tickets are available) and are welcome to stay overnight with you. In addition, guest apartments are available for a nominal fee. May I bring my car with me? Of course. Residents are welcome to bring their private automobiles. Assigned parking (both covered and uncovered ) is available.
May I cook or bake for myself occasionally? Yes. Beautiful kitchens with custom cabinetry and appliances are standard in each apartment, perfect for preparing an occasional meal!
including rehabilitation services, scheduled transportation, guest rooms, private receptions and catering, newspaper delivery, men’s barbershop and women’s hair salons, gift/sundry shop.
What does it cost? Residents pay a one-time entrance fee and then a monthly service charge based on the size of their apartment or Garden Home, the number of persons, and their individual plan and fee schedule.
Can residents become involved in the day to day operations of Kirby Pines? A special Resident Advisory Group comprised of residents has been enlisted to contribute their insights and expertise to management. In addition, there are many other opportunities for residents to work with management on a variety of committees.
Is my Monthly Service Charge subject to change? Yes, but Kirby Pines has one of the lowest percentages of increases in the country. We make every effort to keep monthly service charges as low as possible, but fees must be able to respond to market conditions in order to ensure quality services for our residents. Are my entrance fees and monthly service charges tax deductible? Yes, A percentage of your paid entrance fee and a percentage of your monthly service charge qualify as a medical deduction according to IRS regulations. Would I have to assign any of my property to Kirby Pines? Emphatically, No! Kirby Pines residents pay a onetime entrance fee then a monthly service charge. Your assets remain your own. What other services are available on-site? Kirby Pines offers a variety of ancillary services on-site,
Can individuals not well enough for independent living and not covered under Life Care be admitted to assisted living and the rehabilitation and nursing home? Yes. Non-residents may be admitted to assisted living, the rehabilitation and nursing home, or Alzheimer’s and dementia residence on a private pay basis. However, Life Care residents are given priority status.
Kirby Pines is a non-profit continuing care retirement community plus Life Care. It is owned and operated by Psalms, Inc. and its mission is to provide a quality lifestyle in a quality environment, supporting the concept of continued independence as a priority in the life care decision. Retirement Companies of America, LLC, a professional management company, manages the day-to-day operations of the community. For more information on Life Care call 901-369-7340
3535 Kirby Road, Memphis, TN 38115 • 901.365.3665 • www.kirbypines.com
When Should You Go to the ER? No one ever plans on being in a car accident or having a heart attack. But accidents and unexpected illnesses can, and do, happen. According to the Centers for Disease Control and Prevention, more
• • • •
Persistent vomiting Coughing up or vomiting blood Suicidal feelings Unusual abdominal pain
of allergies as well as a medical history form if you have one. If possible, call your primary care physician ahead of time so they can order lab work if needed or alert ER staff about your condition. If going to the ER with your child, bring an immunization record and a comfort item to help soothe your child.
When going to the ER for medical emergencies that are not life-threatening, you also may want to bring something to read and money for snacks or a soft drink. Try to remain calm so you are better able to communicate with the doctors and nurses who are there to care for you or a loved one.
Now at the Saint Francis Hospitals you can skip the waiting room for medical emergencies that are not life-threatening. With our InQuickER program, simply hold your place online and wait in the comfort of your own home.
than 339,000 Americans are treated in emergency departments across the country every day. Those who arrive in the emergency room (ER) by ambulance usually have a life-threatening condition that requires rapid transportation so they can receive care upon arrival. Others who come by car or on foot will be treated based on the severity of their illnesses or injuries, not on a first come, first serve basis.
If you believe you are having a medical emergency, go to the ER or call 9-1-1 if the condition is lifethreatening or the person’s condition may worsen on the way to the hospital. It is important to be aware that some conditions may seem minor, but could become serious if not treated. In situations that may or may not be a medical emergency, call your doctor’s office first or go to a walk-in clinic.
Some situations clearly require emergency medical attention, such as a stroke. But other cases are not so clear cut. What about a swollen ankle, unexplained fever, or puncture wound? The American College of Emergency Physicians offers a list of symptoms that indicate a medical emergency, including: • Problems breathing • Shortness of breath • Pain or pressure in the chest or upper abdomen • Vision changes • Disorientation or confusion • Sudden or severe pain • Bleeding that doesn’t stop
A walk-in clinic also may be called a minor emergency, urgent care or immediate care center. They do not require appointments and are often open evenings and weekends. Walk-in clinics are good options if you do not need the high level of care provided in an ER, but instead have a minor emergency such as a cut that requires stitches, sore throat, sprained ankle, or other illnesses that are not life-threatening. If you do have to go the ER, be prepared. Bring a list of current medications, including how long the medicine has been taken and how often. Include a list
“We know people want more convenience and communication in the ER experience,” explains Trish Higgins, Emergency Room Director at Saint Francis Hospital-Memphis. “While estimates and averages about emergency room wait times may vary, many emergency room patients end up waiting several hours in waiting rooms with no indication of when they’ll be seen. With this service, users enjoy the convenience of choosing where they wait and a projected time to see a healthcare professional in the emergency room. “
InQuickER does not affect the wait times of other emergency room patients, nor does it allow certain individuals to “cut” in front of others. Additionally, if the projected treatment time changes due to an influx of patients requiring priority treatment, the user will be notified and given an alternate time. • Go to www.SaintFrancisER.com • Select a time • Complete online forms • Arrive at the ER at your selected time • Be seen within 15 minutes of your online selected time
• • • • •
Varicose veins Spider veins Restless legs Charley horses Nighttime cramps
• Intense swelling in feet • Discoloration around ankles • Leg ulcers
EndovEnous LasErabLation (EvLt)
A wonderful alternative to surgical vein stripping for varicose veins, this minimally invasive procedure delivers laser energy through a tiny fiber, causing the vein to close. This procedure can be performed at our practice in less than an hour, and the patient is encouraged to walk immediately following the procedure. In most cases, the patient can return to work the next day.
Large varicose veins are hooked and removed one portion at a time. Unlike older treatment methods, this procedure can be performed in our office using local anesthesia. The patient is able to walk out of the office. Obviously, this minimizes post-surgery recovery time.
scLErothEraPy Ideal for spider veins and small varicose veins, sclerotherapy involves injecting a small amount of liquid into the diseased vein. This acts upon the lining of the vein, causing it to seal shut and thereby be eliminated. It is a quick procedure performed in our office, and no anesthesia is required.
LasEr thEraPy for sPidEr vEins (iPL) This is an alternate method for treatment that uses a laser to eliminate the spider vein by passing the laser over the skin and the visible veins.
vEinWavE™ A revolutionary technique used by doctors around the world to eliminate spider veins on the legs and fine thread veins, known as telangiectasia, VeinwaveTM utilizes the principle of thermocoagulation. It is the only treatment of its kind having received 510 clearance to market by the FDA. Whether you’re a man with reddish veins on the nose, or a woman with spider veins, VeinwaveTM can help. VeinwaveTM provides a relatively painless walk-in, walk-out procedure, with no risk of bruising, scarring or pigmentation.
5050 Poplar Avenue, Suite 718 Memphis, TN 38157 901.761.1123 • 866.834.1579 www.RegionalHVC.com
“We don’t just make veins disappear. We use the latest technologies and the least invasive procedures possible to help improve the quality of life for all our patients.”
Wood M. Deming, M.D., FACC
A Primer on Celiac Disease
When you go to the grocery store, you may see products labeled gluten-free. Many people have asked me “What is the big deal?” and “What does this mean?”
In this review, I will try to explain what glutenfree means, and how it may be very important to you and members of your family as well. Celiac disease is another term for sensitivity to gluten and can also be called sprue or gluten enteropathy. Gluten is present in wheat, rye, barley and is found as well in bread and even breakfast cereals. The following do not contain gluten and may be eaten in any amount: corn, potatoes, rice, soybeans and tapioca just to mention a few. When people with celiac disease eat foods or use products containing gluten, an abnormal immune reaction is triggered that damages the lining of the small intestine. Symptoms include diarrhea, even constipation, vomiting, stomach bloating and pain. Adults particularly experi-
ence bone or joint pain, depression or anxiety, numbness in the hands and feet and even seizures. Long-term complications include intestinal cancer, liver disease, malnutrition, even iron deficiency anemia and possibly a miscarriage. The longer a person goes undiagnosed and not treated, the greater the risk for long-term complications. This disease is diagnosed by certain higher than normal levels of auto-antibodies. Another more specific test is a biopsy of the small bowel through a long thin tube called an endoscope. This would be done by a gastroenterologist. There are specific changes in the villa of the small bowel that allow the physician to make a definitive diagnosis. As far as treatment, the individual with sensitivity to gluten products is required to stay on a lifelong gluten-free diet. There are no studies that show even with healing of the lining of the intestine that one can ever go back on a diet
containing gluten. Thus, there is an expanding need for the gluten-free products you are seeing at the grocery store. They are essential parts of a gluten-free diet. If you have any concern that you may have this relatively rare disease which affects one percent of the American population, you should check with your physician immediately. Myron Lewis, M.D. graduated magna cum laude from Dartmouth College and earned his M.D. degree at Columbia University’s College of Physicians and Surgeons in New York City. He did his internship and first year residency at Vanderbilt University Hospital and completed his residency and GI training at Cornell Medical Center. Dr. Lewis is one of the founding physicians Memphis Gastroenterology Group, P.C.
Delivering the Highest Quality Care You Expect and Deserve
Lawrence D. Wruble, M.D. Myron Lewis, M.D. Michael J. Levinson, M.D. Edward L. Cattau, Jr., M.D. Richard S. Aycock, M.D. Randall C. Frederick, M.D.
T. Carter Towne, M.D. Gary A. Wruble, M.D. Terrence L. Jackson, Jr., M.D. Bryan F. Thompson, M.D. Alex E. Baum, M.D. Christopher D. Miller, M.D.
MEMPHIS GASTROENTEROLOGY GROUP, P.C.
Freedom to Bathe Safely & Independently
FREE 17” ADA Handicap Toilet w/Tub Purchase
Now doing handicap and regular bathroom remodeling!
Locally Owned & Operated 5 Models of Walk-in Tubs Mobility Showers Made in the USA 2 Day Installation
Southeast Urology Network 995 S. Yates, Suite 1 • Memphis, TN 38119 Financing Available (Regions Home Improvement Loan)
Call Terry Quinley for more information.