WellHealth CareConnection: Spring 2018

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CareConnection Innovative Healthcare in Your Backyard Spring 2018


Quick Tips For Simplisity

Behavioral Health

Addiction and Mental Illness

My Story. My Life. A Transplant Saved My Life

Ask the Doc

Abnormal Pap Smears

Type 1 Diabetes

A WellHealth Quality Care Publication

WellHealth Quality Care Healthcare. The WellHealth Way.

Letter from the Medical Editor If you ask anyone in the medical field what’s one thing they would tell their patients, many would say, “you need to care for your whole self first before you can care for anyone else.” Caring for yourself is easier said than done. We all have so many distractions competing for our time that taking care of your whole self may seem impossible. I’m here to tell you that it is possible. As we start to come out of cold and flu season, and the weather is better, it’s time to gear up for the euphoria of springtime. Spring is a great season to check in with your health. While it might seem daunting to put yourself first, let’s start with two easy steps. K. Warren Volker, MD, PhD CEO of WellHealth Quality Care

We should all start by caring for ourselves first before we can care for anyone else.

First, head to your dermatologist and have your skin checked. Just as you see your primary care provider for a well visit, seeing a dermatologist before you start to spend a lot of time in the sun is crucial. To keep your skin in tip-top shape, find a great SPF. Look for something that not only protects you from UV rays but also infrared light and heat that cause cellular damage and pigmentation. The second thing you can do to take care of your health is check in with yourself mentally. Winter can bring the blues, but as spring rolls in, find activities that make you happy. Go on an evening walk, head to your local farmers market or take your bike for a spin. Once you’ve taken these two steps to put your health first, grab a group of friends and enjoy making new memories. Dr. K. Warren Volker

Spring 2018 WellHealthQC.com


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Tips, stories and guides for a

Healthier You In this issue:

Spring 2018

Contents 03.

Letter from the Medical Editor Check in on your health this season

06. Anxiety

P.12 STORY. I spent many nights crying for their The best day of my life would LIFE. family. be the worst day of theirs. MY


A Liver Transplant

Life tips for simplicity


Letter from the Editor





Credits Medical Editor

K. Warren Volker, MD, PhD

Managing Editor Meghan Bailey

Copy Editor

Sara Williamson

Art & Design Brett Benton

Behavioral Health Addiction and mental illness


Spring is in the air Hypothyroidism in Adults The ins and outs of hypothyroidism Ask The Doc A discussion about abnormal Pap smears My Story. My Life. A woman’s journey through an organ transplant Behavioral Health Addiction and mental illness

Contributing Writers Adam Volker, MS, RBT Dr. Alyssa Small Layne Brett Benton Katie Beall Meghan Bailey Dr. Paul Tomasic Sarah Harper Tina Phyfer, APRN

18. 19.

Type 1 Diabetes How to live happy and healthy Dedicated Docs The best doctors in Southern Nevada

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The key is to know how to handle these feelings when they come and not allow them to cause unnecessary pressure on your daily activities. This article will go over some helpful tips to control these feelings and live life a little simpler.


tart a daily planner

Many say that meetings or activities that sneak up on them are the cause of their stress levels increasing. A daily planner can help keep track of your personal and work schedule. Try taking one hour at the end of your week to sit down and write out the meetings, events, activities and tasks that you have planned for the upcoming week. Make sure to stay organized and check off completed tasks as you finish them.

Exercise in the morning Besides having fantastic health benefits, exercise is a great way kick off a productive day. According to the American Psychological Association, moderate exercise of five minutes or more of can help enhance your mood and alleviate long-term depression.

Volunteer or join a group in your community Being active in your local community helps you build networks of friends that you can talk to when you feel stressed. Having someone to vent to who may be going through a similar situation can help lower stress levels.

Get a good night’s rest Much like exercise, there are very few things that can help improve your mood and make you more productive than getting a good night’s rest. According to the National Sleep Foundation, eight hours of continuous sleep not only increases productivity but also has health benefits equivalent to meditation.


Spring 2018 WellHealthQC.com

Written by: Brett Benton

Life is hard and will always throw curve balls at you. The key is to not let it affect your mood. Take a deep breath and try these quick tips to keep your mood up. Before you know it, you’ll see improvement in your health, wellbeing and productivity. Share your experiences with friends and make connections in your community. Your experiences could help other life a stress-free life!

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Letter from the Editor


Days ago, I opened my back door to get into the car and head in for the day of work ahead of me. I was bundled up with a jacket and boots. Only this time I realized the temperature had changed. Noticing that one change in my daily routine opened my eyes to see the blooms on my trees, the little flower buds forming and birds chirping with a bit more spunk. Spring has sprung! Modest temperatures, patio dining, kickball in the park and firing up the BBQ can breathe new life into just about everyone around you. Throughout this issue, you’re going to meet a brave woman who was given a time clock on life. This is the first person we have featured in our magazine that needed a lifesaving procedure. While this was still very recent when we asked her to tell her story, she didn’t hesitate. She knew it was important to help people understand the importance of organ donation, and she’s truly an inspiration.

We are also tackling tough mental health topics because we must continue to be vigilant and not be afraid to talk about our mental health. It is as important as our physical health and nothing to be ashamed of. It’s time to come out of our winter hold up and bloom into our new vibrant and healthy selves. I know I am ready, are you? Cheers to April showers bringing May flowers, Meghan Bailey Managing Editor

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Hypothyroidism IN ADULTS

Hypothyroidism is defined as a deficiency of thyroid hormone and is a common medical condition occurring in as many as one to two percent of the adult populations, up to five percent of people over age 60 and five to 15 percent of women over age 65. The thyroid gland is found just beneath the skin in the lower, forward part of the neck. Its purpose is to make thyroid hormones. Thyroid hormones serve as a regulator of metabolic function throughout the body. Hypothyroidism occurs in both men and women, but it is about five times more common in women than men.


ccording to the U.S. Preventive Services Task Force, a blood test to screen for hypothyroidism is not a standard part of routine blood work in adults, but there are circumstances that should lead to doing a test for hypothyroidism to rule out this disease. The symptoms can be non-specific, but if a patient is having symptoms that may be thyroid related, a test to rule out thyroid disease is indicated. Some of the symptoms and signs that should prompt a thyroid blood test to look for hypothyroidism include weakness, fatigue, cold intolerance, constipation, weight change, depression, menstrual irregularity, dry skin, decreased heart rate (bradycardia) and anemia. There are other symptoms and signs that may be low thyroid hormone related, but these are the most common.


Spring 2018 WellHealthQC.com

Once hypothyroidism is diagnosed, and confirmed on repeat thyroid testing, the next topic of discussion is treatment. Primary hypothyroidism is treated with synthetic thyroid hormone called levothyroxine. The goals of therapy include improvement in symptoms, normalization of TSH level, reduction of the size of goiter (if the patient has enlarged thyroid as part of the presentation), and avoidance of overtreatment, which can have its own ill effects from too much thyroid hormone (called thyrotoxicosis). The initial dose of levothyroxine may vary depending on the initial TSH level and other factors such as body size. Your clinician has formulas to follow to calculate the initial dose. Sometimes older patients with cardiac disease will receive a smaller dose of levothyroxine than may be otherwise indicated with more gradual adjustment over time to avoid overtreatment, which could have cardiac effects. Dose may also vary if the clinician

Written by: Paul Tomasic, MD, MS, FACP, FACE

The single best test to screen for hypothyroidism is called TSH which stands for thyroid stimulating hormone. TSH is a hormonal signal produced by the pituitary gland (a hormone producing gland in the brain). TSH stimulates the thyroid gland in the neck to make thyroid hormone. If the thyroid gland cannot make adequate thyroid hormone for the body’s needs, TSH goes up as the pituitary gland in the brain tries harder to stimulate thyroid hormone production even when the thyroid gland can’t produce more. Thus, an abnormally high TSH is an indication of low thyroid function. The most common

type of hypothyroidism is a lack of thyroid hormone production within the thyroid itself. This is called primary hypothyroidism. In rarer circumstances, there may be injury or alteration of pituitary function where TSH can be low or inappropriately normal leading to overall hypothyroidism. This is called central or secondary hypothyroidism when the signal from the brain is the issue. Futher discussion of secondary hypothyroidism is beyond the scope of this article.

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decides that a full replacement dose is not needed after interpreting the initial lab values. It takes approximately six weeks before a steady state of thyroid hormone levels is achieved. In most cases thyroid bloodwork is checked every six to eight weeks until a normal value of TSH is reached. Thyroid testing may then be done less often. There are some important facts as to how to take levothyroxine. Levothyroxine should be taken on an empty stomach with water, either 30 – 60 minutes before breakfast or at bedtime several hours after the last meal. If a patient is on a calcium supplement, calcium should be taken with food, not at the time of taking levothyroxine. If a patient is taking iron in any amount, whether the iron is in an iron pill or contained in a vitamin pill, the iron should be taken at least four hours separated from the time levothyroxine is taken. Patients should also be cautioned not to take over the counter supplements or products labeled as “thyroid support,” since these products are often high in iodine or may in fact contain some amount of thyroid hormone. Do not take these over the counter products as they may interfere with thyroid measurements while on levothyroxine.

produced from T4). Normally T4 is converted to T3 with the conversion happening in the body outside the thyroid gland. For the great majority of thyroid patients, combination therapy with both T4 and T3 is not recommended. Nearly all patients can achieve a normal thyroid (euthyroid) state with levothyroxine (T4) therapy alone. In a review of nine studies on this topic, only one study reported beneficial effects of combination T4-T3 therapy on mood and quality of life. Although T4-T3 combination therapy is not recommended routinely, there may some special circumstances where it may be considered. Patients who have not felt well since surgical removal of the thyroid, or intentional destruction of the thyroid with radiation, may benefit. Patients with a T3 measurement below or at the lower end of the T3 normal range may also benefit. Hypothyroidism is a common condition. Screening for hypothyroidism should be done for patients with symptoms that are suggestive of the condition. The treatment of primary hypothyroidism is usually quite straightforward. Levothyroxine (T4) therapy is usually adjusted every six to eight weeks until normal thyroid levels are achieved. Hopefully, this information on hypothyroidism in adults will be useful to those adult patients with the condition.

Treatment with either levothyroxine brand name or generic is acceptable. So long as the levothyroxine product used is consistent with the same manufacturer, either can be used. Problems occur when there is a change of generic products between manufacturers as this can lead to a change in the amount of levothyroxine needed to maintain steady thyroid levels. Some clinicians insist on using a brand name of levothyroxine to maintain consistency in thyroid testing, but most patients should be able to use a generic levothyroxine as long as the manufacturer of the generic levothyroxine is consistent. Another common question concerns the need for combination therapy of levothyroxine (which is T4) along with T3 (which is the active thyroid hormone Spring 2018 WellHealthQC.com


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H Ask the Doc

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An In-Depth Discussion About Abnormal Pap Smears We talked to Dr. Alyssa Small Layne, with Las Vegas Minimally Invasive Surgery (LVMIS), to learn more about pap smears and cervical cancer.

CareConnection: What is a Pap smear? Dr. Alyssa Small Layne: A Pap smear is a test that collects a sample of cervical cells to look for abnormalities that may be cervical cancer and or precancer.

CareConnection: When should I have/how often should I have a Pap smear?

CareConnection: Should I do anything to prepare for the test? Dr. Alyssa Small Layne: No special preparation is needed. Pap smears are performed routinely in the doctor’s office

CareConnection: What happens if the Pap smear is positive? Dr. Alyssa Small Layne: If a Pap smear is positive it is considered abnormal. Depending on how abnormal the result is, you may be a asked to come for a repeat Pap smear in six to 12 months, or your doctor may recommend a colposcopy. A colposcopy is procedure that uses a microscope device and different solutions to help magnify areas on

CareConnection: What classifies a Pap smear as abnormal? Dr. Alyssa Small Layne: Pap smears are classified as abnormal based on how the cells look when they are evaluated in the lab by a pathologist.

CareConnection: Does an abnormal Pap smear mean that I might have cancer? Dr. Alyssa Small Layne: An abnormal Pap smear does not necessarily mean that you have cancer. Things that irritate the vagina, such as infections, can also cause abnormal Pap smears. Abnormal changes to cervical cells caused by the HPV virus can lead to cervical cancer, however. It is important to follow up after an abnormal Pap smear because procedures can be done to remove abnormal cervical cells and also to detect precancer and cancer early.

CareConnection: What is HPV? Dr. Alyssa Small Layne: HPV is the human Papanicolau virus. This virus has different strains and is known to cause genital warts, abnormal Pap smears and cervical cancer.

CareConnection: I had a hysterectomy. Do I still need a Pap smear? Dr. Alyssa Small Layne: Supracervical hysterectomy is a procedure that leaves the cervix in place. Total hysterectomy removes the cervix with the rest of the uterus. If you still have a cervix after hysterectomy you will continue to need routine Pap smears.

Alyssa Small Layne, MD

QA &

Dr. Alyssa Small Layne: After age 21 women should have routine Pap smears every three to five years, depending on her age and the type of testing performed. If the Pap smear includes testing for the HPV virus, routine Pap smear can be performed every five years in women over age 30. Pap smears may need to happen sooner if the last Pap smear was abnormal and for patients with certain conditions. Most women can stop having routine Pap smears after age 65.

the cervix that may be abnormal. Sometimes biopsies of the cervix are taken during colposcopy.

Most women with a history of normal Pap smears no longer need Pap smears after a hysterectomy. Women with certain abnormal Pap smears, cervical cancer or precancer may need to continue Pap smears after a hysterectomy even if the cervix was removed.

CareConnection: How can I reduce my chances of getting cervical cancer?

Dr. Alyssa Small Layne: Vaccination to the virus that can cause cervical cancer, HPV, can help reduce your risk of getting cervical cancer. Avoiding and stopping smoking is also important to reduce your risk. Regular follow up with your gynecologist or primary care physician for a Pap smear screening. Pap smear is also important because abnormal cells and precancer can be detected and treated before they cause cancer.

Spring 2018 WellHealthQC.com


Katie and her father, Dr. Jack Hawkins, Jr.

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A Transplant that saved my life

More Than Just a Stomach Virus October 19, 2017, will forever be a day that stands out in Katie’s mind. Her family had just moved from Alaska to Maryland a couple of months prior, and she hadn’t been feeling well. She was extremely bloated, felt full and nauseated all of the time, and her eyes and skin were yellowing. “I was sleeping as much as I could, was constantly short of breath and had zero energy,” Katie said. Like most people, Katie chalked her symptoms up to a nasty stomach virus. On that day in October, Katie was chaperoning her daughter’s second grade field trip, finding herself sitting down frequently to catch her breath. One of the other moms on the trip noticed how similar Katie’s symptoms were to her husband’s, who had been admitted to the hospital for possible kidney transplantation, and urged Katie to seek care immediately. Upon returning to the school, Katie called her husband to tell tell him to pick the kids up from school because she was heading to the ER.


Spring 2018 WellHealthQC.com

hours of October 20 and admitted indefinitely.

nights were terribly uncomfortable and painful.

Waiting for New Life Once admitted to UMMC, she received a crash course in lab work, including what numbers were good and what were bad. She was admitted with a MELD (Model for End-Stage Liver Disease) score, used to stratify severity of end-stage liver disease for transplant planning purposes, of about 20 out of 40. Within a week, her numbers climbed to 30 out of 40. Another week in the hospital passed, and she reached a score of 40 out of 40 — her liver was officially considered failed.

“I was constantly feeling as though I was in a dream; everything from conversations held with and around me to my trying to focus on television or a book to pass the time felt incredibly fuzzy,” Katie said. “I felt lonely, scared, and deathly ill, but I was never truly alone in the darkness of my hospital room. I believed in a power greater than myself (for me that is Jesus Christ) and I cried out to Him in my darkest hours.”

“I had days to live if they could not find a new liver for me. I was not told how long it would take for a liver to become available,” Katie explained. “However, with my MELD score being so high and deadly, I was moved to the top of the recipient list and the first available matching blood-type liver would become mine. How long that would take, I did not know.” In addition to being in end-stage liver failure, her heart and kidneys had begun to fail. Katie was told she may possibly need three transplants: heart, kidney and a full liver from a deceased donor with her blood type. Her body was quickly shutting down. Because of her organs’ delicate conditions, Katie was not allowed to have any prescription pain medication while awaiting a transplant, so her days and

In those three weeks waiting for a transplant, Katie found comfort in visits from her family and her care team, who would come into her room to hold her hand and pray over her. “I never knew their names, and I typically didn’t see them again after that,” said Katie. “My nurses will never know the impact they had on my life: they brought a peace into my room and calmed my spirit when I felt utterly terrified and alone.” Katie and her husband, Dan, made the decision not to allow their young children to see her in the hospital except for twice under Katie’s insistence. Those visits served as a reminder to Katie that she had no choice but to survive. “There were certainly times during her treatment that were scary: her initial transfer from the Emergency Room to the transplant

As told by: Katie Beall Written by: Sarah Harper

Katie doesn’t recall much of her overnight stay at Anne Arundel Medical Center in Annapolis, other than her doctor telling her that she was being transported to the University of Maryland Medical Center’s (UMMC) transplant unit. Shocked and surprised, Katie was driven to Baltimore via ambulance during the dark morning

Katie and her husband, Dan

Katie Hawkins Beall is a proud Troy University Trojan and veteran, plus a loving daughter, sister, military spouse and mother to two beautiful children, Noah and Ellyotte. She enjoys traveling the world, hitting the slopes with her family and making memories at her parents’ condominium on the coast of Panama City Beach, Florida, watching her kids splashing in the waves and eating as much seafood as possible. What outsiders may not know about Katie is that she was given a second chance at life through an organ transplant.

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hospital room and all of us were celebrating.” Katie’s second chance at life finally came on November 13, 2017 when she received the phone call that they had found a match, a high-risk donor’s liver. Choosing to Accept Despite her donor’s status, Katie was informed that because of the severity of her situation, she needed to accept the first liver that became available even if it was considered high-risk.

unit in Baltimore; her three-week evaluation prior to surgery; the possibility that she required a liver, kidney and heart transplant, because the condition of her heart and kidneys weren’t strong enough to support a massive operation; and the day that the coordinating nurse practitioner recommended I bring our children to the hospital to potentially say goodbye to their mom,” said Dan. “However, our faith in God, expert care by the University of Maryland Medical Center Transplant Team, and a series of consecutive miracles enabled Katie’s remarkable recovery.

“I couldn’t fathom that there would be any other answer besides “YES!” but apparently some transplant patients answer “no” because the fear of the surgery and the unknown is too hard to deal with,” Katie explained. “For me, it was black and white: I had decided I would survive, no matter the odds.” Despite knowing she needed to accept the donation, Katie asked the following questions, she believes anyone about to receive an organ donation should gather the facts to make an informed decision: •

Has my donor’s liver been tested? How many times?

How old is my donor? Male or female?

Why is the donor considered high-risk? How did my donor pass away?

Has my donor’s liver been tested? How many times?

Did my surgeon approve this donor

Katie’s donor was considered highrisk due to lifestyle choices and the manner of death, neither of which affected the organ Katie needed to survive. “The best thing I ever did was hang up the phone, pray about my decision, receive peace about it, consult my husband, then call back to my transplant team and accept my new organ,” Katie said. “Please realize that if that organ you so desperately need is available to you, you should take it…your transplant team will never knowingly implant a sick organ into your already failing body, so please accept the first offer – high-risk or not – because there may not be a second phone call.” A New Life Since choosing to accept her new organ, Katie’s life is drastically different. First and foremost, she is extremely grateful for a second chance at life and thanks her donor and her donor’s family for the incredible gift. “[While in the hospital], I also spent many nights crying for my donor’s family. The best day of my life would be the worst day of theirs,” Katie explains. “I used my time alone to pray for them and to pray for my donor.” An important part of Katie’s recovery was writing to her donor’s family, thanking them for the difficult decision they may have had to make and letting them know how much the gift meant to her and her family.

Hope in the Dark On November 1, Katie underwent her first dialysis session to remove the fluid from around her failing heart and to recirculate her blood in an effort to kick-start her kidneys. The session was a success, and she was told she no longer needed to receive a heart or kidney transplant. Not long after, Katie’s doctors informed her that her insurance had agreed to pay for the entire liver transplant and all associated costs. “I couldn’t stop crying, smiling, praising God, and embracing the relief that I finally felt,” Katie exclaimed. “There were tears of joy flowing in that room – about 14 people were stuffed in my tiny Katie’s husband, Dan, children and Katie

Spring 2018 WellHealthQC.com


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Katie now takes a combined 15 different medications to make sure her body doesn’t reject her new liver. Also, each Monday, she has four vials of blood drawn and her liver enzymes, medication levels, kidney function and white cell count are all tested. “Katie is still recovering, but she’s free from the bonds of her illness, and it’s evident in her personality, energy and attitude – her body is no longer fighting against itself,” explained Dan. “I won’t be able to express how thankful I am to have our Katie back – wife, mother and best friend.” She also takes medications that prevent multiple forms of bacteria from attacking her body; folic acid; multivitamins; and supplements that aid in absorbing the medication her body now requires. “No longer do we assume life is a given,” said Katie’s father, Dr. Jack Hawkins, Jr. “We value time with each other and we rejoice knowing our Katie will live to see her children and our grandchildren grow up. We also rejoice knowing Katie’s testimony promises to save the lives of others.” In addition to being a full-time mom and working full-time from home, Katie has started working with the TRIO Foundation of Maryland and

volunteering with the Living Legacy Foundation; both organizations aiding in raising awareness about organ donation. While not every day is easy, Katie has a new lease on life and wants to help educate the public on the importance of organ donation. “Donate your blood and plasma at every chance you can! Not only will your tissues save many recipients’ lives, you will save many recipient families from being ripped apart due to their loved one dying while awaiting an organ,” Katie exclaimed. “You can’t take them with you when you die, so be a HERO: be a DONOR.”

Organ Donation FAQ with Sarah Finke, CRNP, University of Maryland Medical Center

Who can be an organ donor? There are two types of organ donation, deceased donation and live donation. Deceased donation is an opportunity everyone has to give life when one is no longer able to sustain their own life. Regardless of medical history or age, you can register to be an organ donor. People 16 and older typically can register through the state department; those under 16 can be deemed an organ donor by family or medical power of attorney. What are the different types of donation? In addition to deceased donation, adults can be living donors for kidney and liver transplants. Kidney donation surgery is done by a single laparoscopic incision in the belly button, leaving minimal external evidence of the surgery. Both the donor and recipient can live healthy lives with one kidney. Living liver donation involves removing a portion of the donor’s liver for transplant. Unlike the kidney, the liver regenerates to return to close to its original size. What are some of the main reasons people are not organ donors? There tends to be a lack of knowledge about organ donation in general. Arm yourself with knowledge by visiting donatelifenevada.com.

Katie’s husband, Dan, children and Katie


Spring 2018 WellHealthQC.com

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* These locations are not shown on map

Accurate as of 3.30.18

Learn more about our urgent care locations at hcpnv.com/urgentcare

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Behavioral health How Mental Illness Affects Addiction Patients who suffer from mental illnesses are at higher risk for addiction, particularly substance abuse. The adverse impact of substance abuse can be damaging in combination with cognitive problems related to mental disorders.


ccording to a United Nation report report, drug addiction takes 200,000 lives annually. To better understand how drug addiction develops, we need to look at what is happening on a cognitive level to reward this destructive behavior. From a psychological perspective, addiction is a disorder of modified understanding. Drugs can alter normal brain structure and functions, forcing cognitive movement that rewards usage through learning and prevents the accession of adaptive behaviors that enhance sobriety. Simply put, most drugs act on the reward center of the brain, leaving users chasing the next high to feel good again. A recent study by Feltenstein and See distinguishes addiction as a multistage process. In the first stage, a person’s casual drug or alcohol usage becomes uncontrollable and progressively constant. The neurological source of these symptoms is induced by drug deregulation of the brain’s reward system. In this first stage, drugs typically increase dopamine, or the feel-good hormone. Outside of drug use, dopamine creates signals within the brain and produces enjoyable feelings that make people seek life-sustaining conditions such as eating food, sex and finding supportive environments. With drug use, the release of dopamine becomes the case of too much of a good thing.

At this stage, many substance abusers are prone to withdrawal symptoms when they engage sobriety. Depending on the drug being abused, withdrawal symptoms range from vomiting, sleep issues, shakiness, depression and even death. The severity of symptoms


Spring 2018 WellHealthQC.com

In consideration of cognitive effects, extensive research focuses on drug abuse and the developing brain. The human brain continues to develop from the prenatal period through adolescence. Throughout this period, the brain is easily influenced, and drug abuse can potentially divert the normal course of development. According to the CDC, prenatal exposures have uncovered this concern with alcohol disorders, leading the cause of mental retardation in the United States. In addition, early exposure to alcohol in the brain can increase to later substance abuse. In conjunction with prenatal abuse, abuses in adolescent years is a high-risk pool. Most avid adult smokers formed their addictive habits to nicotine in their adolescent years. Recent studies have shown that smoking during adolescence highly affects cognitive skills. A test of working memory, verbal reasoning, and oral arithmetic showed that smokers scored worse than nonsmokers of the same age. Research has also proven that young cigarette smokers experience depression later in life. Modern concerns surround addiction and mental illnesses. Drug-induced cognitive deficits may be more catastrophic to individuals whose behavior already suffers from mental disabilities or illnesses. It has been estimated that more than half of users in the United States also suffer from mental illness, typically anxiety or depressive disorder. Due to the physical changes to the brain, sobriety is often a long and difficult journey. A team of healthcare providers may need to help a user find sobriety, depending on the severity and years of abuse. If you or someone you know may be struggling with addiction, the first step to recovery is being honest with your provider who can provide resources and help.

Written by: Adam Volker, MS, RBT

In the second stage of addiction, individuals fall further, experiencing relapse, skewed decision-making and withdrawal symptoms as a physical result of their brain changing. Signals carried by neurotransmitters, or the body’s chemical messengers, negatively impact the area of the brain associated with judgment, the prefrontal cortex to the nucleus accumbens.

often lead to users looking to minimize the negative physical and emotional effects of sobriety by using again so they can feel “normal.”

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Living Happy & Healthy with

type 1 diabetes


nsulin works very well with most individuals; however,, insulin can also be a difficult drug to manage. When there is too much insulin administered, the blood glucose may drop dangerously low. This condition is called hypoglycemia, which is expressed by symptoms of rapid heart rate, shakiness, dizziness, weakness, agitation and hunger. In a worse case scenario, hypoglycemia can lead to ketoacidosis, coma and death. With the development of improved insulin, insulin pumps and glucose monitors, individuals with type 1 diabetes are living much longer and healthier lives. New medications and other therapies have added years to many lives by reducing complications such as heart disease and kidney disease for diabetics.

Keeping it Under Control

The Diabetes Control and Complication Trial ran from 1982 - 1993. This study investigated the influence of stick glucose control, (HbA1c < 7) vs. conventional acceptable glucose control (HbA1c 9). After 27 years, the results of this study suggest that individuals that maintained HbA1c < 7 had a greater chance to outlive those that had HbA1c averaging nine. This makes perfect sense, the lower the glucose the less cell, tissue or organ damage is to be expected; therefore, increasing years of life. Again, this can be a gentle balance because the lower the glucose the greater the risk of experiencing hypoglycemia. For this reason, many practitioners caution the elderly, frail or individuals with other health issues from trying to maintain a near-normal glucose level. It is also important for diabetics to look beyond their glucose and plan to control and monitor cholesterol and blood pressure. Keeping a normal cholesterol level and blood pressure will also help reduce cardiovascular disease.

Education and Awareness

Meeting with a certified diabetes educator (CDE) is highly recommended for all diabetics. A CDE can help the diabetic develop a better eating plan in coordination with insulin administration. Living healthier and longer is now a reality for diabetics that actively and consistently maintain a healthy lifestyle, which includes an exercise regimen, incorporates stress reduction practices and maintains appropriate glucose levels.


Spring 2018 WellHealthQC.com

Types of diabetes and their classifications

TYPE 1 - is an auto-immune disease. For unknown reasons, the body destroys cells in the pancreas that are responsible for making insulin. Typically this is discovered before the age of 20. When the glucose level remains elevated, it will cause damage to cells, tissue and organs. Individuals with type 1 diabetes will require insulin for life. Type 1 accounts for approximately five percent of all diabetics. TYPE 2 - tends to occur later in life after the age of 20 and usually among individuals that are overweight or inactive. Individuals with type 2 diabetes typically are able to make enough insulin, but their body is resistant to it or unable to metabolize it correctly. This leads to the same circumstance as with type 1 diabetics, with elevated glucose levels in the body causing cell, tissue and organ damage if not controlled. Type 2 diabetics can be treated with lifestyle changes such as weight loss, exercise and diet modification. Other medications, along with insulin, may also be necessary to control the glucose levels. Type 2 accounts for approximately 90 percent of all diabetics. Gestational - develops during pregnancy and will commonly fade after delivery. One in 20 women may develop gestational diabetes. Women that have gestational diabetes have up to a 60 percent chance of developing type 2 diabetes within 10 years.

Written by: Tina Phyfer, APRN

Individuals with diabetes should seek providers that will treat, support and educate the individual with diabetes on: stress management, proper glucose monitoring, recognizing early signs of low glucose levels, how to safely deliver insulin and appropriate skin, foot and eye screenings.


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Dedicated Doctors JOEL K. SCHWARTZ, MD, Dr. Schwartz practices maternal-fetal medicine. He graduated from Cornell University in 1990, and from Jefferson Medical College of Thomas Jefferson University in 1997. Following graduation, he completed his OB/GYN residency training at Mount Sinai Hospital on the Upper East Side of New York City, and then went on to complete his maternal-fetal medicine fellowship at the University of Colorado in 2004. Dr. Schwartz is proud to have played an integral part in the creation of the Colorado Fetal Care Center, one of the foremost, comprehensive fetal surgery programs in the United States. He is board certified in obstetrics & gynecology and has a special interest in ultrasound, particularly in the diagnosis of fetal abnormalities. When he is not in the clinic, Dr. Schwartz loves spending time with his daughter, son and their Wheaten terrier. In his free time, he enjoys running and cycling and has completed 15 marathons and one Ironman.

ALYSSA SMALL LAYNE, MD, Dr. Small Layne was born and raised in Canada with deep Caribbean roots, which sparked her interest in diversity and healthcare disparities. She graduated with honors from the University of Toronto with a Bachelor of Science degree in Neuroscience. She had varied interests that she satisfied with minors in both Caribbean studies and psychology. Her interests in science and community wellbeing led her to pursue a career in medicine. She graduated from medical school at Meharry Medical College and then trained to be a women’s health specialist with a residency in obstetrics & gynecology at the University of Illinois at Chicago. Her medical career has focused on urban and underserved populations with projects in Canada, USA, Barbados and Honduras. While studying, Dr. Small Layne found time to mentor students from disadvantaged communities in science and math. In her spare time, she is an avid hobbyist who can be found exploring farmers’ markets for her latest culinary adventures, hiking, snowboarding and even making her own hair care products.

JESSICA SISTO, MD, Jessica Sisto will always call California home; however, has lived all around the country and the world completing her education. She received her undergraduate degree from Pitzer College, followed by her Master’s Degree at Drexel University. She completed her medical training at the University of Cincinnati in Ohio, during which she spent a year abroad in Central America working on a maternal health education project. This project sparked her interest in international health. She then returned to California to finish her OBGYN residency at the University of California Irvine. Dr. Sisto considers women’s healthcare her passion and has always been interested in underserved communities and women’s global health. She has worked in Nicaragua, Honduras, Ecuador and Tanzania, and plans to continue to fight for all women’s access to healthcare around the world.

LAMARR TYLER, DO, FACOG, Dr. Tyler was born and raised in Chicago, Illinois. He began his residency in the department of family practice, and after his first year, switched to obstetrics & gynecology after discovering his passion for women’s health. He believes that patients should be active participants and engaged in their healthcare. His philosophy is that the doctor-patient relationship is one of a shared partnership. He seeks to provide patients with up-to-date, evidence-based healthcare options, enabling them to make the most informed choices regarding their healthcare needs. He believes every patient is unique and their care should be individualized. He optimizes the most current and minimally invasive technologies to optimize female health. He embraces health and wellness and encourages positive lifestyle changes. In his free time, he enjoys living an active lifestyle and lists cycling, skiing and yoga as a big part of his fitness regimen. Spring 2018 WellHealthQC.com


Our passion for this profession reaches far beyond simply practicing good medicine. It finds affirmation in a patient’s smile, a warm handshake, a jovial conversation. We believe in order to provide life-changing care for our patients, they first need to know how much we care about them. For us, it’s more than just a rewarding career— it’s a labor of love.


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