hEAlTh - NEA Health - A Northeast Arkansas Community Service

P R O V I D I N G N O R T H E A S T A R K A N S A S A N D T H E S U R R O U N D I N G A R E A W I T H H E A LT H F U L I N F O R M AT I O N
HEALTH
ISSUE 2
FALL-WINTER 2005
COSMETIC LASER SURGERY
BABY SHOW
Norbert Delacey, M.D.
4D ULTRASOUND
Where do
DRUG STUDIES come from?
Charles Barker, M.D.
You’re going to BE A MOM!
Lorna Layton, M.D.
Charles Dunn, M.D.
Old problems, NEW OPTIONS
Mark Stripling , M.D.
Learning About
POLYCYSTIC OVARIES
Michael Hong, M.D.
Other articles include Hyperhidrosis, Lasik, Occupational Medicine, Breast Cancer Therapy,
Teen Pregnancy, Kidney Disease, Alzheimer’s Disease and Contour Threads.
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P R O V I D I N G N O R T H E A S T A R K A N S A S A N D T H E S U R R O U N D I N G A R E A W I T H H E A LT H F U L I N F O R M A T I O N
HEALTH
Cosmetic Laser Surgery
Baby Show
ISSUE 2, FALL-WINTER 2005
Contour Threads
Multispecialty Medicine
Preventing Kidney Disease
Occupational Medicine
Old Problems - New Options
Living with Alzheimer’s
Learning about Polycystic Ovaries
Breast Cancer Therapy Update
Let Loose with Lasik
You’re Going to Be a Mom
No Sweat
Where Do Drug Studies Come From?
NEA CLINIC ❧ WOMEN’S CLINIC
OB-GYN PHYSICIANS
Facing the Facts about Teen Pregnancy
PUBLICATION OFFICE
1835 Grant
Jonesboro, Arkansas 72401
[email protected]
www.neaclinic.com
Why I Became A Doctor…
Holly Acebo, Executive Director
NEA Clinic Charitable Foundation
NEA Health is published bi-annually for the purpose of conveying healthrelated information for the well-being of residents in Northeast Arkansas
and Southeast Missouri. The information contained in NEA Health is not
intended for the purpose of diagnosing or prescribing. Please consult your
physician before undertaking any form of medical treatment and/or
adopting any exercise program or dietary guidelines.
Editorial, advertising and general business information can be
obtained by phoning 870-934-5101 or by writing in care of this publication
to: 1835 Grant, Jonesboro, Arkansas 72401. You may also e-mail:
[email protected] and put “NEA Health” in the subject line.
Copyright© 2005 NEA Clinic Charitable Foundation. All rights
reserved. No part of this publication may be reproduced or transmitted in
any form or by any means, electronic or mechanical, including photocopy,
recording and any information storage retrieval system, without written
permission from NEA Clinic Charitable Foundation.
“I chose
Obstetrics
because it is the
most positive part
of medicine. Each
new birth shows
that life must go
on. What a
privilege to be
part of all those
deliveries.”
Charles Barker,
M.D., Ph.D.,
C.C.I., FACOG
“I decided to
become a doctor
when I was about
five years old. My
family doctor,
Doctor Bob, took
my tonsils out
and I quit having
ear and sinus
infections, and I
thought that was
cool. So I wanted
to be able to do
the same for
others.”
Norbert Delacey,
M.D., FACOG
“My uncle Bill, an
Ob-Gyn from
Washington,
D.C., came to
visit our family
when I was in the
6th grade. I so
admired him that
I decided I, too,
would become a
doctor. Since that
visit my goal had
never wavered.
The idea of
helping others as
a career was
something I knew
was meant for
me.”
Charles C.
Dunn, M.D.,
FACOG
“Every conception
and birth is a
miracle, and
every mother
who delivers a
baby is a hero.
Patients are
always excited to
share their new
baby after
arrival. This is a
very happy
profession.”
Michael Hong,
M.D., FACOG
“I became
interested in the
field of medicine
through my love
of the sciences.
Seeing my first
delivery is what
made me choose
Ob-Gyn as my
field.”
Lorna Layton,
M.D., FACOG
on the
cover
“My father was a
small town family
practitioner. It’s
not that he was
actually paid in
chickens and
vegetables, but
we were never
lacking for fresh
corn, tomatoes,
chickens and the
occasional
country ham
placed
anonymously in
the back seat of
his car at the
hospital. Who
would not want to
follow in the
footsteps of a
man so
respected and
appreciated in his
community!”
Mark C.
Stripling, M.D.,
FACOG
1 . NEA HEALTH | FALL 05
VENUS LASER
AURA LASER
NORBERT DELACEY, M.D.,
F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
LYRA LASER
COSMETIC
LASER
T
he use of lasers
for cosmetics is relatively
new. I took an interest when I noticed how many women
asked me what could be done for unwanted hair and
spider veins. Until lasers were designed for cosmetic uses there
were few options. Electrolysis for hair and injections for spider
veins could be performed, but the results were variable. The
treatments were time consuming and painful. NEA Clinic opened
its Advanced Laser Center where both unwanted hair and spider
veins are treated with excellent results. Additionally, facial
blemishes, wrinkles, and stretch marks can be treated.
The Advanced Laser Center has the most sophisticated
up to date Yag Lasers available. A laser is essentially a specially
focused light. It exerts its effect when the tissue focused upon
absorbs the light energy. In the case of unwanted hair, the hair
root absorbs the laser light to destroy the follicle permanently.
The appearance of wrinkles is lessened by the production of
collagen from the tissue underneath the wrinkle in response to the
laser energy. Likewise, pigmented lesions absorb the laser, which
dissolves the pigment. Spider veins contain blood and the pigment
in the blood cells absorbs the laser energy to coagulate and close
the vein making it invisible. Wrinkles, blemishes, and stretch
2 . NEA HEALTH | FALL 05
marks are minimized by skin resurfacing where the surface of the
skin sloughs in response to the laser much the same as with a
chemical peel.
There are three different lasers that are used for
different purposes. The difference between them is the depth that
the laser penetrates the skin. The Venus laser penetrates the least
and is used to resurface the skin. The Aura penetrates to just
under the skin surface. This is useful for removing fine spider
veins and pigmented areas. The third is the Lyra laser, which
penetrates the deepest. It is used for larger spider veins, wrinkles,
and unwanted hair.
The treatments do not take long and are done with an
anesthetic cream to minimize any discomfort. Spider veins can be
treated in one or two sessions. The results are immediate.
Unwanted hair will take five or six treatments spaced a month
apart for a good result. Facial rejuvenation is a technique, which
employs all three lasers to treat wrinkles, remove pigmented
lesions, and resurface the skin, and is usually accomplished with
three treatments spaced a month apart. Stretch marks can also be
treated in a similar manner. As with wrinkles, stretch marks will
not be removed but will become much less noticeable. I
Thinking about a
Baby?
It’s a big decision.
So is choosing a doctor. Fortunately, that part just got easier.
Each of the physicians with NEA Clinic Women's Clinic are board certified and are truly
dedicated to bringing you the best in medical care. Our doctors are connected to a team of over
70 physicians with NEA Clinic, with access to specialists and your complete medical record.
Celebrate your decision with a "Baby Show". See your baby with REAL TIME 4D
ULTRASOUND. With no risk to you or your baby, you can have these real time images
captured onto a video and take home memories of a lifetime.
Why go anywhere else?
Choosing a doctor is the easy part.
Choose NEA Clinic ❦ Women’s Clinic
Call today at 870-972-8788.
www.neaclinic.com
Charles Barker, M.D., Ph.D. • Mark Stripling, M.D. • Charles Dunn, M.D. • Norbert Delacey, M.D.
Michael Hong, M.D. • Lorna Layton, M.D.
Board Certified Physicians
• Physician owned and patient centered
• Designed specifically for enhanced patient
comfort in an environment dedicated to
specialty surgery, diagnostic imaging and
treatment of chronic pain
THE ONLY SPECIALTY SURGICAL HOSPITAL IN THE REGION
909 Enterprise Drive • Jonesboro, AR 72401
870.336.1100
• Superior nurse to patient ratios and
superior patient satisfaction
• Hospital acquired infection rate 10 times
lower than the national average*
comfortable, roomy, private suites & spacious waiting area
* CONSUMERREPORTS.ORG
3 . NEA HEALTH | FALL 05
Baby
Show
W
ith the advent of ultrasound we have been able to
obtain an accurate due date for the expectant mother
as well as confirm baby’s well being. It has been a
marvelous addition to the practice of obstetrics. Of course,
infrequently we find problems with the pregnancy on ultrasound,
but certainly the majority of the time it allows us to see a
beautifully developing baby, or babies
as the case may be.
The typical ultrasound picture
is done in a 2 dimensional view, as if
you took a still photograph of someone.
With this black and white picture we
can measure the baby and obtain dating
as well as assure good growth, location
of the placenta and look for adequate
amniotic fluid around the baby.
Depending on how far along the
pregnancy is, we can also look at
various organs, such as kidneys,
stomach, brain, heart, bladder, etc. to
document normal development.
As technology advances we can
now visualize the baby in a three
dimensional way as if you are looking
with you own eyes at another person. In
other words, you can see depth. In fact
we can see movement, which gives us the
“4-dimensional” ability. This is the 4-D
ultrasound, which we offer in our office at
NEA Clinic Women’s Clinic. We call it
“Baby Show” and you can see your baby
in 3-D with the added fun of watching
the baby move. In fact, we add color to
the picture giving the baby’s skin a normal flesh like appearance.
The best time to schedule this viewing is when the baby
is between 24 and 30 weeks of gestation. Your doctor can tell you
how far along you are, or we can, if you provide us with an
accurate due date. When determining the gestational age it is
calculated from the first day of your last menstrual cycle to the
present date. This is assuming you became pregnant 14 days after
your period began, otherwise your gestational age is decided by
ultrasound. The reason for this window of opportunity is to allow
4D
ULTRASOUND
the baby to be big enough to see his or her features but now so
large as to only catch small glimpses of the baby. Also, we want to
make sure there is enough amniotic fluid around the baby to get a
contrast between liquid (the amniotic fluid) and tissue which
allows for a great view. If the baby is pressed up against the uterus
(womb) and there is no significant fluid between the two it is
difficult to separate the baby’s features
from the uterus. As the pregnancy
advances the fluid level can decrease
making the picture not as clear.
At this point in time we are doing
the“Baby Show”for fun. Our intent is
not to try to diagnose any birth defects,
assure an accurate due date, or
guarantee fetal well-being. With this
ultrasound our technologist will start
in the traditional 2-dimensional mode
to get an overall appearance of the
baby and if so desired can try to
determine the gender (boy or girl).
Then she will change to the 3-D and 4D view so that you can see your baby.
Maybe you will visualize the eyes
opening and closing, or change in the
facial expression. Typically you will get
a nice picture of your precious baby
whether awake or asleep.
In our ultrasound room we have
room for your family to watch on a
large flat screen television set that is
mounted on the wall. You will receive
still photographs of the baby as well as
a videocassette. You may want to bring
your own videocassette if you have a favorite brand or if you
want to put it on an existing tape; otherwise, we will provide you
with one.
If you want to have an ultrasound done for purposes of
dating the baby or looking for birth defects or other problems then
you will need to contact your doctor for scheduling a diagnostic
ultrasound. If you want to see the baby in a moving 3-D
appearance then feel free to call our office to set up an
appointment at 870-972-8788. I
The best time to
schedule this viewing is
when the baby is between 24
and 30 weeks of gestation.
4 . NEA HEALTH | FALL 05
CHARLES DUNN, M.D.,
F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
Contour Threads
™
New, exciting technique of
in office face lift…
“Feather Lift”
TOMASZ MAJEWSKI, M.D.,
F.A.C.S.
PLASTIC & RECONSTRUCTIVE
SURGERY
NEA CLINIC – 870.934.3530
S
The entire procedure is
performed under local
anesthesia in the office…
ome say that since the invention of a mirror about 5000 years ago, people
have been looking at their reflection, lifting foreheads with their hand to see
if that would make them look younger. In the 20th century, advances in
science and technology made the “face lifting” possible. Several procedures, some
of them very complex, have been developed. Most of the current facelift
techniques are very effective in achieving facial rejuvenation, but usually require
significant commitment on the patient’s side: taking time off from the busy
schedule, accepting risks and complications, scars etc. Those factors prompted an
ongoing quest for a procedure that would achieve a goal of facial rejuvenation with
minimal downtime, scars, complication rate and – if possible – minimal anesthesia.
According to the American Society of Plastic Surgeons data, almost
seven million of minimally invasive procedures have been performed in 2004, a 43
percent increase over 2003. Most of those were injections of Botox and dermal
fillers (Restylane, collagen and others), laser procedures, chemical peels etc., but
among the new exciting procedures gaining popularity there is Contour Threads™.
In the past, surgeons tried to use a variety of sutures threaded through the
facial soft tissues to elevate them. Smooth sutures, however, cut through the tissue
and usually the “lift” is very limited. Eventually, plastic surgeons in France, Russia,
China and Brazil developed variety of types of threads with small feathers, cogs or
barbs, which provided more support for sagging tissues by distributing the tension
continued on next page
Nursing
Radiologic Sciences
Clinical Laboratory Sciences
Physical Therapy
Communications Disorders
Social Work
P.O. Box 910
State University, AR 72467-0910
870-972-3112
5 . NEA HEALTH | FALL 05
NEA Clinic is committed to being involved in the
community, improving the health of its patients
and extending the quality of life for Northeast
Arkansas. It is our vision to incorporate a
medically managed wellness regimen, including
counseling and individual wellness programs, into
existing fitness programs that are now offered at
the Athletic Club located on Phillips Drive in
Jonesboro.
A new Approach
to Healthcare…
Good health begins with taking care of our
physical bodies.
Our physicians believe in treating the whole
person, not just the symptoms.
Talk to your NEA Clinic doctor today about
designing a Wellness program just for you.
Fir
Another
from…
st
(870) 932-1898
2617 Phillips Drive • Jonesboro
e
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e
i
l
e
e
W B
in
HEALTH
Forming the region's first Wellness Center is
linked directly to our mission of providing
comprehensive, personalized, quality healthcare
for Northeast Arkansas. We see the new Wellness
Center as an opportunity to offer preventive
wellness programs that promote and improve
health and quality of life.
The development of the WELLNESS CENTER is a
fulfillment of our commitment to improve the
overall health of our community. We are excited to
have this opportunity to offer services that are
focused on disease prevention and improvement
of the quality of life.
We know that the community will be very pleased
with the partnership of these two prestigious
organizations. We are committed to providing the
highest level of health, wellness and fitness
programming.
The mission of NEA Clinic is to provide
comprehensive, personalized, quality healthcare
for our patients throughout the Northeast
Arkansas region. For more information on NEA
Clinic Wellness Center, visit us at
www.neaclinic.com.
Contour Threads™ (continued)
along the entire length of the suture, not just at the very end of it
(Aptos, “feather-lift” etc.).
Recently, the most advanced type of those sutures, the
Contour Threads™, received the FDA clearance and were
approved in the United States (for midface suspension in
September of 2004, brow suspension in December of 2004, and
neck in March of 2005). The sutures are made of a clear
polypropylene, material used in surgery for decades. The pattern
of barbs (shape, size and spacing) was scientifically designed to
optimize performance. The barbed segment of the suture (similar
to a porcupine’s quill) is attached by a smooth portion of the
suture to a long straight needle on one end and the small curved
needle on the other. After preoperative markings are made on
the patient’s skin, the long needle is used to guide the suture
under the skin in the desired direction. The long needle is then cut
off, and the small one is used to anchor the suture to the deeper
tissue within the scalp or behind the ear.
Only small incisions are made in those concealed areas
to place the stitch, tie it, and bury the knot under the skin. There
are no incisions on the face (only needle exit marks that
disappear within few days and leave no scars). After deployment
the barbs open up in an umbrella-like fashion to suspend the
6 . NEA HEALTH | FALL 05
facial tissues. The excess skin “bunches up” in the areas of
anchoring. This excessive skin is not removed, but allowed to
redistribute over a period of few weeks. The entire procedure is
performed under local anesthesia in the office or under light
sedation.
The best candidates for the procedure are men and
women in their thirties through their sixties who want a more
youthful appearance, but do not want a conventional facelift or
brow lift procedure. The procedure does not replace the
traditional face or brow lift, but offers improvement with a
minimally invasive approach. It is safe and effective. There are no
visible scars and recovery is fast. It can be combined with other
procedures (Botox, fillers, lasers, neck liposuction etc.).
Additional threads can be added at the later time, if needed. It
does not preclude performing a conventional facelift or brow lift
in the future. The complication rate is very low.
To assure the high level of accuracy, all cosmetic
surgeons must complete a training course on the surgical
technique before using Contour Threads™.
W. Tomasz Majewski, M.D, FACS is the only provider of
this exciting new procedure in Northeast Arkansas. To schedule
an appointment call (870) 934-3530. I
NEA Clinic
Multispecialty Medicine
STEPHEN WOODRUFF, M.D.
MEDICAL DIRECTOR
NEA CLINIC – 870.935.4150
W
hat is a true multispecialty group, and what are the advantages, both
from the perspective of the patient and the physician? Following the
Mayo Clinic model, NEA Clinic is a true integrated multispecialty
clinic. In a system such as this, the physicians share one common lab system,
imaging center, and, most importantly, one universal electronic medical record.
This allows for more efficiency, consistency, and prevents duplication of testing.
Linkage of the medical record, to all the clinic sites, plus NEA Medical Center,
provides a complete circle of communication, whether it is complex specialty
care, or an Urgent Care visit.
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Now, multispecialty clinics use organizations, such as, The American Medical
Group Association, to come together, and learn how to be at the forefront of
medical care. There is a constant sharing of information with these national clinic
systems, in order to perform even better in the future. More and more,
multispecialty clinics are becoming integrated health care delivery systems. In so
doing, the culture and focus of the clinic, also exist in the acute care hospital,
surgical center, cancer and cardiac center, as well as multiple community services.
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This is exactly where we are going in the future with NEA Clinic, as you see us
develop NEA Medical Center to a major health care entity for our region. We
will help the community become healthier, with organizations like HopeCircle,
the Medicine Assistance Program and Center for Healthy Children as part of our
charitable foundation. We want to be able to fulfill our mission of bringing the
best in medical care to Northeast Arkansas. We will keep you posted on our
plans, and solicit your input on ideas that might serve you better. As we continue
to grow and serve, we thank you, our patients, for helping to make this a reality.
I
www.neaclinic.com
www.neamedicalcenter.com
www.neacfoundation.org
7 . NEA HEALTH | FALL 05
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8 . NEA HEALTH | FALL 05
PREVENTING
Kidney Disease
ANGELA FOWLER, A.P.N.
NEPHROLOGY – NEA CLINIC – 870.935.4150
Our kidneys often go unnoticed, but they
Around 100,000 people a year
sugar increase the risk of progression to
are important to our body’s daily
are diagnosed with kidney disease.
kidney failure.
function.
They
have
numerous
Although some kidney diseases cannot be
The key to preventing kidney
responsibilities. Not only do they filter
prevented, the two main causes can be.
disease is tight blood sugar control and
wastes from our blood that are byDiabetes and High Blood Pressure are
good blood pressure. The American
products of our body’s normal
the most common causes of kidney
Diabetic Association and The National
breakdown of tissue and the food we eat,
damage. Lack of control of either one or
Heart, Lung and Blood Institute
they also control our body’s composition
both can lead to kidney damage.
recommend a blood pressure of 130/80 or
of minerals and electrolytes such as
Increased levels of glucose (sugar) in our
less for diabetics. The use of blood
potassium and sodium. They control the
blood acts as a poison destroying small
pressure medicines called angiotensin
volume of our blood by excreting excess
blood vessels like those found in our eyes,
converting enzyme (ACE) inhibitors or
fluid through the bladder and by doing
heart and kidneys. This damage affects
angiotensin receptor blockers (ARB’s)
this along with other complicated
the filtering ability of our kidneys. When
not only lower blood pressure but have
processes, they help regulate our blood
diabetes damages those small blood
been shown to slow down the loss of
pressure. In addition, our kidneys also
vessels in our kidneys, the nephrons
kidney function. It is also important to
contribute to metabolism by helping to
cannot properly filter our blood. Wastes,
have your blood pressure checked several
synthesize Vitamin D and controlling our
fluids, electrolytes and minerals build up
times a year in a doctor’s office and
body’s red blood cell production by
in our body causing edema and weight
routinely at home or in your local
secreting
a
hormone
called
gain. This damage also causes protein to
pharmacy. Diabetics should have A1C
erythropoietin.
escape from our blood through our
levels checked at least twice a year with a
Kidney disease results from
kidneys. The earliest sign of diabetic
goal of 7 or less and also monitor their
damage to the nephrons. Nephrons are
kidney damage is protein in the urine.
daily blood sugar readings at home. If
tiny structures in our kidneys that
you are diabetic and/or have high
perform the filtering process.
The key to preventing kidney disease is tight blood pressure, you should have
Usually, the damage occurs slowly
your urine tested for protein and
blood sugar control and good blood pressure. blood creatinine levels routinely
over
years
without
many
symptoms early on. When damage
checked. I
occurs, the kidneys gradually lose their
High Blood Pressure not only
ability to regulate fluid, minerals and
causes kidney damage, it can also be a
WEB SEARCH
electrolytes. Damaged kidneys also retain
result of kidney damage. As kidney
wastes that our body does not need.
disease worsens, changes in the kidney
For more information regarding kidney disease, go
to the websites listed below or ask your NEA
When our kidneys are sick they are less
lead to increased blood pressure. Both a
Clinic doctor or nurse practitioner.
efficient in producing the hormone
family history of high blood pressure and
www.neahealth.com
erythropoietin, therefore we make fewer
the presence of high blood pressure
Keyword: DIABETES
red blood cells and become anemic over
increase chances of developing kidney
time. Increased fluid in our bodies causes
swelling and can affect our heart and
lungs. Kidneys should never allow protein
to leak from our bodies into the urine;
however, when damaged they have
difficulty keeping protein in our blood
and it is often seen in the urine.
disease. High Blood Pressure also
accelerates the process of kidney disease
where it already exists. High Blood
Pressure can aggravate the complications
associated with diabetes, including kidney
damage. Research has shown that high
blood pressure and high levels of blood
National Institute of Diabetes &
Digestive & Kidney Diseases:
www.niddk.nih.gov
National Kidney Foundation:
www.kidney.org
American Assoc. of Kidney Patients:
www.aakp.org
9 . NEA HEALTH | FALL 05
Occupational Medicine Specialists –
What We Do…
Richard A. Covert M.D.,
M.P.H., Director Occupational
Medicine - NEA Clinic
870.910.6024
As NEA Clinic strives to broaden its scope of services, it has added the
specialty of Occupational Medicine to its arsenal. However, with the exception
of Human Resource Directors, Safety Managers and Worker’s Comp Case
Managers, few are familiar with this specialty. This article will enlighten you
as to what this field of medicine encompasses, the training required to be a
board certified OM physician and what the role of the OM physician is in the
workplace and the community.
Occupational Medicine as a specialty is concerned with the prevention and
management of injuries, illnesses and disabilities that may be arise out of work,
as well as, the promotion of health and productivity in workers, their families
and the community. It is not a new field of study. It dates back thousands of
years to a time when workers in the Greek mines were noted to die sooner than
their counterparts. In the Renaissance Period, a number of articles were written
about the hazards of certain trades such as the goldsmith or metal worker and
in the 1700’s, an Italian physician by the name of Ramazzini wrote the first
book describing hazards and illness in the workplace.
In more recent times, exposure to chemicals became identified with certain
illnesses, such as mercury, causing toxicity to brain and nerve tissue. This agent
was commonly used in the tanning, taxidermy and felt industry, (hence the term
“mad as a hatter”, later used by Lewis Carrol in Alice in Wonderland). In the 1900’s, the field of Occupational Medicine was recognized as a
specialty and with time, programs to train doctors in this specialty were developed.
Today, to become a Board Certified specialist in Occupational Medicine, requires training in Epidemiology, Environmental Health, Toxicology,
Statistics, Workplace Psychology, Public Health and the Medico-legal aspects of the workplace.
The physician who works in this arena, on a full time basis, is much more than a “company doctor” or the drug test collector. He or she is
concerned with the impact of exposures at work that not only affect the worker, but their families and the community as a whole. These physicians
have to understand work processes, work environments, physical and chemical hazards, ergonomics, local, state and Federal regulations that
control the workplace, as well as, the worker’s comp insurance programs that cover employees, should they get injured. Further, these doctors
often serve in a Preventive Health role by screening workers for diabetes, hypertension, heart disease, lung disease or cancer, while providing
educational programs and assisting employers in providing a safe workplace for all.
In short, the Occupational Medicine physician has great expertise and is expected to wear many hats: caregiver, investigator, communicator,
educator, coordinator and consultant. If you are referred to this specialist, you will find that he or she really has your best interests at heart,
understands the nature of your work and its impact on you. I
10 . NEA HEALTH | FALL 05
Old Problem...
New Options
S
ome of the most
common problems
discussed
with
an
obstetrician-gynecologist have
to do with abnormalities of the
menstrual cycle. Frequent
concerns involve the length and
heaviness of the period as well
as frequency and associated
pain. Most of these concerns
arise from the patient’s
perception of a change in what
she feels is normal for her.
A typical menstrual
cycle has its onset when most
young women are between 1213 years old. It occurs, on
average, every 28 days although
most physicians feel that a span
of 21-35 days can be perfectly
normal. The usual duration of
flow is 4-6 days. The volume of
menstrual blood loss is normally
around 6 teaspoons. Abnormally
heavy periods are generally
associated with volume losses
MARK C. STRIPLING, M.D.,
F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
continued on next page
11 . NEA HEALTH | FALL 05
Old Problems, New Options (continued)
of greater than 16 teaspoons. Actually measuring volume
loss is extremely difficult in a clinical setting so most
physicians rely on the patient’s own perception regarding
duration, timing and amount of her flow.
Although there are numerous causes for
abnormalities in the menstrual cycle including pregnancy
complications, medications, cancers of the cervix and
endometrium, polyps, fibroid tumors and certain medical
conditions such as hypothyroidism, renal or liver failure, and
the most common by far is dysfunctional bleeding. As the
name implies, dysfunctional bleeding means that an
otherwise normal uterus is not functioning in a normal
fashion. The diagnosis of dysfunctional bleeding is not made
until all the other potentially, more serious problems are
ruled out. This may require a pelvic exam, a pap smear,
possibly a pelvic ultrasound and even a biopsy of the lining
of the uterus.
Once your doctor has diagnosed dysfunctional
bleeding as the etiology of the menstrual abnormalities, there
are several treatment options available. Some of these are
old stand-bys, others are relatively new. Oral contraceptives
are one of the safest and most easily used methods of cycle
regulation. The hormone in the pill overrides the body’s own
hormone to control the bleeding of the uterus. There are even
products available now to control the cycle and delay the
period for 90 days or in other words 4 cycles per year. If
remembering to take a pill daily is going to be difficult, there
is an injectible hormone contraceptive that can also eliminate
the cycle and is given once every 3 months.
A relatively new option for patients desiring longer
term, but reversible contraception is an intrauterine device
containing the hormone progesterone. The device is inserted
in the office and is effective for 5 years. Because of the
progesterone hormone the amount of menstrual flow can be
significantly reduced over time.
For the patient who has failed the
other methods of menstrual
control and who has completed her
family, a relatively new technique
called Endometrial Ablation
may be an option. Most women are
not able to get pregnant after an
ablation … discuss your options
with your doctor.
For the patient who has failed the other methods of
menstrual control and who has completed her family, a
relatively new technique called Endometrial Ablation may be
an option. Ablation is a short outpatient surgery that uses
different forms of energy to destroy the thin layer of the
lining of the uterus. This procedure can stop the period of
many women or at least reduce it to a day or two of light
spotting or flow. Most women are not able to get pregnant
after an ablation, so if pregnancy is desired you should
consider one of the other options offered. The procedure
rarely takes more than 30 minutes to complete, with
discharge home within a couple of hours. Most women are
back to their usual activities in one to two days with only
mild cramping.
Discuss your options with your doctor. Between the
two of you, you can plan the treatment that best fits your
needs. I
www.neahealth.com Keyword: MENSTRUATION
12 . NEA HEALTH | FALL 05
Stir Up Your Saturday!
TEX-MEX
BEEF STEW
Slow cookers are ideal for busy days,
especially those cold, wintry ones.
Serves 4; 1-1/4 cups per serving
1 pound top sirloin steak, all visible
fat removed, cut into 1-inch pieces
12 ounces red potatoes, cut into 1-inch
pieces
1 large green bell pepper, cut into 1inch pieces
2 medium onions, quartered
1/3 cup water
1 1/2 tablespoons steak sauce
2 teaspoons very low sodium beef
bouillon granules
2 teaspoons chili powder
1/2 teaspoon sugar
1/4 teaspoon ground cumin
1/2 teaspoon salt
1/4 teaspoon ground cumin
2 tablespoons low-sodium ketchup
continued
HOMEMADE
CORN
TORTILLA
CHIPS
Serves 8; 5 chips per serving
10 5-inch corn tortillas
Commercial salsa or Fresh and
Chunky Salsa
Preheat oven to 400: F. Bake for 8 to 10
minutes, or until crisp. Cool before
serving. Store in an airtight container for
up to 2 weeks.
Serve with salsa. Try a Recipe Search at
the American Heart Association website
for Appetizers and Snacks to find the
recipe for Fresh and Chunky Salsa.
…with these Heart Healthy Recipes from
the American Heart Association.
(Nutritional information on back)
APPLE CRISP
Serves 8
Vegetable oil spray
1 1/2 pounds (5 medium) apples, cored
and sliced, unpeeled
2 tablespoons fresh lemon juice
1/4 teaspoon ground cinnamon
2/3 cup all-purpose flour
1/2 cup firmly packed brown sugar
1/2 cup uncooked oatmeal
1/3 cup acceptable margarine
Preheat oven to 375: F.
Lightly spray a 2-quart casserole dish
with vegetable oil spray. Arrange apples
in prepared dish. Sprinkle with lemon
juice and cinnamon.
In a medium bowl, combine flour, brown
sugar and oatmeal. Cut in margarine
with a fork or pastry blender until
mixture is crumbly. Spread over fruit.
Bake 40 minutes or until apples are
tender.
Copyright © 2003 by the American Heart Association, Low-Calorie & Low-Salt Cookbooks.
13 . NEA HEALTH | FALL 05
Stir Up Your Saturday (continued)
APPLE CRISP
Variation 1:
Peach Crisp — Use 1= pounds (6
medium), peeled and sliced,fresh
peaches in place of apples.
Variation 2: Blueberry Crisp — Use 3
cups fresh or frozen unsweetened
blueberries in place of apples.
Calories: 219 kcal
Protein: 2 gm
Carbohydrates: 36 gm
Total Fat: 8 gm
Saturated Fat: 2 gm
Polyunsaturated Fat: 2 gm
Monounsaturated Fat: 4 gm
Cholesterol: 0 mg
Sodium: 55 mg
Potassium: 172 mg
Calcium: 26 mg
HOMEMADE
CORN TORTILLA CHIPS
TEX-MEX
BEEF STEW
Cook’s Tip: Place 3 or 4 tortillas in a
stack and cut them into 4 wedges.
Repeat with remaining tortillas, making
40 wedges total. Arrange wedges in a
single layer on baking sheets.
Directions: In a slow cooker, combine
the steak, potatoes, bell peppers, onions,
water, steak sauce, bouillon granules,
chili powder, sugar, 1/4 teaspoon cumin,
and salt. Cook on high for 4 hours or on
low for 8 hours.
Just before serving, stir in the remaining
cumin and ketchup.
Calories: 49 kcal
Protein: 2 g
Carbohydrates: 9 g
Total Fat: 1 g
Saturated Fat: 0 g
Polyunsaturated Fat: 0 g
Monounsaturated Fat: 0 g
Cholesterol: 0 mg
Sodium: 39 mg
Copyright © 2003 by the American Heart Association, Low-Calorie & Low-Salt Cookbooks.
14 . NEA HEALTH | FALL 05
Calories: 270
Protein: 28 g
Carbohydrates: 30 g
Total Fat: 5.5 g
Saturated: 2.0 g
Polyunsaturated: 0.5 g
Monounsaturated: 2.0 g
Cholesterol: 69 mg
Fiber: 5 g
Sodium: 411 mg
AD
Living with
Alzheimer’s
Disease
TROY VINES, M.D.
FAMILY PRACTICE
NEA CLINIC – 870.933.9250
A
lzheimer’s disease, and related dementias, affects over
4.5 million Americans. Approximately 50 percent of
people older than 85 years of age are affected to some
degree. Alzheimer’s disease causes a slow progressive loss of
memory and loss of ability to function independently. There is no
cure at the present time.
Once Alzheimer’s disease is diagnosed, the life of the patient has
probably already changed to some degree. Certainly, the lives of
those caring for the Alzheimer’s patient will change as well. The
following tips hopefully will assist those who are caring for their
loved ones with Alzheimer’s.
I recommend a book entitled “The 36-Hour Day. A Family Guide
to Caring for Persons with Alzheimer’s Disease and Dementia”.
Most of the following tips as well as many additional helpful ideas
can be found in this book.
WEB SEARCH
www.neahealth.com
SEARCH: ALZHEIMER’S DISEASE
15 . NEA HEALTH | FALL 05
L I V I N G
1.
Keep the patient active but not upset. A walk,
visiting old friends, or chores they are capable of
doing will give them a sense of worth. Talk to your
mate/family member calmly and gently.
2.
2. Maintain a structured environment. An
uncluttered house, predictable routine for meals
and bedtime are important. Nightlights are helpful.
Change a routine only when one is not working.
3.
ID bracelet for patient. It should state
“MEMORY IMPAIRED” and have your cell phone
or contact number. If your loved one wanders
off, someone can call you immediately.
4.
Stop the patient’s driving. Taking the car keys is
important to do early in Alzheimer’s when driving
deficiencies are noted. Hopefully the patient will be
able to participate in this decision and understand why.
5.
Don’t try to correct every incorrect
statement that the patient makes. This may cause
frustration and agitation. Also try not to
overreact to their actions.
16 . NEA HEALTH | FALL 05
W I T H
A L Z H
H E I M E R ’ S
D I S E A S E
6.
Symptoms may be worse at nighttime (sundowning).
Darkness may cause misinterpretations and
confusion. Plan the more difficult chores such as
bathing during daylight hours when possible.
7.
Avoid illness in yourself. Get regular physician
check-ups. Occasionally get away. Use family,
friends, church, and adult daycare centers to help.
8.
Remove potentially dangerous objects from their
sight. Put away irons, blenders, and other items
that could cause them harm. Cooking can be a big
problem and the stove may have to be unplugged
except when you are using it.
9.
Consider Alzheimer’s Support Groups. Tips can be
shared among those who care for Alzheimer’s
patients. Call the Area Agency On Aging in this area
for group meeting times. The number is 870-972-5980.
10.
Nursing home placement may have to be
considered. Don’t consider this a failure on your
part. At some point, Alzheimer’s patients may
require a level of care that cannot be delivered by
you and your family. I
17 . NEA HEALTH | FALL 05
18 . NEA HEALTH | FALL 05
MICHAEL HONG, M.D., F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
Learning About
Polycystic Ovaries
olycystic ovarian syndrome (PCOS) is a hormonal disorder
that affects 5 to 10% of all women in their childbearing years.
This condition can affect a woman’s physical appearance,
fertility status, as well as increase some long-term health risks. There
are some simple ways to identify this entity as well as treatment
options available for women who are experiencing this condition.
PCOS is a hormonal imbalance that begins shortly after puberty.
Many women with PCOS produce too much insulin, or they are
unable to correctly utilize insulin to metabolize glucose. As a result,
50 to 65% of PCOS patients gain weight easily or have difficulty
losing weight. PCOS women are also at a high risk for developing
Type II diabetes and gestational diabetes during pregnancy.
Follicular stimulating hormone (FSH) and luteinizing
hormone (LH) are responsible for stimulating ovulation. They also
prime the uterus for pregnancy. In women with PCOS the excess level
of LH often inhibits a woman’s ability to ovulate or menstruate at
regular intervals. An average menstrual cycle is 28 days; the bleeding
flow often lasts 5 to 7 days per cycle. Normal cycles can vary from
23 to 35 days. Patients with PCOS typically have cycles greater than
35 days or less than 8 cycles per year. Because their eggs are not
being released at the regular intervals, it affects their chances to
conceive and the predictability of menstrual cycles.
Another problem affecting patients with PCOS is hirsutism.
The cause of hirsutism is an excess production of androgen, or male
hormone. Hirsutism often manifests as acne, excess facial or
abdominal hair, pigmentation changes of the skin, and alopecia
(hair loss). Excess androgen may affect the cholesterol level and
contribute to heart disease and high blood pressure. A woman with
PCOS is at increased risk for cardiovascular disease, most
significantly a heart attack.
P
DIAGNOSIS
To diagnose PCOS your doctor may ask you questions regarding your
general health, menstrual cycle, and family history. There is also a
combination of blood tests and diagnostic tools to assist the evaluation
of PCOS. More than 50% of patients with PCOS will have an
elevated ratio of LH to FSH levels. Testosterone and thyroid testing
are a routine part of a workup to rule out other conditions leading to
similar clinical presentations. Fasting insulin levels as well as
diabetes testing can be offered to diagnose diabetes. Finally, a pelvic
ultrasound is an excellent diagnostic tool to evaluate the classic
characteristics of PCOS.
TREATMENT
Treatment for PCOS depends on a patient’s symptoms and their
immediate fertility needs. Weight loss, even as little as 5% to 7%, can
decrease the circulating androgen and insulin levels. Therefore,
spontaneous ovulation and predictable menstruation can occur with an
aggressive change in patient lifestyle and eating habits.
For those patients whose fertility is not an issue, hormonal
regulation is the most common treatment of irregular cycles. Birth
control pills not only provide effective contraception but also regulate
menstrual cycles and suppress androgen levels. After six months or
longer of birth control pill treatment, one could expect a gradual
decrease of excess body hair growth and acne formation.
For those patients who cannot tolerate birth control pills,
progestin is a second type of hormone that could offer regulation to a
woman’s menstrual cycles. Progestin is prescribed at 10 day intervals
per month. The supplement of progestin allows a woman to have a
predictable menstruation at the end of the 10 day therapy.
Finally, patients struggling with infertility now have two
types of treatment available to correct the hormonal imbalance
leading to infertility. Clomiphene (Clomid) is a fertility drug, which
is designed to increase the production of FSH therefore leading to
spontaneous ovulation. Up to 80% of patients on Clomid ovulate.
More than 40% of these patients will become pregnant.
Metformin (Glucophage) is the second treatment strategy,
which targets a person’s insulin resistance. Metformin was initially
19 . NEA HEALTH | FALL 05
Learning About Polycystic Ovaries (continued)
developed as treatment for diabetes. Over the years
studies have shown that daily Metformin therapy is
successful in stimulating resumption of normal menses
and ovulation. It typically takes 2 to 3 months of
treatment before spontaneous ovulation will resume.
Hirsutism is an undesired cosmetic
manifestation of excess androgen. Different treatment
options are available for excess hair growth. Common
treatments include bleaching, shaving, electrolysis, or
use of hair removal creams. Medications such as birth
control pills and spironolactone are available by
prescription. These agents can reduce the amount of
excess androgen and in turn reduce the growth of future
hair follicles; however, these agents typically take 3 to 6
months before results are visible.
INCREASED RISK OF HEALTH
COMPLICATIONS
Many women with PCOS are at increased risk
for certain health complications. Those health risks
include heart disease, diabetes, high blood pressure, and
abnormal uterine bleeding including uterine cancer.
Early diagnosis and appropriate treatment management
can prevent or limit the complications of these diseases.
If you have concerns regarding infertility, lack of regular
cycles, or a strong family history of PCOS, you should
not hesitate to discuss these issues with your physician.
I
Active Advantage is a membership
based program open to all individuals age
50 plus. Featuring a wide variety of health
seminars, updates, classes and support
groups, Active Advantage offers a variety
of discounts on merchandise and
services,
including
travel
and
merchandise discounts both locally and
nationally.
Active Advantage cost is $15 per
person or $25 per couple on a
yearly basis. Membership includes free
seminars and weekly health events, a
membership packet, quarterly newsletter and a discount card.
Take an active role in your healthcare
by participating in this program designed
to keep you informed and educated about
your health and well-being.
activeADVANTAGE ™
For more
program, or
Clark, Active
NEA Medical
information on this new
to sign up, call Yvonne
Advantage Coordinator at
Center, 972-7414.
www.neamedicalcenter.com
870.972.7000
3024 Stadium Blvd.
Jonesboro, AR
NEA PremierCare • 1835 Grant Street • Jonesboro, AR 72401 • (870) 932-0023 • Fax (870) 932-3191
20 . NEA HEALTH | FALL 05
UPDATE
Breast Cancer Therapy
AROMATASE INHIBITORS
A
new class of hormone therapy drugs called aromatase
inhibitors have been shown to be superior to tamoxifen
in treating certain women with early stage and advanced
stage breast cancer and has revolutionized the treatment for this
common disease. Approximately 60-70% of women with breast
cancer have hormone responsive cancers. These cancers express
hormone (estrogen and progesterone) receptors which, in the
presence of the female hormone estrogen, can stimulate the
cancer cells to divide and grow. These receptors are present in
most postmenopausal women with breast cancer but can even
be present in young premenopausal women with the disease. By
inhibiting these hormone receptors, the cancer cells die and
most women will have regression of the cancer.
Tamoxifen has been used as effective hormone therapy
for many years in treating early stage and advanced stage breast
cancer. It works by inhibiting or blocking the hormone receptors
on the cancer cell. Tamoxifen is used in both premenopusal and
postmenopausal women.
Aromatase inhibitors are a new class of hormone drugs
and 3 are used in clinical practice: anastrozole (Arimidex),
letrozole (Femara), and exemestane (Aromasin). These drugs
work by blocking the actual production of estrogen formed in
peripheral tissues of the body in postmenopaual women. By
blocking estrogen production, the cancer cells will die off. They
do not block estrogen production from the ovaries so these
drugs are ineffective in younger women who continue to have
menstrual cycles and functioning ovaries.
Several clinical trials have shown that the aromatase
inhibitors are more effective than tamoxifen in causing tumor
regression in postmenopausal women who have advanced stage
or metastatic breast cancer. Furthermore, women on aromatase
inhibitors have a much longer time before the cancer starts to
progress.
For postmenopausal women who have early stage
breast cancer, the aromatase inhibitors have been shown to
CARROLL SCROGGIN, M.D.
ONCOLOGY
NEA CLINIC – 870.935.4150
improve their chance of remaining in remission and cured
compared to tamoxifen.
The aromatase inhibitors seem to have less side effects
compared to tamoxifen in these clinical trials. There was a less
chance of blood clots, vaginal bleeding, gynecologic symptoms,
and uterine cancer with the newer drugs. Aromatase inhibitors
cause more arthritis symptoms and a higher risk of osteoporosis
compared to tamoxifen.
The aromatase inhibitors have changed the way breast
cancer is treated. It is recommended to start these drugs first line
in postmenopausal women with both early stage and advanced
stage disease. For postmenopausal women who currently are
taking tamoxifen, clinical trials show a benefit of switching to the
newer medications at some time (even for those who have
completed 5 years of tamoxifen).
Clinical trials are ongoing using aromatase inhibitors
with other forms of treatment. At NEA Clinic, we are
participating in a multi-institutional clinical trial using letrozole
with a drug that blocks a growth factor receptor on the cancer
cell surface. The purpose is to assess the response rate and side
effects of this combination of drugs in postmenopausal women
with metastatic breast cancer. Only through clinical trials can
we in the oncology community develop more effective,
revolutionary treatments for this disease. The use of aromatase
inhibitors will certainly save thousands of lives of women each
year who are diagnosed with breast cancer.
HERCEPTIN THERAPY
E
ach year in the United States approximately 200,000
women will be diagnosed with breast cancer. Effective
screening tests such as yearly mammograms have resulted
in most of these women being diagnosed at an early stage of
disease.The cure rate for breast cancer continues to rise because of
earlier stage of disease at diagnosis and because of more effective
chemotherapy and hormone therapy given after surgery to
prevent recurrences. Despite these advances, a significant number
21 . NEA HEALTH | FALL 05
Breast Cancer Therapy Update (continued)
of women develop recurrent metastatic cancer. Obviously new
forms of therapy must be found to help cure more patients.
One new form of treatment in oncology is targeted
molecular therapy. These drugs target a specific site on the cancer
cells rendering them unable to divide and grow. They are usually well
tolerated by patients since the drugs specifically target the cancer cells
only. Chemotherapy causes more side effects because these drugs
destroy both cancer cells and normal cells.
An example of targeted therapy in breast cancer is the
antibody trastuzumab (Herceptin) which was shown earlier this
year to greatly improve the cure rate in women who have early
stage breast cancer and who are eligible to take the drug.
Approximately 25-30% of women who have breast
cancer overexpress a certain protein on the surface of the cancer
cell, called HER2 receptor. This protein stimulates growth of the
cancer cells. Patients who overexpress this protein have a more
aggressive disease associated with a higher relapse rate, higher
mortality rate and a worse prognosis. Herceptin is an antibody
which specifically inhibits or blocks the HER2 receptors and, in
doing so, kills the cancer cells. It is only effective for the 25-30% of
women who have a HER2 positive breast cancer.
For several years Herceptin has been a very effective
drug in women who have metastatic breast cancer. Patients have a
much greater chance of cancer regression and live much longer
with the use of this antibody. The best results are seen when
Herceptin is administered with chemotherapy or hormone therapy
for advanced stage disease.
Based on the encouraging results with the use of this drug
for advanced stage breast cancer, the question arose whether
Herceptin would help the cure rate for early stage breast cancer.
Earlier this year, two nationwide clinical trials reported that, indeed,
Herceptin therapy with standard chemotherapy reduced the chance of
recurrent breast cancer by 52% compared to women who received
standard chemotherapy alone. Furthermore the survival rate also
improved. It is not often in oncology that we see such a dramatic
improvement in the cure rate with a new form of therapy.
NEA Clinic participated in one of these nationwide
multi-institutional clinical trials and 14 women from northeast
Arkansas with early stage breast cancer gave consent to
participate in the study. These women did not know at the start of
the study if Herceptin would improve their chances for cure. They
have the satisfaction of now knowing that they were part of a study
which has improved the prognosis for women with early stage
breast cancer who are HER 2 positive.
Herceptin therapy obviously will save the lives of
thousands of women over the years. Targeted molecular therapy
has changed the outlook for patients who have not only breast
cancer but other types of cancer. It is hoped that, with this new
form of therapy and other promising developments, cancer can be
treated one day as a chronic disease. I
www.neahealth.com
22 . NEA HEALTH | FALL 05
Keyword: BREAST CANCER
HEALTHSOUTH
®
Parkinson’s
Rehabilitation…
That’s Our Job!
HEALTHSOUTH RECEIVES
EXCELLENCE IN PARKINSON CARE
ACCREDITATION –
“HealthSouth Rehab of Jonesboro offers high
quality disease support across the continuum of
care, and should be among the first care facilities
visited by people with Parkinson’s Disease.”
MEG DUGGAN,
EXECUTIVE DIRECTOR OF THE
PARKINSON FOUNDATION
OF THE HEARTLAND
870.932.0440
1201 Fleming Avenue
Jonesboro, AR 72401
LASIK…
Why is it so popular?
Lasik (Laser Assisted in Situ Keratomileusis) is the most
commonly performed refractive surgery. The reason for its popularity is the
wow factor. Most patients are freed from glasses or contact lenses and have
excellent vision within one day to one week. In addition to a quick visual
recovery there is a relative lack of pain or discomfort. Recent advances have
improved the safety of the surgery and long term data shows a low risk to
proper candidates.
Lasik
can now be
performed on
both nearsighted
and farsighted
patients. It can
also be used to
correct the loss of
reading vision
that
occurs
around the age of
40 to 45. The
Lasik procedure
involves creating
a corneal flap
with a small
instrument called
a microkeratome.
This flap is only
150 microns thick, slightly thicker than a human hair. The excimer laser
then precisely removes small amounts of tissue to reshape the cornea. This
usually takes less than one minute. The flap is then replaced without stitches
and seals down within a matter of minutes. Improved laser and diagnostic
technology have improved the way we do lasik. The Custom Vue by VISX
allows us to precisely measure the imperfections in the focus of the eye. We
can now measure 100 times more accurately than with conventional lasik.
This can reduce glare and halo problems and improve outcomes.
MATTHEW MARGOLIS, D.O.
OPHTHALMOLOGY
NEA CLINIC – 870.932.0485
Alternatives to Lasik include PRK (PhotoRefractive
Keratectomy) which is a surface treatment. The outer layer (epithelium) is
removed and the laser is applied directly to the surface of the eye. This is an
alternative for some patients with thinner corneas and avoids the use of the
microkeratome and flap creation. This usually results in a longer healing
period and has the potential for being somewhat painful.
A newer method called Epi-Lasik or Lasek involves removing
the epithelium in a way that it can be replaced at the end of the surgery. The
epithelium is loosened with a blade or alcohol solution. It is moved aside
and the laser is applied to the surface. The epithelium is then replaced and
a bandage contact lens is placed to hold it down. This differs from PRK
because in PRK the epithelium is lost.
Visual results after lasik have improved since the first FDA
studies. According to one study 99% of patients were 20/30 or better after
one year and 88% were 20/20 or better. Technology continues to improve
and with Custom Vue Lasik there may be less glare and halos. This new
technology uses physics principles from astronomy and applies them to
light traveling through the eye. It builds a three dimensional model of the
eye and perfects the way that it bends light rays. We can very precisely
measure exactly how to reshape the cornea to create the clearest and most
focused image.
After lasik some patients experience dry eyes. This is usually
mild and can be improved with the use of artificial tears. Some people
experience glare and halos at night from bright lights. This is usually
transient and improves after a few weeks.
continued on next page
Newer lasers now have tracking systems which check the position of
the eye continuously through the surgery. This is a great advancement as it
automatically realigns the eye if there is movement before each laser shot. The
VISX eye tracker measures eye position 6 times per laser pulse. These lasers are
potentially safer and may have better outcomes.
23 . NEA HEALTH | FALL 05
Let Loose: LASIK (continued)
Complications from lasik are rare but they can occur. Every time
a patient undergoes surgery they are accepting a small amount of risk. The
most severe risk of lasik includes vision loss from infection or flap
complications. We are continually working to improve the safety of the
procedure but it is surgery.
I personally enjoy performing the procedure because of the great
response we get from patients. There is nothing that would compare to bringing
a new baby into this world and the joys that Obstetrician’s experience, but this
is Ophthalmology’s equivalent. We take a patient that has been dependent on
glasses and contact lenses and free them from their dependence on these aides.
It makes a big difference in their lives and it shows.
My lasik patients have been very happy and I have had great
success with this procedure. I have even performed lasik on family
members. I welcome questions about lasik as people are often curious and
wonder if they might be a good candidate. We offer free, no obligation
consultations in our office. Our lasik coordinator can answer many
questions over the phone. Find out if lasik is right for you, call (870) 9320485. Mention this article for special pricing on your LASIK
procedure. I
www.neahealth.com
870-933-8000
www.simmonsfirst.com
24 . NEA HEALTH | FALL 05
Keyword: LASIK
You’re going to
be a Mom!
ou are excited … but at the same time you
feel awful. You feel nauseous and you find it hard to
Y
keep food down much less liquids. Certain aromas throw
you over the edge. Well, you are among the 80 out of 100 other
pregnant women who suffer from these complaints. About a
quarter of pregnant women will only experience nausea while
50% will have both nausea and vomiting. The persistence of
these symptoms can go beyond the first thirteen weeks of
pregnancy. In the most severe cases of nausea and vomiting
known as hyperemesis gravid arum, significant weight loss can
occur along with electrolyte imbalance, nutritional deficiencies
and low birth weight. It is fortunate that this happens in only
1-2% of pregnancies.
Why does this happen? In pregnancy your hormones,
particularly human chorionic
gonadotropin
(HCG)
and
estrogen start to increase. When
HCG peaks towards the end of
the first trimester nausea and
vomiting during pregnancy is also
peaking. Patients who have
experienced nausea and vomiting
on
combined
hormonal
contraceptives often times will be
sensitive to the high levels of
estrogen in pregnancy. Other risk
factors for nausea and vomiting
during pregnancy are a history of
nausea and vomiting in a
previous pregnancy, a family
history of nausea and vomiting in
pregnancy, migraine headaches,
twin gestation, and carrying a
female fetus.
You may be concerned
that the nausea and vomiting will
LORNA LAYTON, M.D.,
F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
be harmful to your baby but the typically mild to moderate
symptoms that most women experience have extremely little
effect on the outcome of the pregnancy. The majority of studies
on this subject have shown no decrease in birth weight and no
risk of miscarriage.
Use of prenatal vitamins during the time of conception
has been shown to decrease the chances of the need for medical
treatment for the nausea and vomiting during pregnancy. Bed
rest for fifteen minutes in the morning before arising, crackers in
bed, clear liquids, such as apple juice and Jello as initial meals of
the day, small frequent meals, hard candy, avoidance of greasy or
spicy foods, increasing salty foods and sour foods (pickles),
separating solids from liquid intake by an hour and powdered
ginger capsules are all simple interventions that can make a
difference. Acupressure with sea
band elastic wristbands and low level
electric nerve stimulation at the
wrists have also shown some relief of
symptoms.
Vitamin
B6
supplementation is often a first line medical
intervention for nausea and vomiting
of pregnancy. Anti-nausea medication such as Zofran and phenergan
are usually quite effective. When
symptoms do not respond to the
previously mentioned interventions
then intravenous hydration, steroid
use after the 10th week of
pregnancy, and intravenous nutrition may be used.
The good news about
nausea
and
vomiting
during
pregnancy is that for most women
there are successful treatments, so see
your Obstetrician early! I
25 . NEA HEALTH | FALL 05
NO SWEAT
Have you ever had to stop and think
before shaking someone’s hand?
H
MICHAEL RABORN, M.D.
CARDIOVASCULAR SURGERY
NEA CLINIC – 870.935.4150
as your teenager stopped where social contact is not required and
participating
in
school often going to bizarre lengths to hide their
activities?
Have you or a cold, sweaty hands.
member of your family ever resorted to
Hyperhidrosis can present in any
carrying a cold drink around so people number of combinations of facial, axillary,
will assume that this is the reason your palmar, or pedal sweating.
All
hands are cold and clammy? All of the manifestations of the disease process can
above are signs and symptoms of primary be problematic, but palmar hyperhidrosis
hyperhidrosis or excessive sweating. This tends to be the biggest problem in terms
is a condition caused by a hyperreactive of social interaction. Fortunately, this
sympathetic nervous system. Areas of the presentation is the one that most directly
body affected include the face, underarms, lends itself to treatment with a reliable,
hands, and feet. This sweating can occur generally safe, outpatient surgical
anytime, day or night. While stress and procedure.
anxiety can trigger this sweating, people
The sympathetic nervous system
affected
with
hyperhidrosis
can regulates the sweating mechanism and
experience the sweating even sitting in a exerts its control through a chain of nerve
cool, quiet room. Furthermore, even fibers located along the back wall of the
though emotional wellness is not a factor chest cavity. Here the fibers are accessible
in the triggering of
with thorascopic technique
HYPERHIDROSIS
the extra sweating,
using tiny TV cameras to
this
excessive SWEATY PALMS AND FEET visualize the nerve fibers.
sweating can take its
Special instrumentation is
toll on a person’s self confidence and available to interrupt these channels
relationships with others. Coping is controlling the sweating process, thus
difficult, and many people with the preventing excessive sweating of the
condition find themselves hiding their hands and, in some cases, of the axilla and
problem from their closest friends and feet.
Again, this is an outpatient
avoiding social contact.
procedure applicable to a wide range of
In the United States, it has been ages, in one series ranging from 7 years to
estimated that one out of 25 individuals is 74 years of age.
affected – men and women, all races and
In summary, hyperhidrosis is a
all age groups. Children and adolescents disease process that can have far-reaching
are particularly vulnerable. Childhood is and lasting effects on people and their
the time to build self esteem, and young families. If this is a problem you or one of
people affected with hyperhidrosis are at your family members have encountered,
especially high risk for developing please contact us here at NEA Clinic
inappropriate coping mechanisms. Many Matthews location or call us at 219-7685.
quit the band, cheerleading, sports and You owe it to yourself and family
even dating. Adults, too, tend to avoid members to find out what can be done to
social contact, going into occupations literally “turn your life around.” I
26 . NEA HEALTH | FALL 05
NEA CLINIC CHARITABLE FOUNDATION
JUNE MORSE
NEA CLINIC CHARITABLE FOUNDATION
HOPECIRCLE VOLUNTEER COORDINATOR
HopeCircle is a program of NEA Clinic Charitable Foundation with a mission to provide a community of hope, support and educational programs free of charge
for families living with a catastrophic illness. That mission affords HopeCircle many opportunities for service, which utilize the varied gifts of our volunteers.
W
LISTENING
hen a diagnosis of a life-changing illness is given, patients and family members may need to know someone
outside the family is willing to listen – to the fears, the concerns, the questions. HopeCircle volunteers are
available to provide that listening ear. As one patient reported recently: “I got a good report, I’m cancer free. You were
the first to hear the initial horrible report and sit with me while I cried. So, I wanted you to be the first to hear the good
news. Thank you for being here and for listening.”
THE GIFT OF
M
THE GIFT OF
CREATIVITY
THE GIFT OF
TOUCH
THE GIFT OF
LAUGHTER
THE GIFT OF
PRESENCE
THE GIFT OF
SHARING
any of HopeCircle’s most productive workers never come to the Resource Center or the treatment room. They are
the people who knit, sew, crochet and bake for patients. Afghans, shawls, caps, lap robes and turbans are created
by volunteers and given to patients who need them. Patients wear their caps and take their afghans with them to treatment.
Many comment on how special it makes them feel to know someone created something for them and others going through
treatment.
A
touch, a pat or a hug may be just the medicine someone needs and all are readily provided by HopeCircle volunteers
– in the Resource Center, in the treatment room, or in the community. Patients often say, “Thanks, I really needed
a hug today.”
L
T
M
aughter is a sure way to brighten the day and often comes from folks who think they don’t have a laugh in them.
Sometimes the smile or laugh is generated by topics they never thought they could laugh at, but laugh they do.
he presence of someone who chooses to give their time to be with patients is greatly appreciated. Patients look
forward to visits with “their” volunteer and new friendships are formed.
any of our volunteers have experienced catastrophic illness first hand, either through their own diagnosis, or
through the illness of a family member. It is reassuring for patients to talk with someone who has experienced what
they are experiencing. When a survivor tells a patient how they coped when they lost their hair, how long it took it to
grow out, or what they did for mouth sores, the patient knows someone really does know what they are experiencing.
Service comes in many forms,
A helping hand, a touch,
Shared laughter or shared tears,
Service is a gift for both
Giver and receiver.
www.neacfoundation.org
W
hile HopeCircle provides opportunities for service, our volunteers agree with Douglas M. Lawson: “SERVING THE NEEDS OF
OTHERS IS THE LIGHT THAT BRIGHTENS EACH DAY.”
27 . NEA HEALTH | FALL 05
Ken Gibson, P.D. - Pharmacist
Brent Panneck, P.D. - Pharmacist
Our Goal is Your Good Health.
Rebecca J. Barrett-Tuck, M.D.
Jeffrey A. Kornblum, M.D.
Kenneth Tonymon, M.D.
Gregory F. Ricca, M.D. FACS
Specializing in diseases and injuries
of the spine
A referral may not be necessary
We will work with you regarding your insurance requirements
answered 24 hours
Brandi Miller, RN
28 . NEA HEALTH | FALL 05
Where do
DRUG STUDIES
come from?
If you
CHARLES L. BARKER, M.D.,
PH.D., C.C.I., F.A.C.O.G.
OBSTETRICS AND GYNECOLOGY
NEA CLINIC – 870.972.8788
wish to join
Northeast
Arkansas Clinic
in one of our many research
clinical trials as we help
advance scientific research
in the pharmacologic
treatment of human
disease, a list of current
studies may be found
online at www.neaclinic.com.
ore than two million people participated in clinical investigational drug
trials in the United States in 2002. Before the pharmaceutical industry ever
approaches individuals to participate in clinical investigation, there is a
lengthy drug discovery and development process. For every 10,000 compounds
screened, only 250 enter early stage testing. The early testing is designated non-clinical
because the test subjects do not involve humans. Approximately five of the 250
compounds go into clinical (human) testing, and only one will probably make it all the
way to approval by the Food and Drug Administration (FDA).
M
Clinical trials are divided into four phases. Phase I studies are frequently referred to as
safety studies. The main purpose is to study the tolerability and look for adverse effects
of the drug in humans. Phase II studies are short treatment studies of individuals with
the target disease to look at the drug's effect on that disease. Safety is also monitored.
Phase III trials are begun if the drug has both a satisfactory safety profile and shows
evidence of efficacy (ability to treat the disease). Phase III studies are long-term
evaluations of safety and efficacy. After the successful completion of Phase III studies,
a New Drug Application (NDA) can be filed with the FDA as a formal request to
market the investigated drug. Phase IV studies are performed after approval of the
NDA (1) if required as a condition of approval by the FDA, (2) for evaluation of long
term safety, (3) to compare to other drugs in the market, (4) to familiarize physicians
with the compound, or (5) done to pursue additional indications. I
29 . NEA HEALTH | FALL 05
Reality Check:
Facing the Facts About
TEEN PREGNANCY
LOCKE ISAACSON
T
EEN PREGNANCY REMAINS A MAJOR ISSUE in our community, state, and nation. EVERY
MINUTE AT LEAST ONE TEEN IN THE U.S. BECOMES PREGNANT, and 34% of all
teenage girls will become pregnant at least once before they reach the age of twenty. Many people
are unaware of the prevalence of teen pregnancies in our area. In 2002, there were 157 teen births in
Craighead County and 5,683 in Arkansas. Arkansas ranks tenth for the highest teen pregnancy rate in the
United States.
The National Campaign to Prevent Teen Pregnancy offers twelve suggestions, based on teen input,
to help parents better communicate with their teens about teen pregnancy. Teens really do want to discuss
sex, love, relationships, and values with their parents, but they want a conversation, not a lecture. The twelve
suggestions are:
H
H
H
H
H
H
SHOW US WHY TEEN PREGNANCY IS SUCH A BAD IDEA.
(Give us real life examples, and show us how teen pregnancy can interfere with our goals.)
SHOW US WHAT GOOD, RESPONSIBLE RELATIONSHIPS LOOK LIKE.
(Show us respectful communication and responsible relationships.)
TALK TO US HONESTLY ABOUT LOVE, SEX, AND RELATIONSHIPS.
(Even though we are young, we can fall in love, have very powerful feelings, and be interested in sex.)
TELLING US NOT TO HAVE SEX IS NOT ENOUGH.
(Explain your feelings, keep an open mind, listen to us, and take our opinions seriously.)
EVEN IF WE DON’T ASK, WE STILL HAVE QUESTIONS.
(Parents, feel free to start these conversations.)
WHETHER WE’RE HAVING SEX OR NOT, WE NEED TO BE PREPARED.
(Parents should provide honest and helpful information on ways to say no, use protection, and ways to avoid
teen pregnancies and sexually transmitted diseases.)
IF WE ASK YOU ABOUT SEX OR BIRTH CONTROL, DON’T ASSUME WE ARE ALREADY
“DOING IT.” (Facts help make good decisions.)
PAY ATTENTION TO US BEFORE WE GET INTO TROUBLE.
(Reward us for doing the right thing, don’t just shower us with attention only when we do something wrong.)
DON’T LEAVE US ALONE SO MUCH. (Know what we are doing.)
WE REALLY CARE WHAT YOU THINK, EVEN IF WE DON’T ALWAYS ACT LIKE IT.
(We want and need helpful advice.)
WE HATE “THE TALK” AS MUCH AS YOU DO. (Encourage talking and mutual listening.)
FOR US, IT’S NOT ABOUT ABSTINENCE OR CONTRACEPTION; IT’S ABOUT ABSTINENCE AND
CONTRACEPTION. (We need information about both.)
Teen pregnancy is a major issue. It often results in less education and poverty for the teen family.
Children born to teen mothers are more likely to be teen parents and male children, of teen mothers, are
more likely to go to jail. Teen pregnancy rates have been reduced by one- third over the past ten years, but
the teen pregnancy rate is still too high. I
H
H
H
H
H
H
Locke Isaacson is the daughter of Michael Isaacson, M.D. and Julie Isaacson. She recently organized a walk
to raise awareness at her high school which attracted over 290 participants.
www.neahealth.com
30 . NEA HEALTH | FALL 05
Keyword: TEEN PREGNANCY
NEA CLINIC CHARITABLE FOUNDATION
UPCOMING 2005/2006 EVENTS
Duck Classic
Trash to Treasure Giant Yard Sale
DECEMBER 2005
MARCH 2006
www.neacfoundation.org
HopeCircle Triumph of the Human Spirit
MARCH 2006
Woman to Woman Luncheon
BEBE FLEXON GIORGIO ARMANI LAURA ASHLEY NIKE POLO RALPH LAUREN
APRIL 2006
BEBE FLEXON GIORGIO ARMANI LAURA ASHLEY
Glasses in about an hour
on most prescription eyewear
SEE
YOUR DOCTOR. THEN
SEE
US.
320 South Church • 870.972.1818 • M-F 8:00 a.m. - 5:30 p.m.
31 . NEA HEALTH | FALL 05
T
o wish to be well is a part of becoming well.
32 . NEA HEALTH | FALL 05
Seneca (Roman Philosopher)
The Agency
We like to send you
home with a little
something extra.
There’s no other event like the birth of a child.
And there’s no other place like The Women’s
Center at NEA Medical.
It’s there you’ll receive outstanding care and
extraordinary service. Our birthing suites are
equipped with the latest in modern technology,
yet offer you all the comforts and feel of home.
And our dedicated staff and low nurse-topatient ratio means prompt attention to your
every need.
In fact, we’ll even go so far as to spoil you
while you’re here. But don’t get too used to it,
because that “little something extra” is waiting
to be spoiled by you!
Exceeding Expectations
3024 Stadium Blvd.
Jonesboro, Arkansas
870.972.7000
w w w . n e a m e d i c a l c e n t e r. c o m
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