to learn from you - Cape Girardeau County Area Medical Society

July 2014
Vol. 1 • Issue 5
ervices
TO LEARN FROM YOU
Local medical student, Tiffany Amelunke
is currently working with Dr. Paul Caruso.
An introduction to
Bio-Identical Hormone
Replacement Therapy
A partial list
of hormonal
imbalance
symptoms in:
Women
An excess or deficit of hormone levels in the body can cause a wide variety
of symptoms in both men and women. If you are experiencing symptoms of
hormonal imbalance, then BHRT my be what you need to restore your balance.
The Principles of Effective BHRT Treatment
Vitality is a personalized service that encompasses the entire
person, taking into consideration the effects of age, diet, lifestyle,
stress, family history and other health factors of the person
and seeks to develop a treatment plan that is tailored to the
individual needs of each patient.
Vitality balances hormones by determining a person’s
unique hormone profile, then adding what is missing
and reducing what is in excess.
Vitality prescribes only what the patient needs in the
lowest required dose.
Vitality finds the delivery methods that are best tolerated
by the patient and that produce the best outcome.
Vitality seeks to treat the underlying cause of the
symptom rather than just the symptom itself.
Vitality seeks to create a partnership between Patient
and specialist by obtaining frequent feedback,
ensuring patient compliance and making
adjustments to the treatment plan over time, as
required.
VitalityCape
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www.VitalityCape.com
465 S. Mt. Auburn Rd., Suite 103 | Cape Girardeau, MO 63703
573-755-0340 • 800-651-9259
Breast Pain
Irregular Periods
Infertility
Menopause
Changes
Hot Flashes
Night Sweats
Vaginal Dryness
Breast Cysts
Ovarian Cysts
Uterine Fibroids
Endometriosis
PMS
Moodiness
Irritability
Anxiety
Depression
Foggy Memory
Low Energy
Nighttime Urination
Migraines
Sleep Problems
Chronic Fatigue
Weight Gain
Poor Libido
Sexual Dysfunction
Osteoporosis
TABLE OF CONTENTS
Editorial.......................................................................2
Presidents Letter.........................................................4
Medical Society and Alliance News.............................5
Physician’s Page.........................................................6
Public Health...............................................................8
What’s Your Diagnosis...............................................10
Professional Directory...............................................11
ADVERTISERS
Vitality.............................................. Inside Front Cover
Advanced Orthopedic Specialists................................2
Park Pharmacy............................................................3
Bank of Missouri..........................................................3
Cape Girardeau Urology Associates, Inc....................6
Vol. 2 • Issue 1
July 2014
Published by
CAPE GIRARDEAU COUNTY
AREA MEDICAL SOCIETY, INC.
573-334-5691
Fax 573-334-0975
E-Mail: [email protected]
Web Site: www.cgcms.org
Editor
Managing Editor
Douglas Wallace, M.D.
Sara Lee
Wells Fargo ..............................................................10
Kaelin Dental Group..................................................10
Saint Francis Medical Center.......... Inside Back Cover
Larson Financial ........................................ Back Cover
This journal is published by the Cape Girardeau County Area
Medical Society, Inc. and printed by The Printing Co.
Opinions expressed in this journal are those of the writers and
do not reflect offcial opinions of the Cape Girardeau County
Area Medical Society, Inc. unless so stated.
All material for the journal must be submitted by the rst of the month
prior to the publication. May be submitted through mail or email.
All articles and advertisements are subject to approval by the Cape
Girardeau County Area Medical Society’s journal staff. We reserve
the right to decline, withdraw, and/or edit copy at our discretion.
Every effort is made to avoid mistakes, but we do not accept
responsibility for clerical or printer’s error.
2014 BOARD MEMBERS
Sharon Wallace, M.D.
President
Cape Radiology Group
70 Doctors’ Park
Cape Girardeau, MO 63703
334-6071
Grant McWilliams, D.O.
Vice President
Cape Care for Women
150 S. Mount Auburn Rd.
Cape Girardeau, MO 63703
339-1166
Heather Cugini, M.D.
Secretary/Treasurer
Women First, P.C.
1111 N. Mount Auburn Rd.
Cape Girardeau, MO 63701
339-1101
Charles Moon, M.D.
Past President
Advanced Dermatology of Southeast Missouri, P.C.
1359 N. Mount Aubrun Rd.
Cape Girardeau, MO 63701
335-7546
EDITORIAL
Bring Back the Vaccines
Douglas Wallace, M.D.
Sabin & Salk derived different vaccines in the early
1950’s to end the scourge of polio. In the United
States, polio was largely eradicated using the simple
inactivated injected vaccine of Salk and later the
orally administered attenuated vaccine of Sabin.
There is no non-primate reservoir in nature. Person
to person transmission is required for polio virus
survival and worldwide eradication can occur, as it
did for Smallpox.
Following the ground breaking work of Salk & Sabin
with polio, multiple subsequent vaccines have been
developed, which if used ubiquitously worldwide,
could lead to the subsequent eradication of many
viral diseases. If humans are the only reservoir, then
eradication is possible. If there is a non-human host,
continued vaccination of the newborn is required.
There is herd immunity, but if the un-inoculated
disease susceptible population becomes too large,
then outbreaks can occur.
Vaccines have encountered irrational fear as a result
of fraudulent research perpetrated by Mr. Andrew
Wakefield, MBBS; a British former surgeon and
medical researcher. His 1998 paper in The Lancet,
propounded a link between the Measles, Mumps
and Rubella vaccine and autism in addition to bowel
disease. By 2002 no replication of his results could
be repeated by his peers. A 2004 investigation laid
bare a financial conflict of interest held by Wakefield;
his co-authors withdrew their support for the Lancet
article. In 2010 the British General Medical Council
(GMC) confirmed three dozen charges filed in the
2004 investigation by Sunday Times reporter Brian
Deer. Those included four counts of dishonesty
and twelve of abuse of developmentally challenged
individuals. The GMC conclusions led to the Lancet
retracting all of the 1998 paper and Wakefield being
barred from practicing medicine in Britain.
Since the 1998 Lancet article, parents of newborns
have faced the quandary of having their children
vaccinated to prevent disease, while being concerned
that Wakefield’s data might be accurate leading to
Crohn’s or Autism in their healthy baby. This has led
to an increasing number of children reaching school
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CAPE COUNTY MEDICAL JOURNAL
age, who have not received the common battery of
vaccinations against previously common childhood
illnesses. Rubella and Mumps are not without some
significant complications of their own, which can lead
to lifelong problems. The decrease in herd immunity
may be becoming evident at Ohio State University,
where there was an outbreak of Mumps in March
2014, as did Fordham University in February. The
OSU outbreak now includes 220 cases with an
additional 180 in surrounding counties. It is not clear
what percentage received the complete MMR series.
A measles outbreak has now occurred as a result
of unvaccinated Amish missionaries traveling to the
Philippines, where measles is more endemic. There
are clearly other factors in the unvaccinated Amish,
than in those fearful of the discredited Wakefield data.
No matter what the reason, the unvaccinated have
decreased the herd immunity and led to an increase
It’s not just about your shoulder. It’s what you do with it.
As the premier orthopedic practice in
the region, Advanced Orthopedic
Specialists has provided exceptional
bone, joint, and muscle care to patients
in the Cape Girardeau area for more
than 75 years. Our team of boardcertified and fellowship-trained doctors
specializes in evaluating, diagnosing,
and treating all orthopedic injuries and
conditions with the goal of helping you
return to your healthy, active lifestyle
quickly and safely.
Phone Number: (573) 335-8257
Toll-Free: (800) 321-3167
www.advancedorthopedicspecialists.com
in preventable disease.
We began with Polio; yet polio 60 years after a
cure was found remains a political and current
infectious disease health topic. There were recently
approximately twenty children in the United States
who were afflicted with Polio like syndrome. Unilateral
paralysis was noticed in some. Some patients had
been vaccinated against polio, others had unclear
vaccination histories. In some countries insurgents
have claimed vaccination programs are being
operated to sterilize the population; thereby scaring
away patients. The hunt for Bin Laden involved a
polio vaccination program, from which there was a
secondary gain of obtaining DNA from inoculated
children who were thought to be Bin Laden offspring.
But in Syria, polio is an issue and immunization rates
have decreased as a result of the conflicts. As a result,
the WHO has recommended health care workers in
Syria, Egypt, Jordan, Lebanon and Turkey receive a
onetime booster dose for those traveling to the area
in the chance they would encounter a polio patient.
With a global economy and therefore global travel,
the herd immunity previously enjoyed in the United
States, where Polio had been eradicated, may not be
protective enough of the un-immunized. There have
been four cases in the United States this year in both
Amish and non-Amish individuals. The non-Amish
patient had a questionable vaccination history.
In polio there is no cure once the disease is
contracted. But there is a wonderful vaccine that is
painless and has a sixty year track record, without
significant side effects. The alternative includes a life
stripped of mobility and which was once treated with
iron lungs. The complications from cases of Rubella
and measles are far better documented than the lack
of any documentation supporting autism and Crohn’s
as a complication of the MMR vaccine. There have
been great strides in Virology in sixty years and a
great benefit to all of mankind with the extinction of
Smallpox. To have patients denied vaccines, due to
unwarranted suspicion cast by debunked data, does
a disservice to those children who will pay the price of
the naiveté of their parents.
PARK PHARMACY
Convenient, Low Cost
Prescription Service
Bob Prichard, R.PH.
Pharmacist
Park Pharmacy
37 Doctors Park, Ste 2
Cape Girardeau, MO 63703
Phone: 334-4432
Fax: 334-7290
July, 2014
Page 3
PRESIDENT’S LETTER
Subject Matter Experts
Sharon Wallace, M.D.
Edmund Burke would remind us, “The only thing
necessary for the triumph of evil is for good men to
do nothing”.
Preventive medicine can be as simple as Lister
suggesting hand washing before operating, along
with cleaning surgical instruments and wounds with
carbolic acid decreased operative infections. The
addition of refrigeration as a result of electrification
via the Tennessee Valley Authority led to a significant
decrease in food spoilage and an improvement in
public health as a byproduct. Vaccines have led to
the cure of crippling diseases, which may otherwise
have no cure, e.g.: Polio.
The recommendation that women should not get a
mammogram until age 50 and then these should be
done annually thereafter by the ‘advisory’ panel for
National Mammography Quality Assurance (NMQA)
was based on a cost calculation. To quote a recent
commentator on CNN, “the cycle of opinionating
becomes the consensus.” Everyone has an opinion,
although those opinions may not be based on facts.
This recommendation by the ‘advisory’ NMQA
panel was based on exposure to radiation and
reimbursement issues. The panel did not include any
Radiologists who are subject matter experts in the
field; however it did include non-physicians from the
FDA. These recommendations were then embraced
by Health and Human Services, the parent of the
FDA. The recommendations are not embraced by
Mammographers, who on a daily basis help ladies
through early detection. The 40-year-old ABC News
Anchor, Amy Robach, is a superb example of the
flaws in the logic of the FDA panel recommendation:
that women at age 40 do not need mammograms. As
Ms. Robach reported, taking an on-air mammogram
against NMQA advice, she was found to have bilateral
breast carcinoma.
The U.S. Preventive Services Task Force cycle of
opinionating led to the recommendation, “that many
men are harmed as a result of Prostate Cancer
Screening with PSA and few, if any, benefit. This
opinion was prefaced on the idea that the risk of dying
from prostate cancer was low and 70% of the deaths
occurred after age 75. Dismissed was the fact that
finding a cancer early may prevent a painful death,
whether it is before or after age 75. The cost of a
PSA test is low and common sense/clinical acumen
should direct further work up.
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CAPE COUNTY MEDICAL JOURNAL
Non-physicians, Administrators and Commentators
should not offer medical opinion; rather they should
help physicians to effectively deliver cost affordable
health care. Physicians should; based on medical
evidence, clinical acumen, disease natural history,
the gifts of modern technology and patient desires,
continue to practice the Art of Medicine for the benefits
of their patients.
We must be part of the team developing cost
effective, innovative methods of high quality health
care delivery to all patients-the very young, old and
those in between. For Millennia we have had an oath
that many of us took on the day of our graduation. For
those in the cycle of opinionating, there is no oath,
only sound bites and fifteen minutes of fame. As the
Subject Matter Experts we must protect our patients
and see that they are not harmed by the reckless
uniformed talk show host or illogical administrative
health polices. We must be proactive and not
abrogate our responsibilities as first clearly defined
by Hippocrates. We must be key members in the
teams developing innovative solutions to delivering
timely, affordable modern medicine to all our patientsfrom the fetus to the aged. We must be proactive and
not abrogate our responsibilities as Hippocrates saw
them.
2014 CGAMS Board Members
Sharon Wallace, M.D................ CGCAMS President
Grant McWilliams, D.O..... CGCAMS Vice President
Heather Cugini, M.D..........CGCAMS Sec/Treasurer
Charles Moon, M.D.......... CGCAMS Past President
Andrew Dickey, M.D. ........................Board Member
Robert Gardner, Jr, M.D....................Board Member
Mark Hahn, D.O................................Board Member
Charlene McWilliams, D.O................Board Member
Andrew Moore, M.D..........................Board Member
Duc Nguyen, M.D..............................Board Member
Mitchell Ogles, M.D...........................Board Member
George Pjura, M.D............................Board Member
C Nelson Ringer, M.D........................Board Member
Thomas Sparkman, M.D...................Board Member
MEDICAL SOCIETY & ALLIANCE NEWS
Updates from the Alliance
Julie Ogles, President, Medical Alliance
The Cape Girardeau Area Medical Alliance is gearing
up for another great year. We plan to provide
meaningful and educational meetings, volunteer
opportunities and social gatherings to our members
throughout the year. The Medical Alliance is a great
networking opportunity for spouses of physicians and
dentists.
Monthly meetings are held on the 3rd Tuesday of
each month at various locations. At our meetings
we have a time for socialization and a program.
Highlights from last year’s programs included The
Plant Lady, Women’s Safe House, and The Food
Bank. Childcare is provided at all meetings. We
hope you will plan to join us.
Another part of being a member of the Medical Alliance
is our commitment to bettering our community in a
variety of ways. The Alliance members participate in
the following community outreach events each year:
NEWS
As we enter the second year of renewed production of
the Cape Medical Journal, (first published in 1954), I
look back at the first four issues and I am very proud
of what the journal has accomplished. The future of
the journal is bright and I would encourage each of
you to think about writing an article or submitting a
“What’s your Diagnosis” to be published in the journal.
My goal for this journal is for it to be relevant to our
membership and featuring CGCAMS members, is the
best way to ensure the content is relevant. If you are
interested, please contact me at the CGCAMS office.
I also want to remind members that CGCAMS will have
a membership table in the exhibitor room at all future
symposiums. This table will be an unmanned table,
its purpose is to be a place where members and their
practices can provide information (leaflets, brochures,
etc.) on services they provide that are relevant to the
symposium. If you or your practice are interested in
providing materials for the membership table, you will
need to contact me at the CGCAMS office at least one
week before the symposium.
• Backpacks for Fridays is a food program through
The Food Bank. Alliance members drop off
bags of food to a local elementary school each
week that the children take home. Each child
has enough food to feed a family of 4 for the
weekend.
• The Tuning Point tree is a Christmas tree put
up at Southeast Health Fitness Center each
December. The ornaments on the tree are sold
and all proceeds go to fund the Turning Point
class offered at Southeast Health to anyone
who has been diagnosed with breast cancer in
the past year.
Don’t forget CGCAMS Membership Meetings are now
open to spouses and interested professionals who are
not CGCAMS members. In order to keep the cost of
the meetings manageable, each non-member guest
must pay $30.00 for his or her dinner.
• The Smoking is Not for Me campaign is a state
wide Medical Alliance program. Local middle
school students submit poems, essays and art
work describing why smoking is not for them.
Our local Alliance evaluates them and then
awards the winning students at a banquet held
in April. Many of our previous winners in our
local area have also won at the state level.
I welcome all members to contact me with any
questions or ideas about how to get more out of your
CGCAMS membership. We are here to serve you and
welcome any feedback on how to better serve.
Please note that the Practice Management Symposium
on September 13th has been canceled. We will be
hosting a Primary Care Symposium on December 6th.
For upcoming CGCAMS Events
see page 11
Continued on page 7
July, 2014
Page 5
PHYSICIAN’S PAGE
The Importance of Precepting
Charlene McWilliams, D.O.
I remember the wait vividly. We were attempting
to study in a classroom near the back hallway. Not
actually in the hallway, where it would appear we
were lurking, but close enough to know as soon as
anyone official walked by. We were waiting for the
official posting of the results on the bulletin board,
at which point all semblance of not paying attention
would disappear as the crowd scanning the posted
list formed. What was important to motivate the
lurking? The match, of course. Not the residency
match but the clinical rotation match for where my
third and fourth year would be spent. As a student
attending a medical school in a rural town of 16,000
but in a class of over 100 peers, my husband and
I knew the list posted on the bulletin board would
not just give us a location for the next two years of
our life, but also shape the physicians we would
become. The range of locations for clinical training
that our medical school had developed for third and
fourth year medical students, varied from metropolis
locations and large county hospitals, where many
students went on to residency and fellowships, to
smaller preceptor based locations with one-on-one
rotations. Similar to which medical school I attended,
the location for clinical rotations could directly affect
the future physician I would become and shape my
perception of medicine in general.
I matched to my first choice that day and am very
thankful. I had specifically chosen a location that was
entirely preceptor based, with the majority of rotations
one-on-one with practicing physicians in their private
office, rather than in a training hospital. I was on
military scholarship and knew that my rotations
prepping for residency and residency itself, would
occur within the military structure. I was therefore
focused on obtaining the most hands on, real life
experience I could, with what life was like in each
type of medical specialty, as I slogged through my
rotations. My interest in primary care was solidified
as I participated in every aspect of a small town family
medicine practice. I had a very realistic picture of
interrupted dinners and sleep for an emergency page.
In three situations I lived with the actual physician’s
families during the rotations. My understanding of
rural medical communities and the larger regional
support needed for excellent patient care was
expanded. My hands on learning, with every single
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CAPE COUNTY MEDICAL JOURNAL
patient, allowed me to assess quickly my personal
strengths, weaknesses and interests. Those training
years supported our interest to return to a regional
medical community like Cape Girardeau, following
our military training and service.
My preceptor based location had seven other
students placed that year with me. The smaller pool
of eight students led to a collegial atmosphere as we
gathered weekly from around the county for didactics,
testing and learning activities over the next two years.
Those weekly meetings occurred in a regional medical
society office which provided space for our meetings
and an office for our rotation coordinator, Marie. That
office was our only physical anchor during the next
two years and Marie was a cheerful voice on the end
of the phone answering questions and a smiling face
as I turned in evaluations.
Serving the needs
of the Region for
over 40 years
www.capeurology.com
J. Russell Felker, M.D. F.A.C.S
John Paul Hall, D.O. F.A.C.S.
Donald L. Gentle, M.D. F.A.C.S.
Gregg S. Hallman, M.D. F.A.C.S
James E. Outman, D.O. F.A.C.S.
William C. Collyer, M.D. F.A.C.S.
Vincenzo Galati, D.O. F.A.C.S.
Mitchell L. Ogles, M.D.
Although I did not rotate in the Cape Girardeau area
as a student, the students I’ve asked have shared
that they choose to rotate in this county for similar
reasons to my choices. They enjoy the balance of
rural medicine and strong regional medical centers:
that provide direct access to just about any specialty
they wish to examine further. Instead of a large
teaching facility and being taught in most rotations
on a learning “team”, they have direct access with the
practicing physician.
Who was your favorite preceptor from your student
days and why? Have you ever considered sharing
what a “real” practice looks like with a medical student?
Precepting doesn’t need to be every month of the year
or have blocked administrative time. If you have ever
wanted to be part of shaping the future practitioners
of medicine, you don’t need to move or be on staff
at a large university hospital. You can impact one
medical student at a time by precepting them for a
clinical rotation right here in Cape Girardeau County.
Similar to the medical society that supported my
clinical rotations, Cape Girardeau Area Medical
Society shares office space with the regional
Missouri Area Health Education Center (AHEC).
This agency provides coordination and support for
medical students performing clinical rotations in
this area. This is naturally beneficial for exposing
students to the Cape Girardeau location and medical
community, while developing well trained physicians,
who may be our future peers. CGMAS continues to
seek additional ways to partner in strengthening our
medical community.
The Cape Girardeau Area Medical Society Alliance presented a check for $5,745 to Be the Match
Registry, a national registry of potential bone marrow donors on April 28. The money will help fund
future drives. Since 2011, alliance registry drives have added 362 potential bone marrow donors
to the registry. From left are Dr. Andrew Dickey; Dr. Andrew Moore; Denise Mosley, Be the Match
St. Louis region account executive; Beth Daugherty of the alliance; and Dr. James C. Mosley III.
Updates from the Alliance
Continued from page 5
• Be the Match Bone Marrow Registry Drives
were brought to the Cape area by one of our
local members. We set up 2 drives last year and collected samples from “potential heroes”
to be matched to those needing bone marrow
transplants. Last year we raised over $5700.00
for this cause.
The Alliance also hosts social events for our members.
We have Girl’s Night Out’s at local establishments,
Doctor’s Day celebrations and co-host social events
with the Cape Girardeau Area Medical Society.
Our first meeting of the 2014-2015 year, Mimosas in
the Morning, will be held on Tuesday, September 8th
from 9:30-11am at the home of Victoria Moon. Please
mark your calendar and plan to join us.
If you have any questions about the Cape Girardeau
Area Medical Alliance membership or involvement,
please contact me at [email protected]. Yearly
dues are $35.00.
2014 ALLIANCE OFFICERS
President.................................... Julie Ogles
President Elect........................... Vicki Moon
Secretary.................................... Stephanie Galati
Treasurer.................................... Tamara Rivas
Membership................................ Jeri Spence
Fundraising................................. Jennifer Gast
Health......................................... Erin Wilson
Past President............................ Nicole Nguyen
July, 2014
Page 7
PUBLIC HEALTH
It Takes a Village....part 2
Barbra Phlilips, CGCAMS contributing writer
The African proverb “It takes a village to raise a child…”
became very poignant to me upon a recent visit to my
previous school last month. I substituted in the library
to assist for a couple of days, when a former student,
now a high school freshman, came to visit me, a
distressed look on her face. I had worked with this child
in all avenues a teacher works with her students for the
past five years, from elementary book reports to being
her sponsor in BETA and Student Council. Her family
support is strong, her academics modest, and she
possesses a healthy dose of self confidence. Needless
to say, I was shocked as I listened to her tell me: “These
junior high kids are not prepared to handle the peer
pressure to use drugs that is pushed at the high school.”
This revelation, on top of a recent suicide at the same
school, had me asking myself: “What do I need to be
doing in reaching my students, my grandchildren, and
my extended family to help battle the ever increasing
abusing culture?” Obviously, despite my own children
being grown, my responsibilities to support “the village
children” remain.
Media headlines in Cape Girardeau highlight the ongoing
drug addiction battles of this state and county. With a
population of 38,544 within the city limits and a county
population of 76,950, it is devastating to consider that
approximately 9% of 12-17 year-old adolescents have
used illicit drugs in the past month. www.nonprofitsfacts.
com states there are 23 youth substance abuse
prevention and treatment centers in Missouri. Reported
by the Cape Girardeau Health 2012 Report, in 2010
there were 66 methamphetamine laboratory incidents;
a number higher than in the surrounding counties.
CasaColumbia.org states “Adolescent substance use—
smoking, drinking, misusing prescription drugs and
using illegal drugs—is, by any measure, a public health
problem of epidemic proportion, presenting clear and
present danger to millions of America’s teenagers and
severe and expensive long-range consequences for our
entire population.”
(http://quickfacts.census.gov/qfd/states)
How do we as a society, as a village, turn those
numbers around, and save the next generation from
the degenerative physiological effects of drug, alcohol,
and tobacco addictions? I believe it begins with staying
educated about the latest drug fads, learning to recognize
the symptoms of drug abuse or experimentation of
adolescents, and learning where to turn for professional
help. Using a multi-part presentation, this column will
examine abused drugs in the local community, as well
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CAPE COUNTY MEDICAL JOURNAL
as shared input from the local medical community and
law authorities in a collaboration of prevention and
support for adolescents and families in need.
Alcohol, tobacco and marijuana are identified as
gateway drugs for most adolescents.
The 2012 Cape Girardeau Health Assessment states:
In 2010 the Southeast Missouri Youth Substance Abuse
Prevention Coalition (located in Cape Girardeau)
surveyed Cape Girardeau youth to determine how teens
gain access to alcohol, tobacco, marijuana, prescription
drugs and what substances were being used. Of the
youth responding to the survey, they listed tobacco
(30%), alcohol (29.6%), and marijuana (18.2%) as the
drugs of choice and easiest to obtain. Females and
males were equally likely to use and peers were listed as
the primary point of access.
Are you aware?
Emerging drugs, synthetic cathinones derived from the
khat plant, are amphetamine-like drugs known to most
teens as “Bath Salts”. The National Institute of Drug
Abuse 2012 report states:
“Bath salts have been linked to an alarming surge in
visits to emergency departments and poison control
centers across the country. Common reactions reported
for people who have needed medical attention after
using bath salts include cardiac symptoms (such as
racing heart, high blood pressure, and chest pains) and
psychiatric symptoms including paranoia, hallucinations,
and panic attacks.”
NIDA reports the salts are chemically similar to
amphetamines (such as methamphetamine) as well
as to MDMA (ecstasy). In an attempt to evade legal
problems, these synthetic drugs have the same
energizing and agitating effects as amphetamines and
cocaine along with the same dopamine experience as
cocaine, but are at least 10 times more potent.
(http://www.drugabuse.gov/publications/drugfacts/synthetic-cathinonesbath-salts)
In a KOMU news report from May 12, 2011, the Missouri
Poison Control Center reports these synthetics side
effects include violence, rapid heart rate, agitation,
suicide and death. Typically the drug can be snorted,
injected, or ingested. Bath salts, known as Spice, Vanilla
Sky, Route 69, and many others names, are found in
head shops, smoke shops, truck stops, convenience
stores, and online sites. The CDC, March 2012,
reported designer drugs have been legislatively banned
in at least 30 states as of February 2012, including
Missouri (Missouri HB 641).
Abuse of prescription drugs and over-the-counter drugs
is an ongoing problem among teens. As with alcohol,
the ease of accessibility in most homes helps create
this problem. Promoted via music videos and online
tutorials is a cough syrup/soda drink known as “Purple
Drank”.
Typically cough syrup is mixed with Sprite or Mountain
Dew with a Jolly Rancher hard candy thrown in for
sweetness and color; a more extreme high is produced
with prescription strength syrups containing codeine
and promethazine.
Dextromethorphan (DXM) is the
active ingredient found in most OTC syrups and cold
medicines. The NIDA describes the effect of DXM as
similar to those of ketamine, or PCP: feelings of being
detached from oneself or the environment, and the drug
can distort perceptions and emotions. Additional effects
include impaired motor function, numbness, nausea and
vomiting, and increased heart rate and blood pressure.
On rare occasions, hypoxic brain damage can occur.
Combine any of this with alcohol, and accidental death
can result. “A 2008 study found that one in 10 American
teenagers has abused products with DXM to get high,
making it more popular in that age group than cocaine,
ecstasy, LSD, and meth.” http://www.webmd.com/parenting/
teen-abuse-cough-medicine-9/teens-and-dxm-drug-abuse
A collaborative website, Headsup, sponsored by
Scholastic and the National Institute on Drug Abuse is
an interactive web source teaching teens about common
prescription drugs found in homes of family and friends
including stimulants such as methylphenidate (Ritalin®
and Concerta®) and amphetamines (Dexedrine® and
Adderall®). “Ritalin® or Adderall®, can lead to feelings
of hostility or paranoia. Further, taking high doses
of a stimulant may result in dangerously high body
temperature and an irregular heartbeat. There is also
the potential for heart system failure or fatal seizures.”
http://headsup.scholastic.com/articles/get-the-facts-drug-abuse-putsyour-whole-body-at-risk
From Narcon.org are listed the drugs most commonly
abused by teens:
Painkillers: Vicodin®, Lortab®, Lorcet®, hydrocodone,
codeine, morphine, fentanyl, Actiq®, Duragesic®,
OxyContin®,
oxycodone,
Percocet®,
Percodan®,
Demerol®, meperidine, Dilaudid®
Anti-anxiety medications (benzodiazepines):
Valium®, Xanax®, Rohypnol®, Ativan®, Librium®,
alprazolam, diazepam, temazepam,flunitrazepam
Muscle relaxants: Soma®, carisoprodol,
Sleep aids: Amytal®, Nembutal®, Seconal®, butabarbital,
phenobarbital, Ambien®, zolpidem, Lunesta®
Stimulants: Ritalin®, Adderall®, Concerta®, Dexedrine®,
Desoxyn®, methylphenidate, dextroamphetamine
Anesthetics: ketamine, Ketalar®, Ketaset®
Over-the-counter
drugs:
Cough
medications
containing dextromethorphan. While there are dozens of
products containing this ingredient, some common ones
are Vicks® DayQuil® Cough,
Zicam® Cough MAX, Pertussin® ES, Robitussin® Cough
and Cold CF, Sudafed® PE Cold/Cough, Alka-Seltzer®
Plus Cold and Cough Formula and Mucinex® DM.
While these are some of the more common drugs, this
is not a complete list.
For more information, consult this chart:
http://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs/
commonly-abused-prescription-drugs-chart
I think as a parents, teachers and medical supporters,
we must remain vigilant in our efforts to be aware of teen
trends. Together with continuing education, knowledge
and dialogue with young people, we can be the “village
that raises a WHOLE child.”
Resources:
http://dmh.mo.gov/docs/ada/rpts/Status2013/a10-17.pdf
http://teens.drugabuse.gov/peerx
http://www.drugabuse.gov/publications/drugfacts/high-school-youthtrends
http://www.nonprofitfacts.com/MO/Youth-Substance-Abuse-PreventionCoalition.html#b
www.nnepc.org/poison-prevention-education/lectures
http://www.cgcohealthdept.com//FileStream.aspx?FileID=275
http://www.cgcohealthdept.com/Services.aspx
http://medicineabuseproject.org/
www.doctoroz.com/videos/alternate-names-bath-salt-drug
http://www.emcdda.europa.eu/publications/drug-profiles/syntheticcathinones
http://www.webmd.com/parenting/teen-abuse-cough-medicine-9/
glossary-dxm-drug-abuse
http://teens.drugabuse.gov/sites/default/files/PEERx_Toolkit_
FactSheets_DXM_FINAL.pdf
http://kidshealth.org/parent/h1n1_center/h1n1_center_treatment/cough_
cold_medicine_abuse.html#
http://www.narconon.org/drug-abuse/prescription-drugs-guide.pdf
http://headsup.scholastic.com/articles/prescription-stimulants/
http://headsup.scholastic.com/
Local Medication and Hazardous
Waste Disposal
Cape Girardeau Police Department
Jackson Police Department
City of Cape Girardeau - Public Works
July, 2014
Page 9
What’s your diagnosis?
Charles Moon, M.D.
A 35-year-old male
farmer presented with
a three-month history
of an itchy, scaly
eruption on the face
and neck. He treated
the area with an over
the counter anti-itch
cream that contained
1% hydrocortisone,
which helped with
itching, but had no
effect on the rash.
He therefore sought medical care and was
treated with topical Mycolog and Keflex. With
this treatment, the eruption spread to involve
large areas on the face and neck. Additionally, he
developed tenderness and swelling of the affected
skin, pustules, and cervical lymphadenopathy.
Classified listing:
Gently used medical office equipment.
Exam tables, rolling stools, wall unit with
oto/ophthamscope heads.
Break room table, wall
brochure racks, room flags
573-332-7746 x303 ask for Tina
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7 Doctor’s Park
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573.339.7070
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Page 10
CAPE COUNTY MEDICAL JOURNAL
Contact me today!
Bridget Ann Gilbert
Private Mortgage Banker
Cell: 314-288-5381
[email protected]
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Information is accurate as of date of printing and is subject to
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a division of Wells Fargo Bank, N.A. ©2011 Wells Fargo
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CGCAMS CALL FOR SPEAKERS
CGCAMS EVENTS
July 16th- Membership Meeting @
Celebrations, Downtown
“Chronic Headaches”
Join us for an evening of FREE CME. Happy Hour
starts at 6:30 with dinner and presentation by
Robert Gardner, Jr, MD to follow at 7:00.
August 28th- Membership Meeting @
Celebrations, Downtown
Join us for an evening of FREE CME. Happy hour
starts at 6:30 with dinner and presentation to follow
at 7:00.
Interested in speaking at one of the many
CME events hosted by CGCAMS?
If you are interested please contact the
Director at 573-334-5691 or
[email protected] to discuss speaking
opportunities.
October 1st- Membership Meeting @
Celebrations, Downtown
“Working together to Address Domestic
Violence in Southeast Missouri”
Join us for an evening of FREE CME. Happy Hour
starts at 6:30 sponsored by Eye Care Specialists with
dinner and presentation by Safe House for Women
Director of Development Jessica Hill to follow at
7:00.
Please contact the CGCAMS office if you are interested in
speaking or sponsoring a membership meeting.
Answer: What’s your diagnosis?
Tinea Barbae
Tinea barbae is an infection of the skin and hair follicles
caused by superficial dermaphytic fungal organisms. It
is found in a beard distribution on the face and neck, and
almost exclusively affects adolescent and adult males.
It is more common among individuals that work around
livestock and animals. Dermatophytic fungal organisms
infect the stratum corneum of the epidermis, hair, and
nails, but cannot cause invasive infections or sepsis. The
mechanism that causes tinea barbae is similar to that of
tinea capitis. In both diseases, hair and hair follicles are
invaded by fungi, producing an inflammatory response.
Clinically this condition can present as itchy, minimally
inflamed, scaling patches that may not appear annular.
Deeper, swollen kerion-like plaques and pustular
lesions, resembling bacterial folliculitis, may also be
seen in more advanced cases. Due to varied clinical
appearances, tinea barbae is often mis-diagnosed as
a non-infectious dermatitis or a bacterial folliculitis and
is treated inappropriately with oral antibiotics or topical
steroids. Nystatin, used to treat candida infections of the
skin, has minimal activity against dermatophyte strains
of fungus, but is often mistakenly prescribed. Patients
may also use OTC hydrocortisone preparations to relive
itching. Unfortunately use of OTC and prescription topical
steroids will cause proliferation of the fungal infection
and deeper fungal involvement of the hair follicle. This
can lead to pain, permanent beard loss, and scarring.
Combination topical steroid and antifungal preparations
typically cause worsening of tinea infections and are
rarely used by dermatologist.
When recognized and treated appropriately, tinea barbae
is relatively easy to cure. It is typically treated with oral
anti-fungal agents like grieseofulvin, itraconazole, and
terbinafine. Topical antifungals do not penetrate the
deep follicular structure and therefore have a high failure
rate. Oral terbinafine (Lamisil) 250 mg po daily for 2-4
weeks is nearly 100% effective clearing the infection.
Terbinafine is cost effective, rarely interacts with other
drugs (unlike azole antifungals), and has extremely low
rates of hepato-toxicity.
July, 2014
Page 11
PROFESSIONAL DIRECTORY
The Vein & Esthetic Centre
J. Thomas Critchlow, MD, RVT
Diplomat - American Board of
Venous & Lymphatic Medicine
3065 William St, Suite 105
David L. Kaelin, DMD
7 Doctor’s Park
Cape Girardeau, MO
573.339.7070
Cape Girardeau, MO 63703
573-651-1882
CAPE GIRARDEAU UROLOGY
ASSOCIATES, INC.
J. Russell Felker, MD, FACS,
John P. Hall, DO, FACS,
Donald L. Gentle, MD, FACS,
Gregg S. Hallman, MD, FACS,
James E. Outman, DO, FACS,
William C. Collyer, MD, FACS,
Vincenzo Galati, DO, FACS,
Mitchell L. Ogles, MD
3 Doctors Park, Cape Girardeau
334-7748
www.capeurology.com
Charles Moon, MD
211 Saint Francis Drive
Cape Girardeau, MO 63703
573-331-3996 • www.sfmc.net
1359 North Mt. Auburn Rd
Cape Girardeau, MO
573-335-7546 (SKIN)
APPLEMAN PODIATRY
Jeffrey P. Appleman, D.P.M.
Kathleen K. Appleman, D.P.M.
55 Doctors’ Park
Cape Girardeau, MO 63703
Entrance C
(573) 335-FOOT (3668)
Fax (573) 335-3620
DISEASES AND SURGERY OF THE EYE
C. NELSON RINGER, M.D.
TODD J. LUMSDEN, D.O., FAOCO
JOHN R. KINDER, M.D., FACS
RICHARD L. KIES, M.D., FACS
64 DOCTORS’ PARK,
CAPE GIRARDEAU, MO 63703
(573)334-5265 1-800-333-1568
Page 12
CAPE COUNTY MEDICAL JOURNAL
If you are interested in advertising in
the CGCAMS
Medical Journal, please contact
Director Sara Lee at
573-334-5691 or at
[email protected].
Partners in HEALTH
Saint Francis Medical Center understands the power of partnership. Our Medical Partners are a
caring group of healthcare providers and physicians who have come together to offer the very
best care and services to patients in the region.
Employed Medical Partners have direct access to the Medical Center’s powerful resources,
innovative technologies, state-of-the-art facilities and skilled specialists, allowing them to focus
on every facet of patient care.
A collaborative, powerful partnership — it leads to better outcomes for your patients.
To learn more about the benefits of our Medical Partners,
call 573-331-3996 or visit www.sfmc.net.
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