By: Dr. Caroline Leaf
We all have to eat to live, as redundant as that statement may sound. Yet the act of eating is not just a biological function of survival. The consumption of food, as normal as it is, is in fact a highly emotional and metacognitive event. Indeed, this should come as no surprise to us: throughout human history, gathering around a table and eating food has been a way for us to celebrate or commemorate notable seasons, individuals and events. Meals are a focal point for social gatherings, and sharing food is a powerful medium of communication both in-between cultures and among different peoples. I certainly believe that the joy of preparing a meal and sharing it with people is incredibly powerful, and incredibly therapeutic. As my daughter likes to say, one seasoning every cook should use is the pleasure of a hearty gathering, which should be sprinkled generously on every plate. Who needs a handful of digestive supplements when you have good, real food and good, real company?

Yet, like all things, meals can have either positive or negative emotional “seasonings,” both of which affect the way our body digests food. Our gastrointestinal tract (GI tract) is very sensitive to our emotions, since it is connected to the brain’s hypothalamus, which controls both the feelings of satiety and hunger, and deals with our emotional state of mind. The mind and the gut are acutely interconnected, and thus happiness, joy, and pleasure, as well as anger, anxiety, sadness, and bitterness, for example, trigger a physical reaction in you digestive system. The large and small intestines are densely lined with neurons, neuropeptides and receptors (the “doorways” into cells), which are all rapidly exchanging information laden with emotional content. Indeed, we have all experienced this gurgling emotional activity in our guts, colloquially known as a being “sick to your stomach,” a “gut-feeling” or having “butterflies in your stomach.”

Unless we are aware of what our digestive system is telling us, we may fall into the trap of overeating. The pancreas releases at least 20 different emotionally-laden peptides, which regulate the assimilation and storage of nutrients, and carry information about satiety and hunger. Do not ignore the information these peptides provide. Just as eating when you are angry or trying to bury another unpleasant emotion will affect the way that the nutrients in your food are assimilated, eating when you are not hungry will upset your digestive system. Overeating will make the food you eat or drink less beneficial, since the emotions generated by toxic thinking interfere with the proper workings of your body. Eating when you are in a distressed emotional state, or not hungry, is essentially like adding every spice and herb in your cupboard to your meal. All these seasonings will destroy the balance of flavors among the meal’s components. Emotionally-driven food consumption literally adds a flood of chemical, emotional “seasonings” to your food: your digestive system, like your palate, will not know how to interpret such a conflicting range of signals.

When we react incorrectly to the events and circumstances of life, we actually move into toxic stress, or stages two and three of stress. Toxic stress keeps your “fight or flight” response activated, which inhibits gastrointestinal secretion and reduces blood flow to the gut, thereby decreasing metabolism and affecting your body’s ability to digest food. In fact, toxic thinking and emotions, which lead to toxic stress, can affect the movement and contractions of the GI tract, cause inflammation, make you more susceptible to infection, decrease nutrient absorption and enzymatic output, upset the regenerative capacity of gastrointestinal mucosa and mucosal blood flow, irritate intestinal microflora, cause your esophagus to go into spasms, give you indigestion and heartburn by increasing the acid in your stomach, make you feel nauseous, cause existing digestive issues such as stomach ulcers to worsen, and agitate your colon in a way that gives you diarrhea, constipation and/or extreme bloating. To say that you should not eat food when you are stressed, unhappy, angry or any other negative emotion is most certainly an understatement.

A HEALTHY GUT IS A HAPPY MIND

Yet thinking good thoughts cannot excuse an unhealthy diet. The digestive system itself is a rich source of neurotransmitters, which carry signals inside the brain and body. In fact, 95% of the serotonin and half the dopamine in the body are produced in the gut. Considering these neurotransmitters are famous for their mood-calming and reward effects respectively, we should be paying a lot more attention to what we are putting in our gut—what you eat affects the way these neurotransmitters function. Indeed, beneficial symbiotic gut bacteria produce benzodiazepine-like substances, which are naturally occurring anti-anxiety neurochemicals. A healthy gut promotes a calm, satisfied and happy mind.

For more on the history and research of the gut-brain connection, get the book, “Think and Eat Yourself Smart,” or the “63-days to Think and Eat Yourself Smart” online program.
By: Dr. Caroline Leaf

By: Dr. Shanna Ndong
The analogy I often use for genetics is that DNA is the cookbook for the human body, residing inside the nucleus of every cell. RNA transcribes the genes (recipes) to make whatever proteins the cell needs. The human genome contains approximately 20,000 genes. DNA is made up of billions of repeating nucleotide molecules and is organized and condensed with proteins into chromosomes in the nucleus in preparation for cell division.

This article is the first in a three-part series that explores the exciting and rapidly evolving field of epigenetics. Epigenetics is the study of inherited processes that can alter gene expression. In the 1970s, it was discovered that mechanisms other than the DNA sequence itself are important in determining the expression of genetic traits and can be passed to offspring. DNA methylation and acetylation are two such mechanisms. Methyl groups can become permanently attached to cytosine, one of the chemical bases in DNA, and can replicate with it through generations. The attachment of methyl groups significantly alters the gene it binds, inhibiting its transcription. Other molecules, called acetyl groups, were found to play the opposite role, unwinding DNA and making it easier for RNA to transcribe a given gene.

An important concept to mention when discussing epigenetics is genomic imprinting. We inherit two working copies of most genes, (one from each parent) but with imprinted genes, we utilize only one working copy. Depending on the gene, either the copy from mom or the copy from dad is epigenetically silenced through the addition of methyl groups during egg or sperm formation. Uniparental disomy (UPD) occurs when a person receives two copies of a chromosome, or part of a chromosome, from one parent and no copies from the other parent. UPD can occur as a random event during the formation of egg or sperm cells or may happen in early fetal development.

In many cases, UPD has no effect on health or development because most genes are not imprinted. However, one of several genetic disorders can result from UPD if imprinted genes are involved. The most well-known conditions include Prader-Willi syndrome, which is characterized by uncontrolled eating and obesity, and Angelman syndrome, which causes intellectual disability and impaired speech. Both of these disorders can be caused by UPD or other errors in imprinting involving genes on the long arm of chromosome 15.

A number of important conditions may result from external or environmental factors.

It is now well accepted that conditions in the womb can determine later risk for a number of diseases through epigenetic mechanisms, including obesity, diabetes, allergies, asthma, and heart disease. The mother’s nutrition, including vitamin levels (particularly folate, B vitamins, and choline) and blood glucose, as well as mental health and substance abuse history, have all been shown to influence the methylation patterns of key genes in her offspring.

Since DNA methylation is a common mechanism for inactivation of genes, diets high in methyl-donating nutrients may help to alter gene expression, particularly during early development. A mother’s diet during pregnancy (and conception) and an infant’s diet can affect the epigenome (and health) in long-lasting ways. Diets that are rich in folate and choline are essential during these periods. In adulthood, too little of these nutrients can result in hypermethylation, but it is typically reversible with changes in diet.

A number of dietary supplements are of particular interest in the field of epigenetics. Many of these compounds display anticancer properties and may play a role in cancer prevention. I will discuss this topic further in the next article in this series (The Epigenetic Diet and Cancer).

Heavy metals are widespread environmental contaminants and have been associated with a number of diseases, such as cancer, cardiovascular diseases, neurological disorders and autoimmune diseases. Several studies have established an association between DNA methylation and environmental metals, including arsenic, nickel, and cadmium. Various other environmental pollutants that have been linked to disease through epigenetic mechanisms include pesticides (testes and ovarian dysfunction), air pollution (heart and lung disease), and bisphenol A, BPA: hormone disruptor (increased cancer risk).

There is strong evidence that experiences can cause epigenetic changes and that psychological and behavioral tendencies are inherited. A parent’s or grandparent’s exposure to emotional trauma may not only impact their mental health, but animal studies have shown changes in methylation patterns in the brains of their children and grandchildren. This field of research is called behavioral epigenetics, and it will be the subject of the third article in this series.
By: Dr. Shanna Ndong

In the United States, there are 4 different types of midwives with a varied range of training, scope of practice, and experience. Of those, 3 hold national certifications and credentials. The history of the word midwife is derived from two Middle English elements: mid meaning with, and wife meaning woman. Therefore, it simply means being “with woman,” specifically during childbearing.

Traditional/Lay Midwives (TMs)
According to the Midwives Alliance of North America (MANA), TMs are those who for various reasons choose not to hold certifications and/or licenses. They may or may not have training (formal or informal) in the art and science of midwifery. Many believe that they are responsible to their communities, midwifery is a contract between a woman and her midwife, the practice of midwifery should not be legislated at all, or women have the right to choose their care provider irrespective of legal status. They practice solely in out-of-hospital settings.

Midwives have been the traditional attendants of birth dating all the way back to Biblical days in Exodus. In colonial America, many were charged as witches and executed in the Salem Witch Trials. In the South during the 19th and 20th centuries, TMs were referred to as “Granny midwives.” Most were of African Americans or Appalachian descent. The title was given them by the government and was derogatory, suggesting ignorance. However, some referred to themselves in this way to redeem the offensive term, making it one of honor as a “granny” is someone whose age and wisdom are to be revered. They were regarded as elder healers, not just midwives. They had a certain spiritual authority, and considered midwifery a deep calling, just as many of today’s midwives do.

As doctors specializing in obstetrics and gynecology gained popularity in the20th century, the campaign against midwives (especially the African American/granny midwives of the South) began to impose various restrictions on TMs’ practice through legislation. In the South, Jim Crow laws further outlawed midwifery.

Women like Onnie Lee Logan and Margaret Charles Smith from Alabama have long since died, taking many of the secrets of traditional midwifery with them. I recently read a letter of one midwife who is returning to the roots of traditional midwifery. Though it is not the path I or many others would choose, her story brought tears to my eyes while deepening my commitment to become a midwife and promote the instinctive nature of birth again. There are some traditional midwives left, however they are becoming fewer and further between.

Certified Professional Midwives (CPMs)
According to MANA, this a type of direct entry midwife (one who does not have prior education as a nurse) trained in out-of-hospital settings. CPMs are credentialed by the North American Registry of Midwives (NARM) and trained in the midwifery model of care, practicing in freestanding birth centers and homes. One desiring to pursue this path obtains an experienced CPM as a mentor/preceptor with whom they will work side-by-side to learn the skills necessary for practice. Some who obtain this credential have degrees from schools accredited by the Midwifery Education Accreditation Council (MEAC) while others do not and have been trained via self-study of the same books and materials as Certified Midwives (CMs) and Certified Nurse Midwives (CNMs).

These midwives complete an extensive apprenticeship (even if they attend a MEAC accredited school) similar to what other healthcare professionals call clinical internships. Apprenticeships generally last 3-5 years, sometimes longer. When the necessary requirements are complete and both student and preceptor have agreed that she is ready, the application is submitted to NARM. Upon review, the certification exam is scheduled, along with a skills validation. If both are passed, the CPM credential is awarded.

As of 2017, Alabama joined a growing number of states who license and regulate the practice of CPMs. Prior to this, CPMs could be prosecuted and convicted of a class C misdemeanor, incurring fees and jail time. Women wanting the option of home birth were (and are) forced to drive out of state for this type of midwifery care. Though the law has been passed, it will take time to set up a state midwifery board and begin issuing licenses.

Certified Midwives (CMs)
This is another type of direct entry midwife who has a bachelor’s degree in a health-related field who attends graduate school, obtaining a master’s degree. The training is similar to that of a CNM. Practice standards are also similar but without the nursing component. They can practice in any setting (hospital, freestanding birth center, or home). These types of midwives are still relatively rare and not utilized in many states.

Certified Nurse Midwives (CNMs)
Certified Nurse Midwives are midwives trained in the disciplines of both nursing and midwifery. They hold a bachelor’s degree in nursing and a master’s degree in midwifery. They are mostly trained in hospitals, and most CNMs practice there; however, their scope of practice allows for practice in any setting. They care for women across the lifespan, from puberty to menopause and beyond. They are classified as primary care providers, specifically in the realm of women’s health. Many hold a dual certification as a Women’s Health Nurse Practitioner (WHNP). WHNPs function essentially the same as CNMs, but are not trained in labor, birth, or newborn care. CNMs are legal to practice in all 50 US states, as well as many other countries due to the vast scope of their training.

In spite of the recent passage of the CPM law, CNMs in Alabama are not currently able to practice in out-of-hospital settings due to the Alabama laws governing advanced practice nurses. Very few in the state are able to practice to the full scope of their training, even in the hospital. It is my hope as a CNM student that this too will soon change.
By: Rachel Clark, RN, BSN

No group of medications is more controversial in my practice than the ‘statins.’ The statins or hydroxymethylglutaryl (HMG) CoA reductase inhibitors are a group of medications that are used to treat elevated cholesterol levels and lower risk of heart attack and stroke. They include medications like Crestor (rosuvastatin), Lipitor (atorvastatin), Zocor (simvastatin), and Pravachol (pravastatin) to name a few. They act to block the last step in cholesterol production in the liver and lower LDL by 30-60%.

Statins and the Liver
When statins were introduced in the 1990s, regular lab monitoring was recommended to screen for elevations in liver enzymes. The FDA changed the safety labeling after it became apparent that significant elevations in liver enzymes in patients taking statins are relatively rare (0.1%). Routine monitoring of liver function is no longer needed.

Statins and Muscle Pain & Injury

Statins can cause varying degrees of muscle pain and injury that occurs in approximately 4-8% of users. Symptoms can range from myalgia, which is characterized by mild muscle aches and soreness with normal muscle enzymes, to the severe condition known as rhabdomyolysis, which is a combination of kidney failure, very elevated muscle enzymes, and proteins in the urine.

Muscle injury is more likely to occur on higher doses of statin, with concurrent use of other cholesterol medications like Niaspan (niacin) or Zetia (ezetimibe), and in patients with conditions like ALS, hypothyroidism, or renal failure. The onset of muscle symptoms is usually within weeks to months of starting the statin, but may occur at any time. If muscle pain is experienced while taking a statin, an assessment for elevations in muscle enzymes, hypothyroidism, drug interactions, or low vitamin D can be performed. A decrease in dosage or a switch in the statin may be made if muscle enzyme levels are normal.

Statins and Vitamin D
Research is ongoing, but patients taking statins tend to have higher vitamin D levels. However, patients with low vitamin D are more likely to experience statin-related muscle pain. Thus, a vitamin D level should be measured prior to initiating a statin.

Statins and Coenzyme Q10
Coenzyme Q10 (CoQ10, ubiquinone) is an antioxidant that helps to make energy in the muscle cell. Research has been inconsistent on the matter, but some studies have found that statins decrease CoQ10 levels in the muscle and blood. It has been speculated that a reduction in CoQ10 levels in muscle may contribute to statin-induced muscle injury.

Some researchers have suggested that supplementation with ubiquinone or ubiquinol (a more expensive form) can reduce the risk of muscle aches. A meta-analysis of randomized trials concluded that existing trials do not suggest a benefit of CoQ10 for statin myopathy, but larger trials are needed to confirm this lack of benefit.

Statins and Diabetes
Statins have been associated with an increased risk of diabetes that is most significant with high-potency statins like Lipitor and Crestor. A 2016 analysis estimated that high-dose therapy would lead to 50 to 100 new cases of diabetes in 10,000 treated individuals. However, statins have been shown to reduce heart attacks and strokes in known diabetics. Both randomized trials and observational studies suggest that the benefits of statins on reduction of cardiovascular events outweigh the risk of development of diabetes in many.

Statins and Memory Loss

The FDA released a warning in 2012 after it compiled several reports it received through its Adverse Event Reporting System (AERS) of memory loss associated with statin use. Systematic reviews of randomized trials since that time have failed to find an association between statin use and memory loss; however, randomized trials may not detect rare medication side effects. In contrast to the reports above, several studies have even shown a reduced risk of dementia with statin use.

Statins and Cancer Risk

There is no evidence that statins increase or decrease risk for cancer.

Summary

In summary, the statins have had their fair share of controversies, but every medical intervention has risks and benefits. People who benefit most from statin use are patients who already have cardiovascular disease. This includes individuals who have had a heart attack, coronary artery stenting or bypass, angina, or stroke. I want to emphasize that treatment with statins is not about number goals. The ultimate goal of statin treatment is reduction in risk for cardiovascular events like heart attack or stroke, and prevention of death. I believe that the statins can greatly benefit certain high-risk patients and are invaluable drugs for anyone with cardiovascular disease.
By: Shanna Ndong

Several weeks ago, I saw a Facebook post about how secrets can be dangerous things. Webster’s Dictionary defines a secret as something we keep hidden from the knowledge of others. Teaching children about secrets is an important part of keeping them safe from the long-term effects that can be caused by abuse.

According to a sexual abuse prevention workshop called “Parenting Safe Children,” secrecy is a key element to childhood sexual abuse. A Denver mom wrote a blog post about her experience with teaching her son an alternative to secret keeping. In her home, she teaches her children about surprises instead. She recounts the story of a friend who gave her son a cookie and said “shhh…it’s a secret.” To the mom’s utter delight, the son told the woman that in his home, they don’t do “secrets,” but instead they do “surprises.”

The mom explains “Surprises are something we keep quiet about temporarily; then you share the surprise and people are happy. But secrets are meant to be kept quiet forever and they are often protecting something that would make people unhappy.” Surprises are things like a birthday party or a gift. Secrets like sexual abuse leave long-lasting scars on everyone involved.

Often times, sexual predators will test children by asking them to keep smaller secrets (like cookies or other treats), building up to bigger and bigger secrets about what is happening to them. By teaching her children different terminology, she is bypassing this common method of trapping children in the abuse cycle. This little boy was bold enough to say that he doesn’t keep secrets. He is no longer a vulnerable target because of the wisdom of his mother in teaching him about body safety.
It is vital to start early teaching children about their bodies and which parts are ok to touch and which parts aren’t. If these important lessons are instilled in them early on, they are less likely to experience abuse, and the devastating effects it can lead to in the future such as anxiety, depression, and suicidal ideation/attempts.

Body Safety Rules include the following (adapted from Parenting Safe Children Workshop developed by Sandy Wertele, Ph.D. and Feather Berkower, MSW):

1.No one is allowed to touch your private parts
2.You should not touch someone else’s private parts
3.No one is allowed to take pictures of your private parts
4.If someone tries to touch your private parts, say “NO!”
5.When playing friends, play with your clothes on
6.You are allowed to have privacy when bathing, dressing and using the toilet
7.You have permission to say “No” and get away if someone tries to touch your private parts or breaks any of your body safety rules
8.We don’t keep secrets in our family. If someone tells you to keep a secret, tell an adult.

Also, educate children that doctors and nurses sometimes have to examine these private parts of their bodies and that is ok, because Mommy or Daddy is with them. Begin to teach your children these rules now to eliminate them as targets later. If you don’t yet have children, adopt the practice now of not keeping “secrets” so that it will be easier to instill in them these principles when you do.
By: Rachel Clark, RN, BSN

Few of us are aware of the connection between nutrition and depression, despite the fact that we understand to some extent the relationship between nutritional deficiencies and physical illnesses. Depression is still thought by many to be a biochemical or emotional based issue, however nutrition can determine the extent and duration of depressive symptoms.

Neuroscience research conducted by clinicians like Dr. Caroline Leaf and others suggests that nutritional factors are very much intertwined with emotions, cognition, and behaviors. Some of the most common mental health issues include obsessive compulsive disorder, depression, schizophrenia, bipolar disorder, anxiety disorders, and ADD/ADHD.

Numerous studies show that the dietary intake pattern of most American and Asian populations as opposed to Mediterranean countries are often deficient in nutrients such as essential vitamins, minerals, and omega-3 fatty acids. Also, evidence now suggests that the pathology of Major Depressive Disorder (MDD) may be rooted either primarily or secondarily to oxidative stress in the body (A. Sarandol, ET AL.).

Our brains are more sensitive to oxidative stress and free radicals than other tissues. The brain is only about 2% of the weight of the human body, yet it uses approximately 20% of its energy. MDD is also distinguished by the activation of an inflammatory response system, thus increasing free radical production.

What is interesting is that inflammation shows up in different people as different symptoms. Some people may exhibit cardiovascular disease, others diabetes, or an autoimmune disorder. Still yet others manifest depression, anxiety and mental illness. It is no surprise that these things are often listed as comorbidities (the presence of two or more chronic diseases) since they have the same root: inflammation. What was interesting in the study relating MDD to oxidative stress was the conclusion: the drug combination used had no effect on measurable oxidative stress markers in the body at the end of 6 weeks.

So what is the solution? Many people think vitamins will help their nutrient deficiencies, but according to a study done at John Hopkins University, vitamins are at best a waste of money, providing no clear benefit. At worst, they can do more harm than good, with high concentrations of isolated and fractionated vitamins E and A, as well as beta carotene, could increase the risk of death in certain individuals. Therefore, use vitamin supplements judiciously, or avoid them altogether.

This still leaves the question as to how to nourish our bodies, and therefore our brains. The solution is a diet that is high in the various micronutrients we need to keep our bodies functioning such as vitamin C, vitamin E, vitamin B6, vitamin B12, folate (or vitamin B9), zinc, and omega-3 fatty acids (EPH/DHA). The Mediterranean Dietary Pattern (MDP) which is high in fruits, vegetables, olive oil, and oily fish is now thought to reduce inflammation due to its richness in antioxidants that come from these whole foods.

“Optimizing our nutrition is a safe and viable way to help avoid, treat, or lessen the symptoms of mental illness. Poor nutrition is a significant and modifiable risk factor for the development of mental illness,” said Julia Rucklidge, a PhD professor of clinical psychology in Christchurch, New Zealand, who has studied the treatment of ADD/ADHD and other mental health issues with micronutrients for the last 10 years.

We rely on medications, but honestly we need to stop visiting the “pharmacy” and start visiting the “farm” to decrease the prevalence of mental illness. I am not dismissing the effectiveness of medications on some severe forms of mental illness, nor advocating that you should stop treatments prescribed by your healthcare practitioner without first consulting them. They can be very effective for some people in the short term, but on a long term basis have lasting effects on our bodies. Despite our reliance on these drugs, our outcomes are no better than they were 50 years ago.

The research is clear: the well nourished brain is better able to withstand stress and recover from illness. Sixty to eighty percent of people will respond to better nutrition. Let’s get serious about the role nutrition plays not only in our physical health, but also our mental health.
By: Rachel Clark, RN, BSN

Carpal Tunnel Syndrome is a disorder that affects the quality-of-life of a large portion of the population. Many patients suffer with carpal tunnel without realizing what their diagnosis really is, and what the treatment options are. Carpal tunnel syndrome has been associated with overuse type jobs. With the onset of the computer revolution, the keyboard has been a common source of blame for patients with carpal tunnel syndrome.

The symptoms of carpal tunnel include numbness and tingling in the hand. Specifically, the numbness and tingling involves the index finger, the long finger, the ring finger, and part of the thumb. This numbness, tingling, and burning are often associated with an aching pain that radiates into the forearm and occasionally even shoulder pain. The patients often complain that the symptoms awaken them from sleep at night. Many times they describe the sensation, when they awaken from sleep, with symptoms such as they need to shake their hand to make it “wake up.” If left untreated, carpal tunnel can progress to grip loss and atrophy of the hand muscles. When carpal tunnel symptoms begin, they are usually intermittent, but when left untreated they are typically progressive.

The underlying cause of carpal tunnel syndrome is compression of a nerve within the wrist called the Median Nerve. This nerve has 2 functions in the hand. First, it provides sensation to the index, long, and ring finger and portions of the thumb, thus resulting in the symptoms described above. Further, there is one branch of the Median Nerve that causes the muscles of the palm and thumb to function, and when affected it results in weakness in the hand and grip loss.

The anatomy of the carpal tunnel involves 9 tendons and a single nerve that traverse through a tunnel that has been named as the carpal tunnel. This tunnel is roughly located at the junction of the hand and wrist. The structure of the tunnel is a tight fibrous band of tissue that does not expand and will not accommodate for swelling. Because the canal does not have the ability to stretch, when swelling occurs within the tunnel it causes compression of the contents of the tunnel. The tendons tolerate this pressure, but the median nerve which traverses through the tunnel with the tendons does not. However, the cause of the swelling is usually from the tendons. The idea is that the tendons within the carpal tunnel become swollen from overuse. Each tendon is surrounded by a smooth slick layer called synovium, which when aggravated, it swells. It is this swelling that is the underlying cause of carpal tunnel and ultimately causes compression of the Median Nerve.

Evaluation of carpal tunnel syndrome occurs first with the physical exam. There are several specific physical exam findings that strongly indicate carpal tunnel syndrome. If physical exam findings are present, most physicians will proceed with a test called an EMG or nerve conduction velocity. This test is done by providing an impulse externally to the arm with electrodes that measure how fast impulse travels. If there is compression to a nerve such as in carpal tunnel syndrome, this will result in a positive test.

Treatment options for carpal tunnel include bracing. Bracing immobilizes the wrist and allows for the swelling within the carpal tunnel surrounding the tendons to improve with just simply rest. One issue that makes this less effective is that although we can immobilize the wrist itself, fingers still need to work. Some of the tendons traversing the canal, function to create movement within the fingers. So, despite bracing there is still motion within the carpal tunnel, and still a source for friction and swelling. However, bracing is effective and is a good option, especially early on. Anti-inflammatories also may be a good treatment option and function as a good adjunct to bracing.

Another conservative treatment option is to consider injection therapy. With this treatment, a steroid is injected directly into the carpal tunnel usually under needle guidance using ultrasound. The steroid acts as a very potent anti-inflammatory and reduces the swelling within the carpal tunnel. This takes pressure off the nerve and symptoms improve. Unfortunately, this may not be a permanent fix and often times symptoms will return. However it is a useful treatment option in some situations.

When conservative treatment fails, patients will likely be referred to an orthopedic surgeon for surgical treatment. The surgical treatment for carpal tunnel is an outpatient surgery which can be done under local or general anesthesia. Most surgeons prefer general anesthesia. A minimally invasive 2 cm incision is typically made over the base of the palm and wrist and the carpal tunnel is released. This effectively turns the tunnel into a trough. This does not affect the function of the contents of the canal but allows for release of pressure and removal of friction caused from the swelling within the canal. By removing the friction and pressure, the swelling resolves and the cycle of compression is stopped. Carpal tunnel surgery is extremely successful and most patients are able to return to full use of the hand within 3 weeks. Time off work is minimal, provided the patient can perform their work duties with minimal use of the operative hand for about 2-3 weeks. It is not uncommon for patients to have surgery on a Thursday or Friday, and return to limited duty work on Monday.

If you suffer from symptoms of carpal tunnel syndrome, I would encourage you to follow up with your orthopedic surgeon or your primary care doctor, and not ignore your symptoms. Without some type of treatment, your symptoms are likely to progress. However with treatment, there is a high rate of success and improvement in quality of life.

By: J. Patrick Boyett, DO – OrthoSports Athens, LLC

Most women experience pelvic pain at some time during their lives. Many times pelvic pain is just the normal functioning of the reproductive tract or other organs. Other times pelvic pain may indicate a more serious problem that needs urgent treatment. Here we will discuss some common causes of pelvic pain and potential treatment options.

Some “normal” events can cause severe pain. Pain with ovulation is called “mittleschmirtz” and can at times be severe. Functional ovarian cysts are fluid filled structures that if left alone will go away without any treatment.

Dysmenorrhea. This means pain with menstrual period. Some cramping with the menstrual period is normal, but it is not normal to have pain that interferes with a woman’s normal activities. Prostaglandins are compounds in menstrual blood that cause the uterus to contract, and cause cramping. Common medicines used to treat dysmenorrhea, such as aspirin, ibuprofen, or naproxen sodium help by interfering with the production of prostaglandin. Hormonal therapy with birth control pills can also be very effective.

Endometriosis. Endometriosis is a condition in which the type of tissue that lines the uterus implants in locations outside the uterus. This typically causes pelvic pain around the time of the menstrual period, but can cause pain at other times in the cycle as well as pain with intercourse. Treatment includes hormonal therapy +/- surgical therapy, including laparoscopy and hysterectomy.

Fibroids. Fibroids are benign growths in the muscle of the uterus. Fibroids are very common, and usually are not painful. Some fibroids can cause pelvic pressure, pain and excessively heavy menstrual bleeding (menorrhagia). If symptoms are severe enough, hysterectomy may be necessary. In fact, fibroids are the most common indication for hysterectomy in the United States.

Infection. Most pelvic infections that cause pain are caused by Chlamydia and/or Gonorrhea. Infections can also be caused by other bacteria. Infection of the lining of the uterus (the endometrium) is called endometritis. Infection of the fallopian tubes is called salpingitis. Often pelvic infection is given the term Pelvic Inflammatory Disease, or PID. Sometimes pelvic infections can cause severe pelvic pain and fever, but a chlamydia infection may not cause any pain at all. If a pelvic infection is suspected, it is important to be treated with antibiotics, since severe damage to the tubes and ovaries can result if treatment is delayed.

Pelvic Adhesions. An adhesion is where intra-abdominal organs stick together. This is often caused by pelvic infection (PID), endometriosis, or previous surgery. Pelvic pain can occur when adhesions are stretched. For example, if an ovary is stuck to the intestine, ovulation may stretch these adhesions and cause pain. On the other hand, many adhesions cause no pain at all.

Unless adhesions cause the intestines to be blocked (a bowel obstruction), they usually cannot be diagnosed without doing laparoscopy and actually looking inside the abdomen. Most adhesions can be freed during laparoscopy, but they can reform. Freeing the adhesions may or may not relieve pain.

Pain from other organs
The colon sits next to the uterus and ovary. Pain from irritable bowel syndrome can seem like it is coming from the ovary. Usually this is a crampy pain. Constipation and inflammation of the intestine, such as diverticulitis can also cause pelvic pain. As endometriosis can involve the intestines, evaluation of the intestinal tract and laparoscopy may be necessary to determine whether the pain is coming from the intestines or a gynecologic problem.

Bladder. Inflammation of the bladder is felt in the lower abdomen. A bladder infection usually causes burning with urination and urinary frequency. Interstitial cystitis is an inflammation of the bladder not caused by infection, but can cause severe symptoms. Kidney stones also can also cause pelvic pain.

Abdominal wall pain. Nerves in the abdominal wall can be trapped, and cause severe pain. Often this is near a previous surgical incision. It is important to distinguish pain from the abdominal wall from problems inside the abdomen. Often this can be done by numbing areas of the abdominal wall with local anesthetics, which will eliminate pain coming from the wall, but not from internal organs.

As noted above, many of the common causes of pelvic pain will resolve with observation or with simple medical treatment including anti-inflammatory medications, antibiotics, or hormonal therapy. If the pain remains persistent or seems to be gradually worsening, many times a diagnostic laparoscopy may be necessary. This involves placement of a 10 mm camera into the abdominal cavity and inflation of the cavity with carbon dioxide. Looking into the pelvis, different causes of pelvic pain can be diagnosed and treated including endometriosis, pelvic adhesions, and ovarian cyst formation. If laparoscopy alone cannot relieve the pain, or if there are coexisting problems, hysterectomy, with or without removal of the tubes and ovaries, many times becomes the definitive management.

By: Oliver E. Carlota, M. D.

Oliver E. Carlota, M.D. has been in private practice in Athens, Alabama since 1998. He has recently been joined by his wife Amy Carlota, CRNP who completed her Master’s degree as a family nurse practitioner in 2009. He has been in practice with Roberta Ress, CNM, a certified nurse midwife, for a number of years. The goal of their practice is to provide comprehensive, compassionate, and competent women’s health care in a timely fashion. Carlota OB/GYN, P.C. has recently moved to Suite 17 of Athens Professional Plaza. Their beautiful, new office has been renovated and redecorated in a contemporary fashion in order to provide a soothing and comfortable atmosphere for their patients. To schedule an appointment, contact Carlota OB/GYN, P.C. at (256) 233-3100.

Over the last several years, Autism and Asperger’s Syndrome have been frontrunners in discussions regarding health and education in children. So much so that since the 1970s, April has been deemed National Autism Awareness Month according to the Autism Society. This month is recognized in the United States as a special time to educate the general public about both Autism and issues in the Autism community (www.autism-society.org).

Even as prevalent as this discussion has become, there are still many people who are not aware of Autism and Asperger’s, and all that they entail. Basically, Autism is more than a single, identifiable problem. According to www.autismspeaks.org, Autism is a general term for “a group of complex disorders of brain development . . . characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors.” In 2013, the DSM-V diagnostic manual merged all of these various disorders under one, more general diagnosis labeled “ASD” or “Autism Spectrum Disorder.” While the difference between Asperger’s and autism is both subtle and complicated, those with Asperger’s typically do not exhibit a delay in communication skills.

Statistics from Autism Speaks claim that ASD affects over 2 million people in the U.S. and tens of millions around the world. Findings published on their website indicates that roughly 1 in 68 children in the U.S. have been identified as being on the autism spectrum. This is “a ten-fold increase” over the last 40 years. Studies have also shown that autism is more common in boys than in girls, 1 in 42 as opposed to 1 in 189.

Now that you know what autism and Asperger’s are, you’re probably wondering what causes them. Unfortunately, the jury is still out on this question. Just a few years ago, most people would say that scientists have no idea. However, there is now better research as to the links to this spectrum of disorders might be. There is no “one single cause,” just as there is no “one single type of autism.” A few possible causes might include genetics, environment, and nutrition. There has also been great controversy over a possible link to vaccine administration.

Autism is generally diagnosed when children are still very young. Many times parents are the first to notice that something just doesn’t seem right and they can’t figure out what it is. Some of the more common signs or symptoms that children exhibit include but are not limited to social challenges, communication difficulties, and repetitive behaviors.

Social Challenges:
By nature most babies are very social and interactive with parents and caregivers. In contrast, most who develop autism show signs early on that there is an issue. Signs might include not responding to their name, lack of interest in people and failure to engage in babbling and “baby talk.” It is also common for individuals on the autism spectrum to misinterpret what others think or feel and gestures such as smiling or waving often convey no meaning. It is also difficult to see things from the perspective of another.

Communication Difficulties:

By the time most children are 3 years old, they are able to form a few words and/or simple sentences. They can convey like or dislike, respond to their names, and indicate desire for something. Children who are autistic or have Asperger’s syndrome are often delayed in these communication skills. Sometimes, infants will develop autism later but have previously demonstrated the ability to communicate. Others will have significant delays in learning to speak and communicate from a very young age. Many learn to communicate with pictures, sign language, word processing software, and speech generating devices.

Repetitive Behaviors:

Often, children on the autism spectrum will exhibit use of a set of repetitive behaviors, which is “one of the core symptoms of autism”. These repetitive behaviors may include but are not limited to such activities as “hand-flapping, rocking, jumping and twirling, arrangement and rearrangement of objects, and repetition of sounds, words, or phrases”. If someone attempts to stop or discourage these behaviors, children will often become very upset. Those children and adults on the autism spectrum often benefit from order and consistency on daily routines, with even minor changes to that routine deeply affecting behavior.

“Children with autism also exhibit a higher than average occurrence of genetic changes, GI (gastrointestinal) issues, seizures, sleep dysfunction, and sensory processing disorders.”

Throughout my lifetime, I’ve had the profound honor and privilege to work with multiple children and adults who are on the autism spectrum, some more so than others. These amazing people have given me the great gift of their presence in my life and I am forever grateful for it.
By: Rachel Clark, RN, BSN

Often times when we are in pain our automatic response is going to our family physicians and accepting whatever pill they give us. Don’t get me wrong, many times it is needed and fixes whatever is ailing us. However, there are many instances where alternative therapies can play a key role in managing chronic pain, for example, fibromyalgia.

Fibromyalgia is a common syndrome in which a person has long term, body-wide pain and tenderness in the joints, muscles, tendons and other soft tissues. Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety.

According to a Mayo clinic staff writer, symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Research has shown that women are more likely than men to develop fibromyalgia. While there is no cure for fibromyalgia, a variety of medications can help control symptoms. But even more important is knowing how exercise, relaxation and stress-reduction measures also may help.

There are several therapies than can assist in managing the chronic pain associated with fibromyalgia. One of the most popular therapies is massage therapy. Series of massage treatments have been reported for years to reduce chronic pain associated with fibromyalgia. It is important to understand when treating any chronic pain there is no quick fix. It takes time as well as tolerance to reach the goal of “pain management”. It is important to work with a therapist who is familiar with your condition, and can approach your treatment sessions with experience and knowledge. Having a better understanding of how massage therapy can help in the case of fibromyalgia would literally require an anatomy and pathology lecture.

But to put it simply, muscles are surrounded by fascia. This connective tissue plays an important role in the determination of the extent of muscle stretch and contraction. It is very important to understand that fascia also provides pathways for nerves and blood vessels. In cases of fibromyalgia, due to the muscles being in a state of prolonged pathological hypertonus, (or overuse,) fascia becomes tense, causing compression of muscle fibers, nerve tissue and blood vessels. This will cause strain on muscles and tendons, and will always create inflammation. Massage Therapy will not only reduce mental stress but muscular stress!

A few other options for managing your fibromyalgia pain are ionic detoxification and infrared therapy. Fibromyalgia is a reaction to a low-grade inflammatory condition of the muscles, fascia, and other connective tissues. This inflammation can be caused by a number of factors, including stress, hormonal changes, and even toxic chemical exposure. Ionic detoxification reduces the levels of toxins in your body, thus reducing the pain that is the result of those toxins. Individuals who detox have seen a reduction in pain and stiffness associated with arthritis, better sleep habits, and overall well being.

Infrared therapy can be very helpful reducing pain, although it may only help for a short period. The deep heat from Infrared therapy can reduce the amount of lactic acid build up in the muscles which can make you stiff and sore. Infrared therapy comes in many forms such as saunas, lamps, and hand held devices.

Managing fibromyalgia can be difficult, but it is my opinion that combining multiple therapies, along with exercise and a healthy diet will bring aid in managing chronic pain.

For more information about fibromyalgia treatment plans, please call Wendy Couch at 256-374-4127.
By: Wendy Couch