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 (

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, 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

Glaucoma can strike without pain or other symptoms and is a leading cause of blindness in the United States. According to the American Optometric Association (AOA), early detection and treatment is critical to maintain healthy vision and protect the eyes from the effects of potentially blinding diseases, such as glaucoma.

Awareness and understanding surrounding glaucoma is relatively low. According to data from the AOA’s latest American Eye-Q® consumer survey, less than 20 percent of all Americans know that glaucoma primarily causes deterioration to peripheral vision.

The survey also indicated 50 percent of Americans incorrectly believe glaucoma is preventable. While the disease is not preventable, it is treatable, and regular, comprehensive eye exams play a critical role in successful outcomes for patients. The AOA recommends those who suffer from glaucoma have a dilated eye examination annually. More frequent exams may be needed if you notice additional changes in your vision.

“Those individuals who do not visit their eye doctor on a regular basis are putting their vision and quality of life at risk,” said Dr. Davis. “Vision lost to glaucoma cannot be restored, so early detection and treatment are important.”

Americans also are not aware of the factors that put them most at risk for developing glaucoma. Only 16 percent of those surveyed indicated knowing that race or ethnicity may increase their risk. According to the Glaucoma Research Foundation, African Americans ages 45 to 65 are 14 to 17 times more likely to go blind from glaucoma than Caucasians. Other risk factors include people who have a family history of glaucoma, are over age 60, or have had severe eye trauma.

To find a doctor of optometry in your area, or for additional information on glaucoma and other issues concerning eye health, please visit

About the survey:
The sixth annual American Eye-Q® survey was conducted by Penn, Schoen & Berland Associates (PSB). From May 19-23, 2011 using an online methodology, PSB interviewed 1,000 Americans 18 years and older who embodied a nationally representative sample of the U.S. population. (Margin of error at 95 percent confidence level.)

About the American Optometric Association (AOA):

The American Optometric Association represents approximately 36,000 doctors of optometry, optometry students and paraoptometric assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, and in 3,500 of those communities are the only eye doctors. Doctors of optometry provide two-thirds of all primary eye care in the United States.

American Optometric Association doctors of optometry are highly qualified, trained doctors on the frontline of eye and vision care who examine, diagnose, treat and manage diseases and disorders of the eye. In addition to providing eye and vision care, optometrists play a major role in a patient’s overall health and well-being by detecting systemic diseases such as diabetes and hypertension.

Prior to optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor’s degree. Required undergraduate coursework for pre-optometry students is extensive and covers a wide variety of advanced health, science and mathematics. Optometry school consists of four years of post-graduate, doctoral study concentrating on both the eye and systemic health. In addition to their formal training, doctors of optometry must undergo annual continuing education to stay current on the latest standards of care. For more information, visit
By: Chad Davis, O.D.

We are in the midst of cold and flu season, and I have recently seen an uptick in clinic visits for upper respiratory infections. Common complaints include sore throat, cough, nasal congestion, and low-grade fever, and I often feel pressure by patients to prescribe antibiotics for their symptoms. However, most upper respiratory infections are caused by viruses and are not improved by a course of antibiotics.

Antibiotics treat bacterial infections like strep throat, certain kinds of pneumonia, skin infections, and urinary tract infections. Antibiotics are vital to modern medicine and have led to a dramatic reduction in illness and death from infectious diseases. However, very few new antimicrobial drugs have been introduced over the last thirty years and taking antibiotics unnecessarily can lead to an increase in strains of bacteria that are resistant to most or all current antibiotics.

Almost all bacteria have the ability to change or mutate to become less susceptible to drug threats, but the more that antibiotics are used, the more opportunities bacteria have to evolve to resist them. The Center for Disease Control (CDC) estimates that half of all prescribed antibiotics are unnecessary or inappropriate as written. If an antibiotic is prescribed for a viral infection, otherwise harmless bacteria in the body may develop resistance and later transfer it to more dangerous bacteria when a true bacterial infection does occur.

The misuse of properly prescribed antibiotics can also contribute to drug resistance. For example, when patients fail to complete their drug regimens at home, they may allow some bacteria to survive the treatment and develop resistance in the process.

Antibiotic-resistant infections affect 2 million people and are associated with 23,000 deaths annually in the United States. Antibiotic resistance is a major public health concern that limits available treatments and increases costs because of the need for more expensive drugs and longer treatment courses. Some antibiotic-resistant infections cannot be treated by any current medications. Examples of antibiotic-resistant infections include Methycillin-resistant Staph aureus (MRSA), Clostridium difficile, drug-resistant tuberculosis, and drug-resistant gonorrhea.

It is important to note that antibiotic overuse occurs not just in medicine but also in food production. In fact, agricultural usage accounts for 80 percent of all antibiotic use in the U.S. and is a major source of human antibiotic consumption.

Almost 21 million pounds of antibiotics are administered to livestock in the U.S. every year for growth promotion, weight gain, and disease prevention. The antibiotics in meat and dairy, as well as the resistant bacteria, are potentially passed on to humans in undercooked foods. According to the CDC, 1 in 5 antibiotic-resistant illnesses in humans is linked to food. An analysis of supermarket samples by the non-profit Environmental Working Group (EWG) found that the majority of the ground beef, ground turkey, and pork chops sold in the typical American grocery store contains antibiotic-resistant bacteria. Drug-resistant bacteria can also spread from farms through agricultural workers, flies, and trucks that haul livestock and can accumulate in manure that is spread on fields and enter waterways.

So what can you do to reduce the incidence of antibiotic-resistant infections? Here are some tips to promote proper use of antibiotics and reduce resistance:

  • Complete the full course of an antibiotic. It’s important to take all of the medication, even if you are feeling better. If treatment stops too soon, the drug may not kill all the bacteria, and the remaining bacteria may become resistant to the antibiotic that you’ve taken.
  • Do not skip doses. Antibiotics are most effective when they are taken regularly.
  • Do not save antibiotics. You might think that you can save an antibiotic for the next time you get sick, but an antibiotic is meant for your particular infection at the time. Never take leftover medicine.
  • Do not take antibiotics prescribed for someone else. These may not be appropriate for your illness, may delay correct treatment, and may allow your condition to worsen.
  • Practice good hygiene. Wash your hands regularly with soap and water, especially after using the toilet, before eating, before preparing food and after handling fresh meat. Wash fruits and vegetables thoroughly, and keep kitchen work surfaces clean.
  • Don’t push your health provider to prescribe antibiotics. Ask your doctor if they think your illness is viral, and if you can fight it off on your own.
  • Avoid infection by getting vaccines, including the flu vaccine.
  • Use antibiotic ointments sparingly.
  • Avoid antibacterial hand soaps and cleaners.
  • Practice food safety at home. If possible, purchase meat and dairy that have been raised without antibiotics.

By: Dr. Shanna Ndong

During the month of February, Americans see hearts everywhere. Most Americans see it as a month that is dedicated to love. It is also American heart month, a time to show your anatomical heart some love in addition to the heart as you emotional center.
Cardiovascular disease (a fancy medical term that includes heart disease, high blood pressure and stroke) is the number one killer nationwide. It is also known as the “silent killer” as there are many times no warning signs or symptoms associated with heart disease. According to the Center for Disease Control, it is also a leading cause of disability in the US and costs us over $300 billion annually in cost of healthcare, medications, and productivity.

There are many risks associated with CVD. Some of them you can alter, others you can’t. Modifiable risk factors include diet, exercise, tobacco use, obesity, high blood pressure, high cholesterol, and diabetes. Non-modifiable risk factors include gender, family history, age, and ethnicity.

As you begin to take the journey toward better cardiovascular health, it is important not to get overwhelmed. At a conference recently I heard a word that will help keep you from feeling you are in over your head: JOLT, which stands for Just One Little Thing. Rather than thinking you have to make multiple major changes at once, taking it one small modification at a time will have tremendous effects on your heart health. Other things you can do include partnering up with someone else, don’t get discouraged, and reward yourself! Let’s face it. No one wants to make major changes on their own and we all need a little accountability and encouragement from time to time! It is easy to get discouraged with changes when we are focusing on the negative, so reward yourself through the process as you make those small changes. Set goals, and when you reach them, celebrate!

Prevention is key when it comes to cardiovascular disease. At a recent lecture I attended in regard to Whole Food Nutrition, an MD said “Your body never forgets how to prevent what you don’t yet have.”

So what are some things you can do to help prevent cardiovascular disease? The list below is just a few things you can change (

  • Work with your healthcare team-get a check up at least annually
  • Monitor your blood pressure-remember there are no symptoms of high blood pressure most of the time, so check it regularly
  • Monitor your cholesterol- have it checked at your annual exam
  • Eat a well balanced diet with lots of FRESH, RAW fruits and vegetables with moderate amounts of healthy fats such as coconut oil, olive oil, and avacado
  • Maintain a healthy weight- through diet and exercise
  • Regular exercise- at least 30 minutes of activity 5 days a week
  • Don’t smoke- if you currently smoke, you should quit; if you don’t, don’t start
  • Manage other chronic health conditions such as diabetes

Happy Heart Month! Keep your heart healthy. And remember: JOLT- Just One Little Thing.
By: Rachel Clark, RN, BSN

Flu Season Is Here!

The 2016-2017 flu season has arrived.

Influenza (more commonly known as flu) activity in the United States is on the rise. The Centers for Disease Control and Prevention (CDC) reports that out-patient clinic visits for influenza-like illness (where patients report symptoms that suggest an influenza infection) are elevated compared to baseline all over the nation. In Limestone County, significant influenza activity was detected (as reported by the Alabama Department of Public Health, and based not just on symptoms, but also a positive flu test) for the past 3 weeks.

There is also an uptick of hospitalizations related to the flu. Based on CDC data, the age group that has had the most number of hospitalizations for influenza have been people 65 years and older. This is followed by the 50-64 years age group. These age groups also account for majority of seasonal flu-related deaths in recent years.

The good news is that it is not too late to get the flu vaccine to get protected against the flu.

There are specific groups of people that should not skip the flu vaccine, either because they are at higher risk of developing complications, or because they can expose those who are at high-risk to get the infection. These include the following (based on the CDC recommendations):

1. Children aged 6 months to 5 years and 11 months.
2. Adults aged 50 years and older.
3. Anyone with a long-term lung or heart condition (examples include heart failure, congenital heart disease, COPD, asthma), or any chronic kidney, liver, neurologic, hematologic (blood) and metabolic condition (including diabetes).
4. Any individual with immunosuppression (weakened immune system), either because of a known condition (such as HIV) or because they are on medications that weaken the immune system (such as long term steroids).
5. If you live with or care for anyone who meets the criteria for #1-4 (you can give them the flu!).
6. Anyone who is pregnant or plans on becoming pregnant during the flu season.
7. Residents of nursing homes.
8. Health care personnel.
9. Morbidly obese individuals with a body-mass index greater than 40 (if you don’t know your BMI, there are several calculators available online. All you need is your height and weight).
10. American Indians and Alaskan natives.
11. Children 6 months to 18 years of age who are taking long-term aspirin or those who may be at risk for developing Reye’s syndrome.

Symptoms of influenza include fever, headache, and muscle aches. A cold, sore throat, and a non-productive cough can accompany these symptoms. While a lot of people “get over” the flu, some individuals develop complications, which can lead to death or disability. The complications of influenza include pneumonia (from influenza and other bacteria such as Staphylococcus aureus), rhabdomyolysis (muscle inflammation and destruction, which can lead to kidney failure and death), and infection of the brain (encephalitis).

Antiviral treatment is available for high-risk individuals who get the flu. These antivirals are prescribed by your physician or health care provider and can lessen the risk of developing complications (but do not get rid of them entirely). The best cure, however, is prevention, and you can do this by getting your flu shot, washing your hands frequently, and avoiding contact with sick persons. If you get sick, minimize your activity (avoid going to crowded areas where you can spread it to others), wash your hands regularly, and cover your cough.

The flu vaccine is typically well-tolerated, and one of the more common adverse effects is soreness at the injection site. Vaccine technology has gotten advanced over the recent years that some formulations contain very little egg protein, so people with an egg allergy can receive certain types of flu vaccines. If you have questions or concerns about the flu vaccine, talk to your healthcare provider.
By: Sasha Acelajado, MD

A Chiropractor’s primary focus is on the musculoskeletal system—the spine—and it’s correlation with the nervous system. Chiropractors believe that many health systems are a result of spinal misalignments called subluxations. Correcting these subluxations will enable the nervous system to perform in the correct manner and strengthen immunity.

When you decide to visit a chiropractor, there are many different adjusting techniques that he/she may use to correct this subluxation. Here are just a few (of many) techniques that a chiropractor may use:

Spinal Manipulation: The most widely known and used chiropractic procedure. The doctor places his hands on the spinal area that needs to be adjusted and then proceeds to deliver a quick thrust to correct the subluxation. Manipulation resets the position of the spine and its muscular support so that optimal function can be attained. After spinal manipulation, the patient may notice a greater range of motion and reduction or elimination of pain. Extremity adjusting of areas of the hand, wrist, shoulder, elbow, knees, ankles, and feet may also be performed.

Instrument Adjusting: Sometimes instead of the chiropractor using his hands, he will use an instrument to perform the adjustment. There are many different instruments available that chiropractors use but one of the main ones used is called an activator. The chiropractic positions the vertebrae and joints in a manner for healing and pain reduction. The pressure from the activator is normally gentle and painless. This is a wonderful technique to use on elderly patients, babies and others who just do not wish to hear the sound produced from a spinal manipulation.

Pressure Point / Trigger Point Release: Pressure joints are knots in the muscle fibers. The constant contraction in the muscle fibers restricts circulation to the area, depriving it of essential nutrients and causing the build-up of toxins. Pressure points are known to cause headaches, neck, jaw and low back pain. The release works by applying steady pressure to the knotted muscle fiber, which stretches it and increases the circulation to the contracted tissue.
Whatever technique you prefer, find the chiropractor that works best for you!
By: Drs. Lynn and Lorie Hedgepeth

Vitamin D acts as a hormone in the body and was found to play an important role in the maintenance of calcium levels and bone health almost a century ago. Researchers have recently discovered that vitamin D is also necessary for proper function of the immune system, cardiovascular system, muscles, and brain.

Severe Vitamin D deficiency in childhood can lead to rickets that is characterized by bowed legs, bone and teeth deformities, muscle weakness, and short stature. Rickets has become fairly uncommon in the U.S. due to fortification of milk with Vitamin D beginning in the 1930s, but mild to moderate Vitamin D deficiency continues to be an important problem. Vitamin D deficiency in adults is associated with osteoporosis (brittle bones), increased risk of falls, and possibly fractures.

Recently, low Vitamin D has been associated with increased risk for a number of conditions including muscle weakness, cancers, autoimmune disorders, diabetes, dementia/Alzheimer’s Disease, and cardiovascular disease. Elderly individuals with low Vitamin D levels are at increased risk of falls and have higher death rates. Research into whether Vitamin D supplementation reduces these risks is ongoing.

Eighty to ninety percent of the Vitamin D in our bodies comes from sun exposure. Ultraviolet light from the sun (specifically UVB rays) is used by the skin to make Vitamin D. A fair-skinned person who spends 10 minutes in the midday summer sun – in shorts and a tank top with no sunscreen – will receive enough radiation to produce 10,000 international units (IU) of vitamin D. Dark-skinned individuals and the elderly produce less Vitamin D.

According to the Vitamin D Council, the amount of Vitamin D you get from exposure to the sun depends on:

  • The amount of skin you expose – the more skin you expose the more Vitamin D your body will produce.
  • The color of your skin – pale skins make Vitamin D more quickly than darker skins.
  • The time of day – your skin produces more Vitamin D if you expose it during the middle of the day.
  • Where you live – the closer to the equator you live, the easier it is for you to produce Vitamin D from sunlight all year round.

People most prone to a Vitamin D deficiency include those who live in northern regions with little sunlight exposure, people with darker skin, people on low-fat diets, and those taking steroids and weight loss medications. Vitamin D is found naturally in only a few foods such as fish-liver oils, fatty fishes (tuna, mackerel, salmon), egg yolks, and beef liver. In the United States, Vitamin D commonly is added to milk, orange juice, and other foods.

A recent report by the National Health and Nutrition Examination Survey found that approximately 40% of Americans are deficient in Vitamin D, with the highest rates seen in blacks (82%) and Hispanics (69%). There has been an increase in Vitamin D deficiency over the past several decades due to a shift toward indoor work and activities and increased use of sunscreens. One study found that sunscreen with an SPF of 15, when used properly, can reduce Vitamin D formation by as much as 99%. Also, glass blocks UVB rays; so sun exposure through a window does not result in Vitamin D production.

The daily requirement for Vitamin D is at least 600 international units (IU) for adults aged 18-70 and at least 800 IU daily for individuals over 70. There is controversy regarding the recommended daily requirement for Vitamin D, and some groups advocate for as much as 2000 to 5000 IU per day.

You should speak to your doctor before beginning Vitamin D supplements because very high doses of Vitamin D can have negative effects on your health. If you are obese, pregnant, dark-skinned, age 65 or older, or have limited sun exposure, you should talk to your doctor about obtaining a Vitamin D level.
By: Dr. Shanna Ndong