Healthy Mama: Must-know facts about diabetes

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Almost every single one of us knows at least one person who has diabetes or has someone in their family who has it. This condition is prevalent and can be life-threatening if not treated properly. So we went looking for more info and insight about diabetes from a Northwest Arkansas diabetes expert, Melanie melanie_suttonSutton, DNP. She’s an advanced practitioner who specializes in diabetes treatment (and speaking from personal experience after watching her treat a patient in my own family, Melanie is AMAZING at her job.)

Read the Q&A interview below to find out what the differences are in the two types of diabetes, how the disease can impact heart health and what the latest advancements are for treatment.

What causes diabetes?

Type 1 Diabetes is a disease in which the body no longer makes insulin because the body’s own immune system has attacked and destroyed the cells in the pancreas where insulin is made. The cause isn’t entirely clear but it can include both genetic risk factors and environmental factors. People that have Type 1 Diabetes require life-long insulin replacement.

What are the major differences in Type 1 and Type 2?

Type 2 Diabetes is the most common form of diabetes. In type 2 diabetes, the body either doesn’t make enough insulin or can’t use its own insulin as well as it should. The cause of type 2 diabetes is largely unknown, but genetics and lifestyle clearly play roles. Type 2 diabetes has been linked to obesity, genetic risk factors, and inactivity. The risk of having type 2 diabetes increases as a person gets older. There are racial and ethnic groups that are at higher risk for type 2 diabetes. These groups include American Indians, African Americans, Hispanics/Latinos, Asian Americans and Pacific Islanders.

red flag smallWhat are the first red flags/symptoms seen in children who develop diabetes?

The signs and symptoms of Type 1 Diabetes in children usually develop quickly and over a period of weeks. Commons signs and symptoms include extreme thirst, extreme hunger, frequent urination, weight loss, fatigue, irritability or unusual behavior, and sometimes blurry vision.

Are the symptoms for women different than symptoms seen in men? How?

It’s important to keep in mind that many people with diabetes have no symptoms prior to diagnosis. For most however, the symptoms for men and women are largely the same and include: fatigue, unexplainable weight loss or weight gain, frequent thirst, increased appetite, nausea, frequent urination, irritability or mood changes, slow healing wounds, skin changes, and blurred vision. Symptoms that are unique to women include increase in urinary tract infections, vaginal yeast infections or thrush and sexual dysfunction.

What are the most common myths about the disease? What do you wish more people knew about diabetes?

One of the myths about diabetes is that it is caused by “eating too much sugar”, and while a diet high in sugar and carbohydrates can lead to unhealthy weight gain and increased risk for diabetes, it is not the cause.

What we wish that more people knew and understood about diabetes is that it is a chronic and progressive disease. With early diagnosis and aggressive lifestyle changes and treatment it can be controlled and complications can be minimized or prevented altogether.

One of the most important facts to know about diabetes is the increased risk for heart disease in those with diabetes. The risk for heart disease in men with diabetes is 2-3x higher than in men without diabetes. Alarmingly, the risk for heart disease in women with diabetes is 6 times higher than in women without diabetes. The other risk factors associated with diabetes include high cholesterol, nerve damage, kidney disease and damage to the retinas in the eyes.

What is the most challenging part of your job? What part do you enjoy the most?

The most challenging part of treating patients with diabetes is addressing the need to make permanent life-style changes and the importance of maintaining tight glucose control. This isn’t a disease that you get to put away for the weekend and forget. It requires constant attention and planning and for most patients that can be exhausting. The other greatest challenge is helping patients manage the cost and resources required to treat diabetes. Cost of medication and testing supplies can be overwhelming, and trying to balance cost while maintaining tight control can be difficult.

What I personally enjoy most about treating patients with diabetes is watching them get better. This disease requires a tremendous amount of education and effort from patients and to see the lifestyle changes and medications work together to restore good health is very rewarding.

What are the latest advancements in the treatment of the disease?

The latest advancements in the treatment of diabetes are numerous. There are a number of new oral medications being used and others currently being studied to address the different mechanisms of this disease and make treatment easier for patients on a day to day basis. For those that require insulin there are newer delivery options and more choices for insulin than have ever been available.

Many of the newest generation of insulin pumps are now equipped with glucose sensors and provide minute-to-minute feedback about glucose trends. Glucose monitoring has always been a challenge and we now have meters that can detect patterns in the glucose levels and provide suggestions for insulin dosing as well as continuous glucose monitors that can be worn for days at a time and provide the patient with more than 250 glucose readings per day!

Our thanks to Melanie Sutton, DNP for answering our questions about diabetes. To schedule an appointment with Melanie or for more information about diabetes treatment, call Mercy’s Endocrinology Clinic at 479-338-4600. The Mercy Endocrinology Clinic is located at 3333 Pinnacle Hills Parkway, Suite 300B,  in Rogers. Click here for more info.

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The truth about managing pain — Part 2

Note from the Mamas: This is a continuation of last week’s interview of Dr. Solomon Pearce of the Mercy Pain Center about managing chronic pain. (Click here to read the first post.)

The stress of parenthood coupled with untreated daily pain can be an overwhelming situation for anyone. That’s why we asked an expert at the Mercy Pain Center to give us some insight about the field of Pain Management as well as the latest advancements in the field and what every patient needs to know before she lets someone treat her pain. We learned a lot from his answers below.

What are the most common mistakes patients make when trying to manage chronic pain? What do you wish more people understood about this field of medicine?

Having the wrong attitude when it comes to any chronic condition is a pivotal mistake. In particular, a number of chronic pain patients fall into the trap of taking a completely passive role in their own condition. They constantly look for others to do something, give them something, make them feel better, but some patients are unwilling to do anything for themselves.

It’s often hard to realize that your pain is your own. Despite the best intentions of others, ultimately it is your responsibility to get better. What this means is sad depressiontaking an active role in your health.  If you have weak muscles, do your physical therapy. If you’re overweight, lose weight. If you have diabetes, keep tight control of your condition. If you use tobacco products, stop. If you have a stressful life, meditate or do yoga or a hundred other things that you can do to get better.

Some of the most difficult things to do are some of the most beneficial. I strongly encourage all my patients to take a hard look at why they might be suffering so much, when someone else with the same physical problem is functioning fine. Often times these patients realize that they have never dealt with past traumas like physical or sexual abuse. Some realize that they hate their job or are really unhappy in their relationship. Once these issues are dealt with, their pain often gets dramatically better.

I wish people understood that healthcare has become a business and that you have to be careful where you shop. There are a lot of unscrupulous people out there selling hope in the form of medication, supplements, surgeries, or the newest device or procedure. All these can have unwanted effects, and all of them drain your bank account.

If a provider’s treatment doesn’t pass a “common sense test,” and especially if they don’t physically examine you or don’t have the time to explain things in terms you understand, look elsewhere for your care.

What are some of the most recent advancements in the treatment of pain?

The three most promising areas in Pain Management are the advances being made in neuromodulation (spinal cord stimulators), genetically targeted medications, and advances in peripheral nerve radiofrequency ablation.

Neuromodulation uses electrical impulses to change the nerve signals from areas generating pain before they reach the brain. These are implanted devices that are similar to pacemakers, but instead of changing the heart rhythm they change the pain signals. These do really well for patients with chronic pain in their arms or legs.

pills2We have learned a lot about how our bodies process medication, and companies are now making genetically targeted medications that are specifically targeted to how individuals metabolize different drugs. In the future you will not have as much trial and error with medications. You will take a blood test, which will show which designer medication will work the best for you.

Radiofrequency ablation is an old technique where we use electrical energy to create heat, most often to drastically reduce pain along the spine itself. This technique is great in that, unlike most medications that reduce pain for a few hours, this works for six months or more. I have been using this successfully for years to help patients with low back and neck pain, but recent advances in the technology are allowing this to be used in other areas of the body as well. Knee and shoulder pain patients who have wanted to put off a replacement or were told by their orthopedic surgeon that they were not a good candidate can now achieve substantial long-lasting relief with radiofrequency ablation.

What kind of specialized training do pain management physicians have that my general or primary care physician might not have?

Pain Medicine is a subspecialty. It requires four years of medical school, four years of residency, and then a year of fellowship in an Accreditation Council for Graduate Medical Education approved program (this is all after grade school, high school and college, and thus requires 25 years of school/training at a minimum). During this training, pain management physicians learn how to safely and accurately perform a number of pain relieving procedures, extensive instruction in the use of medications, and exposure to a plethora of adjuvant modalities.

Any real Pain Management physician according to the American Board of Medical Specialties should have Board Certification first in one of four specialties (Anesthesiology, Physical Medicine and Rehabilitation, Psychiatry or Neurology), plus an additional Board Certification in Pain Medicine.

Unfortunately, Pain Management has one of the highest rates of non-trained imposters of any field in medicine. For some reason, physicians in multiple specialties often claim they do Pain Management, but they do not have the real training or they stopped short from going all the way through a Pain Medicine fellowship.

I don’t perform C-sections, even though I did 30 or so during my medical school/internship training because I know I don’t have the full training to do it safely. If you need a C-section, go to an OB-GYN. For some reason, that same, simple logic doesn’t seem to sink in with some physicians or some patients when it comes to pain management. Some seem to think, “Since the DEA says I can write for opioids, then I must be trained well enough to do chronic pain management.” This is not true. There are even online companies popping up selling “board certifications” from fake boards to help fraudulent providers trick patients. (These are like the internet ordinations for fake ministers.)

This is a definite “buyer beware” situation because some people are pedaling medications that are addictive and can be deadly if prescribed or used improperly. Same thing goes with doing injections. Just because you played an interventional pain doctor on TV, or stayed at a Holiday Inn last night, doesn’t mean you can safely place a needle inside the spinal canal without injuring the spinal cord.  I hope patients spend a little time to make sure they are going to a reputable physician with all the proper training.

Our thanks to Dr. Solomon Pearce at the Mercy Pain Center for taking the time to answer our questions. Dr. Pearce is Double Board Certified in Pain Medicine and Physical Medicine and Rehabilitation. Before coming to Arkansas, Dr. Pearce was a Naval Flight Surgeon who served in multiple overseas deployments. For more information or to schedule a consultation with Dr. Pearce or his colleague Dr. Green at the Mercy Pain Center, call (479) 986-6199 or click HERE for more clinic info.

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Healthy Mama: The truth about managing pain

Most of us know at least one person who deals with pain on a daily basis. You might even be that person. Pain management is such an important part of medicine, so we went to an expert at the Mercy Pain Centerto get more in-depth answers about this complex issue.

Dr. Solomon Pearce of the Mercy Pain Center gave us some thoughtful answers to our questions, so we’re featuring them in this two-part series of posts about managing pain. (Read the second installment next week.) If you or someone you know is dealing with chronic pain, we hope you’ll seek the advice of a qualified pain management specialist. (Pain management physicians receive specialized training in this area, so be sure to find the right doctor!)

What types of situations and/or conditions cause patients to seek the help of pain management physicians?

Patients who come to me are always seeking relief from some sort of suffering. This suffering comes in a variety of forms, sometimes very obvious (e.g. I have a herniated disc in my back), sometimes very complicated (e.g. I’ve had pain for years all over my body; I’m tired all the time, and I can’t sleep) and sometimes very dangerous (e.g. I’ve had pain for years, all that works is Dilaudid with oxycodone, and hydrocodone, and you HAVE to give me medication).

Does pain management mostly involve medication? Are there additional therapies that are effective at managing pain? 

Real chronic pain management never involves just one treatment modality. Acute pain, sure… my son scrapes his elbow, I put a Band-aid on it and we’re done. My wife’s knee hurts after a run, so she uses some Ibuprofen — all better.  However pain that has lasted more than three to six months, day in and day out, has pills-384846_640 (2)become chronic; it has changed the person. It has affected their emotions, how they move in certain circumstances and what they do on a day to day basis. It truly changes how they live their life.

Thinking that all this damage can be repaired with one magic pill is silly. A good pain management physician should investigate all the areas that may have been effected and prescribe an individualized treatment program. This can include getting the person into physical therapy to work on body mechanics and strengthening exercises, occupational therapy to work on improving their function, cognitive behavioral therapy and biofeedback to help with coping and pain relieving strategies, acupuncture, prolotherapy, massage, aqua therapy, exercise programs, osteopathic manipulation etc.

Some patients need interventions with injections or radiofrequency ablation, spinal cord stimulators, or surgeries. Some need medications, and some need diet modifications. Each patient is different and I find a therapeutic approach which uses a combination addressing all their concerns in order to provide substantial improvement.

Addiction to pain medication has become a much bigger problem in our country in recent years. How do you counsel patients to help prevent these addiction issues?

I agree that our country has a significant problem with opioids. I think that the recent increase is a societal problem that can be partly attributed to physicians and to patients. Some physicians have forgotten how to say “no.” There are certain conditions and certain patient risk factors that make prescribing opioids the wrong choice of therapy.

Way too often I see patients being prescribed opioids for years that never should have been started on them in the first place. It’s hard to tell someone who is suffering “no,” but when addictive drugs may make their problem worse, it’s the right thing to do.

Some patients have becoming increasingly fixated on finding a magic pill that takes away all their pain. The media is constantly telling them there’s a quick fix around the corner and that they can just lay back and everything will be perfect. That’s not reality, but that doesn’t stop some people from seeking that end and getting themselves into trouble.

I avoid addiction problems for my patients in a number of ways. First I thoroughly evaluate each patient’s history, physical exam and diagnostic testing to find the appropriate treatment modalities for that specific patient. I screen all patients for signs of pre-existing tendencies which may indicate they could have addiction problems later on or reasons why opioid pain medication would be contraindicated for them prior to starting any treatment plan.

I strictly control access to prescription medication and monitor for compliance with my instructions through drug screening, prescription monitoring programs, and random pill counts. I always use the lowest possible dose to control their symptoms enough so patients can improve their function. This works very well to reduce the risks of addiction or drug diversion.

Are all pain medications habit forming? How would a patient know if he or she has developed an addiction?

No, not all substances that have pain relieving properties are habit-forming. I have a number of opportunities to interfere with pain signals during their transduction, transmission, modulation and perception. I use a variety of medication classes from topical agents, local anesthetics, anti-inflammatories, blood pressure medications, antidepressants and vitamin supplements which all have no habit-forming traits.

I also use some muscle relaxants, anxiolytics, anticonvulsants, and opioids that can be habit-forming (but not all of them are habit-forming.) If taken appropriately, these medications are very safe.

There’s a big misunderstanding in the general population about the difference between physical dependence and addiction.

Addiction is the inappropriate chronic use of a substance with impaired control of one’s ability to stop using it, feeling as though you have to use it, using that substance even though it causes you harm, and getting cravings for that substance. Medications can do this, alcohol can do this, gambling, sex and even food can become an addiction.

Physical dependence on the other hand simply means that your body comes to depend on a substance to function properly. Examples for this would be how some people are dependent on their coffee to wake up in the morning. A diabetic who uses insulin is dependent on their insulin to control their blood sugar. And some pain patients become dependent on a medication to be able to function throughout their day. This is normal. These people are not going from doctor’s office to doctor’s office seeking more meds or buying them on the street or smoking, snorting, or injecting medication. They are just patients living their normal lives, taking a medication every day, like people do for blood pressure or birth control.

Craving is usually one of the first signs a patient would notice if they were developing an addiction — that feeling that you just have to have something. It becomes all you think about. A person developing an addiction might start using more medication than directed, running out early, or trying to find other places to get medication from.

We’ll continue Dr. Solomon’s answers to our questions about pain management in an upcoming post next week.

Our thanks to Dr. Solomon Pearce at the Mercy Pain Center for taking the time to answer our questions. Dr. Pearce is Double Board Certified in Pain Medicine and Physical Medicine and Rehabilitation. Before coming to Arkansas, Dr. Pearce was a Naval Flight Surgeon who served in multiple overseas deployments. For more information or to schedule a consultation with Dr. Pearce or his colleague Dr. Green at the Mercy Pain Center, call (479) 986-6199 or click HERE for more clinic info. 

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The Need to Breathe: May is Asthma Awareness Month

We can all agree that — out of the thousands of different things that can go wrong with the human body — problems with breathing rank right up there at the top. If you can’t breathe, you’ve got a serious problem. That’s why the science of pulmonology and the experts who practice in this field are so important to our overall health.

Jason_McKinney_1679668925We interviewed Dr. Jason McKinney, a pulmonologist practicing at Mercy, and Staci Hopper, an advanced practice registered nurse (APRN), to get insight on what a typical “day in the life” is like for experts who specialize in keeping Hopper,Stacipatients breathing easy.

What types of conditions and problems do pulmonologists treat?

Pulmonologists most commonly treat COPD (chronic bronchitis, emphysema), Asthma, Bronchiectasis, Interstitial lung disease, Occupational lung disease, Pulmonary Hypertension, Complex Lung Infections, Pulmonary fibrosis, and Sarcoidosis. They often are part of the team diagnosing lung cancer and they help manage its complications.

What are the tests pulmonologists use to diagnose the problem?

Common diagnostic testing includes pulmonary function tests, chest x-rays, CT scans, blood work and sometimes using a bronchoscope to look inside the airways.

Asthma can be a scary condition for kids and parents. What are the red flags parents should watch for that might indicate a problem?

Some red flags parents should watch for include: Shortness of breath that worsens during physical activity, cough, chest tightness, reduced exercise tolerance or prolonged recovery time following exercise, excessive fatigue, and/or wheezing.

asthma-156094_640 (2)What are the latest advancements in the treatment of asthma in kids and adults?

There have been several new inhaled medicines useful in asthma over recent years. There is also some newer injection therapies available for more resistant cases.

What is COPD and who does it usually affect?

COPD stands for Chronic Obstructive Pulmonary Disease and is often a mix of chronic bronchitis and emphysema. In chronic bronchitis, the airways get inflamed and make a lot of mucus. This can narrow or block the airways, making it hard to breathe.

In emphysema, the air sacs are damaged and lose their stretch and ability to absorb oxygen as well. Less air gets in and out of the lungs, which makes the patient feel short of breath.

By far, the most common cause of COPD is smoking. Other causes include secondhand smoke, pollution and fumes, genetics, and asthma. Because COPD develops slowly, it is frequently diagnosed in people aged 40 or older.

What can patients do to prevent the likelihood of developing COPD?

The number one way to prevent COPD, or slow it down if you already have it, is to STOP SMOKING. If you have serious lung symptoms with no clear cause smoking-44467_640 (2)(like smoking) you might need testing for “Alpha one antitrypsin deficiency.”

What do you wish more people understood about lung health?

The biggest thing people need to know is that prevention and early intervention is key. Many lung diseases can be prevented by making good lifestyle choices like not smoking, maintaining a healthy weight and routine exercise and wearing protective equipment when dealing with particles or fumes. If someone is having respiratory symptoms, they need to discuss them with their primary care physician. Many pulmonary problems can be very effectively managed by their primary care physician but for some resistant, complicated, severe or unusual cases, a person may need to see a pulmonologist.

Our thanks to Dr. Jason McKinney for answering our questions about breathing problems, prevention and treatment. To schedule an appointment with Dr. McKinney, call his office at 479-338-3080 or click here for more info on the clinic.

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Healthy Mama: March is Colon Cancer Awareness Month

We know this isn’t always an easy topic to discuss, but it’s an important one and this month is the perfect time to talk about it. March is Colon Cancer Awareness Month which means it’s time to march yourself to the clinic for this important screening test, if you haven’t done it already. Why is it such a big deal? Because colon cancer is the SECOND LEADING CAUSE OF CANCER DEATHS in the United States.

We interviewed Dr. Natasha Nathan, a gastroenterology specialist with Mercy, to find out what we all need to know about the risks of colon cancer and about colonoscopies.

What factors increase a person’s risk of colon cancer?

The factors that increase your risk for colon cancer are:

  • Age
  • Diet
  • Lifestyle
  • Family History

colon cancer posterWhat types of lifestyle changes can lower a person’s risk of developing colon cancer?

There are several good things you can do to lower your risk of developing colon cancer, but these three are the most important:

  • Eat foods high in fiber
  • Eat less red meat
  • Exercise MORE

What are the symptoms that might indicate a person has colon cancer?  (Are noticeable symptoms always present in someone with colon cancer?)

The symptoms you might notice include seeing blood in your stool, having an unexplained weight loss or seeing a change in stool size. Some patients might also have abdominal pain.

But it’s very important to know that some patients may not have ANY symptoms. That’s one of the reasons why testing is so important.

When should a person have her first screening test for colon cancer?  How often is it necessary to repeat the screening tests? 

Have your first test when you turn 50 years old, unless you have a family history of colon cancer OR you have had polyps or cancer in the past. If there’s past cancer or a history of it in your family, start having screenings at age 40.

What are the latest advancements in the detection of and/or treatment of colon cancer?

Some of the latest advancements in this field of medicine include improved stool tests as well as genetic tests. The great news here is that, with early detection, people with colon cancer live longer lives.

What do you say to patients who are fearful about getting a colonoscopy?  What information helps them overcome the natural tendency to procrastinate doing something that seems so unpleasant?

I let them know that our sedation methods have improved over the years which means there is much less pain associated with this test.

It’s also good to know that the preparation method required the night before the test has also improved. Some patients found it difficult to drink all of the prep liquids the night before their scheduled colonoscopy. There’s a new “split dose preparation” method that lets patients drink part of the liquid the night before and then the remainder the next morning. Ask your doctor about the split dose preparation method to see if this would be a good fit for you.

The most important thing I can tell patients about this test is that colon cancer is a PREVENTABLE cancer, and this test is the best tool we have that helps us Thusha_Nathan_1295718211prevent this cancer from taking a patient’s life. It’s as simple as that.

We want to give our thanks to Dr. Nathan for taking the time to answer our questions. For more info on Dr. Nathan or to schedule an appointment with her, call the Mercy Gastroenterology Clinic at 479-338-3030 or click here for more info. The clinic is located in the Physician Plaza at 2708 S. Rife Medical Lane (Suite 300) in Rogers.

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