Freeman Medical Musings Blog

We hear it all the time:

•    “I have too many medications and don’t want to carry all of them with me.”
•    “I would need a suitcase to carry them all to the doctor’s office.”
•    “I’ve taken all my meds to another doctor who requested them and they were never looked at.”
•    “You can call my pharmacy or my doctor to get the list; I don’t have time to do all that.”

But there’s a very important reason why we encourage all Freeman patients to bring all their medications, vitamins and supplements – in their original bottles – to all doctor visits. While prescription medications can boost health and even save lives, dangerous interactions can occur when a patient has the wrong mix or doesn’t know off the top of their heads what they regularly take on a daily basis.

Drug interactions can be dangerous, particularly when prepping someone for surgery. Heart, carotid and lung surgeries are just a few procedures that can be affected by drug interactions.

If your healthcare professional isn’t aware of every medication a patient takes, from a supplement to a prescription drug, or if a patient shows up with a medication bottle and it hasn’t been presented, there’s the potential that a heart, carotid or lung surgery could be affected by drug interactions and would need to be canceled or postponed.

The dangers are real – some medications, and even vitamins and supplements, can negatively interact with pain medications, anesthesia or prescribed medications, especially if it has a sedative action. Another interaction could take place post-operation, when some medications and supplements may deplete a patient’s body of certain vitamins, in turn increasing risks of infection. Vitamin K can thicken the blood. Ibuprofen/Naproxen may deplete vitamin C levels. It’s for these reasons, and so many more, that accurate medicine lists – with the exact dosage listed on the bottles – is so important. Depending on the amount, we may need to hold different supplements and different vitamins or medications for different lengths of time for patient safety.

Most if not all hospitals use an electronic health record system, which is essentially an electronic version of a patient’s medical history that is continuously updated. What people don’t understand is that just because many utilize electronic medical records, different hospitals and medical groups use different systems. I personally confer daily with electronic medical records from multiple health systems in our area. Many of these systems don’t “talk” to one another, so when a new patient from another hospital comes to Freeman, we still have to send and receive information and everything has to be recorded into their new Freeman chart by hand. As much as we would love for it to happen, information doesn’t simply flow from one electronic chart to a new one in an organized manner. That’s why an up-to-date medication list and medication bottles are so important.

I encourage every patient to be proactive when it comes to their own care and to make sure every single one of their providers knows what medications they are taking. This is such an easy way to decrease possible medication and treatment errors.

Everyone is excited summer is around the corner, and with the longer days, people are ready to enjoy the outdoors and the sunshine. However, it’s also important to remember too much exposure to the hot summer sun can be harmful to your skin. The more time you spend in the sun this summer, the more you need to be mindful of the damage it can do.

Skin cancer is the most common cancer, in the US and worldwide, but it’s also one of the most preventable. According to the Skin Cancer Foundation, 1 in 5 Americans develop skin cancer by the age of 70. Having five or more sunburns doubles your risk for melanoma, and 90% of skin aging is caused by the sun. The good news is when detected and treated early, the five-year survival rate for melanoma is 99%! 

It’s no secret the sun can harm your skin with ultraviolet (UV) rays and prolonged exposure. While UV rays are present all year long, they’re stronger in the summertime. Because UV exposure can lead to premature aging and an increased risk for skin cancer, it’s important to take precautions to protect your skin throughout the summer. To keep your skin healthy, vibrant and youthful, here are some dermatologist-recommended tips for summer skin care. 

•    Use sunscreen regularly. Apply sunscreen generously to all exposed skin, including your face, neck, chest, hands and any area not covered by clothing. Reapply every two hours, or more often if you’re swimming or sweating. Choose a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to protect against both UVA and UVB rays. Keep in mind, no sunscreen can completely block out all UV rays, so you should always combine sunscreen use with other protective measures.

•    Wear protective clothing. Lightweight and long-sleeved shirts, pants and long skirts made of tight-woven fabric in dark or bright colors provide the most protection. For more effective protection, select sun-protective coated clothing with an ultraviolet protection factor (UPF) number on the label.

•    Put on a hat and a pair of sunglasses. Wearing a wide-brimmed hat helps protect your face, scalp, ears and neck from sun damage. To shield your eyes from the sun’s harmful rays, look for UV-blocking sunglasses that are large-framed and wraparound.

•    Enjoy the shade. Seek shade and avoid being outdoors in direct sunlight for too long. This is especially important between the hours of 10:00 am and 4:00 pm, when the sun’s rays are the most intense.

Our skin will change throughout the year and should be cared for with consideration of the season. Since your skin needs a little extra attention and care during the summer months, take the time to use a summer-friendly skin care routine to ensure you and your skin have a happy and healthy summer. Enjoy every minute of daylight this summer, knowing your skin is protected!

Ahmed Badawi, MD, PhD, at the Freeman Dermatology and Skin Cancer Center specializes in dermatology identifying and treating conditions of the skin, hair and nails including acne, eczema, nail fungus, psoriasis, rosacea and skin cancer, among many others. He earned his medical degree from the University of Kansas School of Medicine, Kansas City, Kansas, and performed his residency at Washington University, St. Louis, Missouri.

The Freeman Dermatology and Skin Cancer Center specializes in high-quality dermatological care and offers information on the latest treatment and skincare options to help patients live longer lives with healthier skin. Call the office at 417.347.8066 for an appointment or visit freemanhealth.com/specialty/dermatology.

Three Freeman orthopaedic surgeons – Dr. Derek Miller, Dr. Robert Lieurance and Dr. Thomas Sanders – are the first and only physicians in Southwest Missouri to utilize the CORI Surgical System®, a robotic-assisted computerized tool that has proven revolutionary when it comes to partial and total knee replacement surgeries.

Thanks to detailed computer scans and a nimble handheld tool, the system adds an extra layer of pre-surgical planning to surgeries along with improved cutting precision that was almost unheard of 20 years ago.

It all comes down to precision. The robot allows the trio to prepare bone down to an unheard-of tenth of a millimeter, which is an accuracy never seen before; making CORI a true paradigm shift when it comes to knee surgeries.

Prior to surgery, the CORI system eliminates the need for timely and expensive CT scans, x-rays or MRI – deleting exposure to radiation or an additional expense rarely covered by insurance. The system allows Dr. Lieurance, Dr. Sanders and Dr. Miller to map a knee’s anatomy in live time, meaning a more accurate and custom fit for a total knee replacement.

CORI’s other primary benefit is the robotic assistance it offers Freeman surgeons during the actual surgeries. The surgeon is in complete control of the robot at all times, holding a robotic hand piece that replaces the traditional bone saw. CORI tells the surgeon where to manually cut and remove bone, milling down into the bone to a pre-determined setting.

When it comes to partial replacement surgeries, the supporting tissue and ligaments that help stabilize the knee are spared; only the damaged portion of the knee is replaced with a custom-made prosthetic implant. With full knee replacement surgery, the entire knee is replaced with a prosthetic designed to replicate the shape, motion and stability of the replaced knee joint without significant soft-tissue complications.

As a result, all three Freeman surgeons are seeing higher patient satisfaction, better range of motion sooner and the ability to go home more quickly and fewer patients requiring narcotics after surgery. 
 
To learn more about knee surgeries and the CORI surgical system®, visit freemanhealth.com. To schedule an appointment today with any one of our surgeons, call 417.347.5400. 
 

June is Men’s Health Month, a time to offer men awareness of preventable health problems and encourage early detection and treatment for men of all ages. The tendency of some men is to “tough it out” – putting off doctor visits, ignoring symptoms or signs of illness and neglecting their health. "

This kind of procrastination, however, can prove fatal in some situations. Regular checkups, screenings and vaccinations are crucial for men to stay healthy and active, even if they’re feeling good and are symptom-free. Preventative care helps men and their doctors to remain proactive and increase their chances of avoiding health issues, and to effectively treat medical situations before they worsen and become more serious.

As men age, their bodies become more prone to certain diseases and conditions. Cardiovascular disease, for example, is the leading cause of death in men. Men are also more prone to developing symptoms of low testosterone and prostate cancer. Regular wellness checkups will help identify any deficiencies that may be causing other health-related issues, such as erectile dysfunction or high blood pressure. A Freeman primary care doctor can help men develop a personal wellness program to fit their lifestyle and address each aspect of their life – ranging from nutritional guidance and exercise to weight management. 

It's important that men of all ages regularly visit their doctors to screen for the following conditions.

All Ages:
•    Annual wellness exam. A yearly physical with your general practitioner is important for preventive care. Visits may include vaccinations, disease screenings, referrals for blood work, a height and weight evaluation, and potential additional tests for any chronic conditions.
•    Testicular cancer screening: While self-exams should be conducted monthly, the American Cancer Society recommends testicular cancer screenings also be performed at annual wellness visits.
•    Skin cancer screening: Yearly visits to a dermatologist for skin checks are crucial for preventing skin cancer. 
•    Dental exam: A thorough dental exam and cleaning is recommended at least every 6 to 12 months for optimal tooth and gum health.

Age 20 to 39:
•    Blood pressure: Beginning at age 20, men should have their blood pressure checked at least once every two years. 
•    Cholesterol: Beginning at age 20, most men should have their cholesterol checked every four to six years. 

Age 40 to 59:
•    Eye exam: At age 40, men should have a baseline comprehensive eye evaluation even with no signs or risk factors of eye disease. 
•    Blood glucose test: Blood glucose tests are used to screen for diabetes and are recommended for men every three years beginning at age 45. 
•    Colonoscopy: Men who are at an average risk for developing colorectal cancer should have their first colonoscopy at age 45 and then, an additional screening every ten years. 
•    Prostate cancer screening: Beginning at age 50, men should talk to their doctor about beginning regular screenings for prostate cancer. 
•    Shingles vaccine: Men should be vaccinated to prevent shingles at age 50.
•    Lung cancer screening: Men ages 55 to 80 with a history of heavy smoking (more than 30 packs per year) and who actively smoke or have quit within the previous 15 years should have a yearly lung cancer screening, even without symptoms of lung cancer.

Age 60 and up:
•    Pneumonia vaccine: Men over 65 should be vaccinated against pneumonia yearly.
•    Bone-mineral density test: Beginning at age 70, men should have the test at least once and up to as often as every two years depending on risk factors. 
•    Abdominal aortic aneurysm: A one-time screening is recommended for men between the age of 65 to 75 years who have a history of smoking.
•    Yearly eye exam: Men 65 and over with no risk factors should have a comprehensive eye exam every one to two years to screen for cataracts, age-related macular degeneration and glaucoma.
Men can choose June as the month they play a protective role in their health journey. To learn how to conquer new heights to living healthier and enjoy a lifetime of wellness, schedule an appointment with a Freeman Primary Care Physician by calling the Freeman Physician Finder at 417.347.3767 or 800.297.3337 or visit freemanhealth.com.
 

Movement and exercise are both fundamental to leading a healthy and happy life. Physical therapists can help – by identifying underlying movement and strength issues that can put a patient at risk for continuing to have persistent symptoms and to be at risk for developing future injuries. 

Freeman Rehabilitation Service has 80 full-time licensed rehabilitation professionals and 20 part- and full-time operational support staff achieves this by fully evaluating a person from head-to-toe to assess range of motion, flexibility, strength, movement and overall coordination. From these evaluations, they can tailor a person's exercise program and recommendations to help them in their pursuit of remaining as active as possible for a normal life experience. In total, we’ve completed more than 50,000 patient care visits at 10 locations in Joplin, Neosho, Anderson, Carthage and Pittsburg. 

The five most common injuries we regularly see are total knee replacements, rotator cuff repairs, ACL reconstructions, lower back and neck pain, and general balance and strength training.

To that end, physical therapists are focused on getting to the root of an individual's problem. Many injuries that appear to be different can be driven by similar underlying movement dysfunctions and strength imbalances. By focusing on the root of these issues, injury symptoms can begin to be resolved with more long-term success. 

We do this by working to help patients with goal setting and developing a practical course of action for reaching them. We help people to see what we are capable of and what steps they need to take to get there within the desired time frame. We encourage and provide vision for these individuals, which helps empower patients to know first that they can get better. Plus, we know the steps our patients need to take to get there. 

Physical therapists use a variety of ways to work on strengthening. These include body weight, free weight, elastic band and machine-based resistance training. 

We help a wide range of people ranging from those who suffer from traumatic- and overuse-related orthopaedic injuries, to those who go on to require surgery for various problems. We also see people who are at risk for falls due to poor balance. Some conditions we see after injuries to the neurological system includes: Post-concussion, stroke and traumatic brain injury. 

During a patient’s first visit, the patient and therapist develop a plan for helping the patient reach their set goals. Part of this initial plan is a home exercise program the therapists give the patient to work outside their scheduled visits. Follow-up visits are conducted until each patient’s goals are reached. These follow-ups are usually twice weekly or less, depending on the condition or injury or insurance. 

Overall, we are focused on quality versus quantity of visits. We are focused on hands-on interactive care that prioritizes patient engagement and empowerment. We are here for you. 
 

Not long ago, Four States-area residents had woefully limited access to autism services. Since its establishment in 2007, the Bill and Virginia Leffen Center For Autism in Joplin has evolved into a renowned facility by providing comprehensive services for individuals with autism spectrum disorders.

The center is named for the late Bill and Virginia Leffen, who generously donated a $3 million gift to fund the reconstruction of Ozark Center for Autism, which was destroyed by the May 22, 2011 Joplin tornado. In recognition of their generosity, The Ozark Center for Autism was renamed in their honor.

Today, the center serves more than 300 clients per year through outpatient services, a year-round preschool and diagnostic evaluations by a dedicated team of professionals comprising pediatricians, psychologists and behavior analysts.  

The center’s impact is evident through the progress of its young clients, who have shown significant improvements in communication, academics and daily living skills. With a focus on early intervention and individualized care, the center aims to enhance the quality of life for individuals with autism.

Most significantly, the Leffen Center is a source of hope – to clients, their families, caregivers, loved ones and friends. Families have come to us when they thought there was little hope after receiving their diagnosis – and they leave services with hope for a bright future.

Our Day Treatment program provides a 1:1 treatment environment focused on identifying and mitigating the impact of autism on the child’s readiness for being in the classroom with their neurotypical peers. The goal is for the child to be a full participant in the educational experience of their non-autistic peers.

Future goals include the expansion outpatient services for all ages, reducing waiting lists and offering increased opportunities for parent consultations. Through initiatives like the Freeman 5K and Walk for Autism Awareness, the center raises funds to support program development and scholarships.

The center’s commitment to evidence-based practices its dedication to helping individuals with autism lead fulfilling lives. For families in Joplin and beyond, the Bill and Virginia Leffen Center for Autism, the center stands as a beacon of hope and support for families navigating the challenges of autism spectrum disorders.

Freeman 5K and Walk for Autism Is April 20!

Please join us for the 2024 Freeman 5K and Walk for Autism on Saturday, April 20 at the Bill & Virginia Leffen Center For Autism. “Walk, Run and Roar” is the theme, and dinosaur-themed costumes are encouraged. Enjoy a fantastic day and support local children and families affected by autism by registering at runsignup.com/Race/MO/Joplin/FreemanFamily5k or call 417-347-7474.

For more information on autism services, visit freemanhealth.com/ozarkcenter/autism-services or call 417-347.7850.
 

Volunteering can make a big difference in the lives of those we serve, but did you know that volunteering can benefit your health as well? Research shows that volunteering affords significant health benefits, especially for older adults. It also fosters self-worth and strengthens personal relationships.

Boost physical and mental health. Volunteer activities keep people moving and thinking at the same time. Research has found that volunteering among adults, age 60 and over, provided benefits to physical and mental health.

 Volunteers report better physical health than non-volunteers. Research also has shown that volunteering leads to lower rates of depression and anxiety, especially for people 65 and older. It helps minimize stress and increase positive, relaxed feelings by releasing dopamine. By spending time in service to others, volunteers report feeling a sense of meaning and appreciation, both given and received, which can have a stress-reducing effect.

 Reduced stress further decreases the risk of some physical and mental health problems, such as heart disease, stroke, depression, anxiety and general illness. In addition, people who volunteer have lower mortality rates than those who do not, even when controlling for age, gender and physical health.

Gain a new sense of purpose. The work that volunteers provide is essential to everyday activities, giving volunteers a sense of purpose, especially when giving their time and talent in the areas they find meaningful. Older volunteers experience greater increases in life satisfaction and self-esteem.

Nurture new and existing relationships. Volunteering increases social interaction and helps build a support system based on common interests. One of the best ways to make new friends and strengthen existing relationships is to participate in a shared activity.

In many cases, volunteers have diverse backgrounds, which helps expand their social network and allows them to practice social skills with others. People volunteer for different reasons, such as exploring careers, sharpening skills, staying active during retirement, meeting new people and serving their communities. Yet all volunteers share a common desire to improve the health and welfare of people in their communities.

How To Get Involved

 There is a wide variety of volunteer opportunities in every community, whether you're interested in youth, environmental, health, religious or community causes. Check with local nonprofit and cultural organizations, schools, faith communities, or hospitals for options.

 Or consider joining Freeman Health System’s team of volunteers and making a difference in the lives of patients and staff. For more information, call Freeman Volunteer Services Manager Danae Taylor at 417-347-4603.

Kidney disease is one of the fastest-growing noncommunicable diseases in the United States, according to the American Kidney Fund. Nationwide, roughly 15% of American adults – 37 million people – suffer from chronic kidney disease.

Acting chameleon-like, chronic kidney disease’s signs and symptoms go unnoticed in a vast majority of patients until a diagnosis occurs.

Many people don’t realize their chronic kidney disease is something they may already have or have been at risk for quite some time.

The kidneys are vital organs that perform a variety of key functions: they filter blood for toxins, remove the body’s excess waste and fluids and regulate blood pressure, balance important electrolytes and minerals and stimulate red blood cell production.

When our kidneys are compromised in their ability to carry out any of these tasks, the consequences can be debilitating and even life-threatening. Chronic kidney disease progresses from stage 1 to stage 5, after which point patients require kidney replacement therapy in the form of dialysis or kidney transplant. Unfortunately, many patients are at-risk progressing very quickly toward kidney failure, whereas others can maintain stable kidney function very gradually.

Disease progression, experts say, can often be slowed when patients take an active role in making permanent, healthy lifestyle changes.”

The most common causes of chronic kidney disease in Americans are diabetes and high blood pressure. Roughly 37% of the US population have either diabetes or pre-diabetes, and 45% suffer from high blood pressure. Both diseases are perpetuated by unhealthy lifestyle choices.

Making strides towards more disciplined food selections, portion control, increasing physical activity and eliminating smoking will help decrease the risk of chronic kidney disease. These healthy lifestyle choices can also slow the disease’s progression. Even small changes can make a big difference.

Always let your doctor know if you are taking additional supplements or over-the-counter medications. Be sure to take medications only as prescribed. Many medications can be affected by chronic kidney disease if the kidneys cannot process those substances due to being damaged. Likewise, some medications contribute to developing kidney disease such as antacid medications and the nonsteroidal anti-inflammatory drugs.

People are encouraged to meet regularly with their healthcare provider to screen for risk factors for kidney disease.

At Freeman Kidney Center, highly skilled, board-certified nephrologists treat conditions such as acute renal failure, chronic kidney disease, hematuria or blood in the urine, and proteinuria or excess protein in the urine. With appropriate intervention, kidney patients can work and live normal lives. For details, called 417.347.8570.

Once again, Freeman Hearts & Vascular Institute has earned the coveted Level 1 STEMI Center designation. The hospital had to demonstrate it has the providers and resources needed to treat STEMI patients, and its physicians and staff have met and will continue to demonstrate proficiency in the latest proven STEMI standards and meet strict standards of education. 

STEMI is a common name for ST-Elevation Myocardial Infarction, a serious heart attack in which one of the heart’s main arteries is blocked. 

Freeman has a door-to-balloon time of less than 55 minutes, significantly lower than the 90-minute recommendation from the American Heart Association. Door-to-balloon time is a time measurement that starts when a patient with a cardiac emergency arrives at the emergency department and ends with the inflation of a balloon inside the blocked coronary artery. Time is muscle – the more time it takes to correct the problem, the more permanent damage the heart muscle can sustain.

Freeman has received and consistently maintained Level 1 honors since 2017 to the present. Each new designation is valid for three years. Therefore, Freeman will remain a STEMI Level 1 hospital through 2026. 

The STEMI Level 1 designation is a testament to our teamwork at Freeman. The collaboration that takes place with every STEMI patient to ensure that we are providing highly efficient care, without sacrificing quality. Freeman is specifically equipped to treat STEMI patients – improving both speed and quality of care – by coordinating 911 response system, ambulance services and hospitals in a comprehensive, integrated approach.

There are an estimated 550,000 new heart attacks and 200,000 repeat heart attacks (meaning the person has had one before) heart attacks in the U.S. each year, according to the American Heart Association. About 38% of people who go to the emergency room with acute coronary syndrome were diagnosed with a STEMI. That means there are a over 280,000 people who have a STEMI in the U.S. each year. To prevent death, it is critical to restore blood flow as quickly as possible, either by mechanically opening the blocked vessel or by providing clot-busting medication. Studies show patients can recover better when health care providers consistently follow treatment guidelines.

In addition to the Level 1 STEMI recognition, Freeman also received in 2023 the Platinum Performance Achievement Award for Chest Pain – MI Registry from the American College of Cardiology, as well as the Quality Achievement Awards Mission Lifeline: STEMI Gold Plus and NSTEMI Gold awards from the American Heart Association.

Michelle Wolfe is the STEMI Coordinator for Freeman Heart & Vascular Institute, which provides nationally recognized care for Joplin and surrounding areas. To find out more, give the Institute a call at 417.347.5000 or visit freemanhealth.com/specialty/heart-vascular-care.
 

February is Heart Disease Awareness Month, which means it’s a good time to review some simple steps to prevent heart disease and promote cardiovascular health.

Exercise: Staying active through regular exercise such as walking the dog, taking the stairs at work are two ways to improve physical activity on a daily basis. Further, playing a sport, jogging, cycling or weight training are also great ways to burn extra calories. Remember, the current recommendation is about two to three hours of moderate to vigorous physical activity per week.

Food: Increase daily intake of fruits, nuts, vegetables, seed oils, whole grains and oil fish (essentially a Mediterranean diet) while reducing/avoiding intake of fried/processed foods, meats, full fat dairy and sugary snacks and beverages.

Daily Checks: Periodically check your blood pressure and keep it close to 120/80. Maintain a log of your statistics. For patients with hypertension (high blood pressure), follow the DASH (Dietary Approaches to Stop Hypertension) eating plan and limit salt intake.

Diabetes: For patients with diabetes, follow a diabetic diet and closely monitor your glucose and hemoglobin A1c

Just say no: Avoid tobacco use in any form, as well as excessive alcohol intake and the use of recreational/stimulant drugs.

Motivation: Avoid obesity by maintaining an active lifestyle and controlling portion size.

Sleep: Get eight hours of sleep every night. Considering screening for sleep apnea if you are not getting good quality sleep or if you are overweight.

Check in: To further assess your cardiovascular risk, discuss with your primary care provider about checking your cholesterol profile, hs-CRP and CT calcium scores.

Remember, always check with your personal provider or doctor before starting any kind of health regimen.

Darwin Jeyaraj MD, FAHA, FACC, FSCAI is a board-certified interventional cardiologist at Freeman Health System.