Freeman Medical Musings Blog

Each year on March 24, World TB Day raises public awareness and understanding about the disease. According to the Missouri Department of Health and Senior Services, TB is a health threat that’s far from gone and still a major health risk around the globe. Approximately 15 million people in the U.S. are infected with the disease and without intervention, approximately 10% of those people will develop TB, and that can affect those of us living in the four-state region.

“Typically, babies and young children, people infected with HIV or chronic disease(s), the elderly, people with a compromised or weak immune system and those who spend long periods of time near others with TB are more at risk,” explained Grant Pierson, DO. “TB is a contagious infection that usually attaches to the lungs and can spread to other parts of the body such as the brain and spine. It’s transmitted from person to person in the air, often via coughing and sneezing, and people nearby may breathe in the bacteria and become infected.”

Those infected typically have had close, daily contact with someone who has the disease, such as a family member, friend or co-worker. You're not likely to get infected from someone coughing in line at the store or at a restaurant and items such as dishes, drinking glasses, clothing or sheets don’t spread TB. In most people who become infected, the body can fight the bacteria from growing. Then, the bacteria become inactive, although they remain alive in the body and can become active later. This is called latent TB infection (LTBI).

Many people who have latent TB infection never develop TB disease and the TB bacteria remain inactive for a lifetime without causing disease. In other people, especially those who have weak immune systems, the bacteria become active and cause TB disease. People with LTBI can take medicine so that they’ll never develop TB disease. Symptoms of TB commonly include coughing up phlegm or blood, having a consistent fever, night sweats, chest pain, unexplained weight loss and fatigue.

Breathing well is a blessing each and every day. If you think you are experiencing labored breathing or symptoms of TB, the Freeman Lung Institute can help you determine the healthiest options forward. The Lung Institute specializes in high-quality care and offers information on the latest treatment and therapy options to help their patients live a stronger life. Talk to your primary care physician about your lung health today or call our office at 417.347.8315 or visit freemanhealth.com/lung.

About the Author

Grant Pierson, DO, specializes in pulmonary and sleep medicine. He earned his medical degree from the Kansas City University of Medicine & Biosciences in Kansas City, Missouri; performed his residency at St. John Medical Center in Westlake, Ohio; and completed his pulmonary critical care medicine fellowship at Parkview Medical Center in Pueblo, Colorado. He completed his sleep medicine fellowship at the University of Kansas Medical Center in Kansas City, Kansas. He is currently seeing patients at the Freeman Lung Institute.

When referred to the clinic, many of my patients do not realize that their CKD is something they may have already had or have been at risk for quite some time.

Our kidneys are responsible for a number of functions: filtering blood for toxins, removing waste and excess fluids from our body, regulating blood pressure, balancing important electrolytes and minerals, keeping acids in balance, and stimulating red blood cell production, amongst many other processes. When our kidneys are compromised in their ability to carry out any of these tasks, the consequences can be debilitating and even life-threatening.

CKD 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 to progress very quickly to kidney failure, whereas others can maintain stable kidney function or worsen only very gradually. Disease progression can often be slowed down when patients take an active role in making healthy lifestyle changes.

The most common causes of CKD in Americans are diabetes and high blood pressure. Roughly 37% of the US population have either diabetes or pre-diabetes, and 45% of US adults have 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 CKD. These healthy lifestyle choices can also slow CKD progression.

While smoking is a well-known cause of cancer, it is important for patients to understand that it also leads to heart, lung and kidney disease as well. Smoking increases blood pressure and narrows blood vessels in various organs, decreasing oxygen and precious nutrients that are vital to normal body functioning.

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 CKD if the kidneys cannot process those substances as a result of being damaged. Likewise, some medications contribute to developing CKD such as antacid medications and the nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of antacids that can affect CKD risk are pantoprazole, omeprazole and esomeprazole. Examples of NSAIDs are ibuprofen, naproxen, Advil®, Aleve®, Motrin®, Mobic® (also known as meloxicam) and Celebrex® (also known as celecoxib).

In the kidney clinic, we are careful to make sure our patients are on the correct medications and doses for their kidney function. We work with you to make the necessary adjustments to ensure you have the information you need to understand what steps you can take to regain control of your health.

Meet regularly with your healthcare provider to screen for risk factors for kidney disease. You may benefit from a kidney consultation.

Note:

Patients who require dialysis management face several changes, and with those changes sometimes come unexpected challenges. Freeman Health System helps dialysis patients who are in financial need through the Freeman Kidney Fund, which has been used to help patients with transportation, acquiring medications and other aspects of treatment. The March O’ The Kidney Walk is an annual fundraising event for the Freeman Kidney Fund. We are excited to announce this will be held May 8, 2021. You can register at www.freemanhealth.com/marchothekidney. We look forward to seeing you there.

Do you picture an endless parade of grilled chicken and bland salads? Or maybe you think of the seemingly boundless string of diets? Fat free, keto, plant-based, intermittent fasting and every other diet seem to have an expert who endorses it. All of this can become confusing and overwhelming.

To combat this barrage of conflicting information, each March is National Nutrition Month. This campaign is from the Academy of Nutrition and Dietetics and promotes nutrition education. This year’s theme is “Personalize Your Plate.” Healthful eating is not one-size-fits-all, but there are some common elements in healthy eating patterns. Below are four ideas to help you get started:

Eat a Variety of Foods from Many Different Food Groups

Look for a rainbow of vibrant colors in fruits and vegetables. Fresh, frozen, canned and dried all have their place in a healthy diet. Consider mixing it up with protein by adding nuts, seeds and beans. Variety in foods is a great way to add essential vitamins and minerals. For more ideas, visit ChooseMyPlate.gov.

Take Time to Enjoy the Food You Eat

Limiting distractions by turning off the TV or computer is a great first step, but have you tried “setting the mood?” Try setting the table with your favorite dishes, sharing the meal with people you love or lighting some candles.

Select Foods that Make You Feel Good

Eating with food allergies, intolerances or with chronic disease can provide an extra challenge. Learning to eat in ways that support your underlying health conditions can take time and feel defeating, but when you listen to your body’s feedback, you can begin to personalize and enjoy your diet.

Plan Ahead

Keep a grocery list going on paper or in an app in your phone. Buy foods that are easy to grab for a quick snack or that can be packed easily. Create menus that use leftovers in new ways. For example, tonight’s roasted chicken can become tomorrow’s chicken and veggie noodles.

If you need help with setting individualized eating plans, please seek the advice of a registered dietitian nutritionist or your physician.

If you struggle with obesity, the adjustable gastric band (LAP-BAND) surgery at Freeman’s Bariatric Center is highly effective at helping patients lose significant weight and transforming their lives with weight loss that lasts.

The minimally-invasive procedure places the band around the stomach to reduce the amount of food a person can eat at one time. During the procedure, surgeons make small incisions in the upper abdomen before inserting a silicone ring with an expandable balloon around the upper section of the stomach. It creates a small stomach pouch, which helps the patient feel full sooner with a smaller amount of food.

The band can be adjusted to enable patients to increase or decrease the amount of food they can eat at any given time. The procedure can even be reversed by removing the band through additional surgery.

On average, patients can initially lose 65% of their excess body weight within the first year after undergoing lap-band surgery and 70% two years after surgery. Patients may also see an average loss of six inches off both their hips and waist. Results vary widely, depending on the motivation and compliance of the patient. For example, patients who follow the advice of their bariatric surgeon, maintain a balanced and healthy diet and exercise regularly will generally see better results than a patient who reverts to old habits.

Those who commit to making the correct lifestyle choices can expect to lose anywhere from two to three pounds every week on average. Over the long-term, this will drop to around one pound every week.

To be eligible for lap-band surgery, a patient must meet their specific insurance guidelines and requirements. Most plans require a body mass index (BMI) of 40 or higher, or a BMI minimum of 35, with qualifying health problems such as high blood pressure, diabetes or sleep apnea. Some plans will also recognize back or joint issues of the knees or hips.

Freeman Bariatric Center has been recognized as a Center of Excellence (COE) through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). With this accolade, the program was recently approved as a Blue Distinction Center for Bariatrics. These honorary designations are evidence that the Freeman Bariatric Center offers a quality, comprehensive bariatric program serving the Four State region with reputable professional staff to deliver the best possible care.

About the Author

Janice Drake, a registered nurse and Freeman Bariatric Program Coordinator, assists weight loss surgery patients from start to finish. She completed her Bachelor of Science in Nursing from Oklahoma Wesleyan University in Bartlesville, Oklahoma. Working in the operating room for 30 years, Janice served as a surgical technician, a circulating nurse and a charge nurse. Then, she transitioned to bariatric surgery at the inception of the program.

The Freeman Bariatric Center specializes in performing safe and proven weight-loss procedures, using the most minimally invasive techniques possible. Additionally, the group offers educational information on the latest bariatric treatments and surgery options to help patients live a healthier life and achieve their goals. Talk to your primary care physician about bariatric surgery options,  call Janice at 417.347.1266 or visit freemanhealth.com/specialty/bariatric-surgery.

Every November, we recognize National Hospice and Palliative Care Month helping our community understand how important hospice and palliative care can be before you or a loved one are facing a medical crisis.

Hospice and palliative care combine high-quality medical care with the emotional and spiritual support families need most when facing a serious or terminal illness. Palliative care offers comfort and support earlier in the course of a serious illness. Hospice brings patients and family caregivers high-quality, compassionate care and support when a cure is not possible. Together, palliative care and hospice can help people live each moment of life to the fullest!

As we raise awareness and reflect about hospice and palliative care, here are five useful facts about hospice and palliative care and how they can improve the last stages of life for patients and loved ones.

1. Hospice care and palliative care are not the same.

Palliative care is specialized medical care for those living with a serious illness, such as advanced heart failure, cancer, dementia, chronic liver disease, COPD or severe kidney disease.  Palliative care works to improve quality of life through symptom management and can be provided alongside curative treatments. Quality of life has different meanings to different people. The Freeman palliative care team will discuss what quality of life means to the patient and help the patient sort through different treatment options to find the one that best suits their goals of care. 

Hospice is a program funded through Medicare, and most insurances, for people who have a prognosis that could be less than six months and aggressive life-prolonging treatments are no longer benefiting the patient. The main goal is focused on comfort and quality of life and is achieved through a holistic team approach that includes a registered nurse, nurse aid, social worker, chaplain and volunteers overseen by a physician. Different team members visit throughout the week to ensure the patient’s needs are met, whether they are at home, a nursing facility or hospital. 

2. Medicare covers hospice and might cover palliative care.

Hospice is a Medicare benefit and is covered 100%. Most private insurances and Medicaid programs cover hospice services as well. This includes all team members, medications required for symptom management and equipment. A person must have a prognosis of six months to qualify for hospice, although, some people may live longer and will still qualify for hospice services. 

In-home palliative care services may be categorized as palliative care or home health services.  Coverage is based on individual insurance plans.  Some home health or hospice teams may provide in-home palliative care services for those who are not yet appropriate for hospice. 

Freeman Health System offers an embedded palliative care program within the main hospital and an outpatient clinic. Both the inpatient program and the outpatient clinic file with Medicare, Medicaid and insurances. 

3. Hospice and palliative care are not just for people with cancer.

We often think of cancer patients as the ones in need of hospice and palliative care, but anyone with a chronic condition can benefit from this personalized attention. The goal with each is to improve the quality of life, which in turn, can help maintain or improve those with chronic/debilitating diseases such as dementia, Alzheimer’s, stroke, neurological disorders and end-stage heart, lung or kidney disease.

4. Hospice is for the entire family.

Hospice not only supports the patient but supports the entire family. Family members appreciate having a hospice team available 24 hours a day by phone in case there is a medical emergency. Once the patient passes, the hospice bereavement coordinator follows up with family for support. 

5. Hospice care is offered in the home.

When treatments are no longer effective or causing more harm than good, many patients can return to their daily activities in the comfort of their own home. This way, they can be surrounded by the people and things they love. All equipment and medical supplies brought into the home are covered by the Medicare hospice benefit. Respite services, up to five days a month, are available for caregiver breaks as needed.

Freeman’s highly trained palliative care professionals ensure patients and families find dignity, respect and love during life’s most difficult journey. They encourage patients and their families to complete an advance directive to document and share end of life wishes. The Freeman palliative care team is available to discuss and assist in filling out these documents for those who need assistance. Advance care planning involves talking about the care you would and would not want. 

The Freeman palliative care program assists with pain management, symptom control, psychosocial support and spiritual care to patients and their families at all stages of illnesses. These programs combine the highest level of quality medical care with the emotional and spiritual support that families need most when facing a serious illness or the end of life. For more information regarding Freeman’s palliative care services, call 417.347.4094.

Every October, Freeman celebrates National Physical Therapy Month (NPTM) – a time when we recognize our dedicated Freeman physical therapists (PTs) and physical therapist assistants (PTAs) who help transform people’s lives by restoring and improving their motion.

Movement and exercise are fundamental to leading a healthy and happy life! Freeman PTs and PTAs can identify factors that prevent patients from being as active as possible and find ways to help them overcome obstacles so they can be well, mobile and self-sufficient. Freeman PTs and PTAs play an integral role in helping our patients be healthy and encourage everyone to choose physical therapy in their battles against pain, limited mobility and other ailments. Physical therapy can also help individuals combat future injury and chronic disease.

It’s very rewarding to have the opportunity to make a positive impact in someone’s life,” explained Jeff Borum, Director of Rehabilitation Services at Freeman. “Whether it’s from an accident/injury, chronic condition or a planned procedure, we get to help patients regain their confidence, independence and freedom.”

While focusing on the physical ailments, Freeman therapists help patients with strengthening, balance and endurance and also serve as motivators to tackle the emotional and mental components for long-term success.

“Freeman has passionate physical therapists ready to treat patients in a variety of settings,” said Borum. “From Outpatient/Sports to patients in the hospital and pediatrics to work injury therapy, there are skilled clinicians available to meet our community’s needs!”

National Physical Therapy Month is an important time to raise awareness about the key role PTs and PTAs play in helping people find relief from pain, improve mobility and overall functional ability, and live healthier, more physically able lives. If you feel a physical therapist could benefit you, talk to your primary care provider for a referral. Freeman physical therapist professionals are ready to help you take that next step towards moving and feeling better!

There is a significant gap in emergency behavioral health care in our community. Our community, like many others, has had good options for addressing behavioral health crises. Ozark Center maintains a Crisis Line (800.247.0661) that offers hotline counseling or in-person assessment. Local emergency rooms have always provided behavioral health assessment for urgent matters 24/7. However, people experiencing mental illness often have difficulties accessing timely ambulatory behavioral health care, contributing to an overreliance on emergency departments. Ozark Center Urgent Behavioral Services (UBS) will soon fill this gap, beginning October 1.

As an urgent care for behavioral health issues, UBS is the first and only program of its kind in the area. Behavioral health urgent cares like UBS enable better monitoring of patients and reduce risk of self-harm. The less-rushed environment allows for increased time to gain diagnostic clarity and develop alternatives to hospitalization, potentially avoiding a conventional psychiatric inpatient admission.

While the idea of behavioral health urgent care is trending across the United States, not many are operating yet. This makes Ozark Center a pioneer in the field and allows customization of the program to meet the unique needs of our community.

The environment at UBS is trauma-informed, meaning it emphasizes physical, psychological and emotional safety to help individuals rebuild a sense of control and empowerment. This difference in environment is apparent everywhere you look in our UBS facility – from spacious exam rooms with sofas and recliners to private waiting areas. Throughout the building, you’ll also find comforting color schemes and calming local art.

Additionally, UBS is an integrated medical care facility, so co-occurring physical issues can be addressed in tandem with behavioral health needs. The UBS team includes mental health professionals as well as primary care providers, case managers and certified peer specialists, enabling providers to treat the whole person.

UBS is a great option for those experiencing:

• Increasing levels of depression, anxiety, psychosis and/or sleep disturbance
• Urgent need(s) and unable to access same-day appointment
• Substance use issues
• Running out of psychiatric medication
• Missed behavioral health appointments with providers

Located at 3230 Wisconsin Ave, Suite A, Joplin, MO, UBS will be open 11:00 am – 9:00 pm Monday – Friday and 1:00 pm – 9:00 pm Saturday and Sunday. Learn more about the program at ozarkcenter.com/UBS.

About the author

Vicky Mieseler, MS, BCCP, NCP, has been with Ozark Center since 1984. In that time, she has held the positions of substance use counselor, adult psychologist, crisis coordinator, director of community care, director of family preservation services, director of New Directions, director of crisis services and vice president of clinical services. In 2017, she was promoted to chief administrative officer of Ozark Center. Mieseler has been a licensed psychologist in Missouri since 1993 and a nationally certified psychologist since 1997.

September is Prostate Health Month, also known as Prostate Cancer Awareness Month, a time for a better understanding of the health issues associated with a man’s prostate, prostatitis and prostate cancer. According to the Men’s Health Network, most men don’t know what their prostate is nor what it does. It’s time to empower men with knowledge about the prostate, giving them more personal power over their general health and their prostate health!

WHAT IS THE PROSTATE?

The prostate is a walnut-sized gland that functions in the reproductive system found just under the bladder. It undergoes many changes during the course of a man’s life and generally remains stable until men reach their mid-40’s when, in most men, the prostate begins to enlarge.

THE IMPORTANCE OF PROSTATE SCREENINGS

One of the best ways to beat prostate cancer is to get regular screenings using the prostate-specific antigen (PSA) test. By measuring the amount of PSA in a man's bloodstream, the test helps health professionals discover prostate cancer at earlier stages – giving men a better chance for survival. PSA screenings are especially important for men with a family history of prostate cancer and for African-American men, who have a 60% higher incidence of the disease than Caucasian men.

There are several risk factors associated with prostate cancer, including family history, race and diet, but the most common factor is age. Prostate cancer occurs mainly in older men. About six in ten cases are diagnosed in men aged 65 or older, and it’s rare before age 40. The American Urological Association (AUA) recommends all men obtain a baseline PSA test at age 40. This value can help doctors tailor future screening frequency. For example, men who have an initial PSA of less than 1.0 can generally be reassured and told to return at age 45. With thorough screening and careful management, the vast majority of men with prostate cancer will survive the disease and enjoy a high quality of life after treatment!

LEAD A HEALTHIER LIFE TODAY FOR A BETTER TOMORROW

More than 30 million men suffer from prostate conditions that negatively affect their quality of life. Before men face any kind of prostate health issue, the best plan is to prevent prostate problems from starting by first leading a healthy lifestyle. Men’s daily routine, including exercise and nutrition, has a tremendous impact on their prostate health. Healthy habits to improve men’s general heath can help prevent and lower risk factors for prostate disease and conditions. Some tips include:

• Drinking plenty of water and non-caffeinated green and hibiscus tea, which contain antioxidants.

• Exercise and lose weight. A study published in the Journal of Urology found that overweight men, especially men with a high amount of abdominal fat, have an increased risk of prostate gland enlargement or benign prostatic hyperplasia (BPH). Losing extra weight can help reduce the risk for prostate cancer and relieve prostatitis. Walking, jogging, swimming, tennis and other aerobic exercises can help men maintain a healthy weight. Kegel exercises can also strengthen and train men’s pelvic floor muscles to help control urination.

• Eat more prostate-friendly food, including oily fish high in omega-3 fatty acids, vegetables and foods high in healthy fats like avocados, nuts and olives. Foods that help fight prostate cancer include Asian mushrooms, tomatoes, pomegranate juice and walnuts. Eating less sugar and processed foods is also good guidance.

• Stress negatively affects prostate health. In fact, some men unknowingly tighten their pelvic muscles when stressed. This chronic tightening can create pelvic floor muscle problems and can be one of the causes of chronic prostatitis. Stress can also affect men with BPH. Stress can worsen symptoms such as urinary urgency, frequency and pain.

If men lead healthier lives daily, they can better manage their prostate health. Some things are beyond men’s control, but they can control day-to-day factors that lower their risk and give their bodies the best tools for fighting illness. In the case of chronic prostatitis and chronic pelvic pain syndrome, which is a difficult-to-treat and often-painful inflammatory condition, traditional treatments, such as antibiotics, tend not to work. Fortunately, there are more and better treatment options today than ever before!

About the author

Ashley Southern-Devoe, MSN, APRN, FNP-C, at Freeman Urology Associates, is devoted to providing patients the opportunity to express their concerns and getting their questions answered. The team at Freeman Urology Associates, including Dr. James Frogge, place a high emphasis on patient education to ensure patients have a clear understanding about their particular condition. For more information on the quality services provided at Freeman Urology Associates, please call 417.347.3703.

At least 2.7 million Americans are living with atrial fibrillation (AFib), according to the American Heart Association. AFib, affects the heart’s ability to pump blood normally and causes blood to pool in the left atrial appendage and potentially clot. Some patients are prescribed blood-thinning medications, such as coumadin, to prevent a blood clot, but patients who have a bleed risk are at a higher danger when taking blood thinners.

More than half of Americans experience a traumatic event in their life, according to the National Center for PTSD. These events can include anything from military service to car accidents and from assault to natural disasters. In some cases, it may not even be an event the individual personally experiences – trauma can also come from learning about a loved one’s sudden injury or death, or from witnessing someone else experience a traumatic event.

While it’s normal to have trouble sleeping or feel on edge shortly after a traumatic event, most people will start to feel better in a few weeks or months. Those who develop post-traumatic stress disorder (PTSD), though, see symptoms continue longer than that and interrupt their daily lives.

Symptoms of PTSD can include:

• Flashbacks or nightmares 

Unwelcome memories can pop up at any time, or they may be triggered by something that reminds you of an event. A familiar example is the sound of fireworks bringing back memories of battle for combat veterans.

• Avoiding things that remind of you of the traumatic event

You might try to avoid places or people that remind you of the event or try to stay busy to you can avoid thinking about it.

• Increase in negative thoughts and feelings

You might feel sad or numb; things that you used to enjoy might not interest you anymore. You might also feel guilt or shame about the event, and think about what you might have done to prevent it.

• Feeling on-edge

You may have trouble sleeping or relaxing. You might also feel angry or irritable. These feelings can contribute to behaviors like drinking, using drugs or driving aggressively.

The good news, though, is that PTSD is treatable. Therapy and medication can both help ease PTSD symptoms, giving trauma survivors a better quality of life with fewer problems in their relationship, career and education. Even if you wonder if you are ready for treatment or fear that maybe it’s too late to seek help, it’s still a good idea to call a therapist, like those at Ozark Center.

The truth is it’s never too late to recover from a past psychological wound. And the sooner you reach out for help, the sooner you can start to feel better.

For more information about PTSD services at Ozark Center, call 417.347.7600.

Jacob Hefner, EdS, LPC, is Ozark Center Director of Adult Outpatient Services. He has received specialized training in the fields of substance use disorders, first-episode psychosis and mental health treatment. He has over 12 years’ experience in the mental health field.