Obstructive Sleep Apnea (OSA) can do more to your body than just wake you up in the middle of the night. OSA is the most common sleep-related breathing disorder. It is caused by repetitive episodes of apnea – repeated breaks in airflow. While men are more commonly affected by this disorder, women suffering from OSA are at a higher risk of heart failure[1]. Studies have found a link between OSA and heart-related problems such as hypertension, coronary heart disease, cardiac arrhythmia and heart failure.

Hypertension and OSA commonly go hand-in-hand with one another. Hypertension – high blood pressure – develops over many years and can worsen if you do not get enough sleep. OSA can keep you from getting enough rest to help keep your blood pressure down to healthy levels.

More severe cases of OSA have been linked to coronary heart disease, and in a few instances, heart failure. Coronary heart disease occurs when the coronary arteries begin to narrow, which restricts the amount of blood that reaches the heart. OSA can keep you from being healthy in your day-to-day life by keeping you from getting enough sleep to feel energized, which leads to exercising less and eating unhealthy foods more. These issues can compound on one another until heart failure occurs.

How can you tell if you’re affected by OSA? A few of the symptoms of OSA are:

• Excessive daytime sleepiness
• Loud snoring
• Observed episodes of breathing cessation during sleep
• Morning headache
• High blood pressure

The current universal treatment for OSA is the continuous positive airway pressure machine, more commonly referred to as CPAP. The CPAP eliminates apnea and the hemodynamic – change in flow of blood to organs and tissue – changes during sleep. Long-term CPAP treatment positively affects blood flow throughout the body and daytime blood pressure levels.[2] According to the American Academy of Sleep Medicine, treatment for OSA has resulted in an improvement in quality of life with 54 percent seeing improved respiratory function, 49 percent report improved mental health, 41 percent of patients seeing an improvement in blood pressure and 31 percent seeing improved HbA1c – average blood glucose – levels.

Many people view OSA as a sleeping disorder than can keep you or your loved ones awake at night. However, OSA is much more than that, and the results can be much more damaging.

About the author

Jason Maxfield, MD, is a board-certified sleep medicine specialist and an American Academy of Sleep Medicine diplomate. Dr. Maxfield has worked at Freeman for four years and is the Medical Director of Freeman Sleep Center. To learn more about sleep disorders, visit freemanhealth.com/sleepmedicine or call 417.347.8688 to make an appointment.

[1] Mehra, Reena. “Obstructive Sleep Apnea and Cardiovascular Disease in Adults.” UpToDate, 19 Dec. 2017, uptodate.com/contents/obstructive-sleep-apnea-and-cardiovascular-disease-in-adults.

[2] Lattimore, Dee L. “Obstructive Sleep Apnea and Cardiovascular Disease.” Egyptian Journal of Medical Human Genetics, Elsevier, 3 May 2003, sciencedirect.com/science/article/pii/S0735109703001840.

The beginning of summer means warm weather, more daylight, swimming pools and sneezing. With summer in full swing, allergy sufferers all over the country are feeling the effects of allergy season. Allergies occur when your immune system reacts to a foreign substance such as pollen, pet dander or a synthetic chemical. Everyday tasks such as running errands, doing yard work and going for a walk can become exhausting due to high pollen counts, dander and other factors that trigger allergies.

Many people try to ignore their allergies and instead choose to “tough it out.” However, it could come to a point where your allergies become unbearable or even life threatening, and a visit to the doctor’s office is needed. Not addressing the allergy typically leads to watery eyes and runny noses, but more severe cases can lead to anaphylaxis – a severe allergic reaction.  

The first step to ridding yourself of the woes of allergies is to get tested. Allergy testing is used to find out what substance, or allergen, may trigger an allergic response in a person. The two most common types of allergy testing used are skin testing and a serum-specific IgE (immunoglobulin) antibody test. Once the allergy has been identified, the proper course of treatment can be issued.

Just as there are various kinds of allergies, there are various ways to treat them – and while there is no cure for allergies, symptom management through treatment is possible. These treatment options include:

• Antihistamines – to treat the “itchy,” “sneezy,” “allergic” component of allergies
• Anti-inflammatories – to treat the swelling, inflammatory component of allergies
• Environmental modification – making changes in flooring, air conditioning or humidity
• Allergy desensitization – used to gradually expose the patient to increasing doses of the allergen to eventually “desensitize” them to the allergen
• Allergy injections (immunotherapy) – generally used for indoor/outdoor environmental allergens
• Sublingual tablets – a new treatment option that can be used for some indoor/outdoor environmental allergens
• Drug desensitization – used in the case of drug allergy
• Sublingual immunotherapy

Don’t let your allergies keep you from enjoying your summer. With so many different treatment options, no one has to suffer through another summer full of scratchy throats and watery eyes.

About the Author

Nathan Box, DO, FAOCO, is an allergy specialist at Freeman Ear, Nose & Throat Center and is board certified by the American Osteopathic Board of Otolaryngology-Head and Neck Surgery. To learn more about allergies and treatment options, visit freemanhealth.com/allergy or call 417.347.8405 to make an appointment.

We all know we should make a doctor’s appointment as soon as we notice a persistent pain or a mole that changes color. What we may not realize, though, is that the same holds true for our mental health. When you notice something is not right – that you no longer enjoy things you used to love, or your emotions become intense, overwhelming and difficult to manage – it is better to get help than to wait and see.

Now, thanks to Ozark Center and the launch of its walk-in clinic, it is easier and faster than ever to get an appointment with a licensed mental health professional.

Ozark Center began the walk-in clinic to give our community access to screening and assessment as soon as possible after a need is identified. The clinic’s goal is to meet the patient’s high level of motivation to get help with easy access to highly trained and credentialed staff.

Ozark Center’s Walk-In Clinic provides same-day appointments for patients with issues ranging from depression and anxiety to eating disorders and substance use. With a team of 14 therapists, including psychologists, social workers and counselors, patients can be matched to a mental health professional who will meet their needs and who they can see on a regular basis after their initial walk-in appointment.

What to Expect at a Visit to the Walk-In Clinic

Patients will first meet with an admissions specialist to complete initial paperwork and then will meet with a therapist to communicate their needs, explore treatment options and develop a plan of action to get the help they need. No referral is required at the Walk-In Clinic.

If possible, Ozark Center asks that clients call ahead so they can be matched with a therapist that meets the requirements for their insurance and/or to check if they qualify for financial assistance. Patients should plan to arrive by 3:00 pm to ensure they can be seen before the end of the day.

For more information, including what to bring with you for your walk-in appointment, please call 417.347.7567 or visit ozarkcenter.com/WalkInClinic.

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.

Otolaryngologists, more commonly referred to as ear, nose and throat (ENT) doctors, cover a broad spectrum of ailments including tonsillitis, sinus and ear infection, neck pain, skin cancer and more. While many of these ailments appear minor at first, ignoring the symptoms could lead to debilitating medical issues. Since we tend to ignore much of the pain associated with these medical issues, we need to know when it’s time to see an ENT doctor.

Tonsillitis, the inflammation of the pharyngeal tonsils located in the back of the throat, most commonly affects children ages 5-15. Viruses and bacterial infections are typically the cause of tonsillitis. Symptoms of tonsillitis include sore throat, enlarged tonsils, bad breath, tender neck and headaches. You should consult a physician if you or your child experience a sore throat lasting longer than 48 hours, experience painful or difficulty swallowing, or experience extreme weakness or fatigue. Ignoring these signs could lead to more pain and difficulty breathing and talking.

Sinus and ear infections often go hand in hand. Treatment for most sinus and ear infections typically comes in the form of over-the-counter medication. However, if ignored for long periods of time, the infection can spread throughout the body leading the hospitalization. Seeing a doctor may become necessary if you are running a fever or have pain in your head, face or ear that continues to linger after using non-prescription medication.

Neck pain comes in several varieties and from a number of sources. Most neck pain stops after a few days and requires no additional medical treatment. However, although rare, severe head and neck pain could be an early indicator of cancer or an infection. If your neck pain has been bothering you for more than six weeks or the pain continues to worsen, you should see a doctor.

With summer in full swing, many people are searching for the perfect tan. In this pursuit they tend to forego the application of sunscreen and instead decide to absorb as much sunlight as possible. Although this does lead to a sun tan, it can also lead to skin cancer. While the survival rate for skin cancer stands at 99 percent, the longer you wait to seek treatment the greater the decrease in the survival rate. Left unchecked, skin cancer can spread to lymph nodes and vital organs, drastically decreasing the chances of survival.[1] If you notice unusual skin growths that won’t go away, patches of pale skin or rapidly growing moles, you should visit your physician. 

More often than not, the ENT problems we face are resolved quickly and require little or no medical attention. However, it’s always better to be safe than sorry.

About the author

Scott McClintick, DO, is an otolaryngologist at Freeman Ear, Nose, & Throat Center. Dr. McClintick is board certified by the American Osteopathic Board of Otolaryngology-Head and Neck Surgery. He attended medical school at Kansas City University of Medicine and Biosciences in Kansas City, Missouri, and completed his internship and residency at Freeman in 2005 and 2006, respectively. To learn more about the services provided by Dr. McClintick, visit freemanhealth.com/ent or call 417.347.8301 to make an appointment.

Someone in the United States attempts suicide every 29 seconds.* Every 11.7 minutes, someone successfully ends their life. The Four States is no exception. In fact, Missouri loses more lives to suicide than car accidents, yet for many of us, an unspoken code of silence surrounds the issue.

Suicide is a heavy subject, and the stigma attached to mental illness keeps many from talking about their thoughts or feelings. These individuals suffer in silence, and many times, those around them are afraid to ask if they are OK.

Although suicidal thoughts can affect anyone regardless of age, gender, religious beliefs and/or background, tragedy can be avoided if the person struggling reaches out to a trained mental health professional. The best thing you can do to help someone struggling with possible life-threatening depression is to become educated about the warning signs of suicide and know what community resources are available.

Warning signs

• Withdrawing from life
• Displaying extreme mood swings
• Sleeping too little or too much
• Increasing use of alcohol or drugs
• Feeling hopeless with no reason to live
• Feeling trapped
• Having unbearable emotional pain
• Wanting to die or kill oneself

If you recognize these warning signs in yourself, a friend, a co-worker or a loved one, be the change needed to break the code of silence. Talk directly and openly about your concerns. Help the individual get professional counseling treatment to avoid another life lost to suicide.

If you or someone you know is contemplating suicide, Ozark Center’s highly-trained mental health professionals can help. Call the Ozark Center Crisis Line at 417.347.7720 or 800.247.0661 for immediate assistance, day or night. You can also send a text message to 720.7.TXTOZK for an anonymous, two-way counseling session via text message. The National Suicide Prevention Lifeline is also available 24 hours a day at 800.273.8255.

*American Association of Suicidology

About the Author

Debbie Fitzgerald, EdS, LPC, NCC, is director of crisis services at Ozark Center. She has 34 years of experience in the mental health field, and for the past 30 years, she has served the community through her work at Ozark Center. She has certification from the National Board of Certified Counselors, and crisis worker certification from the American Association of Suicidology.

As we move out of summer and into fall we begin to see the weather cool, leaves turn and trash cans fill with tissues. Flu season is here, and while thoroughly washing your hands, using hand sanitizers and avoiding large crowds can help you avoid getting the flu, the best way to stay healthy is to get an annual flu shot.

While the flu shot is not the end-all-be-all of preventing the flu, it helps considerably. According to the Centers for Disease Control and Prevention (CDC), in 2016-2017 flu vaccinations prevented an estimated 5.3 million influenza illnesses, 2.6 million influenza-associated medical visits, and 85,000 influenza-associated hospitalizations.[1] Additionally, the CDC reports that 59 percent of vaccinated patients are less likely to be admitted to the ICU.[2] The flu vaccine is recommended for anyone age six months or older.

Receiving the flu vaccination is especially pertinent to those at risk of serious complications from influenza. Factors that could leave you at a higher risk of serious complications include asthma, cancer treatment, diabetes, kidney or liver disease and obesity. The flu vaccination has been associated with lower rates of cardiac events among people with heart disease, especially those who have experienced a cardiac event in the past year.[3] Even if you get sick with a different strain of influenza after receiving a vaccination, the flu vaccine can help lessen your symptoms.

Getting a flu vaccination goes beyond just protecting yourself. Getting vaccinated benefits your family, your friends and even the community. With more and more people receiving the vaccination, the threat of contracting influenza for those who who cannot receive the vaccine – due to an allergic reaction, age or personal reasons – is greatly reduced.

Many doctors’ offices have the flu vaccinations readily available. However, if you don’t have a regular family physician, you can receive the vaccine at health clinics, pharmacies, urgent care clinics, hospitals and other medical facilities. Some employers even offer the flu shot in the workplace.

Missed time from work and school, plans being cancelled and time spent laying around at home while you recover from the flu can be avoided with the help of the flu vaccine. Avoid the misery of getting the flu by getting your flu shot this year.

About the author

Dennis A. Estep, DO, is the Chief Medical Officer at Freeman Health System. Dr. Estep served as the Freeman OccuMed Medical Director for more than 23 years before taking over in his current position at the beginning of 2018. Dr. Estep is board-certified in Occupational Medicine by the American Board of Preventive Medicine and was named a Fellow by the American College of Occupational and Environmental Medicine.

[1]  Centers for Disease Control and Prevention. (2018, September 06). Influenza (Flu). Retrieved from https://www.cdc.gov/flu/prevent/vaccine-benefits.htm

[2] Centers for Disease Control and Prevention. (2018, September 06). Influenza (Flu). Retrieved from https://www.cdc.gov/flu/protect/keyfacts.htm

[3] Centers for Disease Control and Prevention. (2018, September 06). Influenza (Flu). Retrieved from https://www.cdc.gov/flu/about/qa/vaccineeffect.htm

Halloween: Kids and teenagers get dressed up in the most creative costume they can find, candy is everywhere, face paint ends up on coat sleeves or (somehow) the furniture, houses are decorated with fake cobwebs and carved pumpkins, and old pillowcases are pulled out from cabinets to be used as candy receptacles. Halloween is fun, but Halloween can also be spooky and dangerous if kids and parents aren’t careful.

Even though we often trick-or-treat in familiar neighborhoods and go out every year without fear, consider safety precautions to ensure Halloween remains fun for everyone.

Stay with your crew

There is safety in numbers. Travel with a group and stick with your group as you go around to different houses. Don’t let anyone else leave the group either. Mapping out your trick-or-treating adventure beforehand can help make sure everyone hits their favorite houses and stays together.

Go where you know

To avoid getting lost, visit houses and neighborhoods you are familiar with. This can also help you avoid strangers. Also stay out of the road and only use sidewalks and crosswalks.

Be seen

Bring flashlights or glow sticks and use them while you walk. Beware of that odd crack on the sidewalk or dropped curbs so you don’t trip! It’s getting darker earlier, so being able to see what’s in front of you is important. Using flashlights or glow sticks also help motorists and other vehicles see you.

Keep those hands clean

Bring some hand sanitizer along with you on trick-or-treating adventures. Freeman pediatricians see a lot of sick children after Halloween because everyone shares germs reaching into those candy bowls!

Wear the right attire

When choosing a super stellar outfit, you also need to consider the safety of your Halloween apparel. To avoid trips and falls, wear good, sturdy shoes and costumes and masks that fit.

Check your candy

We don’t want to take candy away from ourselves or from kids, but check the candy in bags before digging in. Some candies are dangerous for tots, like Skittles® or Everlasting Gobstoppers®, and not all kids can eat every candy safely due to allergies. Throw out any candy that may be dangerous or has an open wrapper, and avoid eating homemade goodies.

Freeman wants you and your loved ones to be as safe as possible this Halloween. Get dressed, heed these tips and have FUN!

Dr. Beth Garrett has been a pediatrician at Freeman Children’s Clinic for nine years. She is a member of the Missouri American Academy of Pediatrics (MOAAP) and is currently the membership committee chair. Dr. Garret also serves on the planning committee for MOAAP and is on the Bill & Virginia Leffen Center for Autism diagnostic team. She loves watching her patients grow and develop, and watching families thrive. She is located at Freeman Children’s Clinic, 1030 McIntosh Circle, 417.347.8750.

Veterans’ Day calls us to remember the heroism of the brave women and men who sacrificed their lives while serving our country.

Some veterans and current active service women and men may have experienced a traumatic event as the result of combat. The trauma may be re-lived in nightmares and through flashbacks.

Veterans may find themselves avoiding certain people, places, smells, textures and sounds to prevent an increase in anxiety and memories of the trauma. They may avoid stores because having people behind them in line makes them feel uncomfortable, or they may avoid fireworks because they remind them of a bomb or gun going off.

One form of evidenced-based treatment for individuals who have experienced a traumatic event is virtual reality therapy (VRET). VRET is often used in the course of treatment to specifically treat symptoms of posttraumatic stress disorder (PTSD). VRET can be used alone as a treatment for anxiety and other related fears.

While VRET can be used to treat a variety of fears - including public speaking, heights, storms and flying - it can also be used to treat PTSD. Bravemind, is offered at Ozark Center. It is available specifically for veterans or active duty service women and men who have PTSD and served in Afghanistan or Iraq. It includes scenarios like foot patrol, convoys and medical evacuations via helicopters. Therapists can customize the VRET environment to include explosions, firefights, insurgent attacks and roadside bombs with visuals and sound effects.

The virtual environment helps individuals feel as if they are really in the situation they fear, teaching them how to cope with that fear and anxiety by allowing them to interact with harmless virtual representations of traumatic stimuli to reduce their fear response. They can then learn how to decrease their negative response to the traumatic memory by being in the virtual environment while retelling their traumatic memories to a therapist who is guiding them through the process. After repeatedly doing this, the stress response, fear and anxiety will decrease or disappear due to the individual learning they are in a safe place.

About the Author
Dr. Stephanie Terrell, Licensed Clinical Psychologist, practices at the Ozark Center. Dr. Terrell specializes in the treatment of PTSD using prolonged exposure and virtual reality therapy. She also has extensive experience in psychological evaluations and is trained in smoking cessation and biofeedback. Additionally, Dr. Terrell provides treatment for a variety of other outpatient and inpatient clinical concerns. She has over eight years’ experience in the mental health field.

There is a striking correlation between the temperature and our desire to exercise outdoors; as the mercury on the thermometer moves lower, so does our want to exercise outside. While exercising outside in warmer weather is preferable, exercising outdoors is very healthy for our brains in any temperature.

Outdoor exercise in nature results in consistent improvements in energy, motivation and well-being. People who exercise outside, as compared to inside, have less tension, less anger and less depression¹. Outdoor exercise seems to help stimulate our brains to produce chemicals that play important roles in gratification, clarity of thinking and motivation. Happiness is also shown to improve when we have a variety of stimulation with exercise².

Our body benefits from being used at different angles and speeds, which is afforded by the luxury of exercising outdoors. Even the wind helps give us random degrees of challenge, pushing at times for increased effort and resistance or pulling us along the path faster than usual. Overuse injuries are related to a lack of variety that can come from always doing the same workout in the same way, at the same angles, over and over. Moving from trails, to grass, to asphalt, to gravel provides variety for your body, and you also may find yourself with more energy and motivation to exercise outdoors than when you are inside running on a treadmill.

In addition, outdoor exercise is generally not expensive. We – in the four-state region – are blessed to have a great many natural areas and wonders to explore, many of them nearby and free of charge. Whether kayaking on the creek, running a trail, bicycling in the neighborhood, climbing hills or swinging from trees, outdoor exercise has something for everyone. 

1 J Thompson Coon, K Boddy, K Stein, et al. Environ Sci Technol. 2011. Mar 1:45(5):1761-72.

2M Khazaee-Pool, R F Majilessi, R Saghedi, et al. J Psychiatr Ment Health Nurs. 2015. Feb;22(1):47-57.

About the Author

Chris Peterson is a physical therapist at Freeman Rehabilitation & Sports Center. He helps patients recuperate from injuries, illnesses and surgery. He works with patients to help them manage pain and reclaim their lifestyle and momentum. Freeman Rehabilitation & Sports Center features a sports performance section, basketball performance court, balance testing and treatment, sports concussion testing and the only aquatic therapy program in the area. To learn more, visit freemanhealth.com/sportsmedicine or call 417.347.3737.

Eating healthfully during the holidays seems like an impossible task. What is “healthful eating” anyway? It means no white foods, drink only kale smoothies, and if it tastes good, don’t eat it, right? Wrong. There is a great deal of misinformation about what it means to eat healthy.

Healthful eating is not a restrictive diet plan filled with tasteless, joyless foods, but a mindset and lifestyle that incorporates a balance of all foods. Healthful eating means balance and establishing a healthy relationship with food. Love the donut and love the apple, shamelessly and guilt-free. 

Many times, my clients are so worried about gaining weight during the holidays, and because they are so weight focused, they miss out on the joy of eating. Take the taboo out of your holiday favorites and allow yourself to enjoy them mindfully. Meaning, allow yourself to eat a moderate amount until you are comfortably full. Don’t feel that you can’t have a taste –   deprivation leads to overeating. However, don’t feel you must try everything you’re offered to appease a family member. It’s OK to say, “No thank you – I am full.”

Food is a fuel, and sometimes our bodies need different types and amounts of fuel from day to day. I encourage you to pay attention to your hunger and fullness cues. Eat when you are hungry, and stop when comfortably full. Look for ways to increase fruits, vegetables and legumes. Most of us need more of these, and they do much for our bodies.

I challenge you to be present this holiday season as you spend precious time with loved ones. I encourage you to whip up some of your favorite holiday treats and share them with friends and family. Take time for yourself and reflect on the meaning of the holidays. Eating healthy is much more than weight alone and you are so much more than your weight alone.

Merry Christmas and happy holidays!

About the Author

Haley Brannan, RDN, LD, is a clinical dietitian for Freeman Diabetes Education. Freeman is the only local hospital with diabetes educators that are certified through National Certification Board of Diabetes Educators and certified insulin pump trainers. To learn more visit freemanhealth.com/diabetes or call 417.347.5700.