University Medical Center to open Demopolis location

University Medical Center is adding a permanent location in Demopolis, AL, adjacent to the Bryan W. Whitfield Memorial Hospital, within the hospital’s outpatient facility, effective August 1, 2017.

The initiative began as a temporary response to an immediate need to help Demopolis physician, Dr. Gerald Hodge, cover his practice and to sustain the availability of care to his patients and the community in his absence. With that, clinicians from the College of Community Health Sciences—including family medicine faculty physicians, the OB fellow and a nurse practitioner—stepped in to provide interim clinical care. However, with the recent retirement of Hodge, the only local physician still providing pre-natal care following the closure of the hospital’s obstetrical unit in February 2015, it quickly became apparent that there was a significant, and growing, need for family medicine and pre-natal care in the communities immediately surrounding Demopolis. To that end, the temporary coverage has transitioned to a new, third location for University Medical Center, the practice run by CCHS.

The establishment of UMC-Demopolis is a means by which the College can help that community directly, and support the local hospital, while also developing a model that combines a full spectrum rural practice with medical education, all linked to the larger infrastructure of University Medical Center and the CCHS. Similarly, in an independent effort, administrators from the UAB Health System are working with hospital leadership to develop strategies to improve the hospital’s financial operations and viability.

The serendipity of our work in Demopolis on the physician side with that of the UAB Health System working with the hospital is unique, and strengthens the likelihood of sustained success. UAB will no doubt be very helpful in operational strategies for the hospital. But what the hospital most needs for success is more local physicians, particularly primary care docs. That will be our principal contribution to this unique three-way partnership.

—Dr. Richard Streiffer

Dean and Professor of Family Medicine, College of Community Health Sciences

While UMC-Demopolis will officially be open to patients beginning this week, the plans for further growth are still in motion. The planning and development phase will continue over the coming months, and a grand opening in the fall is anticipated.

College welcomes Bentley as assistant professor

Dr. Brett Bentley

Dr. Brett Bentley joined the College as an assistant professor of Sports Medicine in the Department of Family, Internal, and Rural Medicine.

The Tampa, Fla., native completed his undergraduate degree at the University of Florida in Gainesville, where he played baseball all four years and was a four-time member of the Academic All-SEC Team.

Bentley worked for a year at an inner-city ministry in Atlanta, Desire Street Ministries, before returning to the University of Florida for medical school. After medical school, he completed a family medicine residency at the University of South Carolina. In June, he completed a sports medicine fellowship at the College.

UMC Travel Health Services open in Faculty-Staff Clinic

A new addition to University Medical Center, Travel Health Services provides care for UA faculty, staff and their families as they prepare for international travel. Health care providers in the UMC Faculty-Staff Clinic provide individuals a comprehensive, preparatory experience that includes a consultation, advice for planning, travel-related vaccinations and medications needed in advance of departure.

 

“Nowhere is an ounce of prevention worth a pound of cure more important than when traveling abroad.”

—Dr. Tom Weida, UMC Chief Medical Officer

 

Advice on a wide range of topics is offered, from the more obvious vaccination requirements of individual countries, to conditions of food and water safety, and the activities you have planned—with each considered down to the exact region of the country slated for visit.

As UMC furthers its mission of promoting the health of individuals and communities in Alabama, it is the hope that travel health services will be expanded beyond the UA campus in the near future.

[FIND OUT MORE] about how to book appointments and associated costs, and to access required patient forms.

College, city partner to provide para-medicine program

The College and Tuscaloosa Fire and Rescue Services have partnered to provide a first of its kind in Alabama program that seeks to reduce costly hospital emergency room transports of people with low-emergency conditions.

The program is aimed at “low acuity” patients who might call 911 for back or stomach pain, fever, weakness or bleeding, for example, which might be treatable at the scene.

Under the program, nurse practitioners and social workers, and possibly psychologists, will ride with fire department first responders on low-acuity calls and offer treatment at a patient’s location, eliminating the need for an ambulance ride and a hospital emergency room visit. While care can be delivered at the scene, low-acuity patients will have the option of being transported to the hospital if they wish.

The nurse practitioners will have back-up from physicians, and the social workers can ensure that patients have the resources they need and can connect patients with primary care physicians. The psychologists can offer assistance on managing the nearly 30 percent of low-acuity calls related to mental health.

“This is a way to change how health care is delivered,” said Tuscaloosa Fire and Rescue Chief Alan Martin.

The para-medicine program is modeled after a similar Arizona program, although that program doesn’t have a university as a partner. Based on preliminary results from the Arizona program, the medical cost savings for the Tuscaloosa program could be $6 for every $1 that’s invested, said Dr. Richard Friend, chair of the College’s Department of Family, Internal, and Rural Medicine and co-director of the program along with Dr. John C. Higginbotham, chair of the College’s Department of Community Medicine and Population Health.

The para-medicine program is funded with a legislative allocation through Alabama’s Medicaid program and will use College nurse practitioners and social workers to provide care. The funding is expected to be available Oct. 1.

In fiscal year 2015, in Tuscaloosa there were 11,122 calls to 911, of which 23 percent, or 2,558, were low-emergency calls. At a cost of approximately $645 per call for an ambulance ride, treating callers at the scene would save $1.65 million.

“Trying to stop use of the emergency room for routine care is the goal,” Friend said.

Looney joins College as director of nursing

Wyndy Looney joined the College as director of Nursing for University Medical Center, which the College operates. Her responsibilities include serving as chief nursing officer, improving workflow, standardizing processes and procedures and implementing quality improvement activities.

Before joining the College, Looney was manager of Nursing Operations and Analytics at DCH Health System in Tuscaloosa, where she was responsible for day-to-day operations of the health system’s Patient Care Services division.

She has practice nursing in Alabama for 27 years.

Looney earned a Master of Science in Nursing from the University of North Alabama, graduating with academic honors. She is certified in Nursing Professional Development through the American Nurses Credentialing Center.

Her nursing experience in various clinical and community settings includes pediatrics, newborn care, labor and delivery, perioperative care, school health, nursing education and nursing operations. She has also held positions in nursing management and administration.

While at DCH Health System, which operates DCH Regional Medical Center in Tuscaloosa, Looney received the “Great Catch” Award for identifying and reducing a safety risk for hospitalized patients. She currently serves on The University of Alabama’s College of Nursing Partnership Advisory Council and the Bridger Lectureship.

In 2014, Looney was appointed by Alabama’s state health officer to serve a two-year term on a regional Perinatal Advisory Committee. In a previous administrative role, Looney successfully piloted a regional chronic care coordination program for Alabama Medicaid recipients. As part of the pilot, she developed and implemented a Newborn Transition Program, partnering with local hospitals and pediatricians to ensure that newborns received appropriate follow-up care after being discharged from the hospital.

College hosts third annual Brussels Sprout Challenge at Heart Walk

For the third straight year, UA’s College of Community Health Sciences hosted the Brussels Sprout Challenge during the American Heart Association West Alabama Heart Walk on March 25.

The College and its University Medical Center partnered with Manna Grocery and Deli in Tuscaloosa to roast and serve Brussels sprouts at the walk, which began at the Tuscaloosa Amphitheater and continued along the downtown river walk. More than 900 Brussels sprouts were distributed at the challenge.

To complete the Brussels Sprout Challenge, participants had to eat one roasted Brussels sprout at each mile marker of the 3.1 mile walk. Those who completed the challenge by eating all three Brussels sprouts were awarded a T-shirt at the end of the walk.

The College also provided handouts about the health benefits of Brussels sprouts, which include heart health and cancer protection, as well as Brussels sprout recipes.

The goal of the Brussels Sprout Challenge is to offer a challenge that promotes healthy lifestyle choices – a healthy diet and exercise – while complementing the American Heart Association’s mission to build healthier lives free of heart disease and stroke.

The mission of the College is to improve and promote the health of individuals and communities in Alabama and the region.

Immunizations in older adults, addiction and teens, schizophrenia and cholesterol topics in weekly Mini Med School lecture series

About one-third of people will get shingles in their lifetime, and while the shingles vaccine is only about 50 percent effective, it is still worth it to avoid getting the virus, said Dr. Jane Weida, director of clinical affairs for the College of Community Health Sciences’ Department of Family, Internal, and Rural Medicine.

Weida gave her talk, “Immunizations for Older People — Staying Sharp on Shots,” on Feb. 9 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. The lecture series is open to OLLI participants and to the public.

Shingles is caused by the same virus that causes chickenpox. A painful rash develops, usually on a single area on one side of the body, that can be very painful, said Weida, who is also an associate director of The University Family Medicine Residency, operated by CCHS, and an associate professor of Family Medicine.

View Fox 6’s report on Weida’s talk:

Someone who has had chickenpox can get shingles.

“When you’re little you get chickenpox and then the virus stays in the nerves along the back and neck,” said Weida. “Sometimes, we don’t know how, it reactivates.”

Being older, having poor immune function and having had chickenpox before 18 months of age increases the risk of shingles.

“If you never have had the chickenpox, you can’t get shingles first,” she said. “If you’ve never been immunized for chickenpox or shingles, you should get immunized for both. You can catch chickenpox from someone with shingles, but not shingles.”

Insurance will cover the shingles vaccine after age 60, though it can be given starting at age 50.

Older people need immunizations to boost immunity to diseases, even those to which they have already been immunized, such as tetanus, diphtheria and whooping cough, and to protect against diseases that affect older adults preferentially, including shingles and pneumonia, said Weida.

Weida also encouraged attendees to get their flu shot each year, as 3 million to 5 million people are infected by influenza each year, and 250,000 to 500,000 die each year from the flu. The best time to get your flu shot is about mid-October to November, said Weida.

The flu shot’s effectiveness can fade, Weida said, so it is important not to get it  too early, especially for those older than 65.

The flu is spread through coughing or sneezing and by touching surfaces with the virus. However, soap and water deactivates the virus, Weida said.

Schizophrenia
On Feb. 2, Dr. Thaddeus Ulzen, associate dean of Academic Affairs and chair of Psychiatry and Behavioral Medicine, gave his talk on schizophrenia, which is a chronic and severe mental disorder that affects 1 percent of people worldwide.

Symptoms typically present between late adolescence and early adulthood. Ulzen said that symptoms may be subtle, but those around the person may notice that “something is just not quite right, or the person is not his or herself.”

Symptoms include hallucinations, delusions, thought disorders and movement disorders. Reduced emotions and feelings of pleasure and reduced speaking may also be symptoms.

“I describe it as a disruption of what I call ‘security of thought’—that your thoughts belong to you,” said Ulzen. “The feeling is that someone is intruding on your thoughts.”

Medication can be used to treat schizophrenia, but other aspects must be introduced into the treatment, said Ulzen, including psychosocial interventions and cognitive behavioral therapy. Community treatment, which includes family education and support, is also important.

Schizophrenia cannot be cured, and those affected with the disorder have it for life.

“As a child psychiatrist, I always say that we are in preventive psychiatry. Most disorders we see, including schizophrenia, start quite young.”

Ulzen said he works with general physicians to help them identify the signs of schizophrenia and other psychiatric disorders.

“My job is to help physicians understand that this is the beginning of the big tsunami about to come and never to say ‘It’s just a phase.’ If the patient is concerned enough to walk into the room, they know something is wrong.”

 

Addiction and Teens
In a 2015 study, one out of 17 high school seniors were daily smokers of tobacco, said Dr. Sara Phillips, assistant professor of Pediatrics at CCHS, during her talk “Addiction and Teens” on Feb. 16.

According to the CDC, cigarette smoking causes about one of every five deaths in the US each year and life expectancy for smokers is at least 10 years shorter than for nonsmokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, said Phillips.

“I think if we target young people and try to get them to quit early on, it could be like they never smoked.”

Most teens want to quit, she said, and nicotine replacement and cognitive behavioral intervention can be helpful forms of treatment.

While there are other dangerous drugs that teenagers use, smoking causes annually more deaths than overdoses have in 15 years, said Phillips.

More money is spent on tobacco advertising than any other drug, though there are regulations.

Advertising for alcohol is not regulated, and people aged 12 to 20 years drink 11 percent of all alcohol consumed in the US. More than 100,000 deaths can be attributed to excess alcohol consumption, including the deaths of 5,000 people younger than 21 years, said Phillips.

Younger drinkers are more likely to develop alcohol dependence or abuse later in life, and they are at higher risk of suicide and death from alcohol poisoning. This is for a couple of reasons, said Phillips.

“One, their brains are not fully developed, and two, they’re novices to drinking. They don’t know their limits,” she said.

Of illegal drugs, marijuana is the most commonly used and adolescents can become addicted, despite popular belief, said Phillips.

One study showed an average loss of eight IQ points with heavy marijuana use as a teen and continued use as an adult. It can also lead to memory problems, breathing issues and hallucinations and paranoia.

Genetics can play a role in addiction in teens. Children whose parents are alcohol-dependent are four to six times more likely to develop alcohol dependence compared to others with no family history. Teens with mental health issues are also more at risk to use or abuse substances, Phillips said.


Cholesterol
Treating cholesterol isn’t about treating a number—it’s about treating the risk factors and the disease process, said Dr. Ed Geno, assistant professor of Family Medicine in the College’s Department of Family, Internal, and Rural Medicine.

Cholesterol is essential in the human body, said Geno. Two types of cholesterol levels are checked: LDL and HDL. The two have different clinical implications:

LDL carries cholesterol from the liver to the tissues and deposits it. Geno called this “lousy cholesterol,” which is how he helps patients remember it is not good for that number to be too high.

“Happy cholesterol” is how Geno helps patients remember HDL, which carries cholesterol from the tissues back to the liver.

High levels of the LDL cholesterol can lead to plaque buildup in arteries and lead to cardiovascular disease (CVD).

Statins may be used to prevent CVD in adults.

“We are trying to use primary prevention in treating cholesterol,” Geno said. “That means we are trying to keep someone from ever having a heart attack. Secondary prevention would be keeping a heart attack from happening again.”

When treating a person’s cholesterol, risk factors and the disease process is taken into account—not just the patient’s cholesterol numbers.

Adults without a history of CVD may be prescribed a statin for the prevention of a CVD event and mortality  depending on if: 1) the adult is between age 40 and 75; 2) the adult has one or more CVD risk factors, which include dyslipidemia, diabetes, hypertension or smoking; and 3) the there is a calculated risk by the physician of a cardiovascular event within 10 years.

UMC clinic helps children and families navigate foster care

By Amelia Neumeister

As a foster parent, Dr. Brian Gannon knows that children and families in foster care can face challenges navigating medical care, paperwork, state agencies, schools and other aspects of case management. He has eight children—six of which were adopted. And four of those adoptions were through foster placements.

Physicians can legally request information on foster children, says Gannon, an assistant professor of Pediatrics at the College of Community Health Sciences and a pediatrician at University Medical Center, which the College operates. So he wanted to streamline the flow of information, help to gather all of a foster child’s relevant information in one place and provide them access to health care and resources. To do that, he started the FRESH Start Clinic at UMC.

FRESH stands for Fostering Resilience through Education, Support and Healthy choices. Since opening its doors in July 2016 at UMC, the FRESH Start Clinic provides care for children in foster care and for families and professionals who support them. The clinic is held on Thursday afternoons.

The goal of the clinic is to advocate for the specialized needs of children in foster care and to change the way children in foster care are obtaining medical care, says Gannon.

He and his team of nurses, a receptionist and social work students wanted to create a clinic for foster children based off the Patient-Centered Medical Home, a model of health care that is patient-centered, accessible, continuous, comprehensive and coordinated, and that focuses on quality and safety.

The clinic works in partnership with the Tuscaloosa County Department of Human Resources, and includes all members of the foster child’s team in health care decisions as appropriate, including the foster parents, birth parents, DHR caseworkers and investigators, noncustodial family members, residential home staff and mental health providers.

“There are different [foster care clinic] models across the country,” says Gannon. “A lot of the larger cities will have foster care clinics that are much more involved than what we are starting right now. We’d like to work into that. The goal would be to have mental health, development and social work all on-site as part of the process, because these kids are known to have more needs than your average pediatric population.”

Gannon had the idea for the FRESH Start Clinic after studying similar clinics in urban areas where foster care is more commonly found, he says. By partnering with UMC, he hopes the clinic can serve as a state-wide model and can bring access to rural areas where foster homes are less common.

Gannon says he drew from his experiences as a both a doctor and a foster parent to help plan the clinic.

“There are so many little things that make it difficult as a foster parent to get the care   that the child needs,” he says. “So, my goal was to make all that easier.”

Foster parents can call to set up an appointment in the clinic as soon as the child is placed in their care, Gannon says. They can be seen within a week. At the first visit, the child’s medical, social and psychiatric history will be collected and requests will be submitted for any  additional records needed. Gathering this information helps to streamlines the process of medical care for children in the foster system, Gannon says.

Once additional records are obtained, another visit will be scheduled. The clinic will assess the child’s adjustment to his or her foster placement and will look into any behavioral concerns a foster parent might have. A trauma assessment will also be performed to help families address needs of children who have suffered from abuse or neglect.

From there, the FRESH Start Clinic can provide primary care for children in state custody or can serve as a consultant to their chosen doctor. The clinic also stays in touch with DHR and is notified of any changes in the child’s placement or goals.

The FRESH Start Clinic knows how to gather background information and navigate paperwork that many foster parents simply don’t have time for, Gannon says. If the parents are not dealing with paperwork, they will have less difficulty making appointments, he says.

“I’ve gotten a lot of positive feedback from the foster parents that I’ve worked with as well as the caseworkers, because the DHR caseworkers will have dozens of children on their caseload,” Gannon says. “Often they’ve had more negative experiences than foster parents have as far as interacting with doctors’ offices and things being challenging and not running smoothly, and they’ve been very pleased with the efficiency that we’ve been able to provide to them.”

The long-term goal for the clinic is to create an infrastructure to bring the clinic to a wider audience.

“I would love for this to be a model for the state and have interested doctors all over the state who have extra training and special interests,” he says. “And we could have case managers that make sure all these children get what they need. I think over time that would be a really good goal. But we are starting small—starting with one county.”

Sleep problems, adapted athletics topics at Mini Med School

More than 50 percent of adults in the US experience intermittent sleep disturbances, and only 30 percent of adults report regularly getting enough sleep.

Chronically tired individuals face increased risk of illnesses and an overall lower quality of life, says Dr. Katie Gates, assistant professor of Family Medicine at The University of Alabama College of Community Health Sciences.

Gates gave her talk, “Sleep Problems,” on Jan. 26 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program. On Jan. 19, Dr. Jimmy Robinson, endowed chair of Sports Medicine at CCHS, gave his talk, “Adapted Athletics.”

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

Gates broke down sleep disorders into four categories: Those who can’t sleep includes sufferers of insomnia and restless leg syndrome. Those who won’t sleep likely have delayed sleep phase syndrome. Those with excessive daytime sleepiness may suffer from narcolepsy or obstructive sleep apnea. And those with increased movements during sleep include REM sleep behavior disorder sufferers, or those with periodic limb movement.

Three criteria must be met for a diagnosis of insomnia: First, the patient must complain of difficulty sleeping, difficulty staying asleep or waking up too early. Second, the sleep difficulty must occur despite adequate opportunity and circumstances to sleep. And third, the lack of sleep must negatively affect daytime function.

“Insomnia is a very common complaint, and it does increase with age, unfortunately,” Gates said. Women report insomnia 50 percent more often than men. It can be treated with cognitive behavior therapy or with medications.

Delayed sleep phase is a circadian rhythm disorder, meaning “the brain has gotten off its track,” said Gates. It’s characterized by the person going to bed very late and waking up late.

“This can be genetic or socially reinforced,” she said.

Obstructive sleep apnea is the most common sleep breathing disorder, and it affects 20 to 30 percent of males and 10 to 15 percent of females.

“With my patient population, it seems higher than this,” Gates said.

Risk factors for sleep apnea include age, obesity, craniofacial abnormalities and smoking. Continuous positive airway pressure, or a CPAP machine, is recommended treatment.

In some instances of diagnosing a sleep disorder, a physician may order a polysomnography, or a sleep study.

Cognitive behavioral therapy can be a treatment for some sleep disorders, said Gates, and a therapist may focus on changing false beliefs and attitudes about sleep. One of these might be that everyone needs at least eight hours of sleep, she said.

Music therapy can be another way to treat a lack of sleep.

“Choose music you are familiar with,” Gates said.

She said the music should have a slow and stable rhythm with low-frequency tones and relaxing melodies.

“Try out different genres, like classical or acoustic, to find what works for you.”

View a WVUA report on Gates’ lecture here:

Robinson, in his talk about adapted athletics, said the number of adapted athletes is rising. In the 1960 Summer Paralympic Games in Rome, 400 athletes came from 23 countries. In 2016, 4,316 athletes came to Rio from 159 countries.

The International Paralympic Committee assigns points to athletes based on their impairments. The classification systems differ by sport and are developed to govern the sport. Players are allocated points based on an evaluation by the International Paralympic Committee.

A lower score indicates a more severe activity limitation than a higher score. A team is not allowed to have more than a certain maximum sum of points on the field of play at the same time in order to ensure equal competition with the opposing team.

As time progresses, a disability may get worse, so a player can be reviewed again.

“Disabilities are evolving,” said Robinson. “It’s important to have this avenue to challenge their disability, especially if it’s progressive.”

Robinson, also spoke about the Alabama Adapted Athletics Program, which was started in 2003 by husband and wife Brent Hardin and Margaret Stran. Though the program received an initial funding of only $5,000 from the Christopher Reeve Foundation, it now operates off an annual budget of $450,000, offers six full scholarships and supports five sports: women’s and men’s basketball, tennis, rowing and golf.

Mini Med School series with OLLI continues

There are times patients might ask their doctors for medications and tests that might not be necessary and that could cause harm, according to Dr. Ray Brignac, a family medicine physician who practices at University Medical Center-Northport, which is operated by the College.

During a lecture that was part of the College’s Mini Medical School program with The University of Alabama’s OLLI program, Brignac said doctors and patients need to talk and to use evidence-based recommendations to make the best care decisions possible.

“You need to put as much research into your medical decisions as you do buying a car or a washing machine,” he said. “There’s a lot of information out there. Try to go where the evidence is.”

A national campaign called Choosing Wisely advocates just that. The campaign encourages doctors and patients to have conversations informed by evidence-based recommendations that facilitate good decisions about appropriate care based on a patient’s individual situation, and to avoid unnecessary medical tests, treatments and procedures.

“The Choosing Wisely campaign gives us good tools to be better informed and wiser,” said Brignac, who titled his lecture “Choosing Wisely in Geriatrics.”

OLLI, short for Osher Lifelong Learning Institute, is a member-led program educational program catering to those aged 50 years and older. The College’s Mini Medical School lecture series through OLLI provides an opportunity for OLLI members and community learners to explore trends in medicine and health and to receive important information about issues and advances in medicine and research.

Brignac presented on May 3, and Dr. Catherine Ikard, a physician at University Medical Center and UMC-Northport, presented on May 10.


Choosing Wisely in Geriatrics
Brignac said older people often have more medical conditions and, as a result, take more medications than younger people. While medications have benefits, they also carry risks. “Is it always wrong to take medications? No. But you need to exercise caution,” he said.

He noted that sleeping pills help with insomnia, which affects many people over the age of 60, but studies show increased falls by those taking sleeping pills. Antibiotics do not cure colds and have risks, including diarrhea and damage to nerves and tendons. Nutritional supplements have the potential to react with other medications. Narcotics are not always the best way to treat chronic pain and non-drug interventions like exercise and physical therapy are sometimes more  effective. Non-steroidal anti-inflammatory medications like Aleve and Ibuprofen are safe but can sometimes cause gastrointestinal bleeding and increased risk of heart attack or stroke, and while acetaminophen, found in Tylenol, is a good medication, if taken in excess can damage the liver. Medications for heartburn and acid reflux can carry higher risk of osteoporosis, but sometimes avoiding certain foods and sleeping with the head of the bed raised can help.

“It’s not that you shouldn’t ever take these drugs, but you need to be aware of the risks,” Brignac said. “It’s always good to questions medications – are there alternatives, lower doses?”

Many older patients have low back pain and often ask for X-rays or MRIs, Brignac said. He recommends patients wait a month before tests because most back pain clears up in that time. “If you jump right into testing, you can create needless anxiety, or you might wind up under the surgeon’s knife unnecessarily.”

Brignac joined University Medical Center-Northport last year after a 34-year practice at Selma Medical Associates in Selma, Ala. In addition to family medicine, Brignac also has an interest in geriatrics and nursing home patients and is working to build a “hands-on” nursing home practice in Northport and Tuscaloosa.

Recognizing, Treating and Preventing Strokes
If you suspect someone you know is having a stroke, the most important information that can be relayed to the EMT or physician treating that person is the last known well time, said Dr. Catherine Ikard.  This will determine the course of treatment.

Ikard, assistant professor in Psychiatry and Behavioral Medicine and Internal Medicine, spoke about the causes, symptoms and treatments of strokes at a lecture she presented as part of the College’s Mini Medical School with The University of Alabama’s OLLI program.

OLLI, short for Osher Lifelong Learning Institute, is a member-led educational program catering to those aged 50 years or older. The College’s Mini Medical School lecture series through OLLI provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures by CCHS faculty offer important information about issues and advances in medicine and research.

One of the best ways to identify if someone might be having a stroke is to ask the person to smile. If the smile is lopsided or there is drooping, the person might be having a stroke, Ikard said.

If a stroke is caused by a blood clot, a medication called a tissue plasminogen activator, or tPA, may be given within four and a half hours of the last-known well time, said Ikard.

After four and a half hours, or if the patient cannot receive a tPA for medical reasons, endovascular therapy can be used, which involves the use of a stent retriever that a doctor routes through a catheter to the blocked artery and removes the clot, Ikard said.

“If you suspect a stroke, call 911,” Ikard said. “If it is a stroke, every 30 minute delay could lead to a 10 percent relative reduction in recovery.”