Start Exercise Fitness Training Without Injury

Posted on March 20, 2015March 21, 2015

Start Exercise Fitness Training Without Injury

This week, our new monthly partner, Dr. Andrew Pugliese stopped by to introduce us to Randy Nicholson, of Fitness Firm Studio. He’s a certified trainer who shared some very helpful information on how folks who have not previously trained or former athletes who haven’t trained in a while start exercise fitness training without injury.

As a former athlete who has experience in high intensity and high volume cardiovascular and weight/resistance training, I know too well what it’s like to resume working out after a prolonged layoff and experience overuse injuries. These come from a burst of activity with or without heavy weight/resistance. Too much exercise too soon can easily result in a incapacitating measure of pain or even injury that prevents continuing without another break to recover.

Randy shared what a person who’s motivated to start or resume training should ask a prospective personal trainer to determine what their philosophy is regarding the initial training phase. He also shared the value of using a roller to help facilitate muscle recovery as well as releasing trigger points that can cause muscle spasm.

We talked about the best way to approach beginning training in a step-wise fashion to insure that muscular imbalances, postural weaknesses, and flexibility have been improved upon before moving on to more intense training moves/activities. If you or someone you care about is thinking about resuming or wants to start exercise fitness training without injury they need to check out this week’s episode.

Special Guests:

Randy Nicholson Fitness Firm Studio

NASM
EGOUSE
4th Degree Black Belt in Tae Kwon Do
BS Engineering, University of Chattanooga

Andrew Pugliese, MD, Infectious Disease Consultants

Doctorate in Medicine, St. George University School of Medicine
Fellowship, Infectious Disease, Winthrop University Hospital
Triple Board Certified in Internal Medicine and Infectious Disease
Pioneer in non-surgical treatment of acute and chronic sinusitis
President of Sinus Solutions

Medical Reserve Corps

Posted on March 12, 2015March 21, 2015

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Medical Reserve Corps

The U.S. Department of Health and Human Services (HHS) has approved MAG’s request to form the nation’s first medical society-sponsored statewide volunteer medical reserve corps (MRC). MAG and the Georgia Department of Public Health would oversee MAG’s MRC. MAG is now eligible for limited federal capacity building funds and has in fact received a 2015 grant for $2,500 – though the MAG MRC will require funding from private sources to fully maximize its vision.

The MAG MRC will train physicians to respond to declared emergencies in Georgia, and it will establish a system to coordinate the deployment of those physicians during any such emergencies. The MAG MRC will supplement the official medical and public health and emergency services resources that are available in the state. MAG MRC units will be capable of setting up mobile hospital systems. And under extreme circumstances (e.g., a shortage of health care providers in a given area), MAG MRC units can be called upon to perform some of the functions that would otherwise be performed by the full-time emergency medical response personnel in the state. MAG formed the MRC as a result of 2013 House of Delegates meeting action.

The MRC is a national network of volunteers, organized locally to improve the health and safety of their communities. The MRC network comprises 993 community-based units and 207,783 volunteers located throughout the United States and its territories. Georgia has 19 approved MRCs.

MRC volunteers include medical and public health professionals, as well as other community members without healthcare backgrounds. MRC units engage these volunteers to strengthen public health, improve emergency response capabilities and build community resiliency. They prepare for and respond to natural disasters, such as wildfires, hurricanes, tornados, blizzards, and floods, as well as other emergencies affecting public health, such as disease outbreaks. They frequently contribute to community health activities that promote healthy habits.

The designated point of contact is the Director of Health Protection with DPH. The MAG MRC may also be activated by MAG MRC leadership team as necessary. The MAG MRC Unit will supplement the State of Georgia Public Health Emergency Preparedness’ and Response Unit. The unit will not replace or supplant the existing emergency medical response system or its resources including locally based MRC units.

Special Guests:

John S. Harvey, M.D.

Chief of Surgery, Gwinnett Medical Center
Acting Colonel and Command Surgeon, Georgia State Defense Force
MAG’s President-elect.
Missions have included the Katrina/Rita hurricane and Haiti earthquake victim airlifts. He dealt with the Centennial Park bombing that took place during the 1996 Olympics as a medical command officer.
Doctor of Medicine, Medical College of Georgia

Susan Moore

Susan Moore has been MAG’s Director of Health Policy and Third Party Payer Advocacy since 2013. She helps MAG members resolve third party payer claim disputes and grievances. She has spent 30 years in the health care industry – more than half of those focused on patient safety and health care quality. Moore has a degree in nursing from the Emory University School of Nursing and a Master’s Degree in Public Health from the Yale School of Public Health at Yale University.

Paul Hildreth

Paul Hildreth is the emergency management coordinator/grant coordinator for REMS for the Fulton County School District. He has 14 years of experience in emergency response and crisis management. He is a certified emergency manager and master certified emergency manager. He has been an integral part of the Georgia State Defense Force for 10 years. He has a degree in business operations from DeVry University and an MBA from the University of Phoenix.

Peripheral Arterial Disease

Posted on March 6, 2015March 21, 2015

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Peripheral Arterial Disease

As many as 12 million Americans are dealing with peripheral arterial disease (PAD), a progressive blockage of the blood vessels that carry blood to the lower extremities. For many of these patients, amputation is the outcome, leaving them without a foot, or in others, half or more of their leg. Medical literature has shown that in these patients, their risk of death within 1 to 5 years of their amputation they have a 40% likelihood of amputation of the remaining leg and a significant risk of death. It’s clearly a serious problem.

But we can reduce the rate of amputation among these patients and we can also reduce the severity of intervention required to address the problem if we catch it early. Dr. Joseph Ricotta, vascular surgeon and director of the Northside Hearth & Vascular program, stopped by the studio to talk about what can be done to improve patient outcomes for those with PAD. We talked about the troublesome statistics around peripheral arterial disease, including the fact that among diabetics with PAD who develop a non-healing wound resulting in amputation, as many as 50% of them never receive a non-invasive study that could prevent the loss of their leg.

That means we need our partners in primary care and foot/ankle surgery to take an aggressive stance when presented with patients who are at risk for PAD or who have a poorly-healing wound on their leg or foot. There are numerous non-invasive studies that take only minutes in the vascular surgeon’s office that can readily identify patients who have blockage affecting blood flow to their feet. In these cases, if caught early, surgeons like Dr. Ricotta have more options and greater probability they can reestablish adequate blood flow that helps a wound to heal, preventing or mitigating extent of amputation.

We talked about the fact that Northside offers access to 2 of the country’s 10 robotic devices that significantly improves the effectiveness of minimally-invasive procedures by allowing the vascular surgeons to access and treat previously-inaccessible locations. Additionally, with the assistance of the robot, the surgeons are able to reduce damage that can occur on the inside of the vessel being treated, which reduces the likelihood that scarring after the procedure will block the vessel off again (a leading cause of reocclusion in PAD lesions).

I also spoke with foot and ankle surgeon, Dr. Michael Bednarz of Ankle & Foot Centers of Georgia, whose office is located in Woodstock, just north of Marietta. He talked about treating PAD patients with wounds from the perspective of the specialist who is tasked with managing the wound and ultimately, treating it surgically as necessary (including amputation when efforts to heal the wound fail and serious infection is a risk).

We talked about the fact that amputation should be viewed as a last-ditch option. And Mike shared that no patient should face amputation without having had a vascular study to determine if poor flow is contributing to the wound not healing. He talked about the fact that when he’s presented with a poorly-healing wound, particularly in a patient with PAD risk factors such as diabetes, one of the first things he does is request a vascular study to assess blood flow. He also utilizes Transcutaneous Oximetry, a non-invasive test that shows how well the tissue at the surface where a wound is located is getting oxygen.

With the results of those studies, he is able to address poor blow flow by referral to a vascular surgeon and/or to hyperbaric medicine (readily available in Atlanta and surrounding suburbs) to address poor oxygen levels in the skin. He also evaluates other risk factors such as glucose levels and presence of infection, often resulting in consults with infectious disease and/or endocrine specialists to help heal the limb-threatening wound. We talked about the fact that a multi-specialty approach insures that more patients can avoid amputation and the resultant high mortality rates that come with them.

Early involvement with an experienced wound specialist, vascular diagnostics/intervention, infection control, and endocrinology are all vital in helping patients avoid an amputation that might also cost them their life.

Special Guests:

Joseph Ricotta, MD, Medical Director, Heart & Vascular Institute, Northside Hospital

Doctor of Medicine, Thomas Jefferson University School of Medicine
Surgical Residency, Johns Hopkins University School of Medicine
Fellowship, Vascular Surgery, Mayo Clinic
Fellowship, Advanced Endovascular Surgery, Cleveland Clinic Foundation
Associate Professor of Surgery, Georgia Regents University, University of Georgia School of Medicine

Michael Bednarz, DPM, Ankle & Foot Centers of Georgia

Doctor of Podiatric Medicine, Kent State University School of Podiatric Medicine
Residency, Department of Veteran Affairs Medical Center, Miami
Board Certified, American Board of Foot/Ankle Surgery
Recognized as a “Top Doc” in the WellStar Health System

Patient Engagement

Posted on February 25, 2015March 21, 2015

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Patient Engagement

This week I caught up with our friend, Frank Martin, of The Medical Consultants Group. We talked about how his consulting firm can help a wide range of medical practices, from solo offices to multi-site large groups. Frank talked about the variety of facets of a business that is a medical practice improve operations.

Frank talked about strategies for helping patients related to managing their out-of-pocket obligation, including deductible and co-payment. We also discussed how the ACA has placed new emphasis on patient satisfaction and outcomes relating to how the practice (or isn’t) reimbursed. Another requirement is to provide an electronic portal that allows remote access to patient data BY the patient, coupled with a means to transmit/receive relevant information to/from patients.

We discussed the difference between legacy EMR systems (where software was installed on hardware in the office) and cloud-based applications where data and the software exist on a remote cloud-computing-based architecture. The decision-making capability of the cloud-based applications, coupled with security and rapid access to important data, make modern cloud-based EMR applications the wise choice for practices to convert to today. These modern applications do not require on-site updates of the application on every device. Now, the application is updated where it lives, meaning the user’s experience is not interrupted or inconvenienced.

Frank places great emphasis on helping his client practices become better-running businesses. To that end he works with the group to be able to change processes, or software, business plan, and/or other key facets such as office location and office space leasing to operate more efficiently and profitably.

Special Guest

Frank Martin / Medical Consultants Group

Past recipient, “Volunteer of the Year, Big Brothers Big Sisters”
Published author
Successful entrepreneur in the healthcare sector

The 4 R’s of Gut Health

Posted on February 18, 2015March 21, 2015

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The 4 R’s of Gut Health

Did you know that as much as 80% of your body’s immune capacity comes from your gut? Neither did we. That’s why we’re glad Dr. Ellie Campbell of Campbell Family Medicine came by to blow our minds(again) with information (The 4 R’s of Gut Health) about ways we can dramatically improve our health. She shared how she progressed from her traditional primary care practice to a Direct Pay model to get away from the pressure to see more patients, faster, in order to make a respectable physician’s income. In her office she doesn’t work with insurance companies. Instead, her patients simply pay a monthly membership fee to have access to her 24 hours a day, 7 days per week (sometimes even when on vacation!). She also wanted to be able to provide care to her patients that is based on best practices and evidence rather than being simply limited to what an insurance company will or won’t pay for.

We talked about the fact that, with limited time per patient, prescribing a medication and moving on to the next patient is often the way physicians must conduct their practice. She shared how allergic responses to foods and other environmental sources are behind many of our illnesses (or mirror many illnesses). We also talked about how important what we eat and drink is in our overall health. Dr. Campbell described how food and beverages have such dramatic impacts on our hormone levels and cellular health that we need to look at what we consume much like drugs one can take in a pill.

Dr. Campbell discussed The 4 R’s of Gut Health, going over foods we should eliminate (or at a minimum significantly reduce) from our diets because they cause inflammatory responses in the gut and vascular system (and elsewhere). Things like wheat and plants from the nightshade family such as tomatoes, peppers, potatoes, and eggplant can, for many, create allergic reactions. The challenge is, many of these allergic responses don’t manifest in immediately-recognizable ways. It could be a general feeling of malaise, skin problems, GI problems that can emulate reflux, and more.

The 4 R’s of Gut Health (Explained in greater detail in the interview):

Remove offending substances from the diet.
Replace digestive enzymes, bile salts, immunoglobulins, DAO, and stomach acid where necessary
Re-inoculate the bowel with pre- and probiotics
Repair gastroentestinal mucosa through proper nutritional support

Special Guests:

Dr. Ellie Campbell, DO, Family Practice & Integrative Medicine at Campbell Family Medicine

Doctor of Osteopathic Medicine, Kirksville College of Osteopathic Medicine
Family Medicine Residency, Medical College of Georgia
Board Certified Family Medicine

Correctional Medicine

Posted on February 12, 2015March 21, 2015

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Correctional Medicine

This week we continued our monthly series with Medical Association of Georgia. I sat down with MAG CEO/Executive Director, Donald Palmisano, Jr., and Director of Correctional Medicine, Clyde Maxwell. We talked about how MAG became involved with accreditation of numerous correctional medicine facilities in the state of Georgia.

MAG created its Correctional Medicine Committee in 1975 – following the prison riots in Attica, New York, and just before Georgia State Prison was placed under the jurisdiction of the federal courts for maintaining health care facilities that violated a constitutional prohibition on cruel and unusual punishment. The committee was charged with “studying and recommending ways to improve the delivery of health care in non-federal prisons in Georgia.”

MAG developed standards for evaluating health care in jails and prisons in the state as part of a national initiative; these evolved into the standards that are now used by the National Commission on Correctional Health Care.

In 1982, MAG developed legislation to establish an accreditation program for health care for correctional facilities in Georgia. The state began funding the program in 1983, and MAG subsequently started charging application fees for site accreditation visits.

The Medical College of Georgia assumed responsibility for the health services contract for state prisons in the 1990s.

MAG currently surveys eight county jails and 33 state prisons.

A number of major deficiencies have been corrected at jails and prisons in the state as a result of MAG’s site accreditation visits, including some that were related to…

Physician and nurse licensure
Physician and nurse CPR/ACLS certification
Expired pharmaceuticals
Needle and narcotics security
Nurse call systems
Inmate physicals
Mandatory CQI and infection control meetings

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia

JD Law, Loyola School of Law
Board of Directors, Physician Advocacy Institute
Medical Payment Subcommitte Member, State Board of Workers’ Compensation
Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
Former Director, Government Relations/General Counsel/Director, GAMPAC

Clyde Maxwell, Director of Correctional Medicine of Medical Association of Georgia

Masters, Hospital Administration, Baylor University
Certified Correctional Health Professional
Active duty in the Medical Service Corps for more than 20 years
Designed the “Quick Reaction Hospital” that is used to respond to natural disasters through much of the world

Georgia Prostate Cancer Coalition

Posted on February 11, 2015March 21, 2015

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Georgia Prostate Cancer Coalition

Statistics show that 1 in 6 men will develop prostate cancer in their lifetime. The risk for developing the disease rises with age, being most prevalent among men over the age of 60. However, the risk begins to rise after 40 and prevailing medical thought is men should get at a minimum a PSA test (a blood test that can detect prostate cancer) or if possible a digital rectal exam as well around the age of 40. This will provide an early warning if there are worrisome findings on either study that will afford the patient more options for treatment that are much less traumatic and much more likely to be successful than if the cancer is found at a more advanced stage.

Ken shared his own story about how he was found to have a lump on his prostate on an insurance exam but was not actually recommended to have a biopsy until roughly a year later. At that point it was found he did, in fact, have prostate cancer and that it was a more advanced stage. He ended up having a radical prostatectomy, followed by a recurrence of the cancer. To fight the recurrence of the cancer he underwent radiation therapy and more surgeries. After all of that it was found his PSA levels were rising yet again, prompting his physicians to recommend hormone therapy to slow the progress of the cancer.

After his challenging experiences he began to work to increase awareness of the value of early detection of the disease to help his male counterparts avoid having to undergo similar difficulties. He interfaced with the American Cancer Society to lobby for increased information for men about the risks of prostate cancer and the benefits of early detection. He spent some time as a spokesman for the American Cancer Society. He ultimately co-founded the Georgia Prostate Cancer Coalition, a non-profit organization aimed at creating community awareness as well as raising funds to help provide screening (including some free PSA testing) for men in the community. The organization also collaborates with community businesses to help them provide prostate cancer screening for their male employees.

In speaking with Ken it’s clear that we men can do ourselves a big favor and go to our primary care physician or one of the screening events held by the Georgia Prostate Cancer Coalition to get a PSA test done and ideally, couple that with a digital rectal exam. If our lot in life is to be a prostate cancer patient, we can have a large impact on what our journey is like in dealing with it if we endeavor to catch it early.

Special Guest:

Ken Stevens, Co-founder of Georgia Prostate Cancer Coalition

Mitochondrial Diseases and Hyperbaric Medicine

Posted on January 30, 2015March 21, 2015

Podcast: Download

Mitochondrial Diseases and Hyperbaric Medicine

This week I sat down with experts in the fields of mitochondrial diseases and hyperbaric medicine. Each cell in our body has an “engine” where the nutrition we consume through eating is converted to the energy we need to function and survive. These engines are known as “Mitochondria”. These cellular components use genetic code to function and on occasion there will be problems with the genetic code or with how it is decoded. In these cases, a variety of health problems can reveal themselves, depending on what sort of tissue is made up by these cells in question. These can range from challenges with learning, developmental problems, or disease states such as Alzheimer’s, Parkinson’s, Muscular Dystrophy, and others. Dr. John Shoffner, neurologist and geneticist of Medical Neurogenetics came by with Laura Stanley of the Foundation for Mitochondrial Medicine.

We talked about the research Dr. Shoffner is doing in an effort to find medical therapies that could help patients who are dealing with the variety of disorders caused by mitochondrial dysfunction. We talked about how challenging it can be to identify a health problem(s) that are caused by mitochondrial disease unless a patient’s family is fortunate enough to be seen by a physician familiar with the genetic tests that can be utilized to diagnose them.

As described by the Foundation for Mitochondrial Medicine, “Every aspect of our beings – seeing, breathing, thinking, moving – requires energy. Mitochondria, often called the cells’ “powerhouses,” supply that energy by turning raw materials found in the food we eat and in the air we breathe into a substance called ATP (adenosine triphosphate), which our cells can use as fuel. ATP is, quite simply, vital to life. Without enough ATP, children cannot appropriately develop, grow, learn, move, or even sleep. Adults without enough ATP are unable to sustain brain, muscle, and other vital organ function. A deficit of ATP can also cause invisible damage in some disease states, leading to early failure or dysfunction of organs, or just a chronic state of inefficiency leading to pain, fatigue, changes or limitations in thinking and learning, and increased susceptibility to acquired diseases.”

Laura and Dr. Shoffner shared how they are working to improve awareness of mitochondrial diseases and through research, uncover treatments to halt or at least slow the effects of these diseases. The ultimate goal is to find a way to prevent or reverse these problems.
Dr. Helen Gelly joined us to talk about a recent article she co-authored with Dr. Caroline Fife in Today’s Wound Clinic, called, “Hyperbaric Oxygen Therapy in Wound Care: A Service Under True Pressure“. In the article, Dr. Gelly and Dr. Fife talked about how numerous Medicare Administrative Contractors and Commercial insurers are making changes to indications they are willing to reimburse hyperbaric oxygen therapy for. That means that patients with wounds that place them at risk for amputation or for degraded quality of life due to previous radiation therapy may not be able to receive this evidence-based, effective treatment. We talked about how in some cases where the providers in a given MAC were asked for clinical documentation of their HBO treatments provided, as many as 30% failed to respond. Dr. Gelly shared how this lack of response leads to suspicions of fraud.

It was clear from the Today’s Wound Clinic article and from our conversation that hyperbaric medicine specialists must begin to activate and collaborate to protect this evidence-proven treatment modality. HBO providers need to not only be responsive to requests for data but ACTIVE as it relates to advocating on behalf of educated decisions being made as it relates to the availability of the modality for tomorrow’s patients in need.

Special Guests:

Dr. John Shoffer, MD, CEO of Medical Neurogenics

Former Associate professor of neurology and molecular medicine at Emory University
Former Director of the molecular diagnostics program at Children’s Healthcare of Atlanta
Discovered some of the first gene mutations causing mitochondrial diseases and one of the first genes causing epilepsy
Finalist, 2012 Atlanta Business Chronicle’s Health-Care Heroes Awards

Laura Stanley, of Foundation for Mitochondrial Medicine

IMBA, University of South Carolina Darla Moore School of Business
Former Senior Associate, Korn Ferry
Former Vice President, EzGov
Parent of a child with mitochondrial disease

Dr. Helen Gelly, MD of HyperbaRXs

Doctor of Medicine, Emory University School of Medicine
Internship/Residency: Pediatrics/Emergency Medicine at Emory University Affiliated Hospitals
Board Certified in Emergency Medicine
Fellow of the American College of Emergency Physicians
Fellow of the American College of Certified Wound Specialists
Subspecialty Certified Undersea and Hyperbaric Medicine

Sleep Disorders

Posted on January 23, 2015March 21, 2015

Podcast: Download

Sleep Disorders

It is estimated that as many as 35-40% of Americans experience poor quality of sleep secondary to a variety of sleep disorders. We continued our series with Northside Hospital this week as I sat down with Sleep Medicine specialist, Dr. Robert Albin. We talked about the statistics around sleep disorders and Dr. Albin discussed the serious accidents that have occurred that are thought to be related to sleep deprivation. Some of those include: Three Mile Island, the Exxon Valdez oil spill, Chernobyl, a recent ferry accident in NYC, and more.

Dr. Albin shared how poor quality and low quantities of sleep can lead to heart disease, high blood pressure, poor mental function, depression, and others. We talked about the process sleep specialists go through to determine the source of a person’s sleep disorder. In many cases, the issue is borne out of mental or emotional stress rather than a physical/neurological issue. In those cases the sleep specialist will collaborate with a psychology/psychiatry specialist to help work through those causative issues.

For patients who have a sleep disorder related to brain chemistry/function or an obstructive process such as obstructive sleep apnea, the specialists have specialized tests they can conduct to determine the quality of sleep and determine the cause of the problem. The sleep specialty team at Northside offers a variety of diagnostic studies/treatments and it was the first sleep center of its kind in the city. For our listeners who are themselves or their loved ones are experiencing difficulty sleeping please take a listen to this week’s show and share it! You might help someone you care about.

Special Guest:

Dr. Robert Albin, MD, of North Atlanta Pulmonary and Sleep Specialists

Board Certified, Pulmonology, Internal Medicine, and Sleep Medicine
Doctorate of Medicine, Cum Laude, Emory School of Medicine
Associate Medical Director of NAPS Center for Sleep disorders
Medical Director for Peachtree Road Race and Atlanta Marathon
Past President and current Board member of the Medical Association of Atlanta

Medical Association of Georgia’s 2015 Legislative Priorities

Posted on January 14, 2015March 21, 2015

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Medical Association of Georgia’s 2015 Legislative Priorities

This week I sat down with Dr. Michael Green and Marcus downs of MAG to discuss Medical Association of Georgia’s 2015 legislative priorities. We talked about several issues that have a serious impact on both patient outcomes as well as Georgia physicians’ ability to provide care. Some key areas of focus this year include Physician Autonomy/Scope of Practice relating to physician-extending providers such as optometrists, nurse practitioners, and physician assistants, Third Party Payers, Tort Reform, and Patient Access to Care/Physician Shortage.

Dr. Greene and Marcus shared important information about how the year’s priorities are decided upon from how they’re raised as issues, to how they are elevated through committee to final discussion/determination. They also talked about how valuable it is to have active participation in the process by the members of MAG. We discussed the ways that MAG members are able to contribute input on the process and identification of issues for the association to consider.

Marcus and Dr. Greene also talked about some important legislative issues MAG has been able to provide input on that helped shape or revise laws affecting how physicians provide care within the state of Georgia.

Special Guests:

Dr. Michael Greene, Chairman, Council on Legislation, MAG

Doctorate of Medicine, Mercer University School of Medicine
Former President of MAG, 2003-’04
Board Member, Secure Health Plan of Georgia
Practicing Family Practice Physician, Macon, GA

Marcus Downs, Director of Government Relations, MAG

Recipient, 2012, Outstanding Advocate Award, National Association of School Psychologists
National Institutes of Health Research Fellow, 2000
Former Director, Government Relations/External Coalitions/Research, Georgia Association of Educators

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Start Exercise Fitness Training Without Injury

Start Exercise Fitness Training Without Injury