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Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
In 1982, President Ronald Reagan proclaimed that a week be dedicated to honoring respiratory therapists. This year, Gov. Nikki R. Haley has again proclaimed October 19-25th as Respiratory Care Week. More than 1,800 respiratory therapists are employed across the Palmetto state.
Respiratory therapists are practitioners who have specialized training in cardiopulmonary diseases. They work alongside doctors and nurses and have a wide range of responsibilities. Their responsibilities include diagnostic testing and treatment of respiratory diseases, airway and ventilator management, bronchoscopies, and pulmonary function tests. This is all done in various settings such as acute and intensive care units, outpatient clinical practice, home-health care, pulmonary rehabilitation and public education. It is in these settings that they treat respiratory illnesses such as chronic obstructive pulmonary disease, also known as COPD.
It’s fitting that respiratory therapists are recognized this time of year because it can be an extremely busy time. Many COPD patients find their symptoms become worse when the colder months begin. There are some helpful tips available to combat dyspnea and wheezing, which can be scary and possibly dangerous. Here are a few helpful tips to help you enjoy this time of year.
House getting a little chilly??
Stop! Don’t chop that firewood yet. People with COPD can easily irritate their airways with the harmful particles from a fireplace. Instead, try electrical alternatives to keep your house warm.
Don’t light that cigarette!
First off, as a Respiratory Therapist, I have to say STOP SMOKING! Thousands of toxic chemicals are entering your airways with each puff of a cigarette. Add cold air to that, and it could leave you breathless. If you want to improve your condition and slow the disease process, it’s important that you quit smoking now.
Breathe through your nose and keep it warm!
Breathing through your nose humidifies your air. When it gets colder, try wearing a scarf or other protective gear to warm the air you are breathing in. This will keep the cold air from possibly causing a bronchospasm.
Sweat it to the oldies indoors.
It’s is strongly advised for COPD patients to exercise. Don’t let the colder temperatures keep you from doing so. Keep it indoors! Try stretching, aerobic exercising, strengthening, and breathing exercises such as diaphragmatic breathing and pursed lip breathing.
Inhaler to the rescue!
Talk to your doctor about using a preventive dose of your rescue inhaler before venturing out into the colder temps. Make sure you always have it with you. You never know when you might need it.
Pedestrian safety. When you hear these words, what comes to your mind? Perhaps you’re like me, and you remember your parents telling you to look both ways before crossing the street, but pedestrian safety has evolved to become so much more than just remembering to look before crossing. Now more than ever, rates of traffic related injuries are highest for children ages 5–19 years. In fact, according to Safe Kids Worldwide, more than 22,000 kids were non-fatally injured as pedestrians in 2012. The rise in child pedestrian injury is due to many reasons, including distracted driving and walking, lack of infrastructure, and lack of pedestrian safety skills and knowledge.
As caregivers and stewards for children, we are responsible for teaching and equipping them with certain life skills, including pedestrian safety. Whether your child walks to school or not, at some point, they will be a pedestrian. Statistics have shown that developmentally, kids cannot judge speed and distance of approaching vehicles until age 10.
Here are some pedestrian safety tips to share and practice with your child:
Through funding from the Centers for Disease Control’s Community Transformation Grant, Safe Kids Upstate has enhanced the pedestrian safety resources offered to our community. An interactive model safety town called Pedville has been created to teach elementary school students about pedestrian safety. If you’re interested in scheduling a pedestrian safety presentation for your community or school group, please contact our office (864-454-1100) for more information.
Remember, children model their behavior from observation, so please be a pedestrian safety role model!
Today is South Carolina Mental Health Awareness Day. While observing this day, I’m going to reflect on the stories that mentally patients and their caregivers have shared with me. Their stories all too frequently include frustration and shame when they interface with health systems.
They talk about a lack of coordination of care, their inability to access care and perceived and actual prejudices at the hands of healthcare providers
According to the World Health Organization and the World Economic Forum, mental illness represents the largest economic burden of any other health issue in the world, costing $2.5 trillion in 2010. At the current rate, this burden is projected to cost $6 trillion by 2030. Two-thirds of these costs attributed to disability and loss of work. In the United States, one in four adults will experience a mental health issue at some point in their life. One in 10 children will experience a mental health issue during their childhood.
Mental health issues are more common than cancer, diabetes or heart disease. But as surprising as these numbers may appear, the following struck me the most, of the 450 million people worldwide who suffer from mental illness; the majority (60 percent) do not receive any form of care, with 90 percent of people in developing countries receiving no form of care. In the United States, only one in five individuals affected with a mental health issue seeks treatment. So, why do so few of these individuals seek treatment, treatment that has been proven effective? While thinking about this question, it occurred to me that the patients already answered it for me—lack of access, stigma and shame.
GHS is taking a leading role in raising awareness about mental illness, not only through its services, but by partnering with mental health agencies across the community. GHS supports agencies including the National Alliance on Mental Illness Greenville, Mental Health America of Greenville County, Gateway House and others that advocate and support individuals suffering from mental illness. Support is provided to caregivers in those families, too.
GHS has also devoted substantial resources to outpatient services, its Psychiatry Residency Program, research development, services to the Greenville Memorial Hospital Emergency Department and other areas across the system. We’re making a difference in the lives of people suffering from mental illness. But, what else can be done?
All of us, especially healthcare providers, must begin to address our own individual biases toward mental illness, learn more about it and teach others. We must lead by example and treat people with mental illness with respect and dignity. We also have a responsibility to watch our language by avoiding derogatory terms like “crazy,” “psycho,” “loony,” etc.
As a healthcare delivery system, we must create a new social model where the word “health” is recognized to include mental and physical health. Both should be viewed equally. There should be no lingering shame regarding mental disorders.
This will require an integrated medical-behavioral care delivery where treatment of both physical health conditions and mental health conditions can be managed in a comprehensive and coordinated way. All health systems should strive to have a patient’s physical and mental health practitioners working together in active, regular communication over the entire continuum of the patient’s total health. This coordination will not only improve the access to quality total health care but also contribute to eliminating the social stigma that surrounds mental disorders.
Having a mammogram ranks on the happiness scale somewhere between getting a root canal and taking the car in for repair. The time, discomfort and uncertainty as to what will be the result are sources of stress for every woman for every mammogram. Hopefully nothing is wrong and the mammogram will be negative. When there is an abnormality that requires a return visit for more breast images and testing, the stress is even greater. The ultimate finding may be a breast cancer for which surgery and other treatments will be required. Or, after more tests, they may decide that the mammogram does not require a biopsy and that nothing is wrong. In medical language, this is called a “false positive” mammogram.
A study conducted by the American College of Radiology Imaging Network that addresses the fear and anxiety that go along with having a “false negative” mammogram was published in the Journal of the American Medical Association in April. The 1,028 participants were women receiving mammograms at 22 different centers, who agreed to an interview over the telephone and a follow up interview a year later. The 594 women whose mammogram was negative were compared to 488 women whose mammogram was false positive. The false positive mammogram group reported “at least moderate anxiety” 50.6% of the time, compared to 15.7% of the time for the negative mammogram group. I consider the fact that half of the women experiencing a false positive mammogram had at least moderate to severe anxiety to be huge. When interviewed a year later, the anxiety was much less but still there.
What can be done to decrease the fear and anxiety associated with mammograms in general and false positive mammograms in particular? For one thing, improved communication can help. Doctors need to explain that mammograms are designed to be extra sensitive and have a certain number of expected false positives in order to detect as many early and small breast cancers as possible. Second, younger women in their thirties and forties need to know that the breast tissue is more dense and the likelihood of a false positive mammogram is greater. Third, the likelihood of a false positive mammogram is reduced to half when the radiologist has access to mammograms from previous years.
When I brought this up to Dr. Brian McKinley, medical director of the GHS Breast Health Center, he agreed that doctors should communicate better. He did, however, have a message for women getting mammograms. He said, “A women should feel free to talk to her doctor about her specific concerns so that the physician can offer more personal, targeted bits of information and emotional support. Too often, we doctors assume we know what is causing our patients to worry. Don’t let that happen! Don’t be afraid to engage your doctor and tell him or her what’s really worrying you. For the health of your breasts, get it off your chest!”
What do you think? How stressful is a mammogram? What has been your experience? How well do doctors and nurse practitioners communicate information about mammograms that might reduce the stress? I invite your comments. For more information about mammograms and breast health, call the Breast Health Center at (864) 454-8282.
Today (Sept. 29) is World Heart Day. World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
Greenville Health System would like to spread the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
As a cardiologist, I would like to remind you of several ways GHS supports the theme of World Heart Day, which is to create heart-healthy environments where you live, work and play.
• How you live – Remember to choose healthy food options, increase physical activity, and say NO to tobacco. GHS offers a free smoking cessation support group that meets every Tuesday from 6:30 p.m. to 8 p.m. on the Patewood Medical Campus. For more information, call 455-WELL (9355).
• Where you work – Support heart health education. Many businesses offer heart education, so be sure to take advantage of these classes or invite an expert to speak on keeping your heart healthy. Walk at lunch, park farther away from the front entrance and take the steps.
• How you play – Walk, run or ride the GHS Swamp Rabbit Trail, join the YMCA or simply choose leisure activities that involve movement!
The environments where we live, work and play can have a huge effect on our ability to make the right choices for our heart health. A heart-healthy environment is a space where people have the opportunity to make the right choices for their health.
For more information on events that support your heart health visit ghs.org/healthevents.
Lymphedema occurs due to a disruption in the lymphatic system. Lymphedema can be primary or secondary. Primary lymphedema is caused by malformations of lymph vessels present from birth. Secondary lymphedema is swelling that occurs when the lymphatic system has been disrupted due to surgery, radiation, infection, disease or trauma and cannot adequately move lymphatic fluid and proteins.
The incidence of lymphedema is related to the extent of treatment intervention. Fortunately, the risk of developing lymphedema has been progressively declining as cancer treatments continue to become better targeted. It is important to realize that the risk of developing lymphedema is relatively low. For instance, patients who have axillary lymph node dissection have a lifetime risk of 15-25%. Patients whose surgery is limited to sentinel node techniques have a risk of about 6%.
Lymphedema normally occurs during or after treatment, but it can develop at any time in a person’s life; therefore, it is best to be aware of the signs and symptoms of early lymphedema.
Signs/symptoms of lymphedema:
While lymphedema is not curable, it is treatable. When managing lymphedema, compression is your best friend. During treatment, a lymphedema specialist may use different bandaging techniques or compression garments to supplement the lymphatic system in moving fluid out of swollen tissue. Also, specially trained physical therapists and massage therapists can perform a hands-on treatment called manual lymph drainage (MLD). This helps jump start your lymph system and re-route fluid away from problem areas.
While compression and MLD are paramount, it is also important to protect your skin and be cognizant of situations that increase lymphatic load, or stress on the lymph system. This means avoiding sun burn, bug bites, restrictive clothing and jewelry, extreme heat or cold, or any activity that compromises the integrity of your skin. If you notice some of the signs of lymphedema, notify your doctor. He/she can then write a referral to a physical therapist certified in lymphedema management.
GHS is progressive in its collaborative, patient-centered care model. As a result, a certified lymphedema therapist is embedded in the Center for Innovative Oncology and Survivorship (CIOS). If a patient develops lymphedema, they can be referred to a lymphedema specialist who is a part of the survivorship team at CIOS. This allows patients to be treated by a unified healthcare team.
Research assistant Alex Christ contributed to this blog.
Currently, almost one third of children and adolescents in the United States are either overweight or obese.
Obesity comorbidities include type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, stroke, sleep apnea, gall bladder disease, and certain cancers. Additionally, specific pediatric comorbidities include endocrine, orthopedic, and pulmonary disorders. There are also significant social and psychological concerns.
The etiology of obesity is multifactorial. Current studies link both genetics and environment to obesity. Worsening environmental factors include an increase in sugar-containing foods and beverages, an increase in portion sizes, more availability of fast foods, a diminished family presence at meals, decreased physical activity, and an increase in computer-oriented activity.
Both pediatricians and parents need to address this growing problem. Here are five ways we can encourage families to improve weight control in kids include:
1. Change behaviors. Parents should help obese children self-monitor their intake. A good way to start is to keep a food log. This allows children to identify certain stimuli and habits. Families should then set goals on what to change on how to measure improvement. During this process, parents should use plenty of positive reinforcement for the constructive steps kids make.
2. Family involvement. Having an obese parent increases the risk of child obesity by 2 to 3 fold. Parent should model behaviors by themselves maintaining good eating habits. Parents should involve children in both choosing and making foods. This creates an environment of ownership, which encourages children to feel more invested and rewarded with positive changes.
3. Assess comorbidities. Scare tactics are not recommended as an avenue to create change. However, in adolescence, it is acceptable to discuss how weight affects sleep, orthopedics, breathing or their endocrine system.
4. Increase activity. This should happen in two ways. Children need more exercise and activity, and they also need less television and media time. The AAP recommends no more than two hours of media time a day. Children should be encouraged to join organized activities and spend time participating in spontaneous playtime.
5. Seek professional help. An important step in creating change is often seeking the help of a third party. This should be in the form of a nutritionist, pediatrician or a medically validated weight-loss program. Greenville Health System runs a great program called New Impact. New Impact is a year-long physician led program that includes time spent with a nutritionist, exercise therapist, in support groups, and also offers a family membership to the YMCA. Since its creation three years ago, it has shown great success for hundreds of children. Recently, one adolescent boasted a loss of 120 pounds.
Obesity is a national epidemic. It is also a problem that starts in childhood. Of those children that are severely obese in kindergarten, 70% are still obese in middle school. Of those teens that are obese, most (although not all) continue on to become obese adults. It is imperative that both medical and professionals work diligently to combat obesity throughout childhood and adolescence.
A recent announcement from the University of Arizona describes new scientific evidence that curcumin, an ingredient of the spice turmeric, has cancer-fighting properties.
Turmeric is a plant that grows in India and in other tropical climates. It is related to the ginger plant. Like ginger, the root is the source of a popular spice used in many foods. Turmeric is a bright yellow spice called “Indian saffron” and is used in the making of curry. The active ingredient of turmeric is a water-soluble curcuminoid substance called curcumin.
Curcumin is available as a supplement and has been found to have a number of properties, including decreasing inflammation. Indeed, curcumin has been shown to be as effective as Motrin (ibuprofen) for the relief of arthritis knee pain. In a study of 107 participants, half received 800 mg per day of ibuprofen and half received 2,000 mg per day of curcumin. Pain relief was the same for both groups of participants.
Studies of curcumin have also shown it to be helpful in irritable bowel syndrome and major depression. Despite its virtues and remarkably few side effects, curcumin is still a drug. It can affect a group of important liver enzymes called cytochrome P450. If you decide to take it, you should tell your healthcare provider and make sure that it will not interfere with other medicines you are taking.
Curcumin has been studied as a drug to take along with chemotherapy in certain cancers, as it appears to have some anti-cancer effects. Now researchers at the University of Arizona have identified how it might work against cancer cells at the level of the chemistry inside the cells. It turns out that an over-activated chemical called cortactin is important to the growth of colon cancer cells.
The researchers at the University of Arizona treated colon cancer cells in the laboratory with a solution of curcumin. They discovered that the curcumin “de-activated” the cortactin such that the cancer cells were unable to move and spread to other parts of the body. I acknowledge that this is not a cure for cancer or even a new treatment. It is, however, interesting that there is a plausible mechanism for how the curcumin might help inhibit cancer. This encourages me as I add turmeric as a spice to my food or take curcumin capsules for my arthritis.
Bottom line, curcumin is a known anti-inflammatory substance that can relieve arthritis pain and may have anti-cancer properties. It is reasonable to take curcumin at 2000 mg daily as a substitute for an NSAID drug like ibuprofen or naproxen. For more information about curcumin or other herbs and natural medicines, I recommend AboutHerbs.com, which is sponsored by the Memorial Sloan Kettering Cancer Center. If you would like to learn more about how diet and nutrition can help your health, call us at (864) 455-1346 or visit our website at ghs.org/cios. You can schedule an integrative oncology appointment for a personal consultation.
Ninety percent of the time, the genes that you inherit from your parents do not play a clear, major role in your risk of breast cancer. On the other hand, about 10 percent of the time, there are inherited genetic mutations that contribute to breast cancer risk. The most widely known of these mutations were discovered in the 1990’s in the BRCA1 and BRCA2 genes. The name given to cancer risks associated with BRCA1 and BRCA2 is Hereditary Breast and Ovarian Cancer (HBOC) Syndrome. These mutations are found in the DNA of every cell in our body and are called germline mutations. Since then, genetic tests have become available to determine if you carry one of these gene mutations that may increase the cumulative lifetime risk of breast cancer to as much as 85%.
While BRCA1 and BRCA2 account for many cases of hereditary breast and ovarian cancer, there are other gene mutations that increase breast cancer risk, including p53 (Li-Fraumeni Syndrome), PTEN (Cowden Syndrome), and CHD1 (Hereditary Diffuse Gastric Cancer Syndrome). Who should get tested for genetic mutations associated with breast cancer? Ideally, the testing is done for women who have had breast cancer, especially with onset less that age 50, more than one breast cancer, and close family members with breast cancer at a young age, ovarian cancer, or pancreatic cancer. But there is more to it than that.
Over the past 20 years, the field of cancer genetics has grown dramatically, making the answer to the question more complicated. Now there are specially trained genetic counselors who meet with a person, gather information about the person and their family history, and assess their risk for hereditary breast cancer and other hereditary cancers. The genetic counselor explains in detail the pros and cons of genetic testing and the person then decides whether to go ahead with tests of blood (or sometimes only saliva) to see if a high-risk genetic mutation is present. Genetic counselors carefully help the person understand their unique personal and family situation and assist them in making the right decision for them and their family regarding genetic testing. If a high-risk mutation is found, the person (and interested family members) can meet with a physician who has special expertise in cancer genetics to develop a personalized plan to help reduce the risk of future cancers and increase the chance of finding cancer in an early, treatable stage
Sometimes the testing is not conclusive. That is, a woman who has had breast cancer may test negative for mutations in genes we know about today that are associated with breast cancer, such as BRCA 1 and 2, p53, PTEN, etc. There remains the possibility, however, that there is a yet undiscovered inherited genetic mutation that caused the woman’s cancer. Some women with a history of breast cancer who were tested for BRCA 1 and 2 in the 1990’s have come back in the 2000’s to receive additional testing for high-risk mutations that have been discovered since then.
Today, there is a new wrinkle to the story. Research published in the New England Journal of Medicine on August 7 describes a newly characterized gene associated with an increased risk for breast cancer. The gene in question is called PALB2. If a woman carries a single mutation in one of the two copies in her germline DNA, the cumulative risk of breast cancer by 70 years of age is estimated to be 35%. This is big news for women with a history of breast cancer and their families. For some who previously tested negative for mutations in BRCA1/2, testing now for mutations in the PALB2 or other genes might provide an explanation for their cancer and point to a higher risk for family members. Knowledge of such a mutation might help the person or family members make decisions about surgery or medications to reduce the risk of a future breast cancer.
It is impossible to explain genetic risk for breast cancer in one brief article. The GHS Center for Integrative Oncology and Survivorship has a staff of experienced genetic counselors that provide genetic counseling. The medical director, Dr. Carla Jorgensen, is a medical oncologist with special expertise in cancer genetics. If you have questions or would like a consultation, call the Center for Integrative Oncology and Survivorship at 455-1346.
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