Wednesday, September 28, 2016
Black Plum & Baby Spinach Salad
By: Chef John Hall with Post Office Pies
• 1 pint plum & cucumber relish
• 1 pint baby spinach
• 1 tbsp rough chopped parsley
• 1 tbsp toasted almonds
• Champagne-citrus vinaigrette to taste
• Salt & pepper to taste
1. Toss plum relish with vinaigrette, parsley, and salt & pepper
2. Plate relish in a large ring on center of plate
3. LIGHTLY toss spinach with vinaigrette, almonds, and salt & pepper
4. Place spinach in center of relish
Plum & Cucumber relish
• 10 quarts large dice black plums
• 4 red onions small dice
• 10 large cucumbers, de-seeded and medium dice
1. Mix thoroughly and store
• 1 ½ qt champagne vinegar
• 1 qt fresh squeezed orange juice
• 1 pt fresh squeezed grapefruit juice
• 2 shallot ( or sub red onion ) fine diced
• 5 sprigs fresh thyme, picked and chopped
• 1 cup sugar
• 2 qt olive oil blend
1) Allow shallots and thyme to macerate in vinegar for a minimum of 1 hour
2) Combine all ingredient and mix thoroughly
Monday, September 26, 2016
By Dr. Richard Vest, cardiologist at Birmingham Heart Clinic
What is atrial fibrillation?
Atrial fibrillation (AF) is the most common type of arrhythmia or irregular heartbeat. AF occurs if rapid, disorganized electrical signals cause the heart's two upper chambers—called the atria—to contract very fast and irregularly. As a result, the heart's upper and lower chambers don't work together as they should. When atria do not contract effectively, the blood may pool and/or clot. If a blood clot becomes lodged in an artery in the brain, a stroke may occur.
What are the risk factors?
Age, history of heart disease, high blood pressure, obesity, and other chronic conditions are all risk factors of atrial fibrillation.
What are the symptoms?
People with AF may not feel any symptoms. However, even when AF isn't noticed, it can increase the risk of stroke. In some people, AF can cause chest pain or heart failure, especially if the heart rhythm is very rapid.
Other symptoms may include heart palpitations, fatigue, lightheadedness, dizziness, shortness of breath, and confusion.
If you have any symptoms of atrial fibrillation, make an appointment with your cardiologist. An electrocardiogram or holter monitor may be ordered to determine if your symptoms are related to atrial fibrillation or another heart rhythm disorder.
What tests are used to diagnose atrial fibrillation?
The electrical activity of the heart is measured by an electrocardiogram (ECG or EKG). By placing electrodes at specific locations on the body (chest, arms, and legs), a graphic representation, or tracing, of the electrical activity can be obtained. Changes in an ECG from the normal tracing can indicate arrhythmias, as well as other heart-related conditions.
Another option to diagnose AF is to use a holter monitor. This portable ECG device is carried in a patient’s pocket or worn on a belt or shoulder strap. It records your heart's activity for 24 hours or longer, which provides your doctor with a prolonged look at your heart rhythms.
How to treat atrial fibrillation?
Generally, the treatment goals for atrial fibrillation are to reset the rhythm or control the heart rate and prevent blood clots. For most patients with atrial fibrillation, slowing the heart rate with medication is the most appropriate treatment to regain normal heart rhythm. Electrical cardioversion can also be used.
Wednesday, September 14, 2016
By: James Hajime Isobe, MD
Many of us experience leg discomfort, especially at the end of the day. Heaviness, aching, swelling throbbing, itching, cramping, and restless leg symptoms such as inability to rest at night due to a feeling of something crawling on our legs, and having to get out of bed to “walk off the heebie-jeebies” in our legs are the common complaints of chronic venous insufficiency. This malady is seen in 20-30% of the population in the Western world. About 11 million men and 22 million women ranging from 40-80 years suffer from this problem and are unaware of the underlying disease process. This is because of the mistaken understanding that there is no vein disease present unless the legs are involved with numerous small spider-like veins or with obvious ropey varicose veins. Most of us tend to tolerate the symptoms because they develop slowly over a number of years.
There are several risk factors that make one prone to having venous disease. Heredity is the most common one, and females are twice as likely to have an early onset of symptoms following multiple pregnancies. Obesity, prolonged sitting or standing, and aging tend to contribute to worsening of vein problems. There is no way to prevent venous disease, but conservative treatment using compression hose, preferably 20-30 mm Hg, elevation of the legs in the morning and afternoon, and active exercise help reduce the symptoms.
When one has the symptoms described above, one of the best evaluation of the legs is through an ultrasound study of the leg veins which is done at vein centers such as the Brookwood Baptist Vein Center. This study is painless and takes about a half hour to complete as an outpatient visit. Veins bring back blood from the legs to the heart, and they have valves that prevent blood from falling back down. The ultrasound examination looks at the enlargement of the veins, and if there is any leakage of the vein valves. A consultation with board certified physicians at Brookwood Baptist Vein Center to discuss the findings and treatment process follows.
The modern day treatment of chronic venous insufficiency, a term signifying advanced venous disease, is performed as an office-based procedure using local anesthesia. The major superficial veins that have leaky valves are sealed off with a heat probe, and the ropy varicose veins are removed with microphlebectomy, which removes the veins with a special hook. These procedures are now covered by most insurance carriers. A compression dressing is then applied, and the patient walks out of the office and is active the rest of the day. Treatment of telangiectasia such as spider veins and of reticular veins is deemed cosmetic and is not covered by insurance companies. Sclerotherapy is a method to treat spider veins, which involves injecting a solution into these small veins to shut them down. This is also an outpatient procedure, and is offered as a cash only procedure. Follow-up studies are performed at two weeks and six months post procedure.
Monday, September 12, 2016
By: Tamara Oechslin, OD, PhD
UAB Eye Care Pediatric Optometry Services
Children have returned to school again, and, as we make sure that they have all their supplies for the year, we also need to make sure that they are prepared to meet their necessary visual demands in order to perform their best academically. Approximately 80% of learning is visual, and children spend the majority of their day reading and doing near/desk work that should involve clear, comfortable vision. Unfortunately, more than 25% of students have a vision disorder that interferes with their ability to learn, and this number increases to 70% in students with individual education plans. Schools provide vision screenings to their students, yet these screenings do not replace comprehensive eye exams that can provide a formal diagnosis and treatment for vision problems that can be subtle and not obvious to the child or parents.
Vision screenings requiring a child to read letters on a chart are designed to detect myopia and identify children who may need glasses to see far away. Identifying these students is certainly important to insure he/she can see across the classroom. We know that myopia typically develops in the early to middle school-age years (average age = 10.4 (±1.8) years) and progresses throughout the teens. Because its progression can reduce vision by as much as three or four lines on the visual acuity chart each year, some children grow quickly enough that they can have significant changes in their glasses prescriptions within a school year. This myopic progression is also accompanied by an increase in axial length of the eye which should be monitored with a dilated eye exam to assess the integrity and health of the retina during this active growth phase. As healthcare providers, it is important that we educate and remind parents that their children need to be followed regularly by an eye care professional to monitor not only for changes in their glasses prescription but also the health of their eye.
Farsighted children, or those with hyperopia, usually see well for distance vision screenings and, therefore, may not be referred for additional testing. To see clearly, hyperopic children must recruit extra focusing effort (accommodation) to see clearly at all distances but especially for near work like reading. The added effort is likely the reason that farsightedness has been associated with poor reading ability[7, 8] and reduced academic performance in school-aged children. Current research indicates a relationship between moderate amounts of hyperopia in young children who do not have glasses and poor early literacy outcomes, especially in the presence of poorer near acuity or reduced depth perception. Most screenings do not test near acuity and, even if a child can pass a brief near test, he or she may not have the stamina to maintain the appropriate focusing ability throughout a full school day.  These children may experience headaches, eyestrain, or general inattentiveness by the end of the day.[7, 12] A comprehensive eye exam includes measures of a child’s near focusing ability and an accurate measure of his or her refractive prescription after pupil dilation. This is important because the dilation drops used by the eye care professional relax the child’s accommodation, and this measure is considered the gold standard for precise quantification of hyperopia.
Because vision problems can elicit discomfort with extended near work, we should think of good vision as more than simply reading 20/20 on a chart across the room. While most people become presbyopic and need bifocals around the age of forty, this process begins during the middle school years. Children who previously “grew out” of the need for glasses, may need to revisit reading glasses as this is also an age when reading and homework demands increase at school. Subtle problems with convergence, or the two eyes not working well together for near work, occur in up to 13% of school-age children  without presenting as a cosmetic eye turn. These children commonly report eyes that hurt/feel sore, frequent headaches, intermittent blur, and losing their place when reading or doing close work. Comprehensive eye exams include measures of focusing and eye teaming ability to investigate how well a child’s two eyes function together to maintain comfortable binocular vision for extended near work.
In the primary care setting, well-designed vision screenings play an important role in determining which children may need referrals for potential glasses. Additionally, children presenting with problems with reading or academic performance, complaints of headaches or eyestrain when doing schoolwork, or other suspicion of a vision problem by parents or teachers warrant a referral for a comprehensive eye exam by an eye care professional. While there are many sources for academic difficulty, ruling out a vision problem should be a top priority. Under the ACA, major medical health plans must provide for vision coverage for children. As health care providers, we must educate our young patients and their parents on the importance of comprehensive vision care and encourage them to use these valuable benefits.
1. Walline, J., Vision Problems of Children with Individualized Education Programs. J Behav Optom, 2012. 23(4): p. 87-93.
2. Childhood Vision Screening, American Academy of Optometry, Editor. 2016: Orlando, FL.
3. Jones-Jordan, L.A., et al., Time outdoors, visual activity, and myopia progression in juvenile-onset myopes. Invest Ophthalmol Vis Sci, 2012. 53(11): p. 7169-75.
4. Goss, D.A., Cessation age of childhood myopia progression. Ophthalmic Physiol Opt, 1987. 7(2): p. 195-7.
5. Mutti, D.O., et al., Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci, 2007. 48(6): p. 2510-9.
6. Moore, B., Optometric Clinical Practice Guide: Care of the Patient with Hyperopia, American Optometric Association, Editor. 2008: St. Louis, MO.
7. Simons, K., Hyperopia, accommodative dysfunction and reading. Binocul Vis Strabismus Q, 2004. 19(2): p. 69-70.
8. Grisham, D., M. Powers, and P. Riles, Visual skills of poor readers in high school. Optometry, 2007. 78(10): p. 542-9.
9. Williams, W.R., et al., Hyperopia and educational attainment in a primary school cohort. Arch Dis Child, 2005. 90(2): p. 150-3.
10. Vision In Preschoolers -- Hyperopia In Preschoolers Study Group, Uncorrected Hyperopia and Preschool Early Literacy: Results of the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study. Ophthalmology, 2016.
11. McBrien, N.A. and M. Millodot, The effect of refractive error on the accommodative response gradient. Ophthalmic Physiol Opt, 1986. 6(2): p. 145-9.
12. Chase, C., et al., Visual discomfort and objective measures of static accommodation. Optom Vis Sci, 2009. 86(7): p. 883-9.
13. Anderson, H.A., et al., Age-related changes in accommodative dynamics from preschool to adulthood. Invest Ophthalmol Vis Sci, 2010. 51(1): p. 614-22.
14. Rouse, M.W., et al., Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group. Optom Vis Sci, 1999. 76(9): p. 643-9. 15. Rouse, M., et al., Validity of the convergence insufficiency symptom survey: a confirmatory study. Optom Vis Sci, 2009. 86(4): p. 357-63.
Dr. Tamara Oechslin is an Assistant Professor at UAB School of Optometry specializing in clinical care and research of pediatric, binocular, and developmental vision disorders.
Thursday, September 8, 2016
Rammer Jammer Yellow Hammer
TUSCALOOSA – Jimmy Robinson, M.D., was the first Primary Care sports medicine-trained physician in the State of Alabama. One could say he’s seen a thing or two over the years.
Originally from New Orleans and a graduate of LSU, when Dr. Robinson first came to The University of Alabama, he faced a tough crowd but quickly found a new home.
“I came to The University of Alabama on a rotation as a medical student and realized just how strong the family medicine program was here. I knew right then this was where I wanted to come. It was an ideal family practice program. It had a little bit of everything I wanted from pediatrics to surgery…just everything. There were students from all over the country here for the same reason I was, and we all took advantage of that. We learned from each other. The things we can learn from each other, from other programs and places, is really amazing and should never be discounted,” Dr. Robinson said.
Dr. Robinson said he feels he was truly in on the infancy of sports medicine as a growing field as his work with the Crimson Tide continued in those early days. During his second year of his residency, he chose the one elective that changed the course of his career.
“There was one elective in sports medicine under Dr. Bill deShazo, who our sports medicine clinic is now named for here on campus. Before Dr. deShazo started with the Family Practice program he was with Student Health where he started taking care of the teams under Coach Bear Bryant. I spent a whole month on this sports medicine rotation without hardly ever seeing Dr. deShazo!” Dr. Robinson laughed. “Instead, I did everything the athletic trainers needed me to do. Every day during August practice, doing everything I could. Wrapping sprains, doing x-rays, whatever was needed, I did it. There were no other residents who wanted to do sports medicine, so when my rotation was up, I just kept going back, still doing whatever was needed, even if it was just evaluating a player who had a cold. I was happy with that.”
Eventually, the time came when Dr. Robinson decided to further his training in Sports Medicine by doing a Fellowship in Primary Care Sports Medicine. It wasn’t easy to find a program that would now meet the medical standards set at the Capstone. When he finally found that program, it was at The Cleveland Clinic where he trained with “two of the best sports medicine physicians in the country. We took care of the Cavaliers, Browns, Indians, and the high school football and hockey teams in the area. It was a lot of fun, and I never thought I would be working with hockey players, especially. Working with players that eventually went on to play professionally was very special to me. Keeping them healthy and watching them get to that level gives you a great sense of a job well done on your part as their physician.”
Still, sports medicine was not yet considered a true medical specialty and had a long way to go to get there. But, the best was yet to come.
“When I got the call to come back to Tuscaloosa, I think I accepted in about a nanosecond!” Dr. Robinson laughed. He was heading back to a city and campus he had fallen in love with years ago. He opened his practice in August 1989, and he knew that he had big shoes to fill. All eyes would be on him and his staff to take care of more than 500 student-athletes carrying on the Crimson Tide athletic tradition. But, Dr. Robinson had much more planned for his team.
As the medical director for all the athletic trainers at DCH Regional Medical Center, located just on the edge of the campus, Dr. Robinson and about 14 athletic trainers cover the city and county schools and hold injury clinics on Saturday mornings. Yes…that’s game day morning.
But, when the Tide rolls, everything else fades away.
“You’re so focused on the game and the players that everything just stops,” Dr. Robinson said. “The first thing I teach our Fellows and residents is that you are a physician first and a fan last. So all your decisions and all your actions have to be as a physician first, not as a fan…and that’s regardless whether it’s the first game, a homecoming game, or the National Championship game. It doesn’t matter. You cannot be a fan and take care of these players at the same time. You have to focus on the game, but not to watch the plays. You’re watching for injuries as they happen. There have been many times when an injury happened, and I was on the field before the play was called down. When you’re watching the plays for injuries as they happen, you’ll know if the player has a severe head or spinal injury, and you’ll know more about what to expect when you get to him. When you can see how the player hits the ground, you can anticipate what’s going to happen next. Believe me, I drive my wife crazy because I can’t just watch a game because I’m watching that game to make sure the players are safe.”
It’s easy to say that in Dr. Robinson’s 30-year career in sports medicine, he’s seen some horrible injuries. From fractures, concussions, paralysis, even Tyrone Prothro’s broken ankle in 2005, but nothing compares to the devastation of Wednesday, April 27, 2011. Known as the 2011 Super Outbreak, the Tuscaloosa–Birmingham tornado was a large and violent EF4 multiple-vortex tornado that devastated portions of Tuscaloosa and Birmingham during the late afternoon and early evening hours. The Tuscaloosa–Birmingham tornado was one of the 362 tornadoes that day, which was the largest tornado outbreak in United States history. The tornado reached a maximum path width of 1.5 miles during its track through Tuscaloosa, and attained estimated winds of 190 mph shortly after passing through the city.
Dr. Robinson was there. He was just across the river in Northport and had closed his practice at noon so his staff could get their children out of school. When he got home, his power was out. Because he was across the river from the direct path of the monster twister, he was unaware of the true devastation it caused…until he received a phone call.
“A friend of mine from Birmingham called and said that DCH had a direct hit from the tornado. I got across the river to DCH as fast as I could, but I was coming from the opposite direction from where the real damage was to the city. I couldn’t see just how bad it really was. When I got to DCH, the hospital wasn’t that bad, but the city was in trouble, as we later found out and could see from the news coverage,” Dr. Robinson said. “For a good long time, I was the only physician trained in musculoskeletal medicine working in the ER. We had everything from cuts and scrapes to amputations and surgeries to come through that day. It was a hard day.”
That day, one of the Crimson Tide players, long snapper Carson Tinker, was a patient in the ER, and he kept asking Dr. Robinson to find his girlfriend. Tinker and his girlfriend had huddled together at Tinker’s home during the storm. Dr. Robinson searched the hospital’s triage areas to no avail well into the night. He wasn’t the one that had to tell Tinker that she was one of the storm’s 52 casualties, but he was there for him.
“Of course, I feel a kinship with these players,” Dr. Robinson said. “They’re my patients first, always first, but a friendship develops, too. That’s something special.”
Wednesday, September 7, 2016
By: Mark DeGuenther, M.D.
with Urology Centers of Alabama
For a urology group, September is an important month. September is Prostate Cancer Awareness Month. Prostate cancer is the most common visceral cancer in men, with 1 in 7 men being affected in their lifetime. It is the second leading cause of cancer death in American men. Reports continue to show a decline in early prostate cancer diagnosis, but is this a good thing? There has been a steady decline in early diagnosis since 2011, when the U.S. Preventive Services Task Force recommended against routine PSA (prostate specific antigen) testing. Their recommendation, in my opinion, was based on both poor science (mainly a study period too short to show benefit from screening and data now suggests there is benefit) and the desire to save some money in the short term.
Why would a decline in diagnosis be a bad thing? Experts throughout the specialty are concerned that more men will develop fatal prostate cancer in the future. Nationally, more and more men are presenting with advanced and non-curable disease than at any time in the last 15 years. Presumably, these cases could have been caught earlier and treated effectively if the men had been screened. In addition to men losing their chance of being cured, treating advanced cancer is much more costly than curing it early.
At Urology Centers of Alabama, we have remained steadfast in our support and belief of PSA testing for men with greater than a 10-year life expectancy. Currently, there is an ongoing British trial looking into the benefits of PSA testing. Our hope is that the results of that trial will cause a rebound in appropriate PSA testing.
Wednesday, August 31, 2016
By: Matthew L. Carnes, MD
Birmingham Gastroenterology Associates
Gastrointestinal malignancies refer to cancer of the esophagus, stomach, biliary system, pancreas, small and large intestine (colon) and rectum. An estimated 250,000+ people will be diagnosed with a type of gastrointestinal related malignancy in the USA in 2016. While prevention of cancer is the most important treatment, early detection allows for better treatment options and increased survival from this dreadful disease.
In the 1980’s endoscopic ultrasound (EUS) became a novel technology in the armamentarium of gastrointestinal endoscopy to assist in detection of certain malignancies. Since its introduction, more advanced instruments have been developed and its uses has increased exponentially. During the last decade, EUS has also become increasingly available making this procedure more convenient to patients.
The EUS scope is comprised of a normal flexible thin video endoscope with a built-in miniature ultrasound probe. The ultrasound technology is then used to “see through” the walls of the GI tract and closely examine surrounding structures that can difficult to image, such as the pancreas and biliary tract and can also image surrounding lymph nodes. This technology has the ability to take biopsies of abnormal areas in these surrounding organs in order to gain a tissue diagnosis via a technique called fine needle aspiration (FNA). This is important in gaining the accurate diagnosis to aid in making proper decisions on how to best treat the condition. This is also vital in assisting the staging of the disease if it is malignant with a minimally invasive procedure instead of a full scale surgery.
EUS continues to evolve and can offer a means of therapy for certain conditions. EUS can be utilized to deliver medicine to help with debilitating pain that can associated with pancreatic cancer. Targeted injection and placement of small metallic markers called fiducials can be placed into tumors to allow more specific targeting of radiation therapy. It can also be utilized to assist placing of stents which are used to open blockages in the GI tract that can be caused by cancer as well.
A potential diagnosis of cancer is certainly a scary and life-changing event. With ever-expanding knowledge and understanding of these diseases, we all hope to offer the best treatment with intent to cure. The technology of endoscopic ultrasound will certainly continue to evolve and be an important tool in the world of gastrointestinal cancer.