Thursday, May 30, 2013

Hired a new physician! Tips for Successful Onboarding and Retention!

By: Marchelle Cagle, CPC, CPC-I, PCS

  Hiring a new physician sometimes can take months or years depending on specialty, availability, and locality. Much time has been spent on physician interviews, salary considerations, employment contracts, insurance/hospital credentialing, malpractice enrollment, marketing, and etc. Often times this may be the new physician’s first employment position in a career he or she has spent years of school and planning to achieve and are usually eager to start treating and helping potential new patients.

The first day or year of this new relationship can be crucial for the new hire and the hiring physician or physician group. I was nervous my first day of any new job I started weren’t you.

When practices take the same care with physician orientation as they do with the candidate selection, the short term impact means a more comfortable staff and a more comfortable physician.  Groups who assign a physician mentor during onboarding reported a lower overall turnover rate. The long term impact has potential to be even more powerful; it can positively impact patient outcomes and satisfaction, reduce liability risk, and improve long-term retention. Regardless of profession happier employees have been proven to be more productive long term employees.

So here are some simple but important tips to help with a successful physician orientation.  

·         Assign a point person to handle all aspects of the orientation.  Often times this is a good way for the administrator/manager to start a good and solid relationship with the new hire.

·         Commit to weekly follow-up calls to answer questions, introduce a new topic, or share any news. This will help ensure that your candidate remains invested in your practice.

·         Alert the clinic staff, hospital staff, referral groups, and any other contract groups you work with that your new physician will be starting. Include a bio and photo if you can.

·         Send a welcome packet which can include copies of key policies and procedures that might be helpful for the physician to review ahead of time.

·         Provide a facility/physician directory so that the physician can start becoming familiar with referring physicians and campus amenities ahead of time.            

Here is a link with a sample physician orientation checklist to help you stay on track.

Congratulations if you have recently hired a new physician and may you have a great future together!
Marchelle Cagle
Cagle Medical Consulting, LLC

Tuesday, May 28, 2013

Let's Talk Sugar!

By: Dr. Mohanned Azzam _ Medical West Hospital

Sugar is sweet, and in most cases, it's a treat to get. But when we talk about sugar in the blood stream - too much is not a good thing.

Usually a chronic (lifelong) disease, diabetes usually comes about when the pancreas' production of insulin is deficient. Insulin is what removes sugar from your bloodstream and moves it to muscles, fat, and liver cells - giving you energy. When enough insulin isn't being produced, that sugar never makes it to become fuel for your body.

And that is no good.

Most Common Types of Diabetes:
  • Type 1 diabetes is often found in children, teenagers, or younger adults - and their is no known exact cause. Their bodies just produce little to no insulin and require daily injections of insulin.
  • Type 2 diabetes is by far much more common, and it occurs mostly in adults. While they do produce insulin, the body either isn't producing enough or the body isn't responding appropriately to the insulin (referred to as resistance).
  • Gestational diabetes occurs during pregnancy where blood sugar levels rise in a woman who doesn't have diabetes.
Risk Factors of Diabetes:

Type 1 is a bit of a mystery, as direct links to lineage are inconclusive, and there is much debate on certain vaccinations - but no relationships have been confirmed.

Type 2 is almost all about lifestyle. Let's put it this way: over the past 3 decades, type 2 diagnosese have doubled.
  • If you have a family history of type 2 - then you are at more risk
  • Hispanics, African-Americans, Asians, and Native Americans are all at greater risk
  • Age - over 45 is where the risk really starts to increase
  • Metabolic syndrome (insulin resistance)
  • Overweight - especially with a thicker waistline - raises the occurrence of diabetes
  • High blood pressure
  • An inactive lifestyle (probably leads to being overweight)
Gestational diabetes
  • Having had gestational diabetes before raises the risk
Symptoms of Diabetes:

High sugar levels can cause several symptoms to show in different areas/aspects of your body and its behavior.
  • Fatigue
  • Hungry/thirsty a lot
  • Urinating often
  • Unclear vision, light sensitivity (after many years, you could become blind)
  • Weight loss
  • Painful sores
  • Loss of feeling (damaged nerves)
  • Erectile disfunction
Where there is some danger is in that because type 2 develops at such a slow pace over time, many people don't realize they have it because symptoms either don't show or are extremely slow to show. This is why we constantly suggest healthy lifestyles to reduce your risk.

If you experience the above symptoms, it would be extremely wise for you to contact your doctor and schedule a diabetes test. Find out what's going on - could be nothing, diabetes, or something else. But when these things are happening - your body is talking to you, so listen to it!

Diabetes and the Body:

Diabetes is related to coronary heart disease. By contributing to high blood pressure and its link with high cholesterol, diabetes greatly increases the risk of heart attacks and cardiovascular disease. This also rolls over to raising the likelihood of strokes.

As mentioned above, diabetes can have extremely damaging effects on the eyes. If not properly managed, diabetes will cause blood vessels in the retina to swell and leak. Blindness likely follows.

Diabetes also has debilitating effects on the kidneys, nerves (as mentioned above), digestion, and the skin.

Managing Diabetes:

Looking back over this post, I've been spewing a fair amount of doom and gloom. Let me say that there are many, MANY people with diabetes who live happy and healthy active lifestyles.

In some cases, if caught early enough, type 2 can be reversed with lifestyle changes. Generally, for both type 1 and type 2, treatment involves medicines, diet, and exercise regiments that will help control blood sugar levels.
  • The food you eat is very important. Keep meals well-balanced between starches, fruits and vegetables, fats, and proteins. And make sure you talk to your doctor about portion size. Because of your medications, a measured balance between your medication and the amount of food you eat is helpful to keeping your blood sugar on the level.
  • Exercise. Like with most treatments, getting your body moving is more helpful than not. Talk to your doctor about what you need to do.
  • Your medications. First - be cautious about your medications. There are many things going on with diabetes, and your doctor knows the medication combination for you. Be in line with your doctor and make them aware of any over-the-counter drugs you may take.
  • And speak up! If there's a problem or something doesn't feel right - let your doctor know. Perhaps a simple adjustment in medication can make the difference.
Diabetes is waaaay too common in our world today. Let's do what we can to turn this trend around with more attention paid to what we eat and how we live our lifestyle. While you can definitely live with it, diabetes is a burden with too many potentially serious risks. Keep an active lifestyle and a body weight that doesn't put you at risk.

Take Care,

Thursday, May 23, 2013

Aeroallergens are Nothing to Sneeze At: Birmingham’s Only Pollen Counting Station

By: Heath Haggard and Dr. Wayne Shew
Birmingham’s only National Allergy Bureau (NAB) pollen collection station is located on the campus of Birmingham-Southern College, where it is run by Dr. Wayne Shew and sponsored by Dr. Weily Soong and the Alabama Allergy and Asthma Center.  The partnership between Birmingham-Southern and Alabama Allergy and Asthma began in 2007 when Dr. Soong contacted Dr. Shew to talk about the absence of a pollen station in Birmingham and the need for establishing such a station that would be located within thirty miles of the clinic’s practice.  Dr. Shewfirst began collecting pollen samples using a Rotorod collector, which was soon replaced with the installation of a Burkard Volumetric Spore Trap.  The pollen collecting station was certified as an NAB site in the summer of 2010, and since that time the station has maintained a consistent reporting of pollen counts to the National Allergy Bureau.  The station aids the Alabama Allergy and Asthma Center by providing pollen and mold spore counts which benefit the clinic’s patients, and also provides data useful for clinical research and senior research opportunities to students at Birmingham-Southern College.

The pollen samples used at the station to generate counts are collected using a Burkard Volumetric Spore Trap located on the roof of the Humanities building on the campus.  The Burkard spore trap collects airborne particles on microscope slides coated with Dow Corning high vacuum grease.  Air is pulled through a 2 x 14 mm opening and impacts the microscope slide at a constant volume of 10 liters/minute.  The air is sampled for a 24 hour period, the slide is removed, and the sample is mounted for microscopic examination in glycerin jelly containing fuschin stain.  Fuschin stain is selectively absorbed by the pollen grains, which appear pink when viewed under a microscope at 400x.  The Longitudinal Transverse Method, which involves counting the number of specific pollen grains present in a horizontal pass across the slide either one or two times, is used to count and identify the pollen grains present on the slide.  The number of counted pollen grains can be converted to number of grains per cubic meter of air using the following formula:

Pollen Grains/m3 of air= number of grains counted

Vair sampled               .

Volume of air sampled in the formula described above is calculated using the following formula:


Vair (m3) = Field Diameter (┬Ám)

drum rotation rate   .

Pollen counts generated at the Birmingham station can be accessed through the Alabama Allergy and Asthma Center’s website,, or through the American Academy of Asthma and Immunology’s National Allergy Bureau,
This was written by Heath Haggard of Alabama Allergy & Asthma Center and there subsidiary Clinical Research Center of Alabama in conjunction with Dr. Wayne Shew at Birmingham Southern College.


Monday, May 20, 2013

Photosensitivity: Variants, Diagnosis and Treatment Methods

by Colleen Donohue, MD

Most everyone will be out enjoying the sun during the next several months, and patients taking medication should beware of photosensitivity. Photosensitivity is a seasonal occurrence, and there are two varieties of this reaction, including phototoxicity and photoallergy.

Phototoxic reaction is exposure to sunlight that may cause medication to absorb ultraviolet light that releases into the skin. This reaction is related to the concentration of a drug and will subside when the medication is stopped. Erythema is present within 24 hours of exposure in a photodistributed dermatitis. Edema, vesicles and bullae may also occur, but are uncommon.

Common medications that cause phototoxicity include amiodarone, fluoroquinolones, furosemide, sulfonamides, sulfonylurea, tetracyclines and thiazides. This is not an exhaustive list.

Photoallergic reaction is not drug concentration dependent. Eruption does not occur until 48 hours after exposure and will appear in areas that are not exposed to UV light. Physical appearance is varied compared to phototoxicity. Patients with photoallergy present with an intensely pruritic eczematous dermatitis that can progress to lichenification. A portion of patients can develop a persistent exquisite hypersensitivity reaction after the offending medication has been discontinued, called persistent light reaction, which can occur in up to 10 percent of patients with photoallergy.

Photoallergic medications include chlorpromazine, fluoroquinolones, piroxicam, promethazine and sulfa containing medications.

Diagnosis of photosensitivity can generally be confirmed with a thorough history and review of medications.  Diagnostic methods include photopatch testing to determine photoallergy. Photopatch is similar to allergy patch testing, using patches that contain known photoallergens that are applied to the patient. Development of eczematous patches is a positive result. Testing for phototoxicity includes Minimal Erythema Dose evaluation.

The first line of photosensitivity treatment is discontinuing the medication. Minimizing sun exposure is also of importance even after reaction has occurred. Acute symptoms of phototoxicity can be alleviated with cool compresses, topical steroids and oral NSAIDs. If a patient is severely affected, a steroid taper is beneficial. Photoallergic reactions can be managed similarly.

There are very few patients that suffer from persistent light reaction and chronic actinic dermatitis. Management for these patients includes vigilant protection against UV light exposure. Cytotoxic agents are a treatment option if other methods have failed.

Common sense is always a good start. Remind people to wear sunscreen, read medication warning labels and call their doctor if they have any questions.

Dr. Colleen Donohue is a board-certified primary care physician with Brookwood Medical Center.

Friday, May 17, 2013

Alabama Supreme Court Refuses to Hear Continued Arguments on Trinity Relocation

The Supreme Court of Alabama has denied requests by Brookwood Medical Center and St. Vincent’s Hospital, refusing to consider continued arguments against Trinity Medical Center’s relocation.

The unappealable ruling affirms the November decision of the Alabama Court of Civil Appeals in favor of Trinity and definitively ends any further opportunity for Brookwood and St. Vincent’s to legally challenge Trinity’s Certificate of Need.

Gause, Brown and Abrams Discuss Affordable Care Act

On Wednesday, Gary Gause, CEO of Brookwood Medical Center, Archie Abrams of Blue Cross Blue Shield, and Cynthia Ransburg-Brown of Sirote & Permutt participated in a panel discussion of the Affordable Care Act at the Vestavia Hills Chamber of Commerce. The panel, which was moderated by Doug Dean, Chief Human Resource Officer at Children's of Alabama, answered a number of questions from chamber members focused on how the law would affect the delivery of care in Alabama, as well as how it would affect businesses, consumers, and health care professionals.

Thursday, May 16, 2013


By: Chris Harmon, MD

Outdoor activities are frequently things that people enjoy doing.  We do not advise against them.  However, there are precautions that you can take that will protect you, and still allow you to continue to do those things you enjoy. 

Plan your activities in the early morning hours before 10:00 a.m. or in the late afternoon, beyond 3:00 p.m. This will help avoid the sun's most intense radiation, which occurs between the hours of 10:00 a.m. and 2:00 p.m.

Wear a hat and remember that a hat with a 6-inch brim only provides equivalent sun protection to an SPF #8 sunscreen.  There are new fabrics for protective clothing that provide complete sun block.  They are designed to be loose fitting, cool, and comfortable.

In addition to a hat and protective clothing, we strongly recommend the usage of sunscreens on a daily basis.  When choosing a sunscreen, it is important to look for ingredients that provide broad-spectrum coverage against both UVA and UVB radiation. The active ingredients micronized zinc oxide, titanium dioxide, Helioplex or Parsol 1789 (avobenzene) provide broad-spectrum ultraviolet coverage for both UVB and UVA rays.

For normal daily activities such as going to and from work or school, we recommend the use of a daily moisturizer with a sun block. This will provide protection against incidental ultraviolet radiation that one encounters to and from the car, as well as traveling in the car.

For outdoor activities such as swimming, running, or golfing, we advise using a waterproof sun block. For prolonged sun exposure, all sunscreens should be reapplied every two hours. Although no sunscreens are truly and completely waterproof, we do recommend sunscreens that have the word “waterproof” on the package label when undergoing swimming and other water sport activities.

It is important to remember that sun damage is cumulative, so even short amounts of sun exposure will add up.  Don’t forget to protect your eyes, ears and lips.  So, enjoy the sun and the outdoors, but use common sense, a sunscreen, and protective clothing when appropriate.


Chris Harmon, MD

Surgical Dermatology Group




Monday, May 13, 2013

Doc, I've got sinus!

By: E. Scott Elledge, MD – ENT Associates of Alabama
These words are commonly uttered by patient's presenting to our ear nose and throat office. While I understand where they're coming from, the patient may have a wide variety of problems that we label "sinusitis."
A better way to think of it, and then this will help one understand treatment options, is to divide it up into two categories --- sinusitis and rhinitis.
The term sinusitis applies to inflammation or infection in the paranasal sinus cavities that surround the nose. There are frontal, ethmoid, maxillary, and sphenoid sinuses. These sinuses can be involved in disease processes individually or multiple sinuses.
Rhinitis is the term for inflammation of the nose. When the patient has rhinitis they may or may not have sinusitis. Usually, however, when patients have sinusitis they do have some component of rhinitis or nasal inflammation.
Understanding the purpose of the nose and sinuses helps us to understand disease processes as well as their treatment. The nose is primarily responsible for filtering out infections and irritants such as dust as well as the very important function of humidifying the air we breathe into our lungs. The nose produces approximately 1.5 Liters of fluid in order to accomplish this per day. Also, whether you're in 0°cold or 110° heat, by the time the inspired air enters the lung it is body temperature, quite an amazing feat!
Symptoms of rhinitis include excessive drainage or post nasal drip, congestion, facial pain pressure, and headaches. Symptoms of sinusitis include the same. Therefore, by symptoms alone, it can be difficult to distinguish between the two.
An important structure inside the nose to understand is the turbinates. There are three turbinates on the lateral wall of the nose that contain glandular tissue that produce most of the mucus that provides filtering and humidification function. When the turbinates get inflamed, excessive mucus is produced (i.e. drainage and post nasal drip) and they may swell giving you congestion, facial pain and pressure.
Sinusitis is usually a consequence of an earlier form of rhinitis. Examples of rhinitis include infectious rhinitis (the common cold), allergic rhinitis, and chronic rhinitis from irritants such as smoking or chemicals.
Treatment of rhinitis focuses on the symptoms. Decongestants such as Sudafed are used to treat the congestion which also causes the facial pain and pressure. Antihistamines such as Allegra or Benadryl are used to treat the excessive drainage. Other treatments include nasal steroid sprays such as Flonase which reduce the inflammation in the turbinates thereby addressing both the congestion and drainage problem. We also now have spray antihistamines, such as Astepro, which address the drainage problem. Many medications are packaged as an antihistamine combined with Sudafed for example Allegra-D. In severe cases of rhinitis, short-term anti-inflammatory steroids may be used to provide quick relief.
In the case of sinusitis, the natural drainage mechanism from the sinus into the nose becomes inflamed or occluded and allows for infection from the nose to then secondarily infected sinuses. Treatment of the sinusitis therefore must also rectify the rhinitis problem as well as address the infection with antibiotics. Saline rinses are also very helpful in the case of rhinitis as well as sinusitis. They provide irrigation benefit to wash away infection but also improve the hydration of the nose and saline is actually a mild decongestant.
Treatment guidelines would be to treat rhinitis symptoms with over-the-counter products and if the rhinitis continues for more than 5-7 days then one is at higher risk of the rhinitis transitioning into a sinusitis. Medical intervention with your doctor would be valuable at that point. If rhinitis is occurring frequently or is prolonged then maintenance medications such as the nasal steroid sprays are needed under the guidance of a medical professional.
Sinusitis treatments are based on history and physical exam findings and possibly X-rays. Occasional sinusitis can be treated based on clinical symptoms whereas X-rays, to include CT scans, are utilized to evaluate patients with prolonged or severe symptoms. And in some cases the sinusitis simply cannot be cleared and drainage of the sinus needs to be performed in order to recover. These procedures can be done utilizing endoscopes through the nose to identify the sinus drainage systems and open them up and irrigate the sinus. This has traditionally been done in an operating room setting however recent technology advances, such as Balloon Sinuplasty, allow ear nose and throat physicians to open and irrigate the sinuses in the office with topical anesthesia.
So as you can see, when one says "Doc, I've got sinus" to me that can mean many different problems requiring a wide variety of solutions.
And finally, for a bit of humor, here in Alabama some of my patients pronounce sinusitis as "sign-Unitas" to which I have always wanted to respond " Isn't that what the Colts did in '55..........?"

Thursday, May 9, 2013

FODMAP “Fermentable, Oligo-, Di-, Mono-saccharides And Polyols”

By: Allison Duke Bridges, M.D.

As a gastroenterologist, a significant portion of my daily practise involves treating patients with irritable bowel syndrome.  Treating these patients can prove rather challenging as there are subsets that respond to differently to various treatments, likely reflecting the different proposed mechanisms of IBS such as visceral hypersensitivity, gut flora derangement and so forth.  Dietary modification can be beneficial for IBS patients and the FODMAP diet can be an excellent alternative/addition to medications.  FODMAP was originally discovered by a group in Australia.  It is an acronym deriving from “Fermentable, Oligo-, Di-, Mono-saccharides And Polyols.”  The principal behind this is that the consumption of some common dietary sugars plays a role in fermentation and in osmotic effects in the bowel as well as visceral hypersensitivity.

Fructose is a monosaccharide like glucose and galactose, and when combined with glucose forms sucrose or table sugar.  Fructose is the sugar most commonly found in fruits and honey.  Many processed foods contain high fructose corn syrup. Fructose may cause GI symptoms when the fructose/sucrose balance is offset.  If fructose exceeds the sucrose component, malabsorption of fructose occurs.

Fructans are oligosaccharides typically found in vegetables such as asparagus, artichokes and onions, fruit such as apples and wheat.  Wheat accounts for much of the fructan intake in the typical American diet.  Fructan sensitivity may be why patients that test negative for celiac disease can still have improvement in their symptoms with avoidance of wheat.

Lactose is a disaccharide commonly found in milk products.  Irregardless of IBS diagnosis, up to 90% of people have some degree of lactose intolerance.  The rate varies significantly according to ethnicity and age.  Dairy foods low in lactose include hard cheeses, sour cream and butter.  These foods are considered “safe” even following the FODMAP diet.  Yogurt that contains lactobacillus may be tolerated as well.  Using the enzyme lactase (Lactaid), may aid in one's tolerance to this food group.

Galactan is a polymer of galactose.  Galactans are found in certain vegetables such as legumes.  Humans lack an enzyme to digest galactans.  Consuming these foods create an osmotic effect along with fermatation, resulting in gas, bloating and diarrhea.

The final part of the FODMAP diet are the polyols or sugar alcohols (sorbitol, mannitol, and xylitol) which are found naturally in fruits such as watermelon and are commonly in diabetic sweeteners.  While these may be the best choice for glucose control, they very commonly cause adverse GI side effects related to the osmotic effects.

The key to management of IBS is not necessarily more medication, or instruction to “eat more fiber.”  Many foods high in fiber may also be high in fructose, fructans, or galactans actually exacerbating IBS symptoms. A food diary can be beneficial for IBS patients.  Suggesting a FODMAP elimination diet, with slow re-introduction of each compoent of the diet back into their diets can help identify specific food intolerances and aid in avoiding future IBS symptoms/flares.  For more information on this, I recommend a comprehensive book called IBS—Free at Last! written by a dietician named Patsy Catsos that details the FODMAP diet.
Allison Duke Bridges, M.D.
Gastroenterology Associates, N.A. P.C.

Tuesday, May 7, 2013

The FODMAP Diet for IBS

By: Beth Kitchin, PhD,RD

As a registered dietitian, I have been counseling patients with a variety of medical needs for years. The condition that has always left me empty handed when it comes to patient advice is irritable bowel syndrome (IBS). Advising patients to limit caffeine, fiber, and sugar alcohols, is the standard and often does not eliminate symptoms.Most of our nutrition texts simply state “the patient should avoid foods that irritate the condition”.  For clinicians, helping patients with IBS can be frustrating as well since we have so little to offer patients.

            IBSis one of the most common disorders that doctors diagnose – but the diagnosis is usually one of elimination after many other conditions are ruled out. Unlike celiac disease and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, IBS does not damage the intestines or put patients at risk for intestinal cancers. But IBS can be difficult for patients to deal with and can cause much emotional and physical distress. 

           But there may be a new strategy we can try with our patients called the FODMAP diet. The idea behind it is that carbohydrates from 5 different groups maybe highly fermentable, osmotically active, and poorly absorbed in the intestine and contribute to the symptoms of people with IBS. The idea was developed and studied by an Australian nutritionist. While more research is needed to find out if it really works, it does give our patients a new strategy with which to deal with their symptoms.The foods are abbreviated by the acronym FODMAPS: Fermentable Oligo-, Di-, Mono-saccharides and Polyols.


           Foods are divided up into the following categories: excess fructose, lactose, fructans, galactans, and polylols. Foods high in excess fructose include honey, dried fruits and apples. But fruits that people may be able to tolerate include bananas, blueberries, oranges and many more. Soft cheeses and regular milk are higher in lactose but hard cheeses like cheddar and lactose-reduced milk may be fine. The fructans category includes asparagus, broccoli and eggplant. Foods high in galactans tend to be the starchy beans and peas like kidney beans and lentils. Polylols include fruits and vegetables like apricots, avocados, peaches and pears. Patients do not have to eliminate all of the foods on the list – but rather try to eat fewer foods from within each category to reduce IBS symptoms.Patients may be able to tolerate small amounts from each category.


          I want to stress that there have been few well-done studies on the FODMAP diet. Patient compliance is difficult to monitor and relies on self-report. For many patients, IBS is related to stress and emotions, which can confound the data. Adequately powered randomized clinical trials will be necessary to determine if the diet is truly an effective treatment. However, from a clinical perspective, the FODMAP diet is a reasonable option to offer patients who are struggling with on-going symptoms.

            There is a terrific, easy-to-use list you can print at this website:    Go to the very end of the article and you will see “For a printable chart of high and low FODMAPs, click here” and it will take you to the list. The list is color coded and easy for patients to follow. I recommend referral to a registered dietitian to help patients develop a healthy, low FODMAP diet.Simply eliminating FODMAP foods could result in nutrient deficiencies if substitutes are not made.

Beth Kitchin, PhD, RD
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham

Monday, May 6, 2013

Concern for Former Cooper Green Patients

The Jefferson County Medical Society – representing the physicians of Jefferson County – has repeatedly discussed our deep professional concerns with our elected county representatives regarding the void created by the closure of Cooper Green Hospital and the drastic reduction in providers at the Cooper Green outpatient clinic.  Our doctors have offered to volunteer their time and expertise in order to help engineer a workable solution.   Regrettably, we must report that all of our attempts to work with our elected officials have failed.

We are now left with the worst case scenario:  indigent patients are now suffering from a breakdown in the continuity of care and the lack of the critical physician-patient relationship.  Primary care services – the crucible for preventative care and cost savings – for former Cooper Green patients are almost nonexistent.  As a result, these patients are now flooding the emergency departments of area hospitals as their chronic medical problems like diabetes and high blood pressure spiral out of control.  Along the way, the time and valuable resources of our hospitals and physicians are unnecessarily being consumed at an alarming rate.  We as citizens all depend upon these emergency resources from time to time. 

The “plan” set forth by the County Commission is an abject failure.  A few agreements have been publicly touted for secondary services; however, these do not address the underlying primary (care) problem.  With all due respect to our elected county officials and their well-paid consultant, our county government has no business trying to administer a health plan.

A solution to this problem is obvious to the medical community as we stand united with our area hospitals.  However, our elected officials will not listen.  That’s where we desperately need your help.

We believe that the funds already earmarked (and currently being collected) for indigent care should be redirected to the Alabama Department of Public Health, retaining their specific earmark for use only in the care of indigent citizens of Jefferson County.  The ADPH, under the direction of our State Health Officer, Dr. Don Williamson, has indicated that it can set up a health plan with a third party administrator to identify and enroll qualifying patients.  This will be the most cost efficient and least political solution, and will guarantee that the consumer/patient has a choice in where they will receive their medical care. 

If we do nothing, the health of the least fortunate members of our county will continue to worsen, forcing them to the area ERs for their healthcare.  With increasing frequency, ambulances are already being forced to bypass the nearest hospital because it is full and cannot accept new patients.  Treatment in our area emergency departments is taking longer due to the overwhelming volume of patients.  These issues will certainly result in delays in care and the loss of life – not just in the indigent population, but also for those who are well off and think this issue does not affect them.  Additionally, the healthcare industry in Birmingham – currently a reliable engine of growth for our local economy – will suffer immensely.  Important capital improvements to our hospitals and clinics will be delayed which will result in less up-to-date services and treatments.  These are very important issues to everyone in our community, regardless of where there they live or how much money they make, and demand our immediate attention.

We encourage the public to call their elected officials now.  Let your voices be heard loud and clear on this very important issue.

Jefferson County Medical Society, Inc.
Stephen R. Steinmetz, M.D.

Gregory W. Ayers, MD

Darlene H. Traffanstedt, M.D.
Immediate Past President

Theodis Buggs, Jr., M.D.
Vice President

Roxanne Travelute, M.D.

Thursday, May 2, 2013

Human Papillomavirus Vaccine: The Time Is Now!

By Beth Allen, Nurse Practitioner Senior with ADPH-Family Health Services

According to the Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are currently infected with HPV and 6 million become infected each year.  The Human Papillomavirus or HPV is the main cause of cervical cancer in women.  In the United States, approximately 12,000 women get cervical cancer every year, and 4,000 are expected to die from it.

HPV is also associated with less common cancers such as vulvar and vaginal in women and anal and oropharyngeal in both men and women.  HPV can also cause genital warts.  In the US, around 12,000 HPV associated cancers occur in men. Cancers of the mouth and throat are the most common of these.  Overall, the incidence of anal and oropharyngeal cancers have increased over the past year; therefore, females are only part of the total equation.

The HPV vaccine can prevent most cases of cervical cancer if given before exposure to the virus. The American Society for Colposcopy and Cervical Pathology (ASCCP), experts in cervical cancer testing and prevention, incorporate HPV testing as the proven indicator to oncogenic testing in these HPV cancers.  The ASCCP conclude that at the present time studies are ongoing as to the effect of HPV vaccination on large populations and the vaccine holds promise of reducing these cancers worldwide.

There are two types of HPV vaccine presently available. The quadrivalent vaccine, Gardisil (Merck), targets HPV types 6 and 11 which cause genital warts, and types 16 and 18 which cause the majority of cervical, vaginal, anal, vulvar cancers and precancerous or dysplastic lesions.  The bivalent vaccine, Cervarix (GlaxoSmithKline) targets only HPV types 16 and 18.  The protection afforded by the HPV vaccine is projected to be long-lasting and can be given to both boys and girls. Gardisil is the only vaccine approved for boys.

The CDC Advisory Committee on Immunization Practices (ACIP) guidelines recommend that the HPV vaccine be given to both girls and boys 11 to 12 years of age.  It may be given starting at 9 through 26 years of age. Patients in these age groups with HPV exposure are still recommended for the series, because the vaccine can offer protection against infection with HPV types not already acquired. Additionally, ACIP recommends vaccination after exposure to HPV, even though benefit is less.  Furthermore, in a HPV bivalent study with HPV exposure from one to six years, with HPV vaccination showed a cumulative reduction in moderate and high risk infection.  This is evidence that HPV vaccination within six years of exposure results in preventing cancer precursors. The vaccination is given as a three dose intramuscular administered series.  The ACIP three dose schedule consist of: dose one, second dose is one to two months after the first dose, and the third dose is six months after the first dose.  Additional booster doses are not recommended at this time.  It takes all three doses to get the best protection.

The Alabama Department of Public Health encourages pairing the first dose of the HPV vaccine with the required 6th grade vaccinations given at age 11 to 12.  These vaccinations are covered by many insurance providers including Blue Cross/Blue Shield, Medicaid, and Allkids.  The vaccine is available at all county health departments at little or no cost to children ages 9 to 18.  The Vaccines for Children (VFC) program offers these vaccines at no charge to children who are eligible.  The ADPH’s campaign “Third Time’s the Charm” is currently underway. This campaign promotes the importance of receiving all three vaccines. It includes promotional materials such as postcards, handouts, posters, and ads in parenting magazines.  A birthday card is sent with reminders of vaccines, including HPV vaccine, on 11th and 12th birthdays.  Reminder systems nationwide are recommended by the National Cancer Institute’s (NCI) annual report.  The Alabama Department of Public Health’s campaign can be accessed at and  

 The HPV vaccine has been found to be safe and free of serious side effects through worldwide studies.  When given before exposure to the virus, the quadrivalent HPV vaccine is expected to prevent more than 90% of genital and approximately 60% to 70% of cervical cancers.  The National Cancer Institute’s (NCI) annual report in 2012, a collaborative report involving the American Cancer Society (ACS), the Centers for disease Control and prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR), published percentages  of HPV uptake in the Morbidity and Mortality Weekly Report (MMWR).  The HPV uptake nationally is 53% in girls ages 13-17 receiving one dose and 34.8% uptake receiving all three doses.  Alabama’s statistics are 49.5% uptake with one dose and 31.2% uptake for all three doses.  The movement is to get both boys and girls vaccinated.  It is important to recognize that patients trust their health care provider’s advice. As health care professionals, we have an opportunity to change an outcome and make a positive impact in decreasing cervical and other HPV cancers, and the time is now.