Saturday, July 27, 2013

Don’t forget about ADHD during the summer

By: Tanikqua D. Moore, MD, FAAP

Long days, family vacations, hot weather and NO SCHOOL…it’s summer time! Most children, parents and even teachers tend to forget about ADHD during the summer because it’s of course summer vacation! But children with ADHD display symptoms outside of the school environment. There are other activities and tasks that require attention, focus and age appropriate activity level other than school.

Summer camps involve making friends, reviewing academics and recreational activities. Inattention, hyperactivity and impulsivity often affect a child with ADHD in their ability to make and keep friends. Failing to recognize subtle social cues, anxiety or bossiness may cause other children to avoid a child with ADHD.  Reviewing social skills such as making eye contact, taking turns and not interrupting can help to ease the difficulty associated with making and keeping friends.  Many children with ADHD also have difficulty with working memory; the ability to hold information in the mind and make it available for further processing. Attention is an essential part of memory. Building on information learned the previous year may be expected while participating in certain summer camps. Help your child see how information that was taught previously is relevant to her life or related to things she already knows will help keep the material fresh in her mind. Most recreational activities involve focus, following directions and teamwork. ADHD kids sometimes get lost in group directions. One on one coaching and active demonstrations can help. Keep them busy. Your child should have a job to do while waiting on the bench or during downtimes: assisting scorekeepers, keeping equipment in order, anything that will hold her interest.

Even with school being out, structure and routines can help in terms of behavior by improving efficiency and daily functioning. Routines make daily activities manageable, allowing your child to focus on one thing at a time. But having time for unstructured play is beneficial as well. Unstructured play provides breaks that shorten the day into shorter segments. Breaking daily activities up into pieces and providing a change of pace in between can enable the brain to focus better.

Of course, don’t forget to rest. Getting enough sleep is essential for children with ADHD. A good night's sleep is important for a child’s mood and brain function. Not getting enough rest can worsen ADHD symptoms, leading to loss of emotional control. It can also adversely affect working memory. A bedtime routine can help. Remembering not to forget about ADHD during the summer can lead to an enjoyable summer for the whole family and preparation for maximum success in the fall.
…dedicated to the diagnosis and treatment of ADHD

Friday, July 26, 2013

The Patient’s Perception = The Provider’s Reality


By Michael Sweeney, Vice President at

Social Media outlets including Twitter and Facebook, along with geotargeted internet search engines Google, Bing and Yahoo, are providing medical Patients a court of public opinion.  More than ever, Patient “clients” are grading their Doctor visits, and sharing those grades with other Patient consumers. 

These consumers #1 complaint is customer service, largely relating to time spent in the waiting room area, and time spent in the exam room also waiting for the Provider.  Even after these “longer than necessary waits,” the Doctor then may only invest5-10 minutes with the Patient.  While the overall time spent in the office usually exceeds 75 minutes, only a small fraction of that time is spent with a nurse and/or Doctor.  Of course, the Patient ends up with a bill that reflects an inappropriate fee for the “Perceived” service rendered.

Sites like,,, and even Angie’s List, allow patients to grade their Physician and services provided. Courteousness of Staff, Ease of Appointment, Bedside Manner, Promptness, Spends Time with Me and Average Wait to see the Doctor, are just a sample of the criteria provided these Patient consumers.

These are identifying criteria that trigger upset Patients to grade more frequently and respond more vigorously than do happy patients.  This is the observation of most industries.

While there are counter website services available to medical practices to combat negative feedback, doesn’t it make sense to take a proactive approach and create Consumer Advocacy for your practice..?

Waiting rooms and patient exam rooms are appropriate places to market your services and provide patient education.

Now more than ever, Physicians are “competing” for client Patients.  As Patients wait in waiting areas, it’s time to use tools that allow you to help reduce perceived wait times in your clinic while providing patient education.  Instead of the mainstream media dominating your waiting areas, it’s time to use the existing TV in your waiting room as a Patient education platform pertinent to your specialty, and as marketing tool to promote your ancillary services, drive top-line revenue, discuss technology implemented by your practice for meaningful use and of course provide some light-hearted entertainment. Engage your patients and make them laugh, give them something they will remember or ask for that may be an additional preventive service, test or product that you have started to market to make up for the short fall of insurance reimbursements.

Patient education is supposed to be an integral part of the medical encounter.  From the moment the patient hits the waiting room, through their wait time in the exam room.  Design consultants advise doctors to fill the waiting room with educational materials, including brochures, booklets, and posters.

However, the 21st century Consumer is beyond out dated pamphlets and fold-out marketing cards.  Your Patient Consumers are getting their information from flat screen monitors (televisions).  You have that infrastructure and should utilize it… 

LifeSignsWeb is that tool.

Create your own private waiting room TV network. Improve the patients’ Perceived waiting experience and decrease their perceived wait times. Take control of media and messaging delivered to your captured audience. Benefits should be to improved patient satisfaction, focus delivered patient education and happy light hearted entertainment.

Deliver enhanced informative communications such as office related information (Practice Portal Sign-up), health screenings initiatives, preventive health options, advertise new products, services, local community involvement and speaking engagements, announce locations and of course welcome new providers to your growing practice.

Bring the patients into your Reality. Inform them of the new technology you are implementing to provide them with better patient care and timely access to their records.  Let them know these are compliances that must be met to provide care and to meet the ever changing requirements of healthcare.

Effective communications will and can enrich your Patient Customer’s time in your practice. Let the patient know that their perception is your reality, that you care, appreciate their patience and loyalty, and that you want to be their Doctor, and they will spread the word.


Thursday, July 25, 2013

BOTOX & Overactive Bladder (OAB)

By: Nicole DeSouza Massie, M.D

Overactive Bladder (OAB) is a clinical diagnosis characterized by bothersome urinary symptoms.  The International Continence Society defines OAB as the presence of urinary urgency, usually accompanied by frequency and nocturia.  There are four components: urgency, frequency, nocturia and urgency incontinence. 

There are several treatment options that can help.  The American Urological Association (AUA) recommends First-Line Treatment as behavioral therapies; bladder training, bladder control strategies, pelvic floor muscle training and fluid management.  Second-Line Treatment includes the addition of an oral medication. If the patient does not respond or cannot tolerate the side effects, the Third-Line Treatments include sacral nerve stimulation, peripheral tibial nerve stimulation and most recently added intradetrusor onabotulinumtoxinA (Botox). 

Botox was approved in the fall of 2011 for Neurogenic Bladder and in January of 2013 was approved to treat OAB symptoms, urge urinary incontinence, urgency and frequency in adults 18 years and older when an oral medication does not work well enough or cannot be taken. 

Botox can be used to treat an overactive bladder in both men and women.  Botox is believed to work in two ways.  It reduces activity in the bladder muscle by reducing bladder contractions, which can help reduce leakage, increase bladder capacity and decrease pressure in the bladder which can help protect the kidneys.  Secondly, it is believed to reduce nerve signals from the bladder telling the nervous system that the bladder is full.  Calming these hypersensitive nerves may also help reduce leakage. 

Botox is a procedure where an injection of Botox (100-200 Units) is injected into the detrusor muscle through the bladder wall with a cystoscope.  It can be done as a hospital outpatient procedure or in the office, which is where I treat the majority of my patients and it only takes me about 10 minutes or less to perform. I have found that the majority of the patients tolerate this procedure very well. 

Botox has given patients suffering with OAB a new option.  No longer do the patients have to take numerous oral medications with unsatisfactory results.  Now the patient can have a minor procedure once or twice a year with the potential to dramatically improve their quality of life.
Urology Centers of Alabama

Thursday, July 18, 2013

How Technology Can Improve Your Cash Flow


By : David Luke _ treasury management sales executive at Regions Financial Corp.

How Technology Can Improve Your Cash Flow
Choosing the right options also helps prevent mistakes

Technology can not only improve your cash flow, it can also accelerate your receivables and extend your payables, preventing your company from becoming overleveraged. Using technology optimizes the cash cycle, providing a company with working capital.


The most popular technology options to improve a company’s cash flow are:


Automated Clearing House (ACH)

Automated Clearing House processes debit and credit card transactions through a secure, electronic, nationwide network. Payroll direct deposit is an example of ACH that allows for quicker deposits and decreased administration costs.



Lockbox is an easily accessed post office box to which a customer of the business sends payments. The bank then collects these payments and deposits them, providing faster processing and quicker access to funds.


Quick deposit

Quick deposit allows users to deposit checks by scanning them with a specially designed desktop scanner and transmitting them to a bank. Quick deposit typically has an extended deposit deadline and allows easy error correction and review.


Electronic check services

Electronic check services converts checks to an electronic transaction received by a bank. This allows for quicker deposits and reduced administration costs.


Commercial card

Commercial card allows a business to make purchases from a vendor if the vendor accepts credit cards. This provides reduced administration costs and better purchase control.


Single-use accounts

Single-use accounts act like a paper check by creating a virtual 16-digit account number for each payment, allowing businesses to set credit limits and control spending.


While there is typically a fee associated with these services, the time and associated costs saved make them well worth it. Such services are available to companies no matter their size.


The technology required to implement these processes depends on the business and its needs. If you accept many personal checks at your location, quick deposit or electronic check services may be the best option. On the other hand, if your customers typically mail in payments and your business spends a lot of time processing them, a lockbox may be a good choice.


With any of these options, using some type of software to manage the service and monitor your cash flow is a good idea. Sometimes there may be software related to the technology or bank itself, while other times you may need to choose your own software and manage it internally.


Treasury management, along with technology, improves cash flow and helps companies troubleshoot some of the most common cash flow mistakes, such as poor monitoring, making payments all at once and not having cash available in the right place at the right time.


A lot of companies don’t understand their daily cash position, so they keep excess cash in their accounts for daily settlement. With the technology offered by Regions to manage cash flow and optimize working capital, this cash could be better utilized for debt repayment, investment opportunities and/or general company use.


Cash is the lifeblood of any business, so it is essential to have the cash you need on hand when you need it. Speak with your banker to determine which options will help your business maximize its cash flow and growth potential.



David Luke is a treasury management sales executive at Regions Financial Corp.


This information is general in nature, is provided for educational purposes only, and should not be relied on or interpreted as accounting, financial planning, investment, legal or tax advice. Regions neither endorses nor guarantees this information, and encourages you to consult a professional for advice applicable to your specific situation.


Monday, July 15, 2013

The CyberKnife Advantage

By: Blake Pearson, MD

Over the last decade, radiosurgery has revolutionized the practice of neurological surgery, allowing radiation oncologists and neurosurgeons to provide safe, non-invasivetreatment. Brookwood Medical Center is the only facility in Central Alabama that offers CyberKnife©technology, and numerous patients have benefitted from this painless alternative to traditional surgery for the treatment of both cancerous and non-cancerous tumors.

Cyberknife© radiosurgery is performed collaborativelyamong a neurosurgeon, a radiation oncologist and a radiation physicist. CT and MR-images are used to create a three-dimensional model of the patient’s pathology and the surrounding normal anatomy. A focused high dose of radiation is delivered in a series of beams from a linear accelerator placed on a robotic arm at multiple angles, focusing the radiation at a high dose within the pathologic structure and minimizing the dose to surrounding, healthy structures. Because no head frame is used, the radiation can be fractionated or delivered in a single session, depending on the needs of the case and the pathology being treated. 

In years past, the treatment of metastatic brain tumors was whole-brain radiation and relatively short life expectancy. The use of CyberKnife© allows treatment of multiple intracranial metastases and intracranial metastases in surgically inaccessible areas with very limited morbidity. CyberKnife’ s relatively unique ability to deliver radiosurgery in a fractionated method allows the dose of radiation to be split up over several days, and radiobiologically, this allows a higher dose to be delivered to the tumor than to the surrounding normal structures, reducing the risk of radiation necrosis and allowing treatment of slightly larger tumors. With the CyberKnife© innovation, we have moved away from recommending whole-brain radiation as an initial treatment, since patients will start to develop neurocognitive effects of radiation exposure.

In addition to the treatment of metastatic tumors, CyberKnife© is an outstanding tool for the treatment of meningiomas and acoustic neuromas. CyberKnife© can also treat trigeminal neuralgia, and in my practice, has completely replaced percutaneous rhysolysis as a minimally-invasive option. While the effectiveness still lags slightly behind open microvascular decompression, the minimal risk profile and elimination of the anesthetic risks and avoidance of a craniotomy are very appealing, especially in the elderly population, who are most affected by trigeminal neuralgia.

CyberKnife©can also treat spinal lesions outside the cranial vault, allowing very aggressive management of spinal tumors and warding off cases of tumor-associated paralysis and tumor-associated spinal column collapse before they ever occur. Typical radiation delivery methods provide large doses of radiation to paraspinal wounds and are well known to lead to severe wound complications. CyberKnife© radiosurgery targets the radiation dose directly to the wound and prevents complications, providing a substantial improvement in both quality and longevity of life compared to traditional neurosurgery methods.

Blake Pearson
is a neurosurgeon with Brookwood Medical Center.

Thursday, July 11, 2013

Surgery for Sterilization Reversal using the da Vinci Surgical System

Robert DeSantis, MD, FACOG – Trinity OB/GYN


Each year in the United States over 600,000 women undergo a permanent sterilization procedure.  Studies show that up to 20% of women will regret this decision within five years of their sterilization procedure.  Approximately 5-10 percent of these women will ultimately decide to have the procedure reversed to have a baby.   Currently most of the reversal procedures are done through an open incision in the belly using microsurgical techniques.  This can include from one, up to several days in the hospital and take six to eight weeks of recovery.  Pain is one of the main issues during recovery.


The procedure has also been accomplished with smaller incisions as an outpatient procedure.  Laparoscopic approaches are reported in the literature and are performed in a fashion similar to open techniques.  The American Society of Reproductive Medicine notes that “only surgeons who are very facile with laparoscopic suturing and who have extensive training in conventional tubal microsurgery should attempt this procedure.”  The procedure requires opening the occluded ends of the fallopian tubes that have been tied and anastomosing them with a fine non-reactive suture material using magnification and microsurgical techniques. 


When faced with a decision for tubal reversal, women also have other options available such as advanced reproductive technology including in vitro fertilization (IVF).  Women must evaluate their options and look at both the pros and the cons.  Women younger than 30 years of age with good tubal length have the best chance of success.  Rates have been reported around 75-80% or better in this group.  Success is also based on sperm count and other fertility factors.  Short tubal length is a con to tubal reversal and your physician should discuss this with you prior to proceeding with any fertility surgery.  IVF has been proven to be a better procedure for short tubes.  Success rates decline significantly after age 43 for various reasons and this should be discussed with your healthcare provider.   There are reports of women undergoing tubal reversal between 40-45 years of age with cumulative pregnancy rates ranging between 41-71%.  Boeckxstaens et al published a retrospective cohort study in 2007 in Human Reproduction on tubal reversal versus IVF and showed a significantly higher cumulative pregnancy rate for women younger than 37 years of age.  However, they did not see any significance in women 37 years or older.  Women undergoing IVF have a higher per cycle pregnancy rate, however, the cumulative rate allows for more opportunities to become pregnant and is more cost efficient.  In fact, studies have shown the average cost per delivery for tubal reversal to be half that of IVF pregnancies. 


As an OB/GYN and a da Vinci surgeon, I have performed over 300 cases on the da Vinci system including tubal reversal. The da Vinci technology allows me to perform sterilization reversals with all the advantages of minimally invasive procedures with far more precision than conventional laparoscopy. This translates into a shorter hospital stay, with most patients returning home the same day as surgery. It also leads to less post-operative pain and a rapid return to normal daily activities.  Most patients are discharged home within hours of surgery and return to work within days of surgery.  They are allowed to begin trying to conceive within 10-21 days after surgery.  Success rates with the da Vinci system are comparable to traditional laparotomy with rates as high as 74-80% viable live pregnancies currently reported.  Other procedures performed by using the da Vinci system include hysterectomy, oophorectomy, myomectomy, sacralcolpopexy for prolapse and excision of endometriosis. 


Rodgers AK, Goldberg JM, Hammel JP, Falcone T. Tubal Anastomosis by Robotic Compared with Outpatient Minilaparotomy. Obstet Gynecol 2007; 109:1375-1380.

Patel SPD, Steinkampf MP, Whitten SJ, Malizia BA. Robotic tubal anastomosis: surgical technique and cost effectiveness. Fertil Steril 2008; 90:1175-1179.