Intensive Feeding Program

By: Dr. Michelle Mastin is a clinical psychologist and head of the new Intensive Feeding Program at Children’s of Alabama.


A new Intensive Feeding Program at Children’s of Alabama helps infants, toddlers and adolescents overcome problems feeding and drinking often associated with developmental delays or serious illness. It is the first and only program of its kind in Alabama and one of only a handful of similar programs in the U.S.


The program incorporates pediatric subspecialists, technologies and behavioral psychology into a unique and effective system for teaching both parents and children how to deal with these difficult issues. The program at Children’s is designed in a similar fashion to the one developed at Helen DeVos Children’s Hospital in Grand Rapids, Mich.


The program at Children’s of Alabama is the behavioral psychology component of the new Aerodigestive Program, which encompasses a larger mission of managing complex airway, feeding or nutritional issues. Program specialists evaluate children, develop treatment plans and provide care for a wide variety of conditions using proven, behavior modification techniques coupled with the insight and interventions of speech and language pathologists and occupational therapists.


About half of the program’s patients are expected to be feeding-tube dependent, and in many cases the team will work to normalize the child’s eating and drinking abilities. The Intensive Feeding Program is also capable of dealing with:

• Food refusal

• Oral aversion

• Inability to consume adequate volumes of food and liquid

• Transitioning to age-appropriate textures, consistencies or utensils

• Recurrent vomiting

• Restricted eating patterns


Patients should be referred to the program at Children’s after going through previous attempts to improve their feeding and drinking behaviors. The program is set up to handle tougher, more persistent cases that require multi-disciplined interventions and are often associated with conditions such as gastric esophageal reflux disease, failure to thrive, dysphagia, gastrointestinal problems, developmental disorders, including those on the autism spectrum and behavioral difficulties.


This is an intensive, outpatient program lasting six to eight weeks, five days a week, from 8 a.m. until 5 p.m. Generally, experts will spend about four weeks feeding a child all meals during the week in order to approach identified goals. Care is provided in a room equipped for unobtrusive observation by parents, other caregivers or health professionals.


After that, parents or caregivers will be provided with a small earphone and sent into the treatment room to take over the feeding and drinking interventions. Initially they will be working with their child with the help of therapists. As the caregivers progress and the child demonstrates consistent success, therapists will transition to the observation rooms where they can continue to coach caregivers. It is an effective way to improve the interaction between parents and children at mealtimes.


The results are often impressive. For example, the program at Children’s had its first graduate of the day treatment program in November 2014. This patient was born with significant complex medical challenges, including significant prematurity (born at 22 weeks gestation). The patient came into the program 100 percent dependent upon a feeding tube for nutrition, but was discharged 8 weeks later without the need for G-tube feedings.


Similar programs have been studied and found to be effective. This is a precisely targeted therapy that often succeeds in improving the quality of life for both the child and family. Children’s program is currently evaluating patients weekly and is currently admitting two patients at a time into day treatment. The goal is to expand the program to be able to treat three patients at a time in the second year of the program and four patients at a time in the third year. Referrals forms for evaluation can be found on the Children’s website at www.childrensal.org or by calling 205-638-7590.

Fuse - The Newest and Most Advanced Technology in Colonoscopes

by Kenneth M. Sigman, M.D. Birmingham Gastroenterology Assoc., PC Chief of Gastroenterology - Trinity Medical Center


Colonoscopy has proven its worth over the past 40 or more years. It is clearly the best test for screening for colon cancer and detecting and removing pre-cancerous polyps. Multiple longitudinal studies have confirmed that removing these polyps significantly reduces the incidence of colon cancer. Colonoscopes, and their imaging qualities, have improved remarkably over that time to the current high definition images showing very fine detail of the colonic mucosa. Despite these technologic improvements, a significant percentage of lesions are not seen and are missed - even in the best and most careful examiner’s hands - because haustral folds and turns or flexures create blind spots for these lesions.


A newly designed colonoscope has been developed to improve the field of view and remove some of these blind spots. The standard forward viewing colonoscope (FVC) has one lens with a field of view of 140-170 degrees. The new Fuse colonoscope, full spectrum endoscopy (FSE) produced by the Endochoice company, has three lenses that provide a 330 degree field of view allowing an image of significantly more of the colonic surface, reducing blind spots. This should translate into more complete exams detecting more pre-cancerous polyps (adenomas) as well as smaller, cancerous lesions that may be missed by the FVC. Studies comparing the two types of colonoscopes have shown a significantly lower adenoma miss rate for FSE when compared to FVC. A recent multicenter randomized study, published in the Lancet, showed an adenoma miss rate of 41% for standard FVC vs 7% for FSE. Although more data is needed, these early results are very promising.


The Fuse FSE has been in commercial production for about a year. Several institutions in the US have adopted this technology. Trinity Medical Center in Birmingham is the only hospital in the state of Alabama to offer this advanced method of colonoscopy.


The gastroenterologists of Birmingham Gastroenterology Associates, in association with Trinity Medical Center, continue to be on the forefront of technological advances in GI medicine and offer the most advanced care for their patients. Patients can be scheduled for FSE colonoscopy or any other GI testing by contacting Trinity Medical Center GI Lab or Birmingham Gastroenterology offices.

The Silent but Blinding Disease…

By: Shilpa Register, OD, MS, PhD, FAAO, FNAP Associate Professor UAB School of Optometry

UAB Eye Care is the clinical operation for the UAB School of Optometry, an integral part of the UAB Medical Center. Here, UAB optometrists and ophthalmologists who specialize in eye disease provide comprehensive care to the Birmingham and surrounding area. Our goal is to promote healthy habits and prevent the loss of vision from sight threatening eye diseases such as glaucoma. As part of this goal, we wanted to take a few minutes of your time to inform you of the symptoms and treatment for glaucoma since January is National Glaucoma Awareness month.


Glaucoma affects over 2.2 million people, but only 50% of them are aware that they have glaucoma. If left untreated, glaucoma will lead to blindness making it the 2nd leading cause of blindness in the world. We want this to change!


Glaucoma comes in many forms but most are marked with high eye pressures and subsequent damage to the optic nerve and vision loss. Because there is no pain, irritation, redness, or other noticeable symptom, it is extremely important that all adults obtain comprehensive eye exams from their optometrist on an annual basis. Most people do not notice any vision changes until a substantial portion of their vision has been lost. Any vision loss cannot be regained. The American Optometric Association recommends the following schedule for preventative dilated eye exams:


Table 1

Patient Age                     Risk-Free                                      At-Risk

Birth to 24 months          At 6 months of age                         At 6 months of age or as
                                                                                                recommended

2-5 years                         At 3 years of age                             At 3 years of age or as
                                                                                                recommended

6-18 years                       Before 1st grade and                       Annually or as
                                        every 2 years thereafter                   recommended
                                   

18-40 years                     Every 2 years                                   Every 1-2 years or as
                                                                                                 recommended

41-60 years                     Every 2 years                                   Every 1-2 years or as
                                                                                                 recommended

61 or older                       Annually                                          Annually or as recommended


Glaucoma is a silent disease that affects people of all ages with older adults being at the highest risk. Those individuals who are at-risk for certain types of glaucoma include older individuals, African Americans, Asians, and Latinos. Those patients with a positive family history of glaucoma are at higher risk for glaucoma. Most people do not know that diseases that affect your body also increase their risk of glaucoma including the presence of diabetes, poor perfusion or the presence of vasospasms. During the annual eye exam, optometrists can identify additional ocular risk factors such as high or asymmetric intraocular pressures, optic nerve enlargement, optic nerve asymmetry, high myopia, thin central corneal thickness, and visual field defects that could be indicative of glaucoma.


Optometrists will perform necessary tests to diagnose and monitor glaucoma. He or she may prescribe eye drops or recommend surgical intervention to stabilize the eye pressures and reduce further ocular damage.



What can you do to help your patients? 

• Follow the AOA guidelines and recommend comprehensive dilated eye exams. 
• Recommend that any patients with diabetes, poor perfusion, or vasospasm obtain a comprehensive dilated eye exam. 
• Encourage your glaucoma patients to follow the treatment and follow up recommendations.

To contact UAB Eye Care for referrals and/or consultations, please call (205) 975-2020. We accept most vision and medical insurance plans.

Baptist Health System Signs Letter of Intent with Tenet Healthcare

Baptist Health System today announced that it has signed an exclusive, non-binding Letter of Intent (LOI) with a subsidiary of Tenet Healthcare Corporation, the parent company of Brookwood Medical Center, to form a new, jointly-owned company that will include all Baptist Health System hospitals, Brookwood Medical Center, and their related businesses. The parties have initiated an exploratory period of due diligence, which is intended to result in a definitive agreement. 

The new company would unite Baptist Health System’s four hospitals -- Citizens Baptist Medical Center, Princeton Baptist Medical Center, Shelby Baptist Medical Center and Walker Baptist Medical Center -- with Tenet’s Brookwood Medical Center. Together, the new system would have more than 1,700 licensed beds and include 77 primary and specialty care clinics, approximately 7,300 employees and approximately 1,500 affiliated physicians.

The partnership would build upon the strengths of both Baptist Health System and Brookwood Medical Center, and give the expanded healthcare network access to a sustainable source of capital and the possibility of significant investments in new equipment, facility upgrades and strategic initiatives in the future, creating meaningful opportunities for innovations in care delivery.

“We are excited to engage in an exclusive dialogue about developing a joint venture with Tenet Healthcare,” said Keith Parrott, CEO of Baptist Health System. “A primary reason to enter into a partnership with Tenet is its track record partnering with and growing faith-based institutions and allowing them to continue operating with a faith-based mission and focus. At the same time, Tenet can offer resources such as sustainable access to capital, a strong history of operating well-run hospitals and access to its existing purchasing contracts. This potential partnership represents an opportunity to strengthen our collective efforts and enhance healthcare across central Alabama while preserving and honoring the Baptist name, maintaining our Christian values, and supporting our faith-based approach to healthcare.” 

“Tenet sees great benefit in a partnership with Baptist Health System’s dedicated group of health professionals,” said Garry Gause, chief executive officer, Southern Region at Tenet Healthcare. “This proposed partnership offers the opportunity to improve healthcare delivery to communities throughout central Alabama while preserving the remarkable legacies of Baptist Health System and Brookwood Medical Center. The new organization will enable our institutions to better navigate the changing landscape of healthcare today, and to meet the growing demands for quality care in Alabama tomorrow.” 

Once a final definitive agreement is reached, the new joint venture could be formed as early as next spring. The parties do not plan to provide additional details until such time as a definitive agreement is reached. 

Bariatric Surgery – How one decision can change your life

By: Sue Bunnell, RN and manager of the Comprehensive Bariatric Center at Princeton Baptist Medical Center


As a former weight loss patient, I know first-hand the impact that excess weight can have on a person’s life. Eleven years ago, I found myself at 293 pounds and made a decision that has truly changed my life. I decided to take action and find out more about bariatric surgery.


I remember when my oldest son was a Cub Scout – all I wanted was to be active in his life and participate in the fun scheduled outings. Because of my weight, however, my capacity was greatly limited and both my son and I missed out on the trips.


According to the Centers of Disease Control (CDC), obesity affects approximately 78 million Americans – with Alabama’s obesity rate at 32.4 percent. In addition, the disease is linked to more than 40 other life-threatening conditions, including type 2 diabetes, heart disease, stroke, osteoarthritis and even cancer.


If you are one of the millions who are overweight, I know where you are and I know what you are facing. Looking back, I remember the fear of losing my life and happiness to the disease and also the fear of taking the first step to freedom.


The Comprehensive Bariatric Center at Princeton Baptist Medical Center is dedicated to delivering personalized, cutting-edge services to improve the health and quality of life for our patients. Everything from our individualized program to the design of our facility was created with patient experience in mind.


Recently, our Center was designated as an Optum™ Center of Excellence, indicating that the Center meets or exceeds nationally recognized standards of care. Since opening nearly two years ago, our team of specialist have focused on providing the highest quality bariatric program in the Southeast.


When you visit our Center for the first time, you will notice something different. It’s the size-appropriate chairs that are placed from the valet parking to the patient rooms, the wider halls, the bimonthly support group, the lifelong free follow-up care, the gym that can accommodate 450 pounds and is wheel-chair accessible and the large auditorium for our training and weekly educational classes that truly sets us apart from any other facility in the region.


Our board-certified surgeons are specialized in minimally invasive surgeries, including Roux-en-Y Gastric Bypass (RYGB); Adjustable Gastric Band (AGB); and Gastric Sleeve (GS). In addition to surgical options, we also offer a medical weight-management program, educational sessions, nutritional and exercise counseling, support groups, cooking classes and recovery programs.


If you are struggling with your weight like I was 11 years ago, I would encourage you to schedule a tour or a seminar to find out more about how our services can help you. It has made all the difference in my life – I’m now 145 pounds healthier – and that’s something I am proud to share.



For more information, please visit our website: http://princetonbariatrics.com/  

Eye Care for the Underserved

By: Katherine A. Clore, O.D., Associate Professor UAB School of Optometry

As a Doctor of Optometry and Associate Professor at the University of Alabama at Birmingham School of Optometry, I find many rewards in my profession. From providing primary patient care and preparing future optometrists for a professional career, to research and community service, all aspects of the profession are exceptionally satisfying. However, recently the School of Optometry provided a community outreach program named "Gift of Sight," which gave me a special sense of fulfillment.


The first-time program is a mobile extension of UABSO's Eye Care Clinic whose goal is to provide eye care to those who might not otherwise be able to afford comprehensive eye exams. A comprehensive dilated eye exam can reveal ocular diseases as well as ocular manifestations of systemic diseases. If other care is needed, patients are referred for appropriate treatment throughout the health care community.


According to BB Jefferson, Clinic Coordinator at UAB's School of Optometry Community Eye Care, over 200 patients were seen for complete dilated eye exams. In addition, they were offered donated gift items such as hats, gloves, socks, scarves and blankets. The interns were excited about helping others as well as being able to diagnose and treat various conditions! A quote from one of those who helped helped, with tears running down her face said “I haven’t had a Christmas like this since I was a little girl.” It is always gratifying to treat a patient and have a successful outcome, but it is especially rewarding with patients who likely would not have the opportunity to receive treatment otherwise.


A 2011 study of over 11,000 adults by the CDC found that almost 40% who were considered to have moderate to severe visual impairment said they had skipped seeking care in the past year because of cost or lack of insurance.


In a study conducted in 2007 by the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, they concluded that approximately 5 million high-risk adults in the United States could not afford eyeglasses when needed; being female, having low income, not having insurance, and having vision or eye problems were each associated with such inability.


The "Gift of Sight" to these people is especially precious and The UAB School of Optometry is proud to provide services to those who might not have access otherwise through its year-round Community Eye Care program.


Community Eye Care is an outreach program from UAB Eye Care to the community. Vision screenings are provided at many area schools during the fall. There are also vision screenings at many senior centers and health fairs. Comprehensive eye care is provided at several health department clinics in Jefferson County, such as Bessemer (Bessemer Health Center), North Birmingham (Northern Health Center) and Ensley (Western Health Center). The Community Eye Care Service also provides comprehensive vision services for the adult clients at United Cerebral Palsy of Birmingham (LincPoint).


Community Eye Care also partners with various campus entities to provide services in underserved populations in the Black Belt and for the homeless in the Greater Birmingham area. As collaborators with the Friends of the Congressional Glaucoma Caucus Foundation, mutual goals of disease identification and patient education are met as well.


In describing the program, Dr. Felton Perry, Director of Community Eye Care, is quoted as saying, "It's our way of giving back... We owe it to the community."


The need for vision care is great and Community Eye Care is always exploring other opportunities to serve the community, either through screenings, examinations or education.



If you have an opportunity that you would like to explore with Community Eye Care, contact UAB Eye Care at (205) 975-2020, and leave your contact information with the operator. Someone in the Community Eye Care Service will return your call.

A LOOK AT LEG VEIN PROBLEMS AND TREATMENTS

By: Dr. Robert E. Foster _ Director, BHC Vein Center

The Birmingham Heart Clinic Vein Center diagnoses and treats venous disease with minimally invasive procedures, resulting in less pain and quicker recovery for patients. Our goal is to quickly return patients back to a functional, painless lifestyle.



What is venous disease? About 40 million Americans suffer needlessly from venous disease which occurs in approximately 25 percent of women and 15 percent of men. Unfortunately, only 3 percent of those with venous disease have sought or received treatment that could distinctly improve their lifestyle. Venous disease occurs when diseased or abnormal veins cause blood to flow backwards in the veins of the leg. This causes stretching of the veins as well as leg swelling, pain and ultimately leg wound formation.


What are spider and varicose veins? One of the most common visible signs of venous disease is spider veins which appear as small, purplish or blue clusters of veins on the leg. Varicose veins are larger bluish veins which may be painful due to engorgement when standing or sitting. Spider veins typically do not cause discomfort but if they do become painful, it is important to meet with a physician who is qualified in the diagnosis and treatment of venous disease. Although spider and varicose veins may be unsightly, many patients do not realize that these are outward signs of an underlying serious condition in the deeper vein system which, if not treated, may lead to increased risk for blood clots, swelling, skin color changes and ulceration.


What are the symptoms of venous disease? Venous disease may not present itself until leg pain or skin problems emerge. Venous disease symptoms may include the following:

• Swelling or heaviness in the legs (especially in the evening)

• Leg pain or cramping

• Visible varicose or spider veins

• Discoloration of the skin

• Dry and weeping eczema

• Leg ulcers

• Restless legs


What if venous disease is left untreated? Venous disease can progressively worsen over time due to pressure created by the backflow of blood in the legs. This may lead to additional spider and varicose veins, and in some cases, it may lead to swelling and venous ulcers in the lower calf and ankle. If left untreated, venous disease can markedly affect quality of life by reducing the patient’s ability to sleep, walk or sit/stand for long periods of time due to severe symptoms of the legs. Even if only spider veins are present, you should consult a vein specialist to determine the problem so that it can be treated.


What venous services are offered at the BHC Vein Center?

• Consultation with a vein specialist. Our vein team consists of vein specialists certified by the American Board of Venous and Lymphatic Medicine. They will evaluate you closely to assess the diagnostic and treatment procedures that are the best for your specialized needs.

• Radiofrequency ablation. This minimally-invasive procedure is performed in the office using radiofrequency energy to apply heat to the vein through a thin catheter. This essentially “welds” the vein closed to prevent its ability to reflux.

• Endovascular laser therapy. This is similar to ablation in that a thin catheter is inserted into the vein, but instead it uses a laser fiber to heat the vein wall.

• Sclerotherapy. This is an effective treatment for both spider and varicose veins. A medication (sclerosant) is injected into the affected vein causing it to shrink. Most patients require a series of treatments.

• Phlebectomy. This procedure involves the removal of large visible varicose veins through small punctures in the skin.



If you think you may have venous disease, call the BHC Vein Clinic for a consultation at 205-856-2284 or visit www.birminghamheart.com

It’s the Holidays, Can we Talk?

By: Craig Greer, Director of Special Programs at Comfort Care Home Health and Hospice


The holidays are upon us. It’s a time for family and friends, sharing memories and bonding in the midst of celebrations and gifts. But the greatest gift loved ones can provide and receive is peace of mind. How can we provide another with peace of mind - by talking about life and healthcare choices.


Stephen Covey, author of Seven Habits for Highly Effective People talks about beginning with the end in mind. For each of us, our lives will eventually end in death. Not a happy thought, but a true fact that we cannot deny. Somehow we avoid discussing this reality until there is a crisis.


As a chaplain, I have held hands with family members and heard the same sad theme time and time again. “I know what I would want, but I don’t know what mom would want,” as they agonize over difficult decisions about ventilators, feeding tubes, palliative care or hospice. No matter the decision in these situations, there is no peace of mind.


The time to talk about end-of-life care options is when we are healthy. To do so after a diagnosis is more difficult because of the fear and anxiety. This doesn’t mean it is easy to have this conversation, but it is easier after topic has been introduced and there has been talk about the types of care a loved one prefers. Certainly we may change our minds when a diagnosis occurs, but the fact that there has been discussion makes it easier to revisit our decisions and modify as necessary.


Important decisions for those 19 years old or older can be achieved by pondering the following questions: Who would speak for you if you could not speak for yourself? What types of care would you want to receive if there was less than a five percent chance of meaningful recovery? What does meaningful recovery mean to you? It is critical to have this discussion with your healthcare proxy, so he/she will understand the responsibility involved.


The next phase is discussing options if you have a chronic or debilitating disease. It is important to fully comprehend the diagnosis and how the disease might progress over time. For example Congestive Heart Failure and pulmonary diseases typically don’t improve - these conditions worsen over time and often require frequent hospitalizations. Likewise cancer treatments can cause many side effects that may be intolerable. At what point is it enough? How would you want to live your life? Where would you want to receive care? There are options and you do have choices.


There is no right or wrong answer. It is crucial for all of us to reflect on our values and beliefs in order to come up with a plan and we should talk with all of our loved ones in order to make our wishes known. How can loved ones honor healthcare decisions when they don’t know what those decisions are?


We think of this primarily as a legal issue, but it is also a conversation issue. We must have the talk with our loved ones and then put our wishes down in writing as a last step.


For the past two years Comfort Care Hospice has worked to promote this conversation in our communities for people of all ages. There are many great grass-roots programs to help people navigate this difficult topic. For a list of resources visit our website http://comfortcarehospice.com/advance-care-planning/.



If you would like more information about our community events or to have someone to talk to your group, please contact cgreer@comfortcarehospice.org

LSVT LOUD (Lee Silverman Voice Therapy)

By: Sonya L. Pearson, PT, DPT  _ LSVT BIG Certified Clinician at HealthSouth Lakeshore Outpatient Therapy


LSVT BIG is an evidenced based neurorehabilitation treatment program originally designed to treat the motor impairments related to Parkinson's Disease and evolved from the efficacious speech treatment LSVT LOUD (Lee Silverman Voice Therapy).

The primary manifestations of Parkinson's Disease include bradykinesia (slowness of movement) and hypokinesia (decreased amplitude or range of movement). Individuals with Parkinson's Disease often report that they move slower, have greater difficulty getting dressed, write smaller and are often asked to 'speak up', all of which can be attributed to the effects of bradykinesia and hypokinesia.


The basic principles of LSVT BIG are directly aimed at increasing the amplitude of movement during everyday activities. The four basic principles of LSVT BIG include high effort, progressive movements, continuous activity and motivation. The delivery and administration of this innovative Physical and Occupational therapy is a hallmark feature of LSVT BIG. The program schedule includes 16 individual therapy sessions, delivered four days a week over the course of four consecutive weeks.

During a typical one hour LSVT BIG session participants will perform highly repetitious exercises, which include whole body movements, functional component tasks and BIG walking trials. In addition to the high frequency of delivery participants perform LSVT BIG carryover exercises and homework practice one to two times a day while away from therapy during the course of their treatment. This high level of intensity and frequency assists in increasing the amplitude and speed of movement in their everyday lives.

Participants may experience the following improvements:
Faster walking with bigger steps
Improved balance
Increased trunk rotation
Improved confidence
Restored Hope


Although LSVT BIG was originally designed to treat motor impairments related to Parkinson's Disease, it has since been successfully used to treat other neurological diseases and injuries including: Stroke, Brain Injury and Multiple Sclerosis.



For more information on LSVT BIG, please contact HealthSouth Lakeshore Outpatient Therapy at 205-868-2290.