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To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 15, How Stress Affects You and What You Can Do About It

According to an American Psychological Association survey, 75% of adults questioned reported moderate to high levels of stress in the past month and nearly half reported that their stress has increased in the past year. On this edition of “To Your Health,” Dr. Jim Morrow discusses different stress levels, stress triggers, and what you can do to reduce the effect of stress in your life. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Stress

  • Stress can be good for you.
    • It keeps you alert, motivated and primed to respond to danger.
    • As anyone who has faced a work deadline or competed in a sport knows, stress mobilizes the body to respond, improving performance.
    • Yet too much stress, or chronic stress may lead to major depressionin susceptible people.
  • Everyone knows that bad things in life are stressful
    • But the good things (marriage, new job or new house) are also very stressful.
  • The “good life” doesn’t happen in a vacuum, it takes a lot of mental and physical work.
  • Many of my patients are stressed because they are doing too much for too many people in too short a period of time and with too few resources.

There  Are Basically 3 Types of Stress

  • Acute stress
    • Acute stress is the most common form of stress.
    • It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future.
    • Acute stress is thrilling and exciting in small doses, but too much is exhausting.
      • A fast run down a challenging ski slope, for example, is exhilarating early in the day.
      • That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones.
    • By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach and other symptoms.
  • Examples of Acute Stress
    • the auto accident that crumpled the car fender,
    • the loss of an important contract,
    • a deadline they’re rushing to meet,
    • their child’s occasional problems at school
  • Emotional distress causes
    • Muscular problems including
      • tension headache,
      • back pain,
      • jaw pain and
      • the muscular tensions that lead to pulled muscles and tendon and ligament problems.
    • Stomach, gut and bowel problems such as
      • heartburn,
      • acid stomach,
      • flatulence,
      • diarrhea,
      • constipation and
      • irritable bowel syndrome.
    • Transient over-arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain.
  • Episodic acute stress
    • There are those who suffer acute stress frequently,
    • whose lives are so disordered that they are studies in chaos and crisis.
      • always in a rush, but always late.
      • If something can go wrong, it does.
      • They take on too much,
        • have too many irons in the fire, and
        • can’t organize the slew of self-inflicted demands and pressures clamoring for their attention.
        • They seem perpetually in the clutches of acute stress.
  • It is common for people with acute stress reactions to be
    • over aroused,
    • short-tempered,
    • irritable,
    • anxious
    • Often, they describe themselves as having “a lot of nervous energy.”
      • Always in a hurry,
      • they tend to be abrupt, and
      • sometimes their irritability comes across as hostility.
      • Interpersonal relationships deteriorate rapidly when others respond with real hostility.
      • The workplace becomes a very stressful place for them.
  • The cardiac prone, “Type A” personality is
    • similar to a constant extreme case of episodic acute stress.
    • Type A’s have an
      • excessive competitive drive,
      • aggressiveness,
      • impatience, and
      • a harrying sense of time urgency.
      • In addition there is a
        • free-floating, but well-rationalized form of hostility, and
        • almost always a deep-seated insecurity.
        • seem to create frequent episodes of acute stress for the Type A individual.
        • Type A’s are found to be much more likely to develop coronary heart disease than Type B’s, who show an opposite pattern of behavior.
  • The symptoms of episodic acute stress are
    • persistent tension headaches,
    • migraines,
    • hypertension,
    • chest pain and
    • heart disease.
    • Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months.
  • Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives.
    • They blame their woes on other people and external events.
    • Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.
  • Sufferers can be fiercely resistant to change.
    • Only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.
  • Chronic stress:
    • While acute stress can be thrilling and exciting, chronic stress is not.
    • This is the grinding stress that wears people away day after day, year after year.
    • Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition.
    • It’s the stress of poverty,
    • of dysfunctional families,
    • of being trapped in an unhappy marriage
    • or in a despised job or career.
    • It’s the stress that the never-ending “troubles” have brought
      • to the people of Northern Ireland,
      • the tensions of the Middle East
      • the endless rivalries that have been brought to the people of Eastern Europe and the former Soviet Union.
  • Chronic stress comes when a person never sees a way out of a miserable situation.
    • It’s the stress of unrelenting demands and pressures for seemingly interminable periods of time.
    • With no hope, the individual gives up searching for solutions.
  • Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present.
    • Some experiences profoundly affect personality.
    • A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times).
    • When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.
  • One of the worst aspects of chronic stress is that people get used to it.
    • They forget it’s there.
    • People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.
  • Chronic stress kills through suicide,
    • violence,
    • heart attack,
    • suicide,
    • stroke and,
    • perhaps, even cancer.
    • People wear down to a final, fatal breakdown.
      • Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.
  • Why is too much stress bad for you?
  • Too much stress can be detrimental.
    • Emotional stress that stays around for weeks or months can weaken the immune system and
    • cause high blood pressure,
    • fatigue,
    • depression,
    • anxiety and
    • even heart disease.
    • In particular, too much epinephrine can be harmful to your heart.
  • Sustained or chronic stress, in particular, leads to elevated levels of cortisol, the “stress hormone,”
    • As well as reduced levels of serotonin and other neurotransmitters in the brain, like dopamine
    • These hormone changes have been linked to depression.
    • When these chemical systems are working normally, they regulate biological processes like sleep, appetite, energy, and sex drive, and permit expression of normal moods and emotions.
    • When the stress response fails to shut off and reset after a difficult situation has passed, it can lead to depressionin susceptible people.
    • No one in life escapes event-related stress, such as
      • death of a loved one,
      • a job loss,
      • divorce,
      • a natural disaster such as an earthquake, or
      • even a dramatic dip in your 401(k).
    • A layoff — an acute stressor — may lead to chronic stress if a job search is prolonged.
  • Loss of any type is a major risk factor for depression.
    • Loss of a loved one is a huge stressor
      • Grieving is considered a normal, healthy, response to loss, but if it goes on for too long it can trigger a depression.
    • Loss of health –
      • A serious illness, including depression itself, is considered a chronic stressor.
    • Loss of independence –
      • When patients lose their ability to live alone, or to drive they are very stressed
    • Loss of financial stability –
      • Regardless of cause
    • What you can do?
      • Watch out for signs of stress overload.
        • Symptoms of too much stress can be
        • physical,
        • emotional,
        • mental and behavioral.
        • While everyone is different, some common signs are:
        • memory problems,
        • trouble concentrating,
        • racing thoughts,
        • irritability,
        • anger,
        • sadness,
        • headaches,
        • frequent colds and
        • changes in sleep or appetite.
  • Know your stress triggers.
    • Stress and its triggers are different for everyone.
      • Certain people, places or situations might produce high levels of stress for you.
      • Think about what causes you stress, and brainstorm solutions.
        • If public speaking or presentations make you stressed, start researching early and practice several times.
        • If there are friends or social situations that cause extreme stress, you may want to avoid them when you are already feeling tense or overwhelmed.
    • All forms of exercise
      • reduce stress hormones,
      • flood the body with feel-good endorphins,
      • improve mood,
      • boost energy and
      • provide a healthy distraction from your dilemmas.
      • Plus, exercise may make you less susceptible to stress in the long run.
      • Find physical activities that you enjoy and try to devote about 30 minutes to them each day.
    • While it’s impossible to eliminate all negative stress from your life, you can control the way you react to stress.
    • Your body’s natural fight-or-flight response can take its toll.
    • When you’re faced with a stressful situation that your mind perceives as a threat,
      • it sends various chemicals, like adrenaline and cortisol, throughout your body.
      • As a result, heart rate and breathing speeds up and your digestion slows down. This tires out the body.
      • Relaxation techniques are a huge help in calming you down, boosting mood and fighting illness.
        • Try a variety of techniques — like
          • yoga,
          • breathing exercises,
          • meditation and visualization — to see what works for you, and schedule a relaxation break every day.
  • Manage your time well.
    • Time can seem like a luxury, but there are various ways to manage it effectively.
      • First, focus on one task at a time.
        • Multitasking rarely works.
        • Jot down everything you need to do in a calendar or a task management app/program,
          • prioritize your list and break projects into single steps or actions.
  • Be realistic.
    • Pulling yourself in different directions will only stress you out, so try not to over-commit yourself or do extracurricular activities when you’re super busy with school.
    • Learn to say NO
  • Curb your caffeine.
    • Caffeine might help you study in the short term, but it interrupts sleep and makes you
      • more anxious,
      • tense and jittery
      • This obviously ups your stress level.
      • Try and drink no more than one caffeinated beverage a day.
    • Don’t self-medicate.
      • Some people
        • drink,
        • take drugs,
        • smoke and
        • use other unhealthy behaviors to cope with stress.
        • However, these behaviors can exacerbate stress by negatively affecting your mood and health.
  • Reach out.
    • If you’re stressed out,
      • talk to your friends and family.
      • If you feel like you can’t handle the stress on your own, schedule an appointment with a counselor or therapist.

To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer

by

North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 14, Skin Cancer

One in six Americans develop skin cancer at some point in their life, and skin cancers account for one-third of all cancers in the country. On this edition of “To Your Health With Dr. Jim Morrow,” Dr. Jim Morrow addresses the prevention of and screening for skin cancer, as well as specific skin cancers to be aware of. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Skin Cancer

  • One in six Americans develops skin cancer at some point.
    • Skin cancer accounts for one third of all cancers in the United States.
    • Most patients with skin cancer develop non-melanoma skin cancer.
      • This group of cancers includes basal cell carcinoma, the most common neoplasm worldwide, and squamous cell carcinoma.
      • Fortunately, mortality associated with non-melanoma skin cancer is unusual.
    • However, malignant melanoma accounts for 75 percent of all deaths associated with skin cancer.
  • Melanoma, the eighth most common malignancy in the United States, is the cancer with the most rapidly increasing incidence.
    • 1 of 1,500 Americans born in 1935 were likely to develop melanoma, compared with 1 of 105 persons born in 1993.
    • Non-melanoma skin cancer typically affects older persons; the frequency of melanoma peaks between 20 and 45 years of age.
    • Mortality rates are higher in men than in women.
    • This higher rate may occur because lesions tend to develop in less easily observed areas, such as the back, in men.
    • Mortality is also increased in blacks for this reason, as is the propensity to develop more aggressive tumors and to be diagnosed at later stages.
    • The rising incidence of skin cancer over the past several decades may be primarily attributed to increased sun exposure associated with societal and lifestyle changes and to depletion of the protective ozone layer.

Prevention of Skin Cancer

  • Avoid the sun during peak hours.
    • Generally, this is between 10 a.m. and 4 p.m.
    • Water, snow, sand and concrete reflect light and increase the risk of sunburn.
  • Wear sun protective clothing.
    • This includes pants, shirts with long sleeves, sunglasses and hats.
  • Use sunscreen.
    • Look for water-resistant, broad-spectrum coverage with an SPF of at least 30, which blocks 97 percent of the sun’s UVB rays.
    • Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or sweating.
    • Higher-number SPFs block slightly more of the sun’s UVB rays, but no sunscreen can block 100 percent of the sun’s UVB rays.

Screening for Skin Cancer

  • While early detection and treatment of skin cancer can improve patient outcomes, convincing data regarding the benefit of mass screening programs are lacking.
    • In addition, the ability to identify potentially malignant lesions varies with physician training.
    • So, except for very high-risk persons with a history of skin cancer or atypical mole syndrome, for whom periodic screening is universally recommended, there is considerable debate about who should be screened, who should perform the screening and how often screening should be performed.
    • Part of the screening process should include an assessment of patient risk.
  • Basically,
    • Age 20 to 39 years: complete skin examination every three years
    • Age 40 years and older: annual complete skin examination
  • When screening is performed, the examiner must systematically inspect the entire skin surface.
    • The patient should completely disrobe and remove concealing cosmetics.
    • Daylight is the ideal light source
    • Photographs may improve the quality of documentation and detection of lesion changes over time.
  • ABCDE Rule:
    • Asymmetry (one half of the mole doesn’t match the other),
    • Border irregularity,
    • Color that is not uniform,
    • Diameter greater than 6 mm (about the size of a pencil eraser), and
    • Evolving size, shape or color.

Specific Skin Neoplasms

ACTINIC KERATOSES

  • Actinic keratoses, sometimes called solar keratoses, often arise on chronically sun-damaged body areas such as the face, ears, arms and hands.
    • They may provide an indication of a person’s cumulative ultraviolet light exposure and, therefore, that person’s risk for all types of skin cancer.
    • Actinic keratoses are often ill-defined and irregular, ranging from 1 mm to several centimeters in size.
    • They may be lesions that can be seen or felt, and generally have a scaly appearance.
    • Patients often have multiple lesions.
  • The lesions are usually pale brown or flesh-colored but may be yellow, reddish-brown or even dark brown or black following trauma.
  • The rate of malignant transformation of individual actinic keratoses to squamous cell carcinoma is less than one per 1,000 per year,
    • but treatment of lesions is indicated to decrease the chance of progression to squamous cell carcinoma.
  • Skin biopsy is occasionally required to rule out squamous cell carcinoma.
  • Cryotherapy with liquid nitrogen is the treatment of choice for most cases of actinic keratosis.
    • Curettage, or scraping away the lesion, may also be used and may be used in conjunction with cryosurgery or electrodessication (burning).
    • Surgical excision is rarely required but may be useful in excluding squamous cell carcinoma as a possible cause in lesions that are larger than 0.5 cm in diameter.
    • Chemical destruction of superficial lesions may be used when there are many lesions, particularly on the face and head.
      • 5-fluorouracil (5-FU), is most commonly used.
      • Areas other than the head and neck require the higher concentrations because of greater skin thickness.
      • In conventional regimens, 5-FU is applied twice daily for two to five weeks.
      • Adverse effects include true hypersensitivity, secondary bacterial and herpetic infection, and post-inflammatory pigmentation changes.
      • This therapy is often associated with significant discomfort related to an intense inflammatory response.
      • Pulsed dosing regimens aimed at reducing skin irritation have met with mixed success.
      • Topical corticosteroids may reduce inflammation but also make the treatment end point difficult to discern.
    • Other therapies used occasionally for treatment of actinic keratoses include laser, topical Retin-A, chemical peeling and facial dermabrasion.

BASAL CELL CARCINOMA

  • Basal cell carcinoma is the most common skin neoplasm.
    • Basal cell carcinomas
      • are usually located on the face or the backs of the hands.
      • They typically grow slowly and generally spread only locally.
      • Metastasis is quite rare.
    • While a preliminary diagnosis of basal cell carcinoma may be made on the basis of appearance, incisional or excisional biopsy is required for definitive diagnosis.
    • Cure rates of 95 to 99 percent can be achieved for low-risk lesions using simple excision with margins of 2 to 5 mm.
    • A lesion is considered low risk if it is less than 1.5 cm in diameter; has not previously been treated; is not in a difficult-to-treat area, like the H zone of the face; and is nodular or cystic.
    • Treatment of basal cell carcinomas with cryotherapy can also be successful, but healing may take weeks, and success depends on the skill of the cryotherapist.
      • Mohs’ micrographic surgery is the treatment of choice for most sclerosing basal cell carcinomas, as well as for large tumors and those located in areas that are difficult to treat.
      • Radiation therapy produces cure rates of 90 to 95 percent but has the same limitations as those outlined for squamous cell carcinoma treatment.
    • Other therapies used occasionally include topical Retin-A.

 SQUAMOUS CELL CARCINOMA

  • Squamous cell carcinoma is the second most common skin cancer, comprising 20 percent of all cases of non-melanoma skin cancer.
    • This is the most common tumor in elderly patients, and it is usually the result of a high lifetime cumulative dose of solar radiation.
      • A new study finds that some types of human papillomaviruses, or HPVs, may increase the risk of squamous cell skin cancers.
    • However, other irritants and exposures may lead to squamous cell carcinoma.
    • Up to 60 percent of squamous cell carcinomas occur at the site of a previous actinic keratosis.
    • Changes in an actinic keratosis that suggest evolution to squamous cell carcinoma include pain, erythema, ulceration, induration, hyperkeratosis and increasing size.
    • As many as 50 to 60 percent of squamous cell carcinomas occur on the head and neck.
    • Other common sites include the hands and forearms, upper trunk and lower legs.
    • Squamous cell carcinomas typically appear as small, palpable tumors that may grow moderately rapidly over a period of months and range from a few millimeters to centimeters in size.
    • They may appear nodular, and may be reddish-brown, pink or flesh-colored.
    • Larger squamous cell carcinomas may appear crusted, erythematous or eroded. In contrast to basal cell carcinoma, a definitive edge is difficult to demonstrate when a squamous cell carcinoma lesion is stretched.
  • Histologic confirmation by a full-thickness skin biopsy (incisional or excisional) is mandatory before definitive treatment.
    • Well-differentiated lesions less than 2 cm in diameter can be treated with surgical excision, with a cure rate approaching 99 percent.
  • Squamous cell carcinomas may grow aggressively and are associated with a 2 to 6 percent risk of metastasis.
    • Risk factors for metastasis include increasing lesion depth and location on the lip or ear.
    • The most common locations for metastatic spread are the regional lymph nodes, lungs and liver.
    • Once metastasis occurs, the five-year cure rate for squamous cell carcinoma is 34 percent.
    • Recurrence and metastasis typically occur within three years of initial treatment.
  • Mohs’ micrographic surgery involves gradual lesion excision using serial frozen section analysis and precise mapping of excised tissue until a tumor-free plane is reached.
    • Mohs’ micrographic surgery is used when tissue removal must be kept to a minimum for cosmetic reasons or to maximize function.
    • It is the treatment of choice for difficult and high-risk squamous cell carcinomas, including lesions that are:
      • larger than 2 cm in diameter;
      • located in areas where deep invasion is more likely or tumor extent is hard to assess, such as the nasolabial folds, eyelids and periauricular areas (facial “H zone”);
      • rapidly growing;
      • recurrent or incompletely excised;
      • ill-defined;
      • located in an area of previous irradiation; or
      • Cure rates of 99 percent have been reported.
    • Cryotherapy and the combination of curettage and desiccation are reserved for treatment of superficial tumors, lesions less than 2 cm in diameter and lesions located on the trunk and extremities.
    • Radiation therapy may be employed when preservation of function and cosmesis are critical, when patients refuse surgery, when metastasis is present or when an adjunct to surgery is required for high-risk tumors.
    • Because of the long-term risk of radiation-induced carcinoma, radiation therapy is used only in patients older than 60 years.

MALIGNANT MELANOMA

  • There are four types of malignant melanoma.
  • The two most common ones are:
    • The superficial spreading type is the most common among whites and accounts for 70 percent of all melanomas.
      • It usually occurs in adults and may develop anywhere on the body but appears with increased frequency on the upper backs of both men and women and on the legs of women
  • Nodular melanoma (accounting for 15 to 30 percent of all melanomas) is a dome-shaped, pedunculated or nodular lesion that may occur anywhere on the body.
    • It is commonly dark brown or reddish brown but may occasionally be uncolored.
    • Nodular melanomas tend to rapidly invade the dermis from the onset with no apparent horizontal growth phase.
    • These tumors are frequently misdiagnosed, because they may resemble blood blisters, hemangiomas, dermal nevi or polyps

Bottom Line on Skin Cancer

  • The incidence of skin cancer is increasing by epidemic proportions.
    • The use of tanning beds the risk of basal cell carcinoma by 1.5 times and squamous cell carcinoma by 2.5 times.
    • Basal cell cancer remains the most common skin neoplasm, and simple excision is generally curative.
    • Squamous cell cancers may be preceded by actinic keratoses – premalignant lesions.
      • While squamous cell carcinoma is usually easily cured with local excision, it may invade deeper structures and metastasize.
  • Aggressive local growth and metastasis are common features of malignant melanoma, which accounts for 75 percent of all deaths associated with skin cancer.
    • Early detection greatly improves the prognosis of patients with malignant melanoma.
    • The differential diagnosis of pigmented lesions is challenging, although the ABCD (Asymmetry, Border, Color, Diameter) checklists are helpful in determining which pigmented lesions require excision.
    • Sun exposure remains the most important risk factor for all skin neoplasms.
    • Thus, patients should be taught basic “safe sun” measures: sun avoidance during peak ultraviolet-B hours; proper use of sunscreen and protective clothing; and avoidance of sun tanning.

[Thanks to the American Academy of Family Physicians for much of the information provided in this episode.]

To Your Health With Dr. Jim Morrow: Episode 13, Medical Marijuana in Georgia, An Interview with Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC

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North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 13, Medical Marijuana in Georgia, An Interview with Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC
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Dr. Scott Cooper, Dr. Jim Morrow, and Justin Hawkins

Episode 13, Medical Marijuana in Georgia

How does the new Georgia law (HB 324) allowing prescribed use of medical marijuana work? Is medical marijuana a slippery slope to recreational marijuana use? In a conversation with host Dr. Jim Morrow, Justin Hawkins and Dr. Scott Cooper of Acreage Compass LLC answer these questions and more. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE  back to healthcare.

Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC

Dr. Scott Cooper and Justin Hawkins, Acreage Compass, LLC

Justin Hawkins is the General Manager and Dr. Scott Cooper is the Medical Affairs Director of Acreage Compass LLC. Acreage Compass is jointly owned by Compass Neuroceutical, Inc., a Georgia-based team of physicians, advocates, and patients, and Acreage Holdings, the largest vertically integrated, multi-state owner of cannabis licenses and assets in the United States. Through Acreage Compass, Compass Neuroceutical and Acreage Holdings are partnering to bring safe and consistent medical cannabis oil to patients in the state of Georgia.

For more information go to their website or email Justin Hawkins at justin@compassneuro.com.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Show Transcript

Intro: [00:00:06] Broadcasting live from the North Fulton Business RadioX Studio, it’s time for To Your Health with Dr. Jim Morrow. To Your Health is brought to you by Morrow Family Medicine, an award winning primary care practice, which brings the care back to health care.

Dr. Jim Morrow: [00:00:23] Hello! This is Dr. Jim Morrow. I’m with Morrow Family Medicine. We have offices in Cumming and Milton, Georgia. We’re a primary care practice, where we utilize state-of-the-art technology and old-fashioned ideas to bring you the best care we possibly can. We believe that in Morrow Family Medicine, you’ll feel both cared for and appreciated. And we do realize that you have many choices as to where you receive your care, and we hope you’ll find that Morrow Family Medicine is a good place for you.

Dr. Jim Morrow: [00:00:51] I’m here in the studio at Renasant Bank on Windward Parkway in Alpharetta, Georgia with John Ray, my cohort. John’s running the board. How are you doing, John?

John Ray: [00:00:59] I’m great. I hope you’re well today.

Dr. Jim Morrow: [00:01:01] I’m good. It’s not too hot outside today. So, those are pretty good.

John Ray: [00:01:04] Perfect in Alpharetta and Milton

Dr. Jim Morrow: [00:01:07] Always sunny in Alpharetta, right?

John Ray: [00:01:09] Yeah, you got it.

Dr. Jim Morrow: [00:01:11] So, we’re here today for another podcast. We want you to know that you can reach out to us by e-mail at drjim@toyourhealth.md or or you can tweet us, @toyourhealthmd.

Dr. Jim Morrow: [00:01:24] So, we’re here today to talk about cannabis oil and low-THC oil, what some people refer to as medical marijuana in the State of Georgia. And I’m honored to have two guests with me today from Acreage nchorage Compass LLC. We have Justin Hawkins, the General Manager, and Dr. Scott Cooper, who’s the Medical Affairs Director. Hello, gentlemen. How are you today?

Dr. Scott Cooper: [00:01:48] Doing well, thank you.

Justin Hawkins: [00:01:49] I’m good. How are you? I, actually, have both of my doctors here. So, I don’t know if this is an intervention or an interview, but it’s good to be here.

Dr. Jim Morrow: [00:01:55] We’re going to get into that later, Justin. You can count on it. You can count on it. So, this whole thing has started up in Georgia fairly suddenly. If you haven’t been following the news and haven’t followed the path of low-THC oil in Georgia, there is a bill, House Bill 324 that was passed by the state legislature and signed by the governor at the beginning of April of this year. So, Justin, tell us something about House Bill 324.

Justin Hawkins: [00:02:23] Yes. So, House Bill 324 is a piece of legislation that has been tried over the last six years. And we were successful this year in 2019 under the leadership of Brian Kemp. And what House Bill 324 does is it allows the cultivation, and processing, and distribution of low-THC oil, which is 5% THC in cannabis oil, also referred to as medical marijuana.

Justin Hawkins: [00:02:46] The reason that we wanted to push House Bill 324 is because over the last six to seven years, medical cannabis oil was legal for possessions for qualified patients under the Georgia Department of Health, but there was no real legal access for these patients under these 17 indication list to actually acquire the medicine.

Justin Hawkins: [00:03:06] And so, although medical cannabis is actually illegal under federal law, we’ve seen across the entire country that in over 33 — over 43 states across the country that in-state cultivation is a way that provides medicine to patients, also, by abiding by state law. And so, that’s what House Bill 324 does specifically.

Dr. Jim Morrow: [00:03:25] Well, why was it able to be passed this year when it wasn’t able to be passed the other year?

Justin Hawkins: [00:03:30] So, we were fortunate for a couple of different reasons. Georgia Hope is an organization founded by parents. A lot of the times, they’re parents of these kids who suffer from pediatric epilepsy, mitochondrial disease, autism, and they have really led the fight over the last six years. Fortunately, under the leadership, the new leadership, of Governor Brian Kemp and Jeff Duncan, along with public opinion and the way that we’ve seen the research of these in-state cultivation programs being analyzed, all of that came together in a positive way that said, you know, in-state cultivation is a way for kids, and veterans, and all other patients to get medicine. It’s not going to change the culture of Georgia. And I think between that and between organizations like the one Dr. Cooper and I founded, all of us coming together and moving in one step, really, it was everything coming together at once and we were thankful for it.

Dr. Jim Morrow: [00:04:21] Super. And the law allows for specifics about who can grow this, and cultivate it, and produce it, and so forth. Can you talk some about who, and what, and how many companies, and so forth are going to be involved in it?

Justin Hawkins: [00:04:37] Yeah, we anticipate there’s going to be a lot of interest. Georgia is the eighth most populous state in the nation. It has a huge market, and there’s a lot of patients that are on the registry – 10,000 when we passed the bill, 300 we’re adding per month with no change to the legislation. So, we do believe that in the market of Georgia, it’s a large market. So, from an industry standpoint, there’s going to be a lot of companies and employers interested. What the bill allows specifically, it allows two class 1 organizations with a higher financial stipulation to prove to the state that they have. And it also allows four class 2, which are for smaller entities, small business across the state of Georgia. Those are six private licenses. Now, aside from that, they did allow two university programs to research, and develop, and cultivate. And that’s what the University of Georgia and Fort Valley State University down the south of Atlanta. And so, when you combine, a total of eight enterprises, public and private, that’s who will be the structure of Georgia medical cannabis.

Dr. Jim Morrow: [00:05:38] Interesting. So Georgia’s law, being one of the newer ones, can you tell me how this law is different from the laws in these other states that you mentioned?

Justin Hawkins: [00:05:47] Yeah. So, for instance, I’d like to take the obvious, which is Colorado. So, when you look at Colorado, which passed medical cannabis back in 2000-2001, the way we were different and the largest way that I can contrast between is horizontal versus vertical. And what I mean by that is when you look at Colorado, they allowed a horizontal structure, which means they allowed growers, processors, and distributors, all being separate silos, so to speak. What we did in Georgia is not only do we put a THC cap of no more than 5%, which is very low THC, but what we also did is we allowed vertical integration, which means that the companies vying for these class 1 and class 2 licenses is that they grow, they process, and they distribute their own product.

Justin Hawkins: [00:06:30] And why we feel like that’s very valuable for the State of Georgia is it allows high-quality control. It allows players and companies that know what they’re doing. They have a track record across the country. It allows us to not have price increases with middlemen. So, we’re allowed to go directly to the patient. Obviously, you guys are doctors. You guys know how the pharmaceutical industry works. So, it’s almost like if Johnson & Johnson or Amgen had their own pharmacies, that’s what our company is vying to do.

Dr. Jim Morrow: [00:06:58] Okay. And you called it low-THC oil. And a lot of listeners hearing THC, they’re going to think that this is something that’s going to act and function like marijuana. So, Dr. Cooper, what exactly is low-THC oil?

Dr. Scott Cooper: [00:07:13] It restricts how much THC is in the compound. And let me read you something from the AMA since you bring that up.

Justin Hawkins: [00:07:22] While he’s doing that, I can give you kind of an overview. So, when it comes to low-THC oil, what we have is we have hemp-derived oil, and we have cannabis-derived oil. Hemp-derived oil is what’s often referred to as CBD. And so, you see CBD on the market because hemp CBD oil is now federally legal with the Farm Bill that was passed a couple months ago. With cannabis, you have cannabis oil. And so, when you have natural cannabis, it can be as high as 90%. And so what Dr. Cooper will talk about specifically is that when we form cannabis oil from the actual cannabis plant, then we’re restricting that THC down to 5% per milliliter. And so, that’s what allows us to have different indications. And he’ll speak more to that.

Dr. Scott Cooper: [00:08:05] Sorry for that delay. I didn’t have it prepared for you. So, this is a quote from the FDA stating that it is THC and not CBD that’s the primary psychoactive compound of marijuana. And they approved a medication with low THC for specific seizure disorders, primarily in children. And they approved, and I quote, “They’re committed to this kind of careful scientific research and drug development, continuing to support rigorous scientific research on potential uses of medical marijuana-derived products.” So, we’re not talking about something that is psychoactive. This compounds specifically for specific and, in the case of Georgia, 17 discrete different disease states.

Dr. Jim Morrow: [00:08:51] And these are disease states that have had faulty, not effective medications and treatment methodologies previously pretty much.

Dr. Scott Cooper: [00:09:00] Absolutely. They have done studies with veterans, as well as studies with geriatric patients and chronic pain syndrome. And they found that even in senior citizens, it reduced the opiate use by over one-third. So, we’re looking for a safe medication without the side effects and addictive properties of current therapies that we have for different disease states right now.

Justin Hawkins: [00:09:25] And we say this all the time, it’s not a miracle drug. Dr. Cooper, you’re great at saying this. It’s more of an adjunct. And so, we see a lot of combined with pharmaceutical drugs, it really does make a difference.

Dr. Scott Cooper: [00:09:35] Yeah, this is not going to be replacing every medication that somebody is out there taking right now. This is to help them get over the hump to really control whatever disease state we’re talking about.

Dr. Jim Morrow: [00:09:45] So, in Georgia, the process for acquiring a card, which as I understand is what you have to have to get this, tell me a little bit about the process for going through that.

Dr. Scott Cooper: [00:09:57] Well, the physician, (1), who’s prescribing it has to be registered with the state. So, that’s the first hurdle. Not every physician wants to participate in the program. Then, (2), they have specific paperwork that needs to be filled out and sent in to the Georgia Department of Health. The patient has to be registered, and the patient gets a registration card. And it’s presumed right now it’s not definitely set, but we suppose that this is going to be similar to other states where there will little bit discreet dispensaries specifically for CBD products, and the patient has to present that card to be able to achieve and get the medication.

Dr. Jim Morrow: [00:10:38] And there’s a limit, I’m sure, on how much any particular person can have in their possession at any one time.

Dr. Scott Cooper: [00:10:44] Absolutely. Not just how much they can have at one time in their possession, but how much they can purchase over a 30-day period. And you would have to drink gallons of this stuff to try to get high. So, if you’re going to spend over $100 per bottle, you’re better off doing something illegally if you’re in search of something that’s psychoactive. If high is your goal, you’re not going to get it here.

Dr. Jim Morrow: [00:11:08] So, you take the THC oil, in the case of seizures, let’s say it helps to control the seizures. Do we know how that works in the brain?

Dr. Scott Cooper: [00:11:17] No, we don’t. Yeah, I wish we did. There are a lot of different cannabidiol receptors. We know that what’s available now commercially for these two seizure types, the Epidiolex, does not work for pain disorders or tic disorders. There are two compounds right now in Europe and in Canada that are used for multiple sclerosis-associated pain, as well as cancer-associated pain. And it’s within that realm of cannabis, but it’s a different level of THC. So, there have to be different products specifically developed for different disease states. But yet, we’re at the stage where we know it works, but we don’t know how at this point.

Dr. Jim Morrow: [00:12:01] Well, the results that you see and the stories that you hear about the most heart-wrenching ones are children with disease processes and seizures is a great example are just absolutely mind blowing when you see what this medicine can do for them and what their traditional medicines have not done for them. So, I think it’s a very exciting time.

Dr. Scott Cooper: [00:12:24] That’s absolutely right. I’ll be honest, I was a skeptic when this first came out and was not willing to endorse it, and had patients that were acquiring from other states illegally. And they came in, and their seizures were dramatically reduced. Not controlled, but reduced, such that I could reduce some of the medications that were both expensive, as well as having side effects. And then, saw other patients with autism. Their behavior improved. Parkinson’s disease, tremor improved. Alzheimer’s disease, behavior improved. And that’s when I started looking into it more, and then became an advocate.

Dr. Jim Morrow: [00:13:01] So, the law gets passed. The science says this will work for a variety of different instances. You mentioned 17 different diagnoses that it can be used for. So, along comes Justin and Scott Cooper. And how does this happen that you ended up being in this push to, now, produce and to distribute THC?

Justin Hawkins: [00:13:25] As we were talking earlier, when you look at anybody in this industry, they have a touchpoint. Either they have a family member, or they have a neighbor, or they have a patient that comes to them, and you see them suffering. So, for me, my brother served overseas in Iraq and Afghanistan, and I saw him come back from overseas, and work with the VA. And instead of being on a medication, like a tool like low-THC oil, he was on opiates. And that led to a whole different battle of its own.

Justin Hawkins: [00:13:51] And so, I was very interested from that point. And so, in 2018, Dr. Scott Cooper, and myself, and six other partners around the State of Georgia formed Compass Neuroceutical, which was an advocacy group, all Georgia-based, with a single focus, which was to pass House Bill 324. In doing so, because we were successful with one other company in supporting Georgia Hope, which was the organization with parents, patients, and advocates that have been fighting for this for six years, we all came together. We were successful in passing it.

Justin Hawkins: [00:14:19] Simultaneously, we were talking to national leaders about partnering and having a specific partnership within the State of Georgia to to be a licensed holder and to lead the way in Georgia, so that we could be the standard bearer for the country. And in doing so, we talked to many of the national leaders, and we were fortunate to choose a company known as Acreage Holdings, which is the largest multi-state owner and operator in the United States. They have a great executive leadership team with the board of directors, folks like the former Speaker of the House, John Boeher, former Prime Minister of Canada, Brian Mulroney, governors and former CEOs of international companies.

Justin Hawkins: [00:14:57] And why that matters is you see in this industry, and I tell people all the time, they think I’m joking, but I’m really serious, this industry is either Warren Buffett all the way to-

Dr. Jim Morrow: [00:15:06] Thomas Leary.

Justin Hawkins: [00:15:10] Thomas Leary. All the way to Willie Nelson and in between. And so, the industry is very wide. So, we do a lot of different things. We have good governance and integrity, and we keep stupid away. But on top of that, we have a proven track record of owning more licenses. 20 states, we have 88 licenses across the country. And because we’re the largest, we know how to get safe, reliable product in a quick and efficient manner to patients. And so, with that partnership, we have created what’s now called Acreage Compass LLC, which will be vying for a Class 1 license in the State of Georgia.

Dr. Scott Cooper: [00:15:41] Yeah, if I could add that Georgia Hope was the main thrust behind this. As Justin said, we were able to work with them to finally get it over the finish line. And all of these companies are just drooling over starting business in Georgia. And we were approached by numerous corporations that are in the industry. And we selected the one that we thought had the same vision we do because there are others that are out there that are just interested as this is a bridge to recreational marijuana, and that they really saw medical marijuana as a stepping stone, but they weren’t very interested in the cultivation and in studying which drug combination was going to be best for which disease state. And Acreage has integrity, which is something you don’t see in every partner that was searching out their.

Dr. Jim Morrow: [00:16:31] So, with the passage of the bill, the State is creating this commission, the Cannabis Commission, basically, that will choose these companies. What’s that process like for being chosen? I know you’re doing an awful lot of work, both of you, with Acreage Compass right now in hopes of being selected, but nothing’s written in stone. So, tell me about the process, the timeline, and how you expect all that to happen.

Justin Hawkins: [00:16:56] Yeah. We’re kind of on hold now. I know, Governor Brian Kemp, Lieutenant Governor Jeff Duncan, Speaker David Ralston are doing a whole lot behind the scenes to make sure that a commission is set up in an appropriate way that really has the spear in the integrity of the bill. And so, as of now, the commission is set up – three appointed by the governor, two appointed by the lieutenant governor, and two appointed by the speaker. So, a total of seven appointees to the commission.

Justin Hawkins: [00:17:20] Within the three that the governor has, one of those will be the chair of the commission. In doing so, the commission creates one position under them immediately as the executive director of the commission, which handles the daily functions. This whole commission will be under the Secretary of State’s office as the regulator moving forward in the future.

Justin Hawkins: [00:17:39] So, we’re on hold right now. None of the commission members have been selected. We anticipate from our talks. Of course, this can change between August and September of the appointees being selected. From that process. when they’re selected, they really start from ground up, which means they create the rules and regulations, the application, the criteria. And then, from that point, then private companies are able to do the application, which is a very stringent process. Some are even over 3000 pages from that timeline. Then, three to six months after the applications are submitted, we anticipate the state will then choose which licence holders they feel are competent based on a variety of factors.

Dr. Jim Morrow: [00:18:20] So, you mentioned 10,000 people on the registry now, adding about 300 a month. So, I think, earlier, when we were talking, you said the expectation is a quarter million people on the registry.

Justin Hawkins: [00:18:33] I was talking, when Representative Micah Gravley spoke at our Rotary Club not too long ago, I went out to dinner with him the night before to talk about the different things we could do to work together and other stakeholders. And he had relayed, and we feel very strongly that by the end of next year, we’re almost going to see 50,000 patients in the registry. And it just shows — you saw a lot before House Bill 324 passed that many patients in the 17 indication list were not even registering because there was no real access to acquire this medication. With that, we had 645 doctors as soon as we passed House Bill 324 that were on the registry.

Justin Hawkins: [00:19:11] So, we anticipate both those numbers will dramatically increase. I would argue that about a quarter of a million patients will be registered in Georgia over the next four to five years. And I would even say that’s a conservative estimate. And that’s not to say that this program gets out of control. That’s to say that these, from mitochondrial disease, to autism, to pediatric epilepsy, to PTSD, these are disease states that are large, so to speak. And I know Dr. Cooper can speak to that, but we believe that Georgia is a large market, and it’s been underserved over the last 10 years.

Dr. Scott Cooper: [00:19:47] Yeah, I would have to agree with that. I’d say that, at least, one or two times a day, I have patients that are telling me either they’re already on it, and how do they get a card, or how do they acquire it? People are asking about it. And there were some opponents to the bill who said, “Well, you only have so many people on the registry, so it’s not going to be used.” And I likened that to saying, “Well, the bill hadn’t been passed yet.” So, that’s like saying, “Okay, I see a sign saying Kroger is opening up. When are they opening? And you’re assuming only the people who asked about the sign are going to be future customers.” And the store opens, and, suddenly, you have 100,000 customers. Right. So, I think that once we have the distribution set up and the physicians signed up, that we’re going to see easily well over 100,000 patients within the first year.

Dr. Jim Morrow: [00:20:35] And the patients, those patients will be for these disease processes that are already approved. What does the future of cannabis oil and cannabis, in general, look like medically?

Dr. Scott Cooper: [00:20:46] There are more and more studies that are going on all the time. A lot of them under federal funds. And then, you’ve got the two colleges, universities that will be pursuing some research. Right now, the Georgia Department of Health is the one that regulates which disease states are approved and how many. And they went from seven in one year to 17 the next year. I’m sure, as we gain more experience, we’re going to see future applications beyond what we have right now.

Dr. Jim Morrow: [00:21:15] Okay. So, we’re talking with Justin Hawkins and Dr. Scott Cooper from Acreage Compass, LLC. And Justin, I want to ask you before we go, is  there a way that people can do their own research? Is there a way they can learn something about your company and the business in general?

Justin Hawkins: [00:21:32] Yeah, absolutely. We have our own website, compassneuro.com. That will have information coming out in the next weeks. And then, also acreageholdings,com, which kind of gives you a layout of who Acreage is. We’re in over 20 states across the entire country. We have a public potential merger with a company called Canopy Growth, which is the largest cannabis company in the entire world. And so, the proprietary information that we have, the assets, and the intellectual property, and knowledge is second to none. And so, those two websites are great resources. Dr. Scott Cooper and I live in the Atlanta area. So, we’re always around to answer questions. We’d like to meet patients. We see all the time these children and parents who have been suffering, don’t know what to do. And so, if there’s any of that case, we’re here to to help any way we can.

Dr. Jim Morrow: [00:22:21] Super. John, you’ve been awfully quiet over there. And we have anybody that sent us any questions or comments during our time here?

John Ray: [00:22:32] You’ve got them all stirred up again.

Dr. Jim Morrow: [00:22:34] I like that.

John Ray: [00:22:36] Yeah,.

Dr. Jim Morrow: [00:22:36] If it’s not disease, this or vaccine.

John Ray: [00:22:37] Vaccines. I thought vaccines hit the high watermark, but I think you got it going again today. So, several questions about the — is this a slippery slope to recreational use?

Dr. Jim Morrow: [00:22:52] That’s a great question. Scott, I’ll send that to you. What do you think? If people start using THC, it will going out behind the Wal-Mart and looking for marijuana to buy?

Dr. Scott Cooper: [00:23:03] Well, not only is this my opinion, but actually a study was just published with over 1.4 million people that were surveyed throughout the entire United States. And in the 33 states, plus the District of Columbia, there was not a single area geographically that there seemed to be a breakthrough for low THC, and then they convert over to recreational. This has been disproven conclusively that this is not a gateway drug to tempt people to, then, go to recreational drugs such as marijuana or other types of substance abuse.

Justin Hawkins: [00:23:40] And if I could add one thing, we did one thing different than a lot of states. And Micah Gravley, who’s the author of House Bill 324, with Senator Matt Brass, really pushed this with Governor Brian Kemp. And it was a great way to contrast ourselves to other states who have gone to recreation. If you look at every state that started as a medical program that goes to recreation, they had one thing in their program that Georgia does not. And that’s the ability to have smokable flower. So, with states like Colorado, or California, or Oregon, or Washington, they had smokable flower in their medical program. Not only does Georgia not allow smoking smokable flower, but we don’t allow vaping as well. So, that’s a main difference that we saw, a common denominator.

Dr. Jim Morrow: [00:24:24] Super. That’s a great question, John.

John Ray: [00:24:27] I only ask great questions.

Dr. Jim Morrow: [00:24:31] We’ll talk about that off the air!

John Ray: [00:24:31] Yeah, okay. I’ve got one more if I can try again.

Dr. Jim Morrow: [00:24:35] Sure.

John Ray: [00:24:35] Let’s see if this is a great one too.

Dr. Jim Morrow: [00:24:37] Yeah.

John Ray: [00:24:37] So, the question relates to side effects. So, all medications have some sort of side effects. Are there any other side effects noted in the use of this THC oil?

Dr. Scott Cooper: [00:24:51] If you read the print out for Tylenol, you’ll see a yard-full of potential side effects. You do not need to monitor any blood tests routinely with this low-THC oil. It can have a little bit of a calming side effect and, sometimes, a little bit of sedation, but that’s about it. So, it’s not the high THC that you see with recreational, so you’re not going to get the munchies.

Dr. Jim Morrow: [00:25:18] That’s good.

Dr. Scott Cooper: [00:25:21] As opposed to other drugs, either a lot of marijuana or methamphetamines that lower the seizure threshold, this actually treat seizures.

Dr. Jim Morrow: [00:25:31] Well, that’s wonderful. If you have a medicine that can treat the things we’re talking about that are difficult to treat, and it doesn’t affect your liver, your kidneys, it’s not mood altering or habit-forming, they don’t drug test for in a workplace, that kind of thing, then I think that’s great. And, of course, there’s a new drug test for it, but with the prescription card, is a negative drug screen.

Dr. Jim Morrow: [00:25:48] So, I think that’s a fantastic thing. And I’m very excited as a practicing physician about seeing where this will go. And I’m very excited as a businessman by seeing where you guys go. So, I really appreciate you all being here very much. I think, John, we’re going to wrap it up for today.

John Ray: [00:26:04] Sounds good.

Dr. Jim Morrow: [00:26:05] All right. This is To Your Health.

To Your Health With Dr. Jim Morrow: Episode 11, Making the Move to Assisted Living, An Interview with Derek Bailey, The Right Move Senior Resource and Placement Agency

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To Your Health With Dr. Jim Morrow: Episode 11, Making the Move to Assisted Living, An Interview with Derek Bailey, The Right Move Senior Resource and Placement Agency
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Derek Bailey and Dr. Jim Morrow

Episode 11, Making the Move to Assisted Living

What signs do I need to look for to know my loved one might need assisted living? What should I do to make this transition easier? On this episode of “To Your Health with Dr. Jim Morrow,” Dr. Morrow addresses these questions and much more with Derek Bailey of The Right Move Senior Resource and Placement Agency. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

Derek Bailey, The Right Move Senior Resource and Placement Agency

Derek Bailey, The Right Move Senior Resource and Placement Service

Derek Bailey is the Owner of The Right Move Senior Resource and Placement Agency. The Right Move provides free professional consultation services to local seniors and their families in the Southeast. With years of valuable experience in the local healthcare industry, they are equipped, informed, and connected to ensure you are comfortable with who you trust to provide the necessary level of healthcare for you or your family. If you find yourself faced with a decision on assisted or independent senior living options, in-home personal care, nursing home care, or anything else related to seniors, reach out and allow them to help you make… THE RIGHT MOVE. For more information, go to http://rightmoveresource.com/ or call 770-880-0706.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

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Show Transcript

Intro: [00:00:09] Broadcasting live from the North Fulton Business RadioX Studio, it’s time for To Your Health with Dr. Jim Morrow. To Your Health is brought to you by Morrow Family Medicine, an award-winning primary care practice, which brings the care back to health care.

Dr. Jim Morrow: [00:00:25] Hello, this is Dr. Jim Morrow. I’m with Morrow Family Medicine. We have offices in Cumming and Milton, Georgia. At Morrow Family Medicine, we try to use all the technology that we can, and at the same time, use old-fashioned ideas and old-fashioned care to give you the sort of care that you need and you deserve. We realize that you have many choices when it comes to where you receive your health care, and we do appreciate it when that choice is Morrow Family Medicine.

Dr. Jim Morrow: [00:00:53] We’re here at the Renasant Bank on Windward Parkway in Alpharetta, Georgia. Again, here with John Ray. John’s running the board. John’s looking out for e-mails and tweets. How are you doing over there, John?

John Ray: [00:01:04] I’m doing great. How are you doing, Jim?

Dr. Jim Morrow: [00:01:06] I’m great.

John Ray: [00:01:07] Good.

Dr. Jim Morrow: [00:01:07] I’m great.

John Ray: [00:01:07] Good.

Dr. Jim Morrow: [00:01:08] So, you can email or tweet the show. The email address is drjim@toyourhealth.md or you can tweet us on Twitter. We’re @toyourhealthmd. And we’re very excited today. We’re going to talk today about assisted living and how to help move your parents or your loved one from one home, probably, to a facility that’s not exactly like their home. And we’re very lucky today to have Derek Bailey with us. Derek is the Owner and Founder of the Right Move Senior Resource. And he helps people do this every day. Hey, Derek.

Derek Bailey: [00:01:44] Hey, Dr. Morrow. How you doing?

Dr. Jim Morrow: [00:01:46] I’m good. I’m good. I really appreciate you being here.

Derek Bailey: [00:01:48] We appreciate the opportunity, definitely.

Dr. Jim Morrow: [00:01:50] So, you’re the second guess that we’ve had. And I’m enjoying this. It’s a little bit different from just sitting here and lecturing to our listeners. And I’m kind of liking this. I do appreciate you coming. So, if you would, Derek, start off by telling us about your business, and what it is you do, and how you manage to do it.

Derek Bailey: [00:02:08] Yeah. So, thanks again for the opportunity. Definitely excited to be here with you on the show. The Right Move Senior Resource is here for one reason. We’re here to help seniors navigate care and help them find the right option for them. My background, I spent five years doing hospice care, four years in the hospital setting, and just really saw a need to help families navigate care. I think we do a good job of planning for retirement and kind of getting ready for those years of life. But nobody really wants to talk about the last five or six years of life, and the care that might come up that you need, and the cost for that care, and who can provide that care.

Derek Bailey: [00:02:44] So, after seeing those needs, we decided just to step out and try to fill that need. So, our business, we come in alongside families that are going through situations when mom or dad can no longer stay at home safely. We help them either bring care into the home to help make it safer, or when looking at assisted living senior living options, our goal is to help them find the one that fits their specific needs, their budget, their care needs, their location, and then their preferences on finishes, on amenities, things like that. But, again, at the end of the day, our goal is to help them feel comfortable with who’s providing care for their loved one at that point in time.

Dr. Jim Morrow: [00:03:23] Super. And I know that’s a real need when talking to families that have elderly loved ones. I think they’re two incredibly difficult conversations. One is, “Dad, you can’t drive anymore.” And this is the second one is, “What we’re going to do now that you shouldn’t be at the house by yourself?” So, you hear a lot of people talk about assisted living. And if you drive around the area where we live, there’s an assisted living facility either present or going up on every corner, it seemed like. So, tell our audience exactly what it means when you’re talking about assisted living.

Derek Bailey: [00:03:54] Yeah. So, assisted living is a residential alternative to living at home. So, when an individual might need help with what we call activities of daily living – cooking for themselves, or bathing, medication management, maybe toileting, things like that, and they can no longer do it in their home safely alone – we look at assisted living where they would have their own apartment, where they can kind of have their own space, but there is care available there for them to help them with their activities of daily living. Also, these assisted livings can help with traveling to appointments, taking them to their doctor’s appointments, things like that. So, again, assisted living is for those who may need a little bit of extra help with their activities of daily living and can no longer do them independently at home.

Dr. Jim Morrow: [00:04:42] Well, you mentioned care being available, and I think that’s a point that distinguishes some of these different types of facilities. In the typical assisted living facility, what kind of care would people expect to have that are ready for them?

Derek Bailey: [00:04:57] Yeah. So, there’s actually two different licensures of what we normally see in assisted living or what you see on the side of the road driving down Highway 9 with the 15 that had been built up and down Highway 9. There’s two different licensures – assisted living and personal care. Assisted living license, they have to have a nurse on staff in the building around the clock that is there for nursing needs. Although they don’t manage a lot of the major nursing needs that might arise, but, typically, they’re going to have a certified nursing assistant, the CNA.

Derek Bailey: [00:05:27] And the CNA’s role is to come in and assist them with bathing, dressing, helping them to the toilet, and helping them to know the dining hall if they need help with meals and feeding, but also medication management. That’s a big part. A lot of times, what takes someone from home to assisted living is they’re not managing their medications appropriately. And you know as well as a doctor, taking your medications as prescribed on time is very important to managing certain diseases. And so, that takes them into the assisted living where they can handle that, where they have certified medication technicians or the certified nursing assistants that come in and make sure they’re taking their medications properly.

Dr. Jim Morrow: [00:06:09] And a lot of the assisted living facilities have gradations of care. Tell me a little bit about the independent, versus assisted, versus memory, and so forth.

Derek Bailey: [00:06:21] Yeah, that’s part of what we do in the process of helping a family. So, when we meet with a family, that’s the first thing we do is we assess their care needs. What are those activities of daily living that they need help with? Do they need medication management? Things like that, because all of these independent living, assisted living options, they might not be the right fit for that family.

Derek Bailey: [00:06:43] So, independent living is more of an independent apartment where they don’t need help with those types of things. They’re there more for maybe the meal preparation, maybe socialization. Mom or dad has been isolated in the home for a while, and it’s just nice to get them in and around other people. But they don’t need that much help in the independent living world. When they start to need that help we talked about, the activities of daily living, the help with bathing, to help with dressing, that’s when we look at the assisted living. And to be honest, the assisted livings, they all range in the level of care that they can provide. So, you know that your loved one needs assisted living, but which one can provide the care that we actually need? And that’s what we do. We help them figure out which assisted living can manage their specific care needs.

Dr. Jim Morrow: [00:07:30] And with any of these facilities, of course, paying forward is always a concern. To what degree does traditional insurance or Medicare Medicaid play a role in this?

Derek Bailey: [00:07:41] No, it’s a great question. Every family wants to know who’s paying for it.

Dr. Jim Morrow: [00:07:44] Yeah.

Derek Bailey: [00:07:45] At this point in time, when it comes to independent living, assisted living here in the State of Georgia, the majority of it is private pay by the individual or the family. The only help or care that Medicare or traditional health insurance would actually pay for in the assisted living would be if they needed physical therapy, occupational therapy, or skilled nursing that kind of comes in either through home health or through a third-party therapy provider in the building. That’s what insurance would cover. But as far as the room and board, the daily care at an assisted living, the majority of it is going to be paid by the family.

Dr. Jim Morrow: [00:08:21] And do you have a a range of prices in mind, in general? Tell me about that.

Derek Bailey: [00:08:27] So, it’s a very wide range. As you’ve noticed, all of them being built, they all provide different amenities, different levels of service. And so, on the low end for assisted living, you’re going to be looking in the the $2500 range for probably a shared apartment where you might be in the same apartment with someone else, all the way up to some of the higher end assisted living is are going to cost you $7000 or $8000 dollars a month. So, it’s a very wide range. The average for assisted living apartment here in the Greater Atlanta area is around $3600 a month. So, it’s not cheap when you look at the number, but we try to get families to understand that they’re getting their room and board, all their utilities paid, the food, the activities, and then the care is all lumped into that one number. So, it might look like a very large number, but at the end of the day, you’re getting a lot in that one fee per month. But again, it’s private pay, and it’s a wide range of options to choose from.

Dr. Jim Morrow: [00:09:26] Well, it’s good to have a lot of options in a lot of different facilities that do have those different amenities, so people can have a price range to pick from.

John Ray: [00:09:34] Yeah.

Dr. Jim Morrow: [00:09:35] So, if my loved one – my mother, for example – is getting older and starting to get a little bit frail, what are some of the things I need to be on the lookout for to know that this is a conversation needs to be had?

Derek Bailey: [00:09:48] Yeah, that’s a great question. So, I think we need to start having this conversation much earlier before we start to have issues. The bulk of our clients call us when it’s in the middle of it. And it’s very difficult to make rational decisions when you’re in the thick of things. But at any point in time, when you notice medications being missed, or you’ve noticed they’ve had to go to the physician a few extra times for urinary tract infections, or just losing weight, or overall just getting tired. Also, if you notice their meals, and if they’re not cooking for themselves anymore, or if you’re dropping off meals for them, and they’re not eating them, those types of things are kind of good indicators that maybe mom or dad’s not able to care for themselves anymore. With my grandmother, for instance, we started noticing she kept a very clean house her whole life, and then we started to notice dust piling up, and trash starting not to get taken out, and just little subtle things where we noticed her behavior was different, and we noticed it was time for her to start looking at some senior living options for her.

Dr. Jim Morrow: [00:10:54] That’s great. I appreciate that. I know we have episodes or incidences in the office where we’ll have conversations with family. And, usually, they’re pretty good about noticing that kind of thing, but I like the idea of starting to have that conversation earlier. I never had the privilege of knowing my wife’s mother, but she tells a story about when her mother was getting older, she said, “We need to go look at places where I can live.” And then, my wife, Peggy, will laugh and say she wasn’t sure if that was just because she didn’t want to live with one of her children, or she just want to take the burden off. But it is a large burden. And I think talking about it earlier, and knowing what somebody’s desires are before they get to the point of being in serious need is a very good idea. So, the transition from home to assisted living or other has got to be a very difficult one for everybody involved. Do you have ideas about what can make it easier other than that early conversation?

Derek Bailey: [00:11:50] Yeah. So, a few things I think are very important because, like you said, two of the conversations that are the hardest, “I’m taking your keys away,” and “You can no longer live alone.” You’re taken their way to get around, and taken their independence, and then you’re taking them from their home. So, it is a very big deal. The couple of things that I think have worked with us with families is, obviously, the early conversation. But when the conversation’s too late, it’s getting them involved in the conversation. Asking the senior, the aging loved one, “What are you hoping for in your next home?” And I think really being honest with them as to why we’re having to look at the senior living options as the alternative to what’s been going on.

Derek Bailey: [00:12:32] And then the next thing is getting them involved in the process. So, letting them see the options if we can physically do that. Get them to the options, let them have some input and questions to each assisted living, let them try the food at the assisted living before they make a decision. Really getting them involved in the process gives them a sense that they’re in control of their future rather than someone else is controlling their future for them. I think that’s the biggest thing because we all have kids. We tell our kids what to do. And at some point in time, that role is going to reverse, and that’s very hard. So, allowing them to feel like they still have some power, and some say in their decision making process is important.

Dr. Jim Morrow: [00:13:14] And you mentioned checking out the food and that kind of thing. And obviously, visiting these places is very important. And I think they’re all very, very open to that. I hear from patients that they’ve done a good bit of that kind of thing. But once you move in, and you’re there, and it’s also very new. I’m sure a lot of elderly people or anybody who would be likely to be this way are tempted to just stay in their room and not get involved. And have you seen that the staffs actually try to encourage them to come out and play, if you will?

Derek Bailey: [00:13:43] That’s part of what I think separates some of the good assisted livings from some of the ones that are just kind of middle of the pack or mediocre. They’re actively trying to engage their new residents because that’s very important. That first couple of weeks is a big deal. They know they’re moving someone from their home to a place where they are no longer by themselves completely. So, actively having the activities director come and get them out of the room, getting them to come sit for meals, or they put on a lot of events at these places. So, just really trying to push the resident, the new resident to come out when they can.

Derek Bailey: [00:14:18] What I’ve found to work great in a lot of the assisted livings is they have a team of actual residents that that’s their new job, their purpose. They are there to acclimate a new resident. So, they try to buddy them up with somebody that’s kind of like them or similar situations, and really help them feel comfortable, and using their own residents to help push the new residents into the more social side of things there.

Dr. Jim Morrow: [00:14:44] Oh, that’s an awesome idea. I did not know that. I think that’s a great thing for them to do because it does give them that purpose. And plus, who better to explain to people what it’s like there other than a resident? That’s a great idea. I like that. So, in facilities around the area and, really, in any area, you’ve got the assisted living, and whether it’s independent, or assisted, or memory care. But then, nursing home is a whole different animal. So, if you would explain the difference between nursing home and what we’ve talked about so far?

Derek Bailey: [00:15:20] Yeah. So, nursing home or the traditional skilled nursing facility is there for a much higher level of care that might be needed by a patient. So, if someone is to the point where they are bedridden, or maybe they have certain wounds or diseases that require constant monitoring by a skilled nurse, then we need to look at a skilled nursing home for that situation. Growing up, like my wife’s grandmother, for instance, she thinks all of these places are nursing homes that, “I don’t want to be put into a home.” She thinks some of the nicest assisted living as a home or a nursing home. So, trying to get her to understand the difference, we have that conversation all the time. But when someone requires skilled nursing, 24/7, that’s when we’re looking at a skilled nursing home or nursing facility.

Derek Bailey: [00:16:07] Assisted livings now, with this new assisted living license, can handle someone who may take two people to get from bed to chair. They may be able to wheel themselves around a little bit. But once someone is completely bedridden or needs that nursing attention throughout the day, then we need to look at skilled nursing homes.

Dr. Jim Morrow: [00:16:28] And I know you said that you spent time in hospice. And the home health people are, obviously, involved in the assisted living side. Do you find that the use of home health is able to delay the move to a nursing home for a lot of the people that are in assisted living?

Derek Bailey: [00:16:46] Definitely. And, also, using hospice in the assisted living. Through some licensures and things like that, if home health is managing a lot of the nursing care needs, if it’s a few times a week that they need bandage changes, or just checkups, and things like that, then definitely the home health nurse, the aides can come in and help someone age in place. That’s one of the biggest movements, I think, over the last few years in the assisted living world here, especially in Georgia, is aging in place. And they have begun to use hospice to allow that to happen even at end of life. As long as hospice is involved, the assisted living can, for the most part, manage someone and allow them to stay in their own room throughout the whole process until they pass away. So, you have noticed with the assisted living licenses changes recently, plus hospice being more involved, that we may not have to move to nursing home that towards the end of life if we can help it.

Dr. Jim Morrow: [00:17:45] And in the assisted living centers, do they use sitters in that area either 24 hours or evening sitters? Is that something that this center will allow them to do?

Derek Bailey: [00:17:59] Yeah, at times. So, there will be times that that might be needed. For the most part, the assisted living is going to be staffed well enough to handle the routine care for a resident, the getting them bathed once a day or getting them their medications. But, sometimes, let’s say, after a hospital stay, they come back to the assisted living, and they may need more hourly care than what the normal assisted living could manage. They’ll allow sitters to come in and stay with the resident. And it may only be for a few days just to get them acclimated back into being in the assisted living. But they definitely do rely on sitter services, CNAs to come in and help residents when they need more care than what the assisted living can provide.

Dr. Jim Morrow: [00:18:42] And whether you’re talking about assisted living or nursing home, I think I know the answer for nursing home, but a lot of these patients need specialized diets. And I know in an assisted living, it’s very much a cafeteria style situation. Are they able to prepare specialized meals for patients?

Derek Bailey: [00:18:58] They are. And again, that’s where there’s a lot of newer communities coming out and focusing on those types of things. As the assisted living world is getting bigger and bigger, and they’re allowed to care for more individuals as far as their care needs, you have seen catering to certain diet types, diet restrictions, whether it’s cardiac diet, low sodium diets. Families are able to make that part of their plan moving into the assisted living. And most of them have a chef onboard, and they’re now cooking meals to order.

Dr. Jim Morrow: [00:19:30] Wow.

Derek Bailey: [00:19:31] And so, especially the higher end assisted livings can cook meals to order, much like a restaurant style, and they’ll know a specific resident’s diet restrictions if it’s been put in there when they move in.

Dr. Jim Morrow: [00:19:45] Super. Now, you mentioned a minute ago how the roles seem to flip, and it’s a different point in time for every single family, of course. But at some point, the child becomes a caregiver. Do you have advice for that caregiver as far as not just making the decision about where but about how to best go about making this as painless as possible?

Derek Bailey: [00:20:08] Yeah. Well, that’s something that’s really been on my mind – really, my heart – over the last couple months is that caregiver burnout. We get a lot of clients from the ER, where it’s thrown in their face, where mom and dad has had some type of accident, and they had no idea that mom or dad couldn’t live on their own. So, now they’re picking up the pieces. Where do I go from here? What do I do? How do I get mom and dad to the doctor’s office? How do I manage their medications? And caregiver burnout is a huge problem that I think we face here as our parents age, and those roles reverse, and you’re kind of thrust into a situation that you weren’t prepared for.

Derek Bailey: [00:20:43] So, we’re actually working on kind of a program to help families with that. But I’ll briefly talk about some things that I think we need to focus on. Number one is care. Can they provide the care they need independently? And so, can they manage their own medications? Can they get to the restroom safely? Can they cook for themselves? Those types of things. Number two is the transportation. Can they safely drive themselves to appointments, to social activities? If not, that may fall to the caregiver. So, coming up with a plan for transportation is important to not overwhelm the kid who’s probably still transporting kids around as well.

Derek Bailey: [00:21:25] Another one is the legal side of things. Can you legally make decisions for your parents for their care? So, speaking with an elder care attorney about power of attorneys, both financial and health care, talking about their wishes towards the end of life and being prepared for those conversations, having the legal ability to make those decisions for your parents when they can no longer make those, that’s important. So, speaking with an elder care attorney and getting some of those legal documents taken care of.

Derek Bailey: [00:21:55] Another one of those things to look at is nutrition. Nutrition is a huge part of aging and healthy aging. And it’s really important to make sure our loved ones are eating properly. And so, when you’re thrust into that caregiver role, that’s something that you have to think about. Can they cook for themselves? Is it healthy food? If not, how do we bring them food? Do we deliver it? And that’s a lot of burden on the caregiver. Or are there services that can provide that?

Derek Bailey: [00:22:20] So, these are all things that we’ve been really putting a lot of time and effort into coming up with solutions for. So, hopefully, stay tuned, we’ll have a really nice package for caregivers to really hand them over and say, “Here’s what we have seen that works, and these are the things you need to focus on to keep you from burning out.” Because at the end of the day, they’re going to be caregiver, they’re there to make decisions, but we want to make sure they still have time to be the son, the daughter. We got to make sure they still have time to love their loved ones and not just be thinking about the care that they need.

Dr. Jim Morrow: [00:22:51] I think that’s a great idea. And I think any physician or any practice that deals with adult geriatric medicine would want to have that little packet on hand somewhere to be able to help people out because we do have that conversation quite a bit. And you’re absolutely right about the caregivers. They are running their household, dealing with their family, their children. They’ve got soccer, and school, and projects. And then, they also have to be dealing with the problems that their elderly parents bring. And it bothers them a lot. And I think being able to be aware of that and provide them some sort of assistance is something that would go a long way towards making this entire experience a little bit more tolerable for.

Derek Bailey: [00:23:32] And we also recommend connecting with caregiver support groups. One of our employees actually puts one on monthly. She’s in the Hall County area. But find a local caregiver support group where you can get connected with other people going through the same issue. There’s strength in numbers. There’s ideas that we’ve all tried or others have tried that have worked or not worked. And it’s nice to get around people that can support you and let you know you’re not going through this alone and that there’s help out there for it. So, definitely look into local caregiver support groups.

Dr. Jim Morrow: [00:24:02] I think that’s a great idea. And I know in talking to some of the children of elderly parents that they’ve always felt like this is a very difficult conversation to have, but once they start getting into the conversation and actually dealing with the fact that this loved one is suffering a loss – whether it’s loss of control, or loss of money, or loss of freedom, or independence, whatever it might be – that it makes the entire process a little bit easier because it’s just out in the open, and they can have the conversation, and the caregiver doesn’t have to feel that entire burden on them every minute of every day, which I think is a big problem for a lot of caregivers. So, I appreciate you talking about that.

Derek Bailey: [00:24:44] Yeah.

Dr. Jim Morrow: [00:24:45] So, I’ve got a list here of do’s and don’ts for friends and relatives of people who are moving and making this sort of transition. Things like if you’re asked help with sorting, and packing, and moving. And I think that’s kind of a no-brainer. Listen to your loved one as they talk about what they left behind. It’d be helpful even if you don’t agree with the decision to move. And I’ve seen that happen, and I’m sure you have to, where you’ve got three children, and they have to have a tiebreaker to decide whether or not this should even happen. In your experience, tell me a little bit, if you can, about how you would advise the friends and relatives to help make these things they should do to help make this a little bit better transition?

Derek Bailey: [00:25:28] Yeah, definitely. I think that one of the big things you said there was listen. As our parents age, they just want to be heard sometimes. And so, actively listening to some of their issues or concerns, and helping them understand the move, and helping them try to alleviate some of the issues is very important. But then, also, helping them communicate that to the assisted living that they’ve moved into, because a lot of times, we don’t communicate what we’re upset about or what’s bothering us. And if the assisted living doesn’t know what’s bothering the person, the new resident, then they can’t fix it. So, listen and be an active part communicating with the assisted living.

Derek Bailey: [00:26:04] Another thing I think is to be there, to be present. You don’t have to be there 24/7 because, I think, that can be a little excessive and cause more burnout but do schedule visits. The assisted living allows the resident to come and go. So, go get them, take them to lunch just like you normally would. Try to add some of those routine things that you were doing with them at home, but continue to do that in the assisted living, and help them feel like not every part of life has changed, and that they haven’t just been dropped off somewhere and left. I think that’s one of the biggest fears is, again, back to my wife’s grandmother, “Just don’t drop me off at a home and leave me.” That’s what she keeps saying.

Dr. Jim Morrow: [00:26:43] Well, that continuity is absolutely huge. And I think it’s a gigantic change for everybody in the family now that this person is actually living there. So, I think that’s really good advice. And one thing you said is to listen. We’ve both talked about that. And I think it’s important to listen and not feel like you have to fix that, which has, men, we’re fixers, and we’re trying to pull that nail out of the head, and it can be very difficult. So, about things that you shouldn’t do, I know one of the things that loved ones shouldn’t do is to just feel like they’re going to take over the entire process and run everything. But do you have ideas about other things that are bad ideas during this transition?

Derek Bailey: [00:27:28] Yes. So, I think that’s a great one to not think that the assisted living is just going to take over for you, that they’re going to be involved and help them make the care decisions moving forward. But a few things, I think, to not do. Try not to focus on all the negatives about a particular community. Once you come in, you’re going to see things, you’re going to notice things that might bother you, but address those with the assisted living and try not to bring those up with the loved one. You don’t want to give them more fuel for the fire that might cause them to really be unhappy.

Derek Bailey: [00:28:03] I would say don’t not show up. Don’t ignore the loved one. If they call, answer. If they need you to come, come by and visit. Be very involved. And then, don’t ignore the assisted living. The assisted living is, now, kind of filling in that caregiver role. And so, they need your advice on what mom or dad likes or what their routines might be. So, don’t ignore the assisted living as well. Make sure you’re there helping them now care for your loved one as you have done for so many years before.

Dr. Jim Morrow: [00:28:34] Right, right. Well, I think that’s all great advice. It’s very informative for me. And I even work in the environment. So, it’s a good thing for me to know. And I’m sure it’s very good for our listeners. If you would tell everybody how they can get in touch with you at the Right Move?

Derek Bailey: [00:28:48] Yeah, definitely. You can check us out online. Our website is www.rightmoveresource.com. That’s R-I-G-H-T Move Resource dot com. You can definitely give us a call. Our phone number is 770-880-0706. Check us out on Facebook, anything like that. But definitely just reach out. We’re here to help. We’re very in-person. So, give us a call, reach out online, and we’ll get somebody connected with you definitely.

Dr. Jim Morrow: [00:29:15] All right. And I’m wondering, John’s over here at the board, I’m wondering if we have any questions that anyone’s emailed or tweeted to us.

John Ray: [00:29:22] The question is, how much time do we have, right, because I’ve got several questions here. So, let’s start with a couple, and we’ll see how this goes. So, one question here is, how far in advance, knowing that things change rapidly with seniors and what their journey is, how far in advance should someone be in touch with you, Derek?

Derek Bailey: [00:29:47] I think as early as possible. If there comes a point where a loved one or an aging parent is actively saying, “We need to start thinking about this,” jump on it because you may not get that opportunity. A lot of aging people, they don’t want to talk about these issues, but if it comes up in a conversation or as soon as you notice some type of change, reach out. We may not be looking for assisted living within the next year, but there may be other resources that we need to be looking into that we can connect them with, whether it’s some care coming into the home or looking at setting up for VA benefits or Medicaid things because a lot of the financial help that can help pay for assisted living would be through the VA or through Medicaid. And that takes years to plan for now that there’s look back periods and things like that. So, it’s never too early to reach out. And if it’s just a phone call, we’re more than happy to give 10, 15, 20 minutes of our time just to offer up some suggestions now and to tell them to call us back at this point in time when you need some more help.

John Ray: [00:30:49] So, another question we’ve got here – I’m summarizing this – that this individual says, “Hey, I know that there are some facilities where that are a combination of assisted living and memory care that, I guess, are kind of sequential in terms of the way a senior’s journey might go. And if I think my parent has a memory issue, should they go in early to get priority for that memory care unit? Is that the way that works in these facilities?” The concern is getting into memory care units that, sometimes, have limited capacity. That’s the bottom line on the question.

Derek Bailey: [00:31:38] Yeah, definitely, definitely. It’s much easier to move into a memory care if you’re already a resident of that building. You definitely have first priority. Especially if you find one that you like above others, it’s definitely important to get into that building and be in the assisted living environment. That way, you have first priority. But also, and what studies have found out, and what we’ve noticed is with those memory issues that can advance, a lot of times, if we get them into assisted living earlier, and as they receive the routine care, their medications are taken correctly, their incontinence issues are addressed, we can actually stay out of memory care for much —  stay out of there longer. So, we can stay in the assisted living world and really thrive there first and push off moving into memory care until a much later date.

Derek Bailey: [00:32:26] Memory care is much more expensive than the assisted living. So, if we can help save them some money by staying in the assisted living longer, help the individual with the aging process and kind of stave off the results of what dementia and Alzheimer’s can do later on, that’s a good idea to get into assisted living earlier.

John Ray: [00:32:44] Okay. One more question if we got time for one more, Jim.

Dr. Jim Morrow: [00:32:47] All right then.

John Ray: [00:32:48] Okay. So, here’s someone that’s written in, and they say, “I don’t trust online reviews.” So, I can sympathize with that. And that’s obviously where you come in in terms of giving onsite help with places that folks ought to look at, maybe places they ought to avoid. “How do you continue to monitor what’s going on at different facilities? How do you do that?”

Derek Bailey: [00:33:18] That’s a great question. That’s very important. There is a lot of information online. And the reason I started my business is really because of that, because there’s a lot of misinformation, and there’s a lot of people out there that are going to take your information, and really not correctly guide you to where you need to be. So, we are on the ground in these facilities weekly, monthly, visiting them, keeping up with our clients that are moving in and out of these facilities. And we’re making sure that they’re doing the right things.

Derek Bailey: [00:33:47] Things change all the time. We know staffing changes all the time. So, we try to keep on top of that as the boots on the ground, so to speak. And that’s why I wanted to be different. I wanted us to be in the communities, knowing the options, and knowing who’s providing great care at that point time. We also do follow up surveys with all of our clients. So, we do incremental every-two-month surveys to make sure that they’re happy, that they’re doing a good job. And we stay on top of any issues that might come up. So, if we’re getting bad surveys from a particular community, we know maybe we need to go help them address that situation or we can tell our future clients these are the issues we’ve had with that. So, it’s very important to stay in the communities, to stay talking with our previous clients to make sure they’re getting good care.

John Ray: [00:34:32] I think that’s what we’ve got time for. But we ought to let everyone know that if they’ve got further questions, they can put them on our Facebook page, and we can make sure that Derek gets those questions. We can answer them there.

Dr. Jim Morrow: [00:34:43] Absolutely.

John Ray: [00:34:43] Right?

Dr. Jim Morrow: [00:34:43] Yes, absolutely. They can e-mail. Once again, the email is drjim@toyourhealth.md. And on Twitter, @toyourhealthmd. We are on Facebook. It’s To Your Health on Facebook. Morrow Family Medicine’s Facebook page, of course, is there if you want to leave a message there. And we will definitely connect you with Derek.

Dr. Jim Morrow: [00:35:02] I do want to remind everybody that Morrow Family Medicine has a walk-in hour every morning, Monday through Friday, 7:30 to 8:30. If you decide one evening there’s something you need to have checked out, whether it’s a cough, cold, bellyache, rash, ask a question, doesn’t matter to us, if you feel the need to be seen, you can just show up at one of our offices Monday through Friday, 7:30 to 8:30, and we will see you. That way, there’s never a day you can’t be seen at Morrow Family Medicine. And I do believe that’s all we have for today. So, this is Dr. Jim Morrow, and that’s To Your Health.

To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease

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To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 9, Lyme Disease

What causes Lyme Disease? What about chronic Lyme Disease? What is it about some treatments of chronic Lyme Disease that should be concerning?  On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more. Dr. Morrow also talks about why he maintains ownership of his practice and what that means for his patients.

Dr. Morrow’s Show Notes on Lyme Disease

  • Today, I am going to talk about Lyme Disease, and before I am finished, I suspect that some of you will be shaking your heads and changing the dial, metaphorically at least.
  • Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States.
    • Transmission occurs primarily through the bite of an infected deer tick.
    • Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC.
    • Georgia has had cases of documented Lyme disease but the numbers are very low.
    • Identification of an erythema migrans rash following a tick bite is the ONLY clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.
    • The Centers for Disease Control and Prevention recommends a two-tier approach using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal.
      • This is a tremendous point of conflict among patients. The test reports a series of positive or negative “bands” that correspond to possible infection.
        • In order for the test to be POSITIVE, you MUST have FIVE or more positive bands. This is due to cross-reaction or false positive results on any one band.
        • Very often, when we get these results back, 1-3 bands are positive. I have seen too many times when the patient, or even on occasion, the clinician, made the diagnosis of Lyme disease based on this.
  • This is just wrong and is completely unfair to the patient. And it can make the patient vulnerable to the mountain of information available that would make them believe that they could someday have what has been labeled as “chronic Lyme disease”
  • The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease.
  • Doxycycline is often the preferred agent for oral treatment because of its activity against other tick-borne illnesses.
  • Preventive measures include
    • avoiding areas with high tick burdens,
    • wearing protective clothing,
    • using tick repellants (e.g., DEET),
    • performing frequent body checks and
    • bathing following outdoor activities, and
    • instituting environmental landscape modifications (e.g., grass mowing, deer exclusion fencing) to reduce the tick burden.
  • Although there is controversy regarding treatment of post–Lyme disease syndrome and chronic Lyme disease, there is no biologic or clinical trial evidence indicating that prolonged antibiotic therapy is of benefit.
  • Symptoms of early Lyme disease usually begin one to two weeks after a tick bite (range of three to 30 days)
  • There are three well-recognized clinical stages of Lyme disease, and clinical manifestations are different at each stage.
  • As many as 80 percent of patients develop the characteristic erythema migrans rash, which may be confused with other similar conditions.
  • Erythema migrans is classically reported as a single lesion
    • most commonly appears as a uniform red oval rash with average size of about 7-8 inches. It can be as small as a couple of inches.
  • Approximately 19 percent of Lyme rashes are a “bull’s-eye” rash. So, if you are basing the diagnosis only on a bulls eye rash, you could easily miss this.
  • Multiple similar rashes may occur in up to 10 to 20 percent of patients.
  • Associated symptoms are similar to a nonspecific viral illness and often include fatigue, malaise, fever, chills, myalgia, and headache.
  • Following this initial stage, the bacteria disseminate systemically via the lymphatic system or blood.
  • With untreated disease, the most common sites of extra-cutaneous involvement are the joints, nervous system, and cardiovascular system.

Stages of Lyme Disease

  • Early localized
    • Erythema migrans – (typical rash)
    • Virus-like illness (e.g., fatigue, malaise, fever, chills, myalgia, headache)
  • Early disseminated:
    • Cardiac (e.g., atrioventricular block)
    • Dermatologic (e.g., multiple erythema migrans lesions)
    • Musculoskeletal (e.g., arthralgia, myalgia)
    • Neurologic (e.g., lymphocytic meningitis, facial nerve palsy, encephalitis)
  • Late
    • Arthritis (can be one or multiple joints)
    • Neurologic symptoms (e.g., encephalomyelitis, peripheral neuropathy)
  • These are associated with a positive test for Lyme disease

Chronic Lyme Disease

  • Symptoms attributed to Chronic Lyme Disease are chronic pain, fatigue, neurocognitive, and behavioral symptoms
    • Clinicians who subscribe to the idea that chronic Lyme is a real entity will misread, either intentionally or through ignorance, the lab tests for Lyme disease.
    • Too often, they will explain to the patient that the only treatment for their symptoms is long-term antibiotic treatment with or without some other very involved, complex and almost always wasteful treatment THAT ONLY THEY CAN PROVIDE.
    • Perhaps the most recognized and contentious facet of this debate is whether it is effective, appropriate, or even acceptable to treat patients with protracted antibiotic courses based on a clinical diagnosis of CLD.
    • Patients and their families spend an unbelievable amount of money every year on these treatments. Thousands and thousands of dollars are wasted and just handed over to unscrupulous physicians who prey on the hardship of others.
  • The dialogue over CLD provokes strong feelings, and has been more acrimonious than any other aspect of Lyme disease.
    • Many patients who have been diagnosed with CLD have experienced great personal suffering; this is true regardless of whether Lyme infection is responsible for their experience.
    • On top of this, many patients with a CLD diagnosis share the idea that the medical community has failed to effectively explain or treat their illnesses.
      • In support of this patient base is a community of physicians and alternative treatment providers as well as a politically active advocacy community.
      • This community promotes legislation that has attempted to shield CLD specialists from medical board discipline and medicolegal liability for unorthodox practices, to mandate insurance coverage of extended parenteral antibiotics, and most visibly to challenge legally a Lyme disease practice guideline.
      • The advocacy community commonly argues that Lyme disease is grossly underdiagnosed and is responsible for an enormous breadth of illness; they also argue that the general scientific and public health establishments ignore or even cover up evidence to this effect.
      • A large body of information about CLD has emerged on the Internet and other media, mostly in the forms of patient testimonials and promotional materials by CLD providers.
      • This volume of information can be confusing and difficult to navigate.
    • The concept of CLD has for the most part been rejected. Clinical practice guidelines discourage the diagnosis of CLD and recommend against treating patients with prolonged or repeated antibiotic courses.
      • National and state public health bodies agree with this rejection of CLD.
      • Within the medical community, only a small minority of physicians have accepted this diagnosis: 2.1%
    • Many patients referred for Lyme disease are ultimately found to have a rheumatologic or neurologic diagnosis.
      • Rheumatologic diagnoses commonly misdiagnosed as Lyme disease include osteoarthritis, rheumatoid arthritis, degenerative diseases of the spine.
      • Some patients are found to have neurologic diseases, including multiple sclerosis, demyelinating diseases, amyotrophic lateral sclerosis, neuropathies, and dementia.
      • Some CLD advocates have argued that these various conditions are simply manifestations of Lyme disease, but these hypotheses are unable to be proven.
      • There is no evidence that these conditions are related to Lyme infection at any time.
    • Bottom line on chronic Lyme disease is that there is just no science behind it. No study has ever shown a definitive link between these vague symptoms and Lyme disease.
      • The only information even found with the infamous Google search is found on non-medical sites. Websites of any scientific value (those reporting actual scientific studies) reveal NO DATA supporting chronic Lyme disease.
      • The symptoms of chronic Lyme can sometime be explained by other REAL disease processes, but more often than not, these symptoms are just the symptoms of life. They can happen to anyone and do happen to a huge percentage of people in the everyday living of life.

(Information included in these notes comes, in part, from the American Academy of Family Physicians website at www.aafp.org.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

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To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

Sleep apnea affects not only a partner who can’t sleep for the snoring, but it reduces quality of life for the person affected by this condition. So why does sleep apnea occur, and what are the best treatment options? On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more, and talks about his own experience with sleep apnea.

Also in this episode, Dr. Morrow welcomes two 8th grade students from Taylor Road Middle School in Johns Creek, Cion Kim and Ananya Shaeker. To complete a project assignment for their language arts class, Cion and Ananya used a previous episode of “To Your Health” to explore the dangers of vaping for their peers. Impressed by their work, Dr. Morrow was delighted to welcome Cion and Ananya to the show!

Ananya Shaeker and Cion Kim
Ananya Shaeker and Cion Kim

 

 

Dr. Morrow’s Show Notes on Sleep Apnea

Sleep Apnea

  • There are two kinds of sleep apnea: obstructive apnea and central apnea.
  • Obstructive sleep apnea is the most common type.
    • Nine out of 10 people who have sleep apnea have this type of apnea.
    • something is blocking the airway that brings air into your body (also called the trachea).
    • When you try to breathe, you can’t get enough air because of the blockage. Your airway might be blocked by your tongue, tonsils, or uvula (the little piece of flesh that hangs down in the back of your throat).
    • It might also be blocked by a large amount of fatty tissue in the throat or by relaxed throat muscles.
  • Central sleep apnea is less common. This type of sleep apnea is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don’t get the “go-ahead” signal from your brain. Either the brain doesn’t send the signal, or the signal gets interrupted.

Obstructive Sleep Apnea

  • Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep.
  • People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping.
    • These short stops in breathing can happen up to 400 times every night.
    • If you have sleep apnea, periods of not breathing can disturb your sleep (even if they don’t fully wake you up).
  • This results in fragmented, non-restful sleep that can lead to symptoms such as morning headache and daytime sleepiness.
  • Obstructive sleep apnea affects persons of all ages, especially:
    • Men,
    • people who are overweight, and
    • people who are older than 40 years of age are more likely to have sleep apnea.
  • However, it can affect anyone at any age.
  • There are many health conditions associated with obstructive sleep apnea, including
    • hypertension,
    • coronary artery disease,
    • cardiac arrhythmias, and
    • depression
  • Predictive clinical features are:
    • Loud snoring,
    • gasping during sleep,
    • obesity, and
    • enlarged neck circumference.
  • Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited.
  • The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory (a sleep study).
    • Home sleep apnea tests are available and in recent years have become more reliable.
    • Home portable monitoring can be used as a substitute for in-laboratory polysomnography for the diagnosis of OSA in patients with a high likelihood of SA.
    • Most patients prefer home monitoring, and clinical outcomes among patients diagnosed by either method are comparable regarding sleepiness, sleep-related quality of life, and compliance with continuous positive airway pressure (CPAP) therapy

What is the Result of Untreated Obstructive Sleep Apnea?

Relation to Hypertension

  • About one half of patients who have essential hypertension have obstructive sleep apnea, and
  • About one half of patients who have obstructive sleep apnea have essential hypertension.
  • A growing body of evidence suggests that obstructive sleep apnea is a major contributing factor in the development of essential hypertension.

Excessive Daytime Sleepiness

  • Excessive daytime sleepiness is one of the most common sleep-related patient symptoms
    • affects an estimated 20 percent of the population. Persons with excessive daytime sleepiness are at risk of motor vehicle and work-related incidents, and have poorer health than comparable adults.
    • The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications.
    • Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy.
    • Obstructive sleep apnea is a particularly significant cause of excessive daytime sleepiness.
      • An estimated 26 to 32 percent of adults are at risk of or have obstructive sleep apnea, and the prevalence is expected to increase.
      • The evaluation and management of excessive daytime sleepiness is based on the identification and treatment of underlying conditions (particularly obstructive sleep apnea), and the appropriate use of activating medications.

Connection to Heart Disease

  • The connection between sleep apnea and heart disease is evolving very rapidly.
  • People with cardiovascular problems such as high blood pressure, heart failure, and stroke have a high prevalence of sleep apnea.
  • Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly.
  • One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well.
  • If you treat people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence to think there is a cause-and-effect relationship between hypertension and sleep apnea.
  • Why does your blood pressure go up when your sleep is disrupted by sleep apnea?
    • Your blood pressure will go up because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and the brain, because they have priority.
    • The problem is that things that go on at night tend to carry over in the daytime, even when the sleep apnea patient is awake. The low oxygen levels at night seem to trigger multiple mechanisms that persist during the daytime, even when the patient is breathing normally.
  • How can CPAP (continuous positive airway pressure) reduce the cardiovascular consequences of sleep apnea?
    • The available evidence tells us that when you treat people with sleep apnea using CPAP, their blood pressure is not only lower at night—it’s also lower during the day. That’s a very good thing.
    • Moreover, people with atrial fibrillation (a common type of irregular heart beat) with sleep apnea that is appropriately treated have only a 40% chance of coming back for further treatment of their atrial fibrillation.
      • If their sleep apnea is untreated, the chance of a recurrence of atrial fibrillation goes up to 80%. The message to heart patients with sleep apnea is: With treatment of your sleep apnea, your chances of improvement are considerably better.

Can Sleep Apnea Be Prevented or Avoided?

  • There are things you can do to prevent sleep apnea. The following steps help many people:
    • Stop all use of alcohol or sleep medicines. These relax the muscles in the back of your throat, making it harder for you to breathe.
    • If you smoke, quit smoking.
    • If you are overweight, lose weight.
    • Sleep on your side instead of on your back.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 7, Allergies

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To Your Health With Dr. Jim Morrow: Episode 7, Allergies
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Dr. Jim Morrow, Host of “To Your Health With Dr. Jim Morrow”

Episode 7, Allergies

Allergies affect almost 50 million people in the United States alone. On this episode of “To Your Heath,” Dr. Jim Morrow, an allergy sufferer himself, takes them all on:  food, plants, drug, environmental, and contact allergies. Dr. Morrow also talks about Forsyth BYOT, a non-profit established by Dr. Jim and Peggie Morrow to support technology initiatives in Forsyth County Schools.

Dr. Morrow’s Show Notes on Allergies

Allergies

  • When you hear someone talk about having allergies, usually they mean rhinitis or upper respiratory symptoms (runny nose, watery eyes, itching eyes and ears and nose, sneezing).
  • Allergies also can be due to food, medications, animal dander or plants.

Allergic Rhinitis

  • The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing.
  • Individuals with allergic rhinitis should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
  • Specific testing (blood or skin) should be performed for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed.
  • Sinus imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
  • Intranasal steroids should be prescribed for patients with allergic rhinitis whose symptoms affect quality of life.
  • Oral second-generation/less sedating antihistamines should be prescribed for patients with allergic rhinitis and primary complaints of sneezing and itching.
  • Intranasal antihistamines may be prescribed for patients with seasonal, perennial, or episodic AR.
  • Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
  • Combination pharmacologic therapy may be prescribed for patients with allergic rhinitis who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
  • Immunotherapy should be prescribed for patients with allergic rhinitis who have inadequate response to pharmacologic therapy
  • Avoidance of known allergens or environmental control may be considered in patients with allergic rhinitis who have identified allergens that correlate with their clinical symptoms.
  • Inferior turbinate reduction may be considered for patients with allergic rhinitis with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.

Allergy Testing

  • Many types of allergies: environmental, foods, drug, contact.
  • An estimated 10% to 30% of the global population has an allergic disease.
  • Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features.
  • Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell–mediated reactions are the main types of allergic responses.
  • The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing.
  • For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred.
  • In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment.
  • If this is ineffective, IgE-specific antibody or skin testing can exclude allergens.
  • An oral food challenge should be performed to confirm the diagnosis. Results of laboratory testing for food-specific IgE are generally poor, even less helpful than those for percutaneous skin testing.
  • Patients with an anaphylactic reaction to an insect sting should undergo specific antibody or skin testing.
  • Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis.
  • Patch testing can help identify the allergen responsible for contact dermatitis.

Food Allergies

  • Patients with suspected food allergies are commonly seen in clinical practice.
  • Although up to 15 percent of parents believe their children have food allergies, these allergies have been confirmed in only 1 to 3 percent of all Americans.
  • Family physicians must be able to separate true food allergies from food intolerance, food dislikes, and other conditions that mimic food allergy.
  • The most common foods that produce allergic symptoms are milk, eggs, seafood, peanuts, and tree nuts.
  • Although skin testing and in vitro serum immunoglobulin E assays may help in the evaluation of suspected food allergies, they should not be performed unless the clinical history suggests a specific food allergen to which testing can be targeted.
  • Furthermore, these tests do not confirm food allergy. Confirmation requires a positive food challenge or a clear history of an allergic reaction to a food and resolution of symptoms after eliminating that food from the diet.
  • More than 70 percent of children will outgrow milk and egg allergies by early adolescence, whereas peanut allergies usually remain throughout life.
  • The most serious allergic response to food allergy is anaphylaxis. It requires emergency care that should be initiated by the patient or family using an epinephrine auto-injector, which should be carried by anyone with a diagnosed food allergy.
  • There are no recommended medications to prevent IgE- or non–IgE-mediated allergic reactions to food. Allergen-specific immunotherapy or immunotherapy with cross-reacting allergens is not recommended to treat food allergy.
  • Some environmental allergens cross-react with foods, such as:
    • Birch pollen:  Carrots, celery, fresh fruit (e.g., apples, cherries, nectarines, peaches, pears), hazelnuts, parsnips, potatoes
    • Grass pollen:  Kiwi, tomatoes
    • Ragweed pollen:  Bananas, melons (e.g., cantaloupe, honeydew, watermelon)

Nonallergic Rhinitis

  • Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies.
  • Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available.
  • Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes.
  • There are several subtypes with overlapping presentations, including:
    • nonallergic rhinopathy,
    • nonallergic rhinitis with nasal eosinophilia syndrome,
    • atrophic rhinitis,
    • senile or geriatric rhinitis,
    • gustatory rhinitis,
    • drug-induced rhinitis,
    • hormonal rhinitis, and
    • occupational rhinitis.
  • Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible.
  • First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium.
  • Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms.
  • Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.

Hives (Urticaria)

  • Hives are typically large, raised areas on the skin that can itch and spread and coalesce into huge areas of swelling
  • They can be caused by many things, including:
    • Colds
    • Bladder infections or other types of infection
    • Allergies to food, particles in the air, or things that touch your skin
    • Insect stings or bites
    • Medicines
    • Heat, cold, or pressure
    • Exercise
    • A serious disease, but this is uncommon In many cases, no specific cause is found.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Forsyth BYOT

In 2013, Dr. Jim and Peggie Morrow found that hundreds of students in Forsyth County did not have the technology necessary to succeed in the highly technical environment that school is today. The county relies on online work a great deal and so many students were having to go to the library or a Starbucks to access assignments because they did not have internet in their homes.  Additionally, many did not and do not have internet capable devices that make this work possible either.

So, the Morrows made it their mission to bridge this gap and help these students try to break the cycle of generational poverty that so many of them are born to.

In the last five years, over $300,000 has been raised and donated by Forsyth BYOT to the Forsyth County Schools for this purpose. Forsyth BYOT seeks to raise awareness of the problem and find sponsors to donate or raise money outright through two yearly fundraisers, the BYOT Golf Tournament in May and the iRUN for BYOT 5K & FunRun in October.  Donated funds are given to the school district, which has staff in place to first determine which students are in need and then to purchase and distribute internet hotspots or devices to that family.

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