Mobile Outreach Clinic Brings Health Access to Community’s Vulnerable

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Mobile Outreach Clinic Brings Health Access to Community’s Vulnerable

With Funding Help from Southern Regional AHEC and NC AHEC

On Tuesday, August 24th, a ribbon-cutting ceremony took place at Fayetteville State University’s Southeastern NC Nursing Education and Research Center, celebrating “Bringing Care to the Community” and revealing the Beyond the Bedside Mobile Nursing Clinic. Its financial sponsor and FSU partner, TRUST, along with Clinical Site Development Grant funding from Southern Regional AHEC through the NC AHEC Program, helped to bring the mobile unit, housed within a retrofitted RV, to realization. Soon, the Bronco-blue-and-white mobile clinic, clad with the buoyant, bright artwork of FSU student Albert Bass, will travel to the areas of Cumberland County in most need, to meet the basic healthcare needs of our citizens. 

At the ceremony, FSU Chancellor Darrell T. Allison noted that the unit is a win/win for the campus and the community, especially during a pandemic. It offers an affordable solution to those who need healthcare, but do not have the transportation necessary to travel to their doctor’s office. The service also provides hands-on clinical experiences to nursing students attending FSU. “We celebrate this momentous occasion to further prove that we are doing what we said we would, by serving the citizens of Cumberland County”, he told the guests on Tuesday afternoon. “The people of our community will come to see this as a symbol of FSU’s example and service.”

Southern Regional AHEC is proud to be part of this important project that coincides with our organization’s mission to increase access to care while increasing the number and diversity of healthcare professionals in our region. 

Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

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Now is the Time: Catch-up to Get Ahead on Childhood Immunizations

By Adm. Brett P. Giroir, M.D.,Assistant Secretary for Health

August 2020

During National Immunization Awareness Month, the U.S. Department of Health and Human Services (HHS) is urging healthcare providers and parents to “catch-up to get ahead” on childhood immunizations.

The COVID-19 pandemic has led to worrisome declines in well-child visits and routine immunization rates. Although we have made progress to reverse this trend, without high vaccination rates there is a risk for outbreaks and further strain on our nation’s healthcare system.

As a pediatric critical care physician, I know all too well the devastating consequences that diseases, like whooping cough and measles, can have on children and their families. It is tragic to see a child become sick, or even die, from a disease that we can prevent with safe and effective vaccines. In our fight against the COVID-19 pandemic, we cannot let down our guard against preventable childhood diseases. Now is the time to get every child back on track with recommended vaccines.

To increase childhood immunization rates and reduce potential outbreaks of vaccine-preventable diseases before flu season, HHS is coordinating the “Catch-up to Get Ahead” effort. Together a number of government and private sector partners will enhance access to essential immunization services by:

  • Increasing immunization opportunities by encouraging extended office and clinic hours for the administration of catch-up vaccines;
  • Informing parents about COVID-19 safety precautions and practices in place in healthcare settings and encouraging them to take their children to get vaccinated; and
  • Catching children up on their immunizations to mitigate pressures on our healthcare system when the influenza and SARS-CoV-2 viruses begin co-circulating in the coming months.
  • Promoting the importance of childhood immunizations.

It’s imperative to make sure our children are vaccinated on time throughout their childhood before they are exposed to potentially life-threatening diseases. Vaccines are a safe and effective way to guard our children against 16 serious diseases, such as rubella, polio, and cancers caused by HPV.

Getting children back on track with recommended vaccines is safe, but there may be delays, as many children need to catch-up during this time. Additional precautions are in place in healthcare settings to prevent the spread of SARS-CoV-2, the virus that causes COVID-19. Most vaccines are also available at no or low cost to the parent. Parents should talk to their healthcare provider if they feel that cost is a barrier to getting their children vaccinated.

To learn more about vaccines and vaccine-preventable diseases, visit vaccines.gov.

Why Do Some People Develop Diabetes and Others Don’t?

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Why Do Some People Develop Diabetes and Others Don’t?

By Lenny Salzberg, M.D.

May 2020

Risk factors for type 2 diabetes

Why do some people develop diabetes, and others don’t? Lifestyle and environmental factors account for the majority of the diabetes epidemic. We know that an energy-dense Western-style diet (food trucks, anyone?) and a sedentary lifestyle (thanks, COVID-19 L) are responsible for the epidemic of obesity, and that obesity often leads to diabetes. But not everyone who is obese gets diabetes, and not everyone with diabetes is obese! Why???

Genetics! Scientists have already identified 500 genes that are associated with type 2 diabetes, which together account for 20% of the predisposition to type 2 diabetes. But genes don’t explain everything. In addition to genetic factors, there are “epigenetic” factors, which are influences outside the DNA. These include things like aging, the environment, and exposure to substances during gestation. For example, prenatal exposure to famine has been associated with a higher risk of developing type 2 diabetes. Also, the children of women who have gestational diabetes are eight times more likely to develop diabetes themselves! So, if you don’t want your baby to grow up to have diabetes, don’t get pregnant during a famine, but if you must, don’t get diabetes while you are pregnant!

What are some surprising risk factors for diabetes? Many of us know about the risks incurred by lack of exercise and by drinking Mountain Dew and other sugar-sweetened beverages (e.g. sweet tea). But did you know that eating a low fiber diet, not sleeping enough, and even exposure to loud road noise are all independent risk factors for diabetes? Did you know that drinking 3 or more cups of coffee (either caffeinated or decaffeinated) is associated with a lower risk of diabetes?

The Microbiome

One of the frontiers in diabetes risk management involves our complex intestinal ecosystem: the “gut microbiome.” The gut is nearly sterile at birth. However, by age three, the gut has acquired most of the microbes that will be present through adulthood. These microscopic organisms (certain types of bacteria, fungi, and viruses) share a symbiotic relationship with the lining of the gut.

The two main types of bacteria in the gut are called Firmicutes and Bacteroidetes. Firmicutes are found predominantly in the small intestines, while Bacteroidetes reside mostly in the colon. These bacteria are involved in nutrient metabolism, drug metabolism, maintenance of the gut lining, and protection against pathogens. Dysbiosis (an imbalance of gut microbes) occurs as a result of an unhealthy diet, antibiotic treatment, or chronic infection. In one study, four days of a meat-based diet rapidly decreased the abundance of Firmicutes in the gut. Who would have thought that eating meat was bad for us? Also, it has been shown that the guts of patients with diabetes and prediabetes have fewer of the type of bacteria that change carbohydrates into short-chain fatty acids (SCFAs). SCFAs affect metabolism, energy balance, and the stability of the immune system.

Strategies to prevent and treat diabetes through manipulation of the gut microbiome are being developed. We know that you can help your own microbiome by consuming “prebiotics”, like vegetables and fruit. Probiotics, like kefir and yogurt, may also improve your gut microbiome! In the meantime, pick your parents well, eat a high fiber diet, avoid meat, drink a lot of coffee AND get enough sleep, and try not to live next to a highway! Good luck!

Corona, No Lime

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Corona, No Lime

By Ebaad Malick, M.D.

March 2020

For most of us, these past few weeks have been full of fear, news reports, memes on social media, and thoughts about finally getting that modern Japanese toilet installed (look it up). Of course, I am talking about Coronavirus, or, more specifically, COVID-19. At the end of this article I will include helpful links to some of the world’s top health organizations with easy-to-digest information about the virus and how to manage this developing pandemic. For now, I think we should all take a step back and think about a few things.

COVID-19 has engulfed all of the world on one key issue, thereby uniting us all against it. People are packing grocery stores to stock up on food and cleaning supplies. Around the globe, there have been cancellations of major sporting events and public gatherings. Even celebrities and politicians are being tested (or finally deciding to get tested), and there are a few instances of leading doctors and healthcare workers who have tragically passed away due to the disease.

At times like these, I hope we can at least feel more empathetic to those in our society who everyday can’t get the supplies they need, or who live in constant fear of opportunistic diseases due to their socioeconomic status. Hopefully, we can now better understand why so many people act out of fear and try everything they can to migrate to a safer area for their family.

All of a sudden, we are all injected with our own fears, and we begin to act out of that fear. Some of the pettier issues in our lives seem smaller. Our fragile humanity has been exposed. Viruses do not discriminate the same way we humans do. They don’t care if you are black or white. They don’t care if you’re rich or poor. They even don’t care if you’re one of those people that put pineapples on pizza (why, though?). A virus can infect almost anyone who is exposed to it; even with certain genetic factors and risk factors at play.

At this time, I would like to thank all physicians, nurses, and other healthcare workers who are putting themselves at risk by being the first to respond to people with symptoms of COVID-19. When a patient comes into the clinic coughing up a storm, it is the person working the front desk that is exposed first; even before the patient gets a mask or further precautions. Nurses are still taking vital signs and touching the patients more than anyone. In major sporting leagues, they have suspended the season to help control the spread of the virus and protect players, spectators, and their families. However, there is no suspending hospitals, clinics, and laboratory testing.

COVID-19 belongs to a class of viruses called Coronaviridae. So far, it has been shown to mainly affect people over 60 who have heart failure, diabetes, and immunosuppression (weakened immune system). Nevertheless, it is important to note that new information comes in every day, and there are still some cases showing up in all age groups. Leading scientists and medical professionals caution us to understand that everyone is still at risk, even if the first wave of reported deaths and hospitalizations are in older populations with comorbid medical conditions. So far, it appears that the virus is transferred via respiratory droplets, similar to the flu. This is why social distancing is important to reduce the amount of time you are within 6 feet of another person. We should also understand that touching our noses and mouths can transmit the virus if we touch an infected surface (like metals and fabrics). By washing our hands we can decrease the chance of transmitting the virus to ourselves or someone else.

For more information about the Coronavirus please use one of the following links:

Center for Disease Control (CDC)

World Health Organization (WHO)

The Best Diet? No Diet at All.

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The Best Diet? No Diet at All.

By Kristina Kurkimilis, DO

February 2020

My (not so formal) formal disclosure: the following represents the opinion of a second-year family practice resident, fitness enthusiast, and nutrition dabbler…namely, myself.

“Diet” is defined as, “…the kinds of food that a person, animal, or community habitually eats”; or “…to restrict oneself to small amounts or special kinds of food in order to lose weight.” Nowhere in this definition are you told how to eat; you’re only told that dieting involves restricting food. However, how do you know what you’re supposed to restrict? Also, how can the restriction of any kind of food be completely sustainable?

This brings me to my next definition, “fad diet.” This term refers to “…a popular diet used to lose as much weight as possible in a short amount of time.” For example, some fad diets (like the South Beach Diet, the Lemon Diet, and “juice cleanses”) call for the complete elimination of entire food groups. I have a lot of issues with these fad diets! For one, the goal should never be to lose as much weight as possible, but instead to lose weight in a healthy way. Second, losing weight in a short amount of time only leads to “yo-yoing” (sudden weight loss followed by sudden weight gain).

Why do I sound like such a diet hater? Because I believe that if you’ve decided to make a commitment to your health by losing weight and eating better, then you should do yourself the favor of creating sustainable new lifestyle habits that will last a lifetime, rather than dieting for just a few weeks so that you can fit into that dress or that pair of pants. Instead of crash diets or fad diets, I recommend small, sustainable changes that will eventually evolve into lifetimes habits.

When it comes to dieting, small changes will be much more productive than the drastic changes demanded by a fad diet. For example, let’s take a diet that promises that you will “…lose 15 pounds in a week if you eat zero carbohydrates.” You may be able to do this for a few days, or until you’re tempted by cake at your best friend’s birthday party. At that point, you might think, “I can cheat with one piece of cake today, and then jump right back to my diet tomorrow!”  Unfortunately, that one piece turns into a few pieces, or you add some pizza and fries! This is a common story that I hear pretty frequently in my office. The intent to eat better and lose weight always starts off strong, when the motivation is high and there is a “newness” to the whole process. But then you start to crave what you can’t have, you want to be able to enjoy a drink or a meal with your friends, or you have a tough day at work and just need that ONE thing you’ve sworn off of to feel better. This is no way to live your best life! Instead, you’ve created a life full of deprivation, guilt, and shame.

Instead, I think you should adopt an “80/20 lifestyle.” This means that instead of eliminating something completely, you try to abstain from it 80% of the time. Then, following the rules below, you can spend the remaining 20% enjoying live and giving yourself some grace!

More generally, try to follow the following rules, which I give to all patients who are seeking out a healthier diet:

  • Eat whole foods (foods as close as possible to the way nature made them). Try to avoid frozen, processed, or packages foods.
  • To make rule #1 easier, shop the perimeter of the grocery store, because the shelves in the middle of the store are usually reserved for less healthy items, like packaged and frozen foods.
  • Limit foods that have white grains, added sugar, and added salt. You can still eat foods with natural sugar in them (like fruit), but for a zero on the “added sugar” part of the label. Replace white bread and white pasta with their whole-grain counterparts, and don’t keep a salt shaker on your table at home!

So, if it’s your best friend’s birthday, go ahead and have a piece a cake. If you keep up with the “80/20 rule,” you won’t feel like it’s “cheating,” and you’ll avoid the temptation to binge later on. For some people, the word “diet” is enough to make them feel restricted. Instead, I challenge you to create new habits and change your lifestyle rather than trying a fad diet, failing, and regaining the weight you were trying to lose. You may feel like the tortoise in the race against the hare, but who wins the race? Slow and steady.

Nutrition, Simply Put.

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Nutrition, Simply Put.

By Kristina Kurkimilis, DO

July 2019

Whether you follow doctor’s orders or follow the latest fad diets, it’s so easy to quickly become overwhelmed by what is good or bad, healthy or unhealthy, right or wrong when it comes to food choices. We doctors always tell patients to “improve their diet,” or we write “Discussed diet with patient” in our clinic notes…but really, what does that mean? If you’re a middle aged patient with diabetes, hypertension, and high cholesterol, there are different recommended diets for each of these chronic illnesses, so what foods would be good to eat for all of them? Where is the best place to start on your lifelong journey of better eating?

The very first step I recommend to anyone looking to change their diet it to keep a food diary. Or, for the technologically inclined, download the free food tracking app called MyFitnessPal. For a month, track everything you eat or drink and, most importantly, how you feel. Note if you were really stressed before you picked up that donut in the breakroom, or write it down if you had bad diarrhea after the burger and fries you ate for lunch. Especially if you are plagued with a diagnosis like diabetes or hypertension, I urge you to also keep a diary of your sugars and/or your blood pressure to see how those are affected by the food you eat. You can learn so much by simply tracking (without judgment) what goes in your body. The reason I recommend tracking for a month (rather than a week, as some people suggest) is because you can start to see trends and patterns over a month; whereas tracking for only a week may tempt you to make different choices just so you “look good on paper.” A month is also enough time to create a habit, and the goal with nutrition should be to form good habits that are sustainable over a lifetime (not just to lose a few pounds).

Once you have tracked for a month or so, make small changes in your diet that are sustainable. For example, switch those sodas with bottled water. Instead of a sugary dessert every night, try something that’s naturally sweet, like fruit. If you’re always super-sizing your meal when you eat out, try to get the regular size; or instead of getting fries, try the salad for your side.

If you aren’t sure where to start with these decisions, your doctor is here to help! Don’t be afraid to bring your food logs to your next doctor’s visit. By that point, you will have already shown great commitment to change, and your doctor will be more than willing to help you figure out the next steps towards a sustainable diet. It is imperative to remember that your doctor is not only here to treat sickness, but to provide guidance to prevent sickness!

Grab your notebook or grab your smartphone and commit to 1 month of logging your food choices. The first step to better nutrition is to personalize your diet and eating habits, and what is more personal than keeping a “diary” of the factors that cause you to overeat, or the things that raise your blood sugar or blood pressure? Most “fad” diets will work for a short period of time. In contrast, a complete change of lifestyle may take longer but will be sustainable for an entire lifetime. If you are willing to put in the legwork in on the front end, then you will reap the results for a long time to come!