Mini Medical School Topics: Women’s Health, Injury Prevention and Telemedicine

Breast cancer is the second leading cause of death among women, so prevention and screening are important, not only for breast cancer but also for other gynecologic cancers, according to Dr. Kristie Graettinger, a physician in Obstetrics and Gynecology at University Medical Center.

Graettinger provided a presentation, “Women’s Health Update: Cancer Prevention,” at the Oct. 20 Mini Medical School program conducted in collaboration with UA’s OLLI program.

In addition to her presentation, three other faculty members presented during the month of October. Dr. Ray Stewart, a physician in Sports Medicine at UMC, talked about “Preventing Injury” on Oct. 6, and Dr. Karen Burgess, a pediatrician at UMC, gave a presentation on “Telemedicine” on Oct. 13.

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by UMC providers give information about issues and advances in medicine and research. OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel.

In her presentation, Graettinger said to think of cancer prevention as three tiers: “prevention, screening and treatment.” Prevention is interventions to reduce the risk of cancer, including maintaining a healthy weight, being physically active, having a diet high in fruits, vegetables and whole grains and low in processed foods and red meats, and receiving vaccinations that can protect against cancer, such as the HPV vaccine for cervical cancer. Examples of screening include mammograms for breast cancer and pap smears for cervical cancer.

“The goal is first to try and prevent cancer, and also to identify people at risk for the disease,” Graettinger said.

Breast cancer is the second leading cause of death among women, right behind lung cancer, and will affect 1 in 8 women in their lifetimes. Approximately 250,000 cases of breast cancer are diagnosed every year.

Having a first-degree relative, such as a mother or sister, with breast cancer doubles the risk, but that amounts to only 15 percent of women diagnosed. Breast cancer screening includes mammograms, clinical exams performed by a physician or health professional, breast self-exams and genetic testing.

A mammogram is an x-ray of the breast. Currently there is not a consensus among organizations about the age a woman without a family history of breast cancer should be – ranging from 40 to 50 – to begin receiving annual mammograms.

There is recent evidence that clinical breast exams might not be helpful for women without symptoms of breast cancer, “but have that discussion with your doctor,” Graettinger said. She added that the concept of breast self-exams has shifted to “being aware of your breasts.”

For women with the inherited BRCA gene mutation, “this is serious business and increases the risk of breast cancer from 1 in 8 to 1 in 2, or by 50 percent, and the risk of ovarian cancer is 10 times greater,” Graettinger said. Having the BRCA gene is “not extremely common, but it’s not rare,” she said, adding that women with a personal history of breast cancer should consult with their physicians about this genetic testing.

Other gynecologic cancers include cervical, ovarian and uterine cancer. Of those, only cervical cancer has a screening test – pap smears, which detect precancerous changes on the cervix. Pap smears are now recommended every three years for women ages 21 to 65.

Ovarian and uterine cancers are detected by signs and symptoms, “which is scary because sometimes these are found in the later stages,” Graettinger said. Symptoms of ovarian cancer are vague and include pelvic and abdominal pain and pressure, bloating and feeling full quickly, and irregular bleeding. Approximately 20,000 cases of ovarian cancer are diagnosed annually. Pressure, pain and bleeding after menopause are common symptoms of uterine cancer, which primarily strikes women over the age of 50.
In Stewart’s presentation, he said that “sprains and strains are where the vast majority of injuries are occurring.” The most common sports injury is an ankle sprain, followed by a groin sprain and a hamstring sprain.

Stewart said the goal is to introduce preventive measures to avoid the injury. A warm up is a good way to do that. A warm up should get the body moving, introduce a light sweat and “literally warm up the muscles,” he said.

Stretching is a good way to prevent injuries, too. There is dynamic stretching, which are bouncing, jerking movements, static stretching, which are slow, deliberate movements that are held for about 20 seconds, and then proprioceptive neuromuscular facilitation, or PNF stretching, which combines static stretching with isometric movements to increase flexibility.

To prevent an ankle sprain, Stewart suggested wearing an ankle support to reduce the risk and to conduct balance training: stand on one leg in order to train muscles to support the ankle.

To prevent a hamstring sprain, Nordic hamstring exercises are best, Stewart said.

There is a higher injury rate of the ACL in women, and prevention requires regular exercises. Plyometrics, known as “jump training” help may reduce an ACL injury, but must be performed throughout the athlete’s season. After the participant stops performing the training exercises, he or she becomes at risk for injury again.
Burgess introduced many of participants in the Mini Medical School series to the concept of telemedicine for the first time.

Telemedicine is any medical information exchanged from one site to another through the use of technology. It could be a phone or computer.

“We use it to improve access to care,” said Burgess.

Many parts of Alabama are rural and are underserved in primary care and specialty care providers. Unfortunately, many of the underserved areas in Alabama are also areas with limited connectivity, which makes it difficult to access telemedicine, Burgess said.

Burgess spoke about Telemedicine and Telehealth efforts at the UA College of Community Health Sciences, which operates UMC, including the asthma education program that she and Beth Smith, a nurse practitioner in pediatrics at UMC, have led. Students at Greensboro Elementary School in Hale County and their parents are taught through telemedicine about asthma symptoms, medication and treatment. The program teaches  students how to use a spacer with their asthma inhaler for more effective usage of their medicine.

The program so far has revealed that students and parents are learning more about asthma and how to treat it.

One participant said: “Until today I had no idea what telemedicine was. Thank you for coming here and telling us about that today.”

Sports Medicine Tip: Recovering from an Ankle Sprain

The following tip comes from Sports Medicine Fellow Dr. Hunter Russell, who is a physician in University Medical Center’s Dr. Bill deShazo Sports Medicine Center.

Ankle sprains are one of the most common reasons athletes miss time from activity, and it is estimated that ankle sprains account for almost half of all sports-related injuries. Depending on the severity of the sprain, it can sometimes take several weeks before athletes are able to fully participate in their sport.

An ankle sprain is a stretching or tearing of one or more of the ligaments in the ankle. Ligaments are strong fibrous bands that attach one bone to another. There are numerous ligaments in the ankle, but the most common site of an ankle sprain is the outside, or lateral, ankle. This usually happens when someone “rolls” their ankle to the inside, which stretches the lateral ligaments. Medial ankle sprains (or inside) occur when the opposite happens-an ankle rolls to the outside. These types of ankle sprains can lead to high ankle sprains, which generally have a longer recovery period. All ankle sprains can be associated with significant bruising and swelling.

Evaluation soon after injury is important because sometimes these injuries can be associated with fractures, especially if you are unable to put weight on the injured ankle. X-rays are not always needed, but your doctor may order an x-ray to ensure there are no broken bones. As with most medical problems, a detailed history of how the injury occurred helps lead to an accurate diagnosis.

Once an ankle sprain has been diagnosed, the goal is returning to activity as soon as it can be done safely. Treatment often includes a short course of anti-inflammatory medications, ice, compression and elevation. Depending on how bad the sprain is, your doctor may prescribe an ankle brace or refer you to physical therapy. One of the more important aspects of recovery is early mobilization. This helps improve your range of motion, strength and balance. Ice and compression are used to help reduce swelling and improve pain. Ice should be applied for 20 minutes at least three times a day. The easiest way to do this is to use a small trash can, fill with ice water and submerge the entire ankle. In general, you are able to return to activity when ankle strength is equal on both sides and you have full range of motion.

Sports Medicine Tip: Keeping Bones Healthy

The following tip comes from Sports Medicine Fellow Dr. Matt Andres, who is a physician in University Medical Center’s Dr. Bill deShazo Sports Medicine Center.

With conditions like osteopenia and osteoporosis, many people are concerned with bone health and wonder what they can do to improve the health of their bones.

Like your muscles, your bones need to be used to grow stronger. Stressing bones through activity and exercise encourages them to increase calcium content and grow stronger.

All people benefit from the effects of exercise on the bones, but sedentary adults receive the greatest benefit. Weight-bearing and resistance exercises are the most beneficial types of activities for strengthening your bones.

But too much of a good thing can be a bad thing: If you have unusual aches or pains that do not resolve after a few days rest, then you might be overdoing it. So start slow and gradually increase the intensity of your activities while shooting for a goal of 30 minutes of exercise three to four times a week. And remember, if you’re not eating a proper, well-balanced diet with a steady source of calcium, you may not be able to get the full benefit from your exercise. Exercise is the best medicine, and something is better than nothing. Your bones will love you for it.