Sleep problems, adapted athletics topics at Mini Med School

More than 50 percent of adults in the US experience intermittent sleep disturbances, and only 30 percent of adults report regularly getting enough sleep.

Chronically tired individuals face increased risk of illnesses and an overall lower quality of life, says Dr. Katie Gates, physician at University Medical Center operated by the UA College of Community Health Sciences.

Gates gave her talk, “Sleep Problems,” on Jan. 26 as part of the Mini Medical School lecture series put on by CCHS in collaboration with UA’s OLLI program. On Jan. 19, Dr. Jimmy Robinson, endowed chair of Sports Medicine at CCHS, gave his talk, “Adapted Athletics.”

Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and resident physicians provide information about issues and advances in medicine and research. OLLI, short for the 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.

Gates broke down sleep disorders into four categories: Those who can’t sleep includes sufferers of insomnia and restless leg syndrome. Those who won’t sleep likely have delayed sleep phase syndrome. Those with excessive daytime sleepiness may suffer from narcolepsy or obstructive sleep apnea. And those with increased movements during sleep include REM sleep behavior disorder sufferers, or those with periodic limb movement.

Three criteria must be met for a diagnosis of insomnia: First, the patient must complain of difficulty sleeping, difficulty staying asleep or waking up too early. Second, the sleep difficulty must occur despite adequate opportunity and circumstances to sleep. And third, the lack of sleep must negatively affect daytime function.

“Insomnia is a very common complaint, and it does increase with age, unfortunately,” Gates said. Women report insomnia 50 percent more often than men. It can be treated with cognitive behavior therapy or with medications.

Delayed sleep phase is a circadian rhythm disorder, meaning “the brain has gotten off its track,” said Gates. It’s characterized by the person going to bed very late and waking up late.

“This can be genetic or socially reinforced,” she said.

Obstructive sleep apnea is the most common sleep breathing disorder, and it affects 20 to 30 percent of males and 10 to 15 percent of females.

“With my patient population, it seems higher than this,” Gates said.

Risk factors for sleep apnea include age, obesity, craniofacial abnormalities and smoking. Continuous positive airway pressure, or a CPAP machine, is recommended treatment.

In some instances of diagnosing a sleep disorder, a physician may order a polysomnography, or a sleep study.

Cognitive behavioral therapy can be a treatment for some sleep disorders, said Gates, and a therapist may focus on changing false beliefs and attitudes about sleep. One of these might be that everyone needs at least eight hours of sleep, she said.

Music therapy can be another way to treat a lack of sleep.

“Choose music you are familiar with,” Gates said.

She said the music should have a slow and stable rhythm with low-frequency tones and relaxing melodies.

“Try out different genres, like classical or acoustic, to find what works for you.”

View a WVUA report on Gates’ lecture here:

Robinson, in his talk about adapted athletics, said the number of adapted athletes is rising. In the 1960 Summer Paralympic Games in Rome, 400 athletes came from 23 countries. In 2016, 4,316 athletes came to Rio from 159 countries.

The International Paralympic Committee assigns points to athletes based on their impairments. The classification systems differ by sport and are developed to govern the sport. Players are allocated points based on an evaluation by the International Paralympic Committee.

A lower score indicates a more severe activity limitation than a higher score. A team is not allowed to have more than a certain maximum sum of points on the field of play at the same time in order to ensure equal competition with the opposing team.

As time progresses, a disability may get worse, so a player can be reviewed again.

“Disabilities are evolving,” said Robinson. “It’s important to have this avenue to challenge their disability, especially if it’s progressive.”

Robinson, also spoke about the Alabama Adapted Athletics Program, which was started in 2003 by husband and wife Brent Hardin and Margaret Stran. Though the program received an initial funding of only $5,000 from the Christopher Reeve Foundation, it now operates off an annual budget of $450,000, offers six full scholarships and supports five sports: women’s and men’s basketball, tennis, rowing and golf.

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.

Robinson joins UMC full time

Sports Medicine physician Dr. James Robinson has relocated his private practice to University Medical Center. He will also become a full-time professor of Sports Medicine for The University of Alabama’s College of Community Health Sciences, which operates UMC and UMC-Northport.

Robinson’s private practice was located at West Alabama Family Practice and Sports Medicine in Tuscaloosa. Robinson says that in addition to providing patient care, he is devoting his time to teaching medical students, Family Medicine residents and Sports Medicine fellows. The College, which operates a family medicine residency, also functions as a regional campus for the University of Alabama School of Medicine, providing clinical education to a portion of third- and fourth-year medical students.

Robinson will continue in his positions of director of UMC’s Dr. Bill deShazo Sports Medicine Center, and he will continue to oversee the College’s Sports Medicine Fellowship. And he will remain as head team physician for The University of Alabama Athletics, a position he has held since 1989.

“Dr. Robinson has been very effective as fellowship director while part-time with the College,” says Dr. Richard Streiffer, dean of the College. “We are very excited that he will be with us now full time, allowing him to expand his teaching and share his considerable practice experience with us in additional ways.”