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Maryville Daily Times features Dr. Jaclyn Hone and Direct Primary Care

Dr. Jaclyn Hone listens to to Lydia Pair's heart at Trinity Direct Family PracticeThe Maryville Daily Times featured an article on Trinity’s Direct Primary Care program in Maryville and the great work that Dr. Jaclyn Hone is doing there.  Check out the article below.  If you are interested in how DPC might work for you give us a call at 980-8551 in for the Maryville office and 244-1800 for the Hardin Valley office.

Direct medical care reinforces relationship between doctor, patients

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The Black Dog of Depression

            “I am the most miserable man living.  If what I feel were equally distributed to the whole human family there would not be one cheerful face on the earth.  Whether I shall ever be better, I cannot tell.  I awfully forebode I shall not.  To remain as I am is impossible.  I must die or be better.”  That quote is by none other than Abraham Lincoln.  Likewise, Winston Churchill referred to his depression as his “black dog.”  Most depressed patients aren’t quite so striking in their descriptions.  They may complain of a loss of interest in things that used to seem important to them, or a general fatigue, or frequent tearfulness, or just a persistent irritability.

Depression may be the 3rd most common psychiatric disorder behind anxiety and phobias, with approximately 15 million Americans experiencing a depression each year. So, since we can all have some bad days or a period of sadness, what, from a medical perspective, defines an actual depression?  According to the most common psychiatric definition, as contained in something called DSM 5, a major depression involves: A depressed mood or a loss of interest or pleasure in daily activities consistently for at least a 2 week period.   Overall functioning must also be impaired by the change in mood.  In addition, at least 5 of the following symptoms must be present:

  • Depressed mood
  • Decreased interest or pleasure
  • Weight change of 5% or more (up or down)
  • Sleep disturbance
  • Psychomotor agitation or retardation – consistently slowed movements or agitated movements
  • Fatigue
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent thoughts of death and/or suicide

As you read through that list, some of you may be seeing a description of yourself or someone you love.  Before we take a moment to look at what can be done about it, let’s first ask how does someone get here – what causes someone to get depressed?  That can be a complicated question as depression is often the result of any combination of several factors.  Everything from genetics to circumstances and how we think about those circumstances can play a role.  Sometimes chronic stress and anxiety or even physical illness or loss can trigger a depression.

The wide range of causes of depression plays into the several kinds of treatment that are employed.  Primary care doctors are sometimes called the psychiatrists of the masses since the majority of depression treated medically is carried out in primary care offices.  When seeing your primary care physician for possible depression, a number of physical contributors such as hypothyroidism , low testosterone, or medication side effects can be ruled in or out.

If these physical causes are not a significant factor and a major depression is diagnosed, several treatments can be considered.  Starting with simple approaches, regular exercise such as a brisk walk has been shown in studies to sometimes help as much as a prescription antidepressant.  Likewise, informal counsel with any mature friends or family can be helpful.  Pastoral counsel from a trusted pastor is often a further aid in working through a depression.

Beyond these helps, specific medical interventions can be considered.  Formal counsel can often provide further tools to battle depression.  Finally, prescription meds can have their place as well.  These are far from 100% effective and it can sometimes take time to find the one that is most effective for a given individual, but at times they can be enormously helpful.

Depression, as Lincoln said, can be absolutely miserable, both for the individual, and for those around them.  Ideally, it should be responded to as aggressively and directly as a heart attack, since in its own way it can be just as devastating.  So if you suspect the black dog of depression is sinking its teeth into you, get it checked out.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835

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Maintain Your Brain

            Seventy year old Mrs. Lansing drew a complete blank as I asked her if she could recall any of the five words I’d given her to remember some 4-5 minutes ago as part of her mental status exam.  Inwardly I always wince at those moments.  It feels like I’m unintentionally bullying a harassed person into looking the fearful specter of their approaching dementia directly in the eye.  Her husband quickly came to her rescue with a small white lie, “That’s alright darlin’, I don’t remember any of them either,” and we all smiled with relief.

Dementia is the common term for a set of symptoms including memory loss, mood changes, and difficulty with communication and reasoning.  Modern medicine is trying to replace the term with “major and minor neurocognitive disorder”.  Yah, for now let’s stick with the term everyone knows, dementia.  There are several types of dementia, with the most common two being Alzheimer’s disease (AD) and vascular dementia (due to atherosclerosis [plaque] on the blood vessels supplying the brain) coming in a close second.

AD currently affects about 5 million Americans.  There are a handful of approved prescription medications to treat AD.  They delay (but do not stop) the progression of the disease by about 6 to 12 months.  This is useful, but far from a cure.  Likewise various supplements and vitamin treatments have come and gone over the years.  When subjected to careful scrutiny the results have generally been disappointing.  The likelihood of AD dramatically increases with age, roughly doubling in likelihood every 5 years after age 65.  If one lives to 85 years old the likelihood of having AD is almost 50%.

So can anything be done to prevent it?  Of course certain risk factors cannot be altered, such as age, family history and genetics.  But at the same time, there is a growing body of research showing that certain lifestyle choices have a substantial impact on whether AD or vascular dementia will indeed show up in your life.  Certain treatable maladies contribute to a significant increase in dementia.  For example, dementia is:

  • 41% higher in smokers
  • 39 % higher in people with high blood pressure
  • 22% higher among whites who are obese
  • 77% higher in diabetics

So obviously there is room for better lifestyle and aggressive treatment of these

conditions to help delay or prevent the onset of dementia.  A recent article predicted that substantial improvement in lifestyle factors could reduce the risk for AD (and perhaps even more so vascular dementia) by 50%.

What lifestyle factors can substantially impact the likelihood and/or timing of you or me getting dementia?

  • Being a regular exerciser could reduce AD by 21%. A recent study showed 5% greater brain mass retention in active folks vs. inactive.  Five percent may not sound like a lot, but when it comes to the brain, it is substantial.  A reasonable goal in terms of time and activity would be a 30 minute brisk (3-4 miles per hour) walk or the equivalent 5 days per week.
  • Quit smoking
  • Avoid excess alcohol. Anything beyond one drink a day in females or two daily in males is associated with increased risk of dementia.
  • Stay socially connected and mentally active.
  • A heart-healthy diet rich in nuts, seeds, whole fruits and vegetables, olive oil, fish and other low fat meats, and low in sugars and simple carbohydrates is beneficial in reducing vascular dementia.
  • Finally, if you have diabetes, cholesterol issues, obesity, or high blood pressure, treating these well can impact the incidence of dementia.

In the end, there is no way to guarantee that you will avoid the scourge of dementia.  At the same time, we want to avoid the fatalism that assumes that nothing we do will impact its likelihood or timing.  Dementia is a grim enemy.  While more weapons against it are sought, it’s worth using every one that is available to delay or prevent it.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835

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Facetime with a doctor?

Telemedicine is expanding the availability of healthcare options to more people.  When you’re stuck at work or on the ball field with your son, it would be great to have a quick appointment with a trusted medical professional from Trinity.  Someone who knows you best and has your chart available is the best person to provide you care.

Take a look at this survey and help us determine how we bring this new resource to you and your family.  Thanks!!

Telemedicine Survey

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