HealthLinks Charleston May/June 2022

COMPLIMENTARY CHARLESTON | DORCHESTER | BERKELEY CHAR L E S TON Best Doctors, Dentists, Senior Living, Fitness Centers andMore... MAY/JUNE 2022

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Exterior Services Interior Services Meet Our Interior Designers Cat Ingegneri, Katherine Brickell, and Alexandra Little are experts in guiding each client through the material and product selection process. Their expertise is essential in advising our clients on how to incorporate their personality into their dream home. FIX-N-LIST Patricia Blackstock (843) 725-8310 LOWCOUNTRY CONTRACTORS LUXURY REMODELING From paint touch-ups to full remodeling projects, we pay to update your property before listing it! Increased property value and a shorter market time are guaranteed with this unique program only offered by Lowcountry Contractors and Patricia Blackstock, Realtor. We are so confident in our Fix-N-List program that we pay for it upfront with our own money and get reimbursed at closing. Spruce up your home’s exterior with our expert services installing decks, James Hardie Siding, roofs, gutters, windows, doors, painting and even repairing termite damage. Our design and project management teams work closely together to deliver a wide range of interior services, including kitchens, bathrooms, flooring, space planning, custom designs, and home additions! 1204 Palms Blvd, Isle of Palms, SC @lowcountrycontractors (843) 242-8838

1200 Hospital Dr., Mt Pleasant, SC 29464 • 843.375.4000 • Your Choice for Critcal Care The average hospital is not designed to handle the demands of patients requiring Critical Care. That’s why Vibra Hospital of Charleston is special. Our many services are focused on improving the lives and medical conditions of patients who need more specialized care for their recovery or who are not yet ready to be transferred to a lower level of care, such as a skilled nursing facility or other sub-acute facility.

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8 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com 15 | TELEHEALTH ISN’T GOING ANYWHERE. … “The practice went from 2% of telehealth visits to 90% within a week. Now, as COVID wanes, they find that 20% of patients are making the choice to do virtual visits because they like the platform and its convenience.” 18 | DON’T IGNORE THOSE FLOATERS AND FLASHES Though there’s a chance that floaters and flashes might be no more than an inconvenience, it’s entirely possible that they could be a sign that trouble brewing in your eyes has the potential to cause long-term damage and even blindness. 21 | AGING GRACEFULLY MEANS LIVING PROACTIVELY It is critical for seniors to adopt a proactive mind-set and schedule regular visits with their primary care physician. 24 | EARLY INTERVENTION IS THE KEY WITH BIPOLAR DISORDER Recognizing the signs and symptoms of bipolar disorder early on can help lead to more effective treatment and management of the disease. 28 | WHEN TIME AND REST DON’T CURE YOUR PINCHED NERVE For the tiny minority who have a severe compression of the nerve, surgery is best done sooner than later to minimize the damage and to support healing. 31 | CREATING A SAFE PLACE IN HEALTH CARE FOR LGBTQ PATIENTS Many LGBTQ patients are hesitant to share their gender and sexuality experiences, reducing the proficiency of health care providers to address the whole patient. 33 | BEST IN HEALTH With over 10,000 votes from readers, patients and local medical professionals, HealthLinks is proud to present our 2022 Best in Health winners. 65 | SWITCHING TO DIRECT PRIMARY CARE Direct primary care practices don’t accept health insurance. Instead, patients pay the practice directly. 74 | PAY ATTENTION TO THE SIGNS OF MÉNIÈRE’S DISEASE Patients with suspected Ménière’s disease are encouraged to keep a food diary, but diet is only one part of the puzzle. 82 | CONVENIENCE IS IMPORTANT IN HEALTH CARE People are more likely to keep up with their regular health care appointments, preventive care and meetings with specialists if health care facilities are conveniently located. 84 | CCMS: MAKING PREVENTION A PRIORITY? Because of the pandemic, many lifesaving screenings have been delayed one to two years. Issue 11.3 MAY/JUNE 2022 CHARLESTON FEATURES

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 9 89 | SERVICE DOGS HELP IN MORE WAYS THAN ONE Service dogs can help with a range of basic activities like opening doors and picking up objects off the floor, but they also provide companionship and emotional support. CONTENTS SPONSORED MEDICAL CONTENT On the Road to Recovery. ..........................................................27 Health-Boosting Therapy Via IV..................................................67 Lowering the Cost of Prescriptions.............................................69 Kotary Robotic Dental Implant Center........................................70 Yoga for 'Every Body'..................................................................73 Paving the Way for Better Wellness............................................77 Health and Wellness All In One Place.........................................78 Is Incontinence Wrecking Your Lifestyle?....................................87 DIRECTORIES Primary Care. .................................... 102 BY THE NUMBERS Telehealth............................................ 16 Bipolar Disorder.................................. 25 LGBTQ Health Care............................ 32 Direct Primary Care............................. 66 IN EVERY ISSUE Publisher’s Note.................................. 10 About the Cover................................. 11 Living Healthy Area Events................. 12 There's an App for That...................... 80 A Unique Case.................................... 92 Charleston Area Nonprofits................ 94 The Lighter Side of Health Care. ........ 97 Healthy Pet: Happy Pet....................... 98 The Facts on Food & Drink............... 100 The Pulse on Charleston Nurses. ...... 104

10 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com Issue 11.3 May/June 2022 Publisher CULLEN MURRAY-KEMP Managing Editor THERESA STRATFORD Assistant Editor MOLLY SHERMAN Copy Editor BRIAN SHERMAN Art Director KIM HALL Webmaster GEORGE CONKLIN Internet GENE PHAN Sales Manager MANDY WILLIS Writers Media Consultants ANDY BIMONTE BRANDON CLARK CRYSTAL WILSON-CHAMBERS ERIC WILSON Photographer JENN CADY TO ADVERTISE IN HEALTHLINKS, PLEASE CALL 843-732-4110 Distribution Manager CAROL CASSIDY Administration & Bookkeeping GINGER SOTTILE Distribution U.S. Post Office, Harris Teeter, Publix, CVS, Food Lion, Medical Offices MEDICAL MARKETING GROUP HealthLinks Charleston reserves the right to refuse advertisements. Acceptance of advertisements does not imply the service or product is recommended or endorsed by HealthLinks Charleston. No part of this publication may be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from Medical Marketing Group, LLC. Medical Marketing Group 4 Carriage Lane, Suite 107, Charleston, S.C. 29407 843-732-4110 • CHARLESTON In my last publisher’s note, I spoke pretty candidly about the challenges I was facing with mental health. I alluded to the circumstances – my father passing, buying this business, stress around sleep – that pushed me to ask my doctor about adding a prescription medication – SSRI – to my mental health “toolbox.” Two or so months later, I can say that I am happy that I decided to try the medication. Important side note: It takes five or so weeks for most SSRIs to take effect, so don’t worry, as I did, if you don’t feel any reprieve within the first few weeks. In taking the medicine, I was concerned about losing my edge and competitiveness with my business and various activities. The edges have been smoothed but not lost. I still passionately despise losing! With the help of meditation, exercise and a relatively healthy diet, I have found a rhythm in life that was previously absent. My perspective changed a bit, too. Previously I struggled with the “never satisfied” complex – my work – and really, myself, were never enough. My new focus is to offer myself a more gentle, self-appreciative approach. Smile and laugh more, with the clear understanding that not everything is dependent upon this one moment or decision. Another realization I’ve come to understand through the quietening of my anxiety storms is that I must slow down and truly engage with people. Because I was so wrapped up in my self-criticism, my anxiety didn’t allow me to pause, think and engage with life. I’ve found that sometimes I’m even more productive when I move slower and with more purpose. Ultimately, anxiety never gave me a choice. It’s a health challenge without bias. Without warning, it can bound any of us at any moment. We can only be disciplined in our efforts control it. We must equip ourselves with a “mental health toolbox” that allows us to keep moving forward. Fortunately, there are an ever-growing number of mental-health resources that surround us in this community. Be it mental, physical or emotional health, our hope is that HealthLinks can help connect our readers with the best-possible providers and health solutions for them. Cheers to good (mental) health, Cul len Murray Kemp Cullen Murray-Kemp PUBLISHER'S NOTE LAURA HAIGHT JILL HARPER CINDY LANDRUM STACY DOMINGO BRIAN SHERMAN HOLLY LAPRADE COLIN MCCANDLESS MOLLY SHERMAN ISABEL ALVAREZ ARATA HELEN MITTERNIGHT L.C. LEACH III CHRISTINE STEELE JANET PERRIGO KATHERINE WATERS BILL FARLEY DENISE K. JAMES Scan to discover our other HealthLinks platforms!

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 11 ABOUT THE COVER... First I want to say thank you to all who voted in this year’s Best in Health. There are so many wonderful health care providers in the Lowcountry. We truly feel blessed to live among them. Those who garnered the most votes by their constituents, patients and colleagues are in the pages of this magazine. Congratulations to all who won! We also asked some questions of many of the winners. We hope you enjoy reading their responses. The photo shoot we planned went off without a hitch. Thank you to all who attended. We also want to thank Dish & Design for providing our “model” winners with bites to eat during the shoot. Cambria Hotel in Mount Pleasant hosted this event, and we want to thank them for their hospitality. And Jenn Cady, our talented photographer, did an excellent job of capturing the essence of our health care community. We also highlighted primary care in this issue. The general and family practices are some of the most important in health care. They see their patients regularly and are usually the first line of defense. We covered stories about primary care as it relates to seniors, telehealth, basic first aid and direct primary care. Please also take note of some of our other interesting stories about service dogs, bipolar disorder, LGBTQ health care and another valiant “unique case” story. We want to take the time to thank our team – our editor, graphic designer and wonderful writers – for making this issue a success. We also want to thank our sales team for working hard on distribution and making the magazine accessible to you, our loyal readers. And we couldn’t do any of these stories without our incredible sources. Thank you all for lending us your expertise. We hope you enjoy this issue of HealthLinks. Please send feedback and story ideas to Here’s to the “Best in Health,” Theresa Stratford, managing editor MAY/JUNE 2022 COMPLIMENTARY CHARLESTON | DORCHESTER | BERKELEY MAGAZ I NE Best Doctors, Dentists, Senior Living, Fitness Centers andMore... MAY/JUNE 2022 CHARLESTON PHOTOGRAPHY AND POSING EXPERT VISIT JENNCADY.COM AND SCHEDULE YOUR PHOTOSHOOT TODAY!

12 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com HEALTHY AREA EVENTS l ving MAY 7 Dragon Boat Festival 8 a.m. Brittlebank Park Dragon Boat Charleston is a nonprofit organization that serves a rowing club made up of about 150 members in the Lowcountry. Some are cancer survivors, some are community paddlers, some are premier racers and some like to watch the sunset on the Ashley River. The mission is to promote physical and mental wellness among cancer survivors and their community through dragon boating. MAY 7 19th Annual Mom’s Run & Family Fun Day 7 a.m. Philip Simmons High School Honor moms everywhere by supporting a cause that helps women and their families suffering from postpartum depression and anxiety. This is Postpartum Support Charleston’s largest fundraiser, allowing the organization to further its mission of providing support and resources to women and their families. MAY 12 - 14 Faith and Mental Health Conference 2022 5 p.m. Charleston Southern University A three-day event in beautiful Charleston exploring how faith and mental health go hand-in-hand.

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 13 MAY 21 She Tris 7:30 a.m. I'On Club, Mount Pleasant MAY 28 Run Charlie Run 5K 3:30 p.m. The Joe, Charleston The Run Charlie Run event is back after a two-year hiatus. Pre-registration takes place until April 30. Packet pickup is at Fleet Feet in Mount Pleasant. Participants get a ticket to tthe baseball game that evening, starting at 6:05 p.m. JUNE 14 - 16 Summer Institute 2022: Redefining a New Era in Adolescent Health 11 a.m. North Charleston Marriott Everyone has their own definition of reproductive health. Summer Institute 2022 is here to help you expand yours. The theme for Summer Institute 2022 is “Redefining a New Era of Adolescent Health: From ______ to Facts.” Learn from some of the leading voices in adolescent health care. She Tris is a beginner women’s triathlon event. Any level can accomplish this race. The swim portion is in a pool where participants share the lane for a range of 200 to 250 meters. The bike is 8 to 9 miles and the run is 2 to 3 miles. JUNE 17 2022 Charleston Oxygen Ball Evening Charleston Gaillard Center The American Lung Association will be hosting its Oxygen Ball, an exciting evening filled with incredible performers by local community celebrities, special guests, a silent auction and more. All funds raised support the mission of the American Lung Association. JUNE 18 Charleston Charity Duck Race Guggenheim Terrace on Daniel Island Hosted by the Rotary Club of Charleston, the Charleston Duck Race is an annual fundraising event that supports local nonprofits and service projects. Check the race website for updated information.

14 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com CreatingExtraordinary HealthCare June 2022 Memory Care | Skilled Care | Short-Term Rehab 843.406.6251 |

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 15 A lot of things that became essential during the heart of the COVID pandemic have gone the way of paper files and the $2 gallon of gas. Remember double masking, wearing sterile gloves to the supermarket and washing your groceries in the garage? Telehealth, however, is not only hanging on, but its future, especially as technology expands, is looking good. TELEHEALTH ISN’T GOING ANYWHERE By Laura Haight

16 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com Telehealth is an umbrella term for a number of methodologies, including virtual visits that connect physician and patient through visual and audio technology, phone calls and the sharing of data from wearable or implantable devices. Prior to COVID, fewer than 1% of patient medical visits were done remotely, while at the height of the pandemic, that number rose to 45%, according to Helping to drive adaptation across the board is an increasing acceptance of wearable tech and a focus on increasing development of new medical devices utilizing artificial intelligence and driven by the accessibility of 5G networks. Technology has always been a part of Dr. Darren Sidney’s practice. Dr. Sidney is an electrophysiologist with Charleston Heart Specialists, where implantable tech – pacemakers, defibrillators and wearable heart monitors – have been around for years. Electrophysiologists specialize in treating heart rhythm issues so their patients are used to being monitored remotely. “All the devices we implant have remote capability,” explained Dr. Sidney. “So we can see what their heart rhythm is doing from anywhere in the world.” New wearable devices such as KardiaMobile’s EKG, Apple Watch and Samsung Galaxy Watch 3, now approved as Class II medical devices by the Food and Drug Administration, are helping Dr. Sidney consult with patients without bringing them into the office. “Every day, I get emails from patients sending me strips,” said Dr. Sidney, who is on staff at Trident Medical Center. “More often than not, we’re talking them off the ledge. But sometimes we do find something abnormal, and we’re able to prescribe medication, walk them through some things or triage the situation – like do they have to come into the office or go to the ER.” For his specialty, this immediate access to information is critical. He anticipates some of the implantable tech will fall off as more and more patients become tech savvy and comfortable with wearable tech. But a big part in the equation, he believes, will be whether insurance companies develop codes to make charting and billing for telehealth visits easier and if they ever cover wearables such as FDA-approved smart watches. “That will open the floodgates,” he said. “It will be a game changer.” Communicating health data with your physician is one modality under the telehealth umbrella. Another is visits, which Dr. Sidney’s practice offers but does only a few each month. “My preference for a first-time visit is in person,” he admitted, adding that “by the time they get to me, most patients have seen a primary care doc, a cardiologist and have had some kind of imaging. A lot of times, we know what the plan for these patients is before we even meet them.” That’s not the case for Dr. Steven Newman, a primary care physician with Poinsett Family Practice in Greenville. TELEHEALTH By the Numbers Today, 80% of employers believe telehealth will be a significant part of health care delivery in the future.** 91% of employers will offer telehealth service for mental health.** Prior to the pandemic, patients nationally waited an average of 24 DAYS for a medical appointment and spent less than 18 MINUTES with the physician.** The Health and Human Services Administration found that the highest share of video telehealth visits were used by adults 18 TO 34, those making more than $100,000, those with private insurance and those who were white. They were lowest among those without a high school diploma, older adults, Latinos, Asians and Blacks. (*Source: ASPE - Office of Health Policy) The CDC reports that as COVID took hold, 41% of U.S. adults delayed or avoided in-person medical visits. Telehealth helped resolve the problem with virtual care providers able to see a higher volume of patients, often outside typical office hours. (*Source: Forbes) 58.5% of telehealth users are female.* 28.7% of telehealth users are between 51 AND 70.* 70.5% are white.* *Source: Trilliant Health.** Source: Merritt Hawkins. Dr. Darren Sidney Dr. Steven Newman

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 17 FOR AN APPOINTMENT CALL 843.797.3960 9295 Medical Plaza Dr. Ste A-B, Charleston, SC 29406 At Trident Dermatology®, Our Priority is to Deliver Quality Dermatological Care to Informed Patients in a Comfortable and Convenient setting. • Treatment of a variety of skin conditions, including acne, eczema, psoriasis, rashes, etc. • Diagnosis and treatment of various skin cancers by our fellowship trained Mohs surgeons and our in-house lab. • Various cosmetic services including wrinkle treatment, laser hair removal, peels, lesion removals, vein treatment, etc. SERVICES When COVID hit, “we needed to convert as many patients as we could to a virtual visit,” he said. The practice went from 2% of telehealth visits to 90% within a week. Now, as COVID wanes, Dr. Newman finds 20% of patients are making the choice to do virtual visits because they like “the platform and its convenience.” He cautioned that there is a “fairly limited spectrum of conditions amenable to be done virtually.” In that spectrum, he includes mental health and notes that “counseling about depression, anxiety, OCD, PTSD and those types of modalities clearly don’t need a physical exam.” Statistics that show behavioral health is a significant driver in the increase of telehealth visits. The increased accessibility at more medical practices is also helping to bring mental health services to underserved communities where no current practice exists. Where will all this go? Dr. Newman expects to see readily available devices in two to five years that will “measure vitals with much greater accuracy and may even be able to transmit electronically to labs.” A quick finger stick to measure cholesterol, potassium, sodium and blood sugar may all be accessible at home, he believes. But the big unanswered question is: Who’s going to pay for it? Another big question lingers for Dr. Newman who, as a primary care physician, is on the front lines of patient diagnosis. “We have to be very careful about not overutilizing virtual visits even though they are clearly convenient. Convenience is not always without a price. The price is you can’t develop relationships as easily with people with a Zoom meeting or a phone call. There is the element of human touch, of holding someone’s hand when they’re depressed. … You can’t do that over the phone. The patient and the physician have to understand that we cannot lose the humanity that makes the doctor-patient relationship one of the most sacred in the world.”

18 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com Are you bothered by what might be described as cobwebs, swirling amoebas, dancing squigglies or strange black dots every time you open your eyes? Do flashes of light that seem to originate somewhere inside your head remind you of Independence Day fireworks? If your line of sight is interrupted by these unwelcome issues, you’re not alone. Floaters and flashes are common maladies that become increasingly prevalent as you age. And though there’s a chance that they might be no more than an inconvenience, it’s entirely possible that they could be a sign that trouble brewing in your eyes has the potential to cause long-term damage and even blindness. Regardless of what shape it takes, a floater is “a spot in our vision that moves and floats when you move your eye,” according to Dr. Brad Bodkin, the founder and owner of The Vision Center at Seaside Farms in Mount Pleasant. He said floaters are caused most frequently when the vitreous, or gel, that fills the back of the eye pulls away from the retina, the light-sensitive layer of tissue that communicates information about images to your brain. Dr. Eric Nelson of Carolina Vision Associates in Upstate South Carolina pointed out that the vitreous, which is firm at birth, tends to deteriorate over time, causing pieces to break off and create those optical annoyances. Both optometrists agreed that there are limited treatments for floaters, though Dr. Bodkin said that procedures with lasers may work “in some cases.” Usually, though, once you notice floaters, they’ll probably never leave you completely. Dr. Nelson said over time, gravity pulls them toward the bottom of your eye and possibly out of your field of vision. “The further down they are, the less likely you are going to notice them. But they won’t sink all the way to the bottom. It depends on the starting point. A piece of the vitreous is only going to fall so far.” “They are always present, but our brain learns to tune them out,” Dr. Bodkin noted. “You don’t notice them as much as you did in the beginning.” By Brian Sherman DON’T IGNORE THOSE FLOATERS AND FLASHES Floaters are usually part of the aging process. At the age of 50, you have a 50% chance of having to deal with them.

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 19 That doesn’t mean, however, that you should ignore them. “They can be serious. The symptoms of a retinal tear or detachment can be a new floater,” Dr. Nelson said. “The best thing to do is to let an eye doctor look at it and make sure the retina is safe. If there is damage, it is usually permanent or semipermanent. If there’s a tear, the cells die and don’t come back.” “A retinal tear can be fixed with a laser, but a full-blown detachment is pretty invasive surgery,” he added. “Whenever you see flashes and new floaters, make sure a doctor looks at you within 24 hours. If you have lots and lots of floaters and flashes, it’s a sign that something has happened to the retina.” Flashes, which might look like lightning streaks originating somewhere near your eye, eventually subside but also can be a sign that something is seriously amiss. Dr. Bodkin said they can be caused by any type of tugging on the retina, adding that they also might be a result of your brain “thinking something is happening.” “Flashes can be brain-related. It’s usually some sort of trauma to the head that causes neurons to fire and confuses your brain,” he commented. According to Dr. Bodkin, standard procedure when a patient complains of floaters or flashes is to dilate the eye so it can be examined directly. He said imaging also is helpful to confirm or document his findings. Dr. Nelson pointed out that floaters are usually part of the aging process. He said at the age of 50, you have a 50% chance of having to deal with them, with your odds of having them increasing by 10% every decade. “It’s a symptom of having more candles on your birthday cake,” he said. Though Dr. Bodkin agreed that candles and floaters are closely related, he added that floaters can occur at any age and can be caused by any type of trauma to the head, “from violent vibrations to anything that jostles the eye.” Both optometrists agreed that it’s vitally important to visit an eye-care specialist as soon as possible after you notice floaters or flashes. Your ability to use your eyes to interact with the world might depend on it.

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www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 21 When we think of aging gracefully, we imagine entering into a season of life when meaning and purpose coalesce with comfort and quietude. Though it is the final chapter, it can be filled with ample opportunities to suck the marrow out of life. Pursuing physical and mental stimulation and taking a more proactive approach to health care are imperative to prolonging and fully enjoying this season. Establishing an ongoing patient-provider conversation is fundamental to living well at any age. According to Dr. Jerome Aya-Ay, primary care physician at Palmetto Proactive Healthcare, “Many Americans live in the reactive phase when it comes to their approach to health care.” While this practice is not beneficial for any patient, he stresses that it is even more critical for seniors to adopt a proactive mind-set and schedule regular visits with their primary care physician. As the body matures, the risk for disease increases, as does the impact of physical and psychological stressors. The following are five aspects of aging of which every senior should be aware and that can be addressed with a primary care provider: 1. Simply put, age is a risk factor for cardiovascular disease, hypertension, high cholesterol and diabetes. Regular appointments allow primary care physicians to conduct screenings and counsel patients on preventive measures. Dr. Aya-Ay recalled a 68-year-old patient who suffered a ministroke. Prior to the stroke, he “thought he was invincible” because he was seemingly in good health. Dr. Aya-Ay was able to guide the patient to a full recovery, and the man has no residual effects. But, he stresses, prevention is preferable to any reactive treatment. “You might look and feel great, but, with age, your risk for heart attack and stroke increases.” 2. Polypharmacy is a growing problem among the elderly population. According to Dr. Aya-Ay, most people start engaging in their health care in their 30s and 40s. From that point on, medications may be prescribed by other physician specialists. Polypharmacy can easily become counterproductive and even detrimental to a person’s health. Having a primary care physician who keeps track of and adjusts medications can help seniors avoid common side effects such as cognitive impairment and imbalance. Additionally, the AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, or the AGS Beers Criteria, contains nearly 100 medications or medication classes that elderly patients should avoid. “As a primary doctor, I quarterback everything,” Dr. Aya-Ay explained. “I look specifically at medications that do not benefit seniors, and I can alter or even eliminate them.” AGING GRACEFULLY MEANS LIVING PROACTIVELY By Jill Harper

22 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com 3. Malnutrition and undernutrition pose unique challenges to an aging body. Elderly people are more prone to osteoporosis and, therefore, need a diet that is rich in calcium and vitamin D. Whether it is not eating enough of the proper nutrients or consuming an excess of unhealthy food, the failure to practice good dietary habits is detrimental to a person’s health. Dr. Aya-Ay pointed out that some families live in food deserts, and, as a primary care provider, he can assess dietary needs and prescribe proper supplements. 4. In addition to proper nutrition, seniors need to engage in regular activity to improve balance and prevent falling. Bones are not a static structure. Appropriately stressing the bones with weight resistance and activities such as water aerobics will improve bone density. Dr. Aya-Ay counsels patients to find structured programs designed for geriatric patients. Additionally, part of the patient-provider conversation includes discussing home conditions such as carpets, rugs, stairs and showers. He also ensures that patients have a trusted and capable person nearby and an established plan if they do fall. 5. Preparation for the final stage of life is one of the most important conversations that seniors should proactively pursue with their physicians. Primary care providers can help patients decide between requesting a full code or do-not-resuscitate. Some providers, like Dr. Aya-Ay, will go so far as to help patients establish a living will and power of attorney and can facilitate conversations with loved ones so that everyone understands a patient’s wishes. Having an ongoing conversation about the unique aspects of aging is crucial to living proactively. Dr. Aya-Ay recommended that elderly patients see their physician every three months or more frequently if there are specific health concerns that need to be addressed. Establishing a working relationship with a primary care provider is one of the most important ways to ensure that the final years are truly the golden years. PHYSICIANSPLAN.COM RAPID WEIGHT LOSS PLANS FROM $99. The clinical teamat Physician’s Plan can help create a customized weight loss plan that will jump start your metabolism to help you achieve your weight loss results – faster! WEST ASHLEY: 843-769-5510 MT. PLEASANT: 843-606-3333 SUMMERVILLE: 843-261-1111

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24 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com Bipolar disorder is a mental illness that affects an estimated 7 million Americans annually. Recognizing its signs and symptoms early on can help lead to more effective treatment and management of the disease. Steven Krozer, PMHNP-BC, CEO, and head practitioner with iTrust Wellness Group, a psychiatric treatment facility in Greenville, said bipolar disorder is characterized by a series of highs and lows in mood. When an individual with bipolar is experiencing an elevated mood, the condition can manifest itself in extreme irritability, impulsive spending, insomnia, promiscuous behavior and extreme psychosis. During periods of lows, the disorder can cause depressive episodes in which a person has low energy and feels a lack of motivation. “People who struggle with sleep tend to have more severe symptoms,” noted Krozer. He explained that these mood fluctuations can occur over a period of days, weeks or months and typically in a cycle linked to events such as time change or a change of seasons. The different types of bipolar disorder include bipolar 1, which is more severe and less common, and bipolar 2, which is the most commonly EARLY INTERVENTION IS THE KEY WITH BIPOLAR DISORDER By Colin McCandless

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 25 diagnosed and less acute form of the disorder. Krozer emphasized that the most important point concerning treatment for bipolar disorder is that it differs from how depression is treated. Antidepressant medications are used to treat depression, whereas an antidepressant prescribed to treat bipolar could either make the response worse or result in no change at all. Medical treatments for bipolar include mood stabilizers and anti-psychotic medications. It cannot be treated with therapy alone, asserted Krozer. He advised a team-based approach combined with taking the appropriate medications. “The most important thing to consider is balance,” stated Krozer, adding that bipolar disorder affects the brain’s ability to regulate electrical and chemical pathways and creates an imbalance. During episodes of mania when people with bipolar are experiencing elevated moods, their dopamine levels are too high, whereas dopamine levels drop too low amid cycles of depression. Traditional treatments such as mood stabilizers can be used to help regulate the chemical and electrical imbalance bipolar causes, essentially fixing the wiring in a person’s brain. Krozer cited the analogy of faulty wiring in a house, which isn’t going to work properly until you correct the problem. “Unless you fix it, it won’t go away,” he said. Krozer recommended that if you suspect a family member or loved one may be bipolar, bring the person to see a mental health specialist such as a doctor specializing in mental illness or a nurse practitioner. He further suggested people taking mental health medication who “feel off” should consider seeing a specialist to determine if they have bipolar disorder. If there has been a misdiagnosis and a person is being treated with antidepressants, the medication can “produce an outcome opposite of the intention or a suboptimal outcome,” he said. “People naturally have highs and lows,” Krozer added. “It’s when it gets to extreme levels that it impacts quality of life and social functioning.” At iTrust Wellness Group, providers are trained to screen for physical, hormonal, electrical and chemical issues. “We believe that mental health is just as important as physical health,” he asserted. The National Alliance on Mental Illness serves as a helpful resource for information on bipolar disorder and offers online screening tools, according to Krozer. He also qualified that bipolar disorder is not necessarily a bad diagnosis, pointing out that an elevated mood can allow a person to accomplish more during these episodes of mania than they typically would. “Some of the most productive people are diagnosed with bipolar disease,” stated Krozer, referencing billionaire entrepreneur Elon Musk as one prominent example. “It’s kind of a superpower in some ways. But it could be detrimental if you don’t get the right treatment.” This is because every time someone with bipolar experiences symptoms, it can inflict damage to the brain over time. However, as long as bipolar disorder is properly managed, an individual with the condition can find balance and function in society. “Early intervention and treatment are key,” Krozer said. “We’re trying to promote getting effective and timely care so we can optimize the function of their brain.” BIPOLAR DISORDER By the Numbers The average age-of-onset for bipolar disorder is 25. On average, bipolar disorder results in a 9.2-YEAR reduction in expected life span. Bipolar disorder affects approximately 2.6% of people living in the United States annually. Bipolar disorder affects 45 MILLION people worldwide. ONE IN 20 American adults experienced a serious mental illness such as schizophrenia, bipolar disorder or major depression in 2020. Sources: CDC, World Health Organization, National Institutes of Mental Health and National Alliance on Mental Illness. Prevalence of bipolar disorder is highest among people in the 18 TO 29 demographic – 4.7% – followed by the 30 TO 44 age range at 3.5%.

26 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 843.352.9982 Personalized Treatment for Substance Use Disorders from a Local Team that Cares. Contact us and take your rst step on a road to recovery. "A er leaving treatment and re-entering my life sober, I was fearful, anxious and felt alone in my recovery. Upon entering the Lantana program, not only was I provided with top notch individual and group therapy, I now had a community of peers and sta to lean on.” – Chris C Personalized Assistance in Locating the Best Senior Living and Care Options We also offer a (Mobile Senior Driving PROGRAM) where we help the driver and their family make a decision about if it is appropriate to retire from driving, or if it is safe to continue to drive. We will: • Listen to your specific needs • Create a customized solution • Hold your hand through the entire process • Help with planning and transition resources Call (843) 233-9251 Don’t know where to start? YOUR TOTAL SOLUTION FOR PEACE OF MIND AND MINIMIZING STRESS Giving families the peace of mind by managing all the details and work that go into senior relocation. RELOCATION DOWNSIZING & CLEAN-OUTS ESTATE SALES & ONLINE AUCTIONS TURN DOWNSIZING INTO RIGHTSIZING 843-410-2763 We’ll help make it easy. Our compassionate, experienced professionals are ready to get started today, beginning with a FREE in-home consultation at your convenience.

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 27 In the past, if you were trying to recover from drug addiction, you would be isolated in a form of rehabilitation. But Lantana Recovery Center in Charleston believes the best way to bounce back from substance use disorder is to keep you firmly in the community, with an array of people, steps and connections to ensure the best personal treatment. “We work with those struggling with any type of substance,” said Bob Hennen, clinical director with Lantana. “And we provide each client with a treatment team and customized care plan that lasts as long as necessary in order to ensure that clients have the best possible outcomes.” Founded in 2018 as an independent agency by partners Dominic Rosa, Eric Carver and Warren Phillips, Lantana’s model for treatment is based on the approach that the majority of people struggling with substance abuse do not need to be completely removed from the community to receive help and begin recovery. In the past four years, 57% of the people who have come to Lantana sought treatment for alcohol abuse – the number one substance use disorder in the United States. Addiction to opioids, such as fentanyl, prescription medications and heroin account for another 27%, while other misused substances, including cocaine and methamphetamine, make up the remainder. “Many individuals entering treatment are experiencing a concurring mental health condition such as depression or anxiety,” Hennen said. “Our approach is to not only treat these conditions simultaneously through intensive professional therapy and psychiatry but to involve the person’s family, friends and as many other support elements as necessary to help each individual recover.” For example, a person in early alcohol recovery will be encouraged by both Hennen and family members to create a safe home environment – one that is free from exposure to substances and to avoid the risk of relapse. Attendance at 12-Step meetings also is required because each individual will benefit from being connected with an outside mentor who also is in recovery. Personal growth to develop plans to move toward overall wellness often is the final piece of the treatment. According to Hennen, recovery from any misused substance is ultimately a choice of the abuser. “All of these elements have been shown to correlate with success rates,” Hennen said. “But early recovery can be a stressful time, as people may struggle to cope with cravings or the stress of being without the use of a substance.” Based on findings by the National Center for Drug Abuse Statistics, 31.9 million Americans age 12 and older currently are using illegal drugs. Although illicit drug use was recognized by the U.S. government in the 1960s as a national problem, the Centers For Disease Control, headquartered in Atlanta, reports that more than 100,000 drug-related deaths still occur each year in the United States. The Charleston area is only one small part of this problem, but Hennen said he personally hopes for a day when that problem will finally be overcome. “There are no obstacles too great to overcome to achieve sustained recovery – but there are obstacles along the way that pose a risk for a return to use of substances,” Hennen said. “And through our support services of fellowship, mentorship and personal growth, Lantana aims to create a space where individuals can achieve confidence, self-reliance, resiliency and successful long-term recovery. ON THE ROAD TO RECOVERY For more information, visit By L. C. Leach III SPONSORED MEDICAL CONTENT

28 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com For the vast majority of people suffering from a pinched nerve, the typical advice of rest, limited movement of the affected area and alternating ice and heat packs can solve the problem in a matter of hours or days. In some cases, pinched nerves will resolve on their own within four to six weeks, and over-the-counter nonsteroidal anti-inflammatories such as ibuprofen, naproxen and acetaminophen can help relieve pain. When these remedies don’t work, physical therapy or a steroid injection into the affected area is often the next line of treatment. However, in about 1% of pinched-nerve cases, surgery may be the only truly successful solution. Sabino D’Agostino, D.O., is a board-certified neurosurgeon who divides his time between working on the medical staff at Trident Medical Center and his own private practice. After completing seven years of additional training at the Medical University of South Carolina, he specializes in surgical procedures that address pinched nerves, known in medical terms as radiculopathy. While most people would consider surgery a last resort, Dr. D’Agostino stresses that the level of pain is not the determiner of the seriousness of the problem, and for the tiny minority who have a severe compression of the nerve, surgery is best done sooner than later to minimize the damage and to support healing. According to Dr. D’Agostino, “A variety of situations can cause a pinched nerve: Smoking is a big risk factor because spinal disks become malnourished from lack of healthy oxygen. Similarly, uncontrolled diabetes allows sugar to clog the blood vessels that feed the body. Obesity creates undo physical strain, and genetics can also be a cause. Accidents and injuries can be at fault, as can rheumatoid arthritis, the aging process, repetitive-motion tasks, occupations that require twisting and heavy lifting, sedentary jobs and tumors or cysts.” With aging or disease, the disks that cushion the vertebrae of the spine can become brittle and crack, leaking bone debris or a jelly-like filler from the center of the disk into a small space known as the foramen. The result is a crowding WHEN TIME AND REST DON’T CURE YOUR PINCHED NERVE By Janet E Perrigo

www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com | 29 or compressing of the existing nerve in the spinal canal – creating the pinched nerve. A herniated disk is one that slips out of its place between two vertebrae, also causing compression of the spinal nerve. Regardless of the cause, most pinched nerves originate in the neck, the upper middle back or the lower back. The average patient is 40 to 60 years old. It is rare and usually a matter of genetics when young people develop this condition. Dr. D’Agostino described the nerve roots that exit the spinal column as “a little less than the size of the diameter of a No. 2 pencil lead. A healthy nerve is pink and supple; an unhealthy one is pale and lifeless. When I observe the damaged nerve regain its rosy color, I know I have released the compression on it. The surgery has been successful. Full healing, however, may depend on the length of time the nerve has been compressed and the amount of damage that has been done in that time. I would rather see 100 patients and refer 99 of them for anti-inflammatory steroid injections or to a physical therapist just so that I could catch that single individual who needs immediate surgical attention to save their nerve function.” Although many patients with this condition are referred to neurosurgeons by their family physicians, it is also acceptable to self-refer. As Dr. D’Agostino pointed out, “Who you see first will determine your options.” He encouraged those who have had pain for some time and are not responding to less-invasive treatment to see a surgeon. Tests such as X-rays, CT scans, MRIs and EMGs will help determine the necessary procedures. The good news is that not all spinal surgeries require overnight or extended stays. Depending upon the extent of the operation, pain relief may be almost instantaneous. A typical two-week follow-up usually completes the treatment. Don’t suffer, hoping your pinched nerve will resolve itself. Seek professional help to find the best way to heal as quickly as possible. Your back will thank you. 4 Carriage Lane, Suite 108, Charleston, SC 29407 828.396.5634 | Affordable, Efficient, Flexible STRESS TESTING & NUCLEAR IMAGING • Routine Stress Tests • Nuclear Stress Test • MUGA Testing • Amyloidosis Testing UTLRASOUND IMAGING • Echo • Vascular • Abdominal ➡ Avoid the HIGH costs of hospital testing ➡ Flexible appointment times for busy schedules ➡ Fastest report turnaround ➡ No facilty fees ➡ LOWEST self pay rates ➡ All major insurance accepted ➡ Convenient and friendly staff Why pay 10 times more at a hospital for testing? Healthcare is a personal choice; understand your rights and options Services we offer: • Premier mobile nuclear and ultrasound imaging • Charleston Imaging Center in West Ashley

30 | www. Char l es tonPhys i c i ans . com | www.Hea l thL i nksChar l es ton . com 1200 Hospital Dr., Mt Pleasant, SC 29464 • 843.375.4000 • What is a Critical Care Hospital? Critical Care hospitals like Vibra Hospital of Charleston, are uniquely designed to effectively care for medically complex patients. Critical Care hospitals have physicians, nurses and staff who specialize in caring for patients who are critically ill and/or have complicated medical needs like respiratory care. Choosing the right post-acute setting for critically ill patients is crucial for achieving the highest outcomes for these complex patients.