LeBlanc: The act of shadowing

Have you ever had a loved one with dementia follow you around like a lost puppy? This is called “shadowing.”

Shadowing is the act of an Alzheimer’s or dementia patient attempting to keep his or her caregiver in sight at all times.

When caring for my father, there were times when I didn’t even have to turn around; I could feel the warmth of his breath heating up the back of my neck! He constantly would follow me around like a small boy clinging to his mother’s dress.

Even if I left him with a respite caregiver for an hour or two, he perpetually would ask where I was, sometimes more than 20 times in a half-hour. This obviously could drive the person staying with him almost to the point of madness. The behavior usually began about an hour or so before he began showing signs of “Sundowner’s” (Sundown Syndrome).

When someone is cognitively impaired there is a profound sense of fear involved. People living with dementia can experience this all day long. When they finally get to a stage where they just don’t feel safe alone anymore, the shadowing becomes even more excessive. I’ve always said controlling their anxiety is half the battle of caring for them.

Primary caregivers become security blankets, lifelines and the center of their loved ones’ world. They never want to be alone. This is how it was with my dad. He would follow me everywhere, and I do mean everywhere – bathrooms included! It got to the point that when I went into the john, within seconds my father would be knocking on the door asking what I was doing in there. To be honest, there were times when I was just in there searching for a moment of peace and solitude.

If this should happen to you, try to recognize what time of day it occurs the most. This will give you a notion of when to find a repetitious activity that will keep them entertained. Redirection might be the key. Consider asking them to help fold laundry or work on a hobby they always used to enjoy, such as a jigsaw puzzle or playing solitaire.

With my dad, one of the best redirection tools I used was a bowl of ice cream. Many times I found myself asking “Are you sure you don’t want another bowl?”

Also, I can’t tell you how many times I woke up to find my dad just staring at me, watching me sleep or actually waking me up just to ask if I was sleeping.

Shadowing is just one of a myriad of symptoms Alzheimer’s victims exhibit, but for the caregiver it definitely can be one of the more unnerving ones.

Specialist at Springbrook Hospital works to restore hope

When Andrew Stellpflug speaks about mental illness, substance abuse or cases involving psychotic episodes or severe depression, he comes across with genuine empathy. That’s because Stellpflug has a solid grasp on those topics, but not from personal experience.


Andrew Stellpflug, top left, with the staff at Springbrook Hospital on Grove Road in Brooksville. The facility offers in-patient and partial hospitalization programs to help those with mental disorders and substance abuse problems. KIM DAME

Stellpflug’s job is to help victims of mental illness or substance abuse find treatment and recovery.

As the Outreach Specialist for Springbrook Hospital, Stellpflug aims to bridge the gap between those who are at the threshold of losing all hope and linking them with resources to help them get their lives back on track.

Springbrook Hospital treats major mental disorders, severe depression, substance abuse, dual diagnoses, and other psychotic and mood disorders. Stellpflug travels among three counties — Hernando, Pasco and Citrus — spreading the word about in-patient and partial hospitalization programs that Springbrook offers.

Most notable is that Stellpflug is in his early 20s. A 2010 high school graduate, he is trying hard to make a difference.

His biggest challenge, he said, is changing the stigma attached to mental illness.

According to the National Institute of Mental Health, an estimated 26.2 percent of Americans ages 18 and older — about one in four adults — have a diagnosable mental disorder. Mental disorders are the leading cause of disability in the United States and as many as 45 percent have two or more disorders.

It is difficult knowing there are people in the community with undiagnosed or untreated illnesses, or caught in the grips of addiction, Stellpflug said. Many people still hesitate before seeking help because of the stigmas. “They are fearful of what others will think or will be denied help,” he said.

Stellpflug is on a mission to change that.

Springbrook Hospital, at 7007 Grove Road, about seven miles west of Brooksville, is the only local state-licensed, private-care hospital specializing in the treatment of mental health and substance abuse. The facility provides in-patient care and partial hospitalization care using an outpatient format.

Dual diagnoses, such as a drug or alcohol addiction along with a psychiatric illness, are common and treatable at Springbrook.

In a dual diagnosis situation, clients with substance struggles also exhibit one of more of the following symptoms, according to Springbrook.

♦ Mood disorders

♦ Depression

♦ Bipolar disorder

♦ Anxiety

♦ Phobias

♦ Panic attacks

♦ Obsessive/compulsive behavior

♦ Post traumatic stress disorder

♦ Depression due to chronic pain

The Eclipse Dual Diagnosis Program is customized to each client with a dual-diagnosis. An individualized program is based on need, and designed to provide long-term solutions and coping skills.

With a large population of retirees and older residents, Springbrook also provides senior care for those who are struggling with depression, prescription drug dependency and other psychiatric disorders. Many never have been diagnosed, Stellpflug said.

In fact, the Department of Health and Human Services reports suicide rates are highest among adults age 60 and older.

Bridges Senior Adult Program focuses on depression, psychotic disturbances, mood disorders, memory loss, grief and loss, aging issues and other issues. Clients have in-patient and out-patient options after assessments are made, and type and duration of treatment is determined.

Springbrook’s programs often are centered on redirecting a person’s focus and helping them become proactive in creating a healthier future.

The partial hospitalization program entails regular meetings in focus groups designed to give clients coping tools to maintain their progress. Stellpflug is proud of the facilities in all three counties that provide transportation to and from the sessions and offer well-care check-ins.

Springbrook Hospital is the only facility in the area that receives people committed under the state’s Baker Act, Stellpflug said, meaning patients who are admitted involuntarily to a treatment facility would be taken to Springbrook and transported later to a facility that meets their specific needs.

Stellpflug maintains communication with clients, both current and past, checking in to ensure they don’t feel like they are going through their journey of recovery alone.

Going through mental health issues and/or trying to control a substance addiction can be the most difficult time in a person’s life. Both are topics that need to be discussed more openly because dialogue can help initiate awareness, tolerance, and acceptance, mental health experts say.

Prescription drugs are becoming the leading drug of choice for addicts across the country. “It’s just tough for people to seek help” Stelelpflug said. “They often have to hit their bottom or get Baker Acted to get the help they need.”

SpringbrookHospital can be reached at (352) 596-4306.

LeBlanc: Learning to adapt

As caregivers, we have many rivers to cross, but I believe that one of the deepest and darkest areas is the constant task of having to adapt and re-adapt, as the disease of Alzheimer’s progresses. Alzheimer’s, and most other dementia related diseases, are rushing like a torrent down stream, with only a life-ending waterfall ahead. There are no survivors; that is, not yet.

I’m continually advising other caregivers that when they find something that works for their loved one, stick with it for as long as the disease allows it, always keeping in mind, however, that the disease is going to win.

There were many changes that I had to adapt to while caring for my dad. One of the most endless was teaching myself to slow down. On my own I could still do whatever I wanted at as fast a pace as I desired. But my poor father was always stuck in the slow lane. Attempting to rush him only heightened his anxiety and sent his confusion levels sky high.

Every day I counseled myself to back up and slow down. I’m happy to report that, after many trials and errors, I finally adjusted to his clock, making things better for both of us.

I also had to teach myself to use “in time communication.” Instead of telling my father he had a doctor’s appointment on Friday morning when it was only Wednesday which caused him to repeatedly ask for days on end, “aren’t I supposed to be somewhere,” I began to inform him only at the moment when it was time to start getting ready. I also told a therapeutic lie about the appointment being, for instance, at 10:00 a.m., when it was actually at 11:00 a.m. However, we were usually late anyway.

I have a dear friend who’s fighting this disease and he points out that for him, what used to feel like everyday-drudgery, is now a standard for him. He has found a novel way of doing things; a “new kind of normal,” if you will.

Things got easier when he realized he had to discover and accept his new limitations. This man has always loved to do woodwork, but the projects that he now works on are not as elaborate as compared to his previous work. He still spends hours in his garage working on some of the most beautiful and amazing crafts, but he has toned it down some.

Another point he makes is how hurtful it has become when people remind him of how much his skills have diminished. This type of comment is condescending. Harsh words like “Why are you doing that?” or “You know better than that” need to be tossed out in the trash. It may start feeling like we’re always skating on thin ice, but we really need to watch what words we use when we’re around this disease. Sometimes we also must adjust our compassion levels.

Our loved ones have no choice. They have to adapt. Now it’s up to us to convert our ways. It’s going to take a lot of practice and patience. Change does not always come easy, but then again, neither does learning to be a caregiver.

Medical team repairing leg of Weeki Wachee mermaid

In Hans Christian Anderson’s classic The Little Mermaid, it is the heroine’s fascination with the human world that prompts her to dream of trading her tail for human legs.

Samantha Maywell, 24, a “mermaid” at Weeki Wachee Springs State Park, dreams of getting her aquatic tail back.

On Aug. 22, the dark-haired, sparkling blue-eyed, two-year veteran of the underwater world of Weeki Wachee Springs nearly lost her left leg in a boating accident off a Hernando Beach canal.

According to Maywell, she and a group of friends were in a pontoon boat not far from shore when waves became choppy due to an upcoming storm. “We weren’t moving,” Maywell said, “although the boat was on.”

Another watercraft drifted to the side of the pontoon boat, and the vessels bobbed side by side. As Maywell tried to push them apart, a wave knocked her off balance, sending her off the bow and directly into the craft’s propeller.

The accident nearly severed her left leg, breaking bones and leaving muscle and tendon hanging. One of the passengers on the other boat immediately tied a lifesaving tourniquet to Maywell’s leg, and she was rushed to Bayonet Point Hospital.

“I remember everything up until after they cut off my bathing suit,” Maywell said. When she awakened in the recovery room, her leg was reattached.

Maywell doesn’t recall ever thinking she might lose the leg, but learned later how close she had come to having it amputated.

Two weeks in the hospital and two surgeries later, Maywell returned home in a wheelchair. “I was home for four days before going back to receive a third surgery,” she said.

Her physical therapy began in the hospital, where Maywell was encouraged to move around to keep her blood circulating in her leg and to prepare her eventually to regain the strength to walk. She progressed to a walker and now uses crutches to get around.

Physical therapy inside Oak Hill Hospital’s Rehabilitation Center began on Sept. 23 under the direction of Paul Ernandes, director of physical therapy. Using deep pressure, Ernandes and physical therapist Valerie Rabideau work to remove adhesions and scar tissue from the surgical area. They also use deep pressure to ensure adequate circulation is restored to the leg and into the foot.

At times the pain becomes evident when either Ernandes or Rabideau presses hard, causing Maywell to flinch slightly in pain. Yet her face remains poised and she engages in comfortable conversation with her therapists.

Maywell is a tenacious fighter. Her medical team is inspired by her progress. “She is doing better than expected considering the amount of trauma she suffered,” said Ernandes.

v v
Maywell visits Oak Hill three times a week for one-hour sessions. She said she looks forward to the therapy, believing it eventually will lead to her returning to her job as a mermaid at the tourist attraction.

She will continue undergoing massaging and prodding, pulling and sculpting the scar tissue out of her surgical area to allow the leg to resume functioning normally. And it will take months of weight-bearing and exercises to strengthen her muscles so she can walk comfortably and swim with full range of motion while wearing her tail.

According to Ernandes, Maywell’s leg must be at 100 percent range of motion to return to her position. “She is at about 45 percent,” Ernandes said, which he called tremendous progress.

She has become an inspiration at the clinic, where her therapists are quick to admire Maywell’s strength.

Maywell and the therapists joke around, exchange stories and do everything possible to make sure their efforts are successful.

v v
While the journey since the accident has been slow and steady, Maywell’s experience hasn’t tarnished her optimism and self-confidence.

The most difficult part has been accepting that her leg now has limitations it never did before. “It won’t bend the way it used to,” she said. But the most important part, without question, is the realization that she could have and almost did lose her leg.

“The best part is that I still have my leg,” she said.

Maywell began weight-bearing therapy Friday where she walked for the first time without crutches.

Her body responded with apprehension at first, said Rabideau, which is a natural defense behavior. “She hasn’t walked in three months,” she said.

Maywell was pleased with her progress and proceeded to receive additional deep pressure to help her knee bend to the 90 degrees needed to return to full function. She was at about 60 degrees.

Once the doctor gives her the OK, Maywell will begin working in water with the goal of a return to performing in the cool Weeki Wachee Springs.

The experience has been life-changing. But she surprised her medical team and many in the community by keeping her leg. Now she fights to ensure she also keeps her mermaid tail.

Second-hand smoke and your pet

Understanding the health risks of second-hand cigarette smoke is important to maintaining the health of ourselves and our children. Laws help protect nonsmokers by prohibiting smoking in public facilities, aboard public transportation, even in parks and entertainment venues.

Media focus also is responsible for helping the public become aware of the potential deadly consequences of smoking or breathing in second-hand smoke.

But what happens to other family members, like the family dog, cat or bird, when they are exposed to a smoker inside the home? Many don’t even think about the effects on pets that breathe in or ingest cigarette smoke or tobacco products.

If they did, Dr. Lorraine Castrovilly, DVM, at Garrison Animal Hospital, is confident that most pet owners would take the necessary precautions to protect the health and safety of their pets. “At the very least, they might at least stop and think about what they are doing,” she said.

Studies have been conducted on the harmful effects, Castrovilly said, and articles keep appearing in veterinary journals. “Usually we see second-hand smoke as it relates to someone in the car, like a spouse or children,” Castrovilly said. “We don’t think of it so much with pets. But there is a lot of research now that shows that second-hand smoke is really harmful.”

In the practice she shares with her husband, Dr. Patrick Jones, Castrovilly does her best to educate her clients. She is an advocate for public health, regularly lecturing on the risks of cigarettes and other tobacco products on pet health.

Castrovilly has been working as a veterinarian for 22 years. “It is what I always wanted to do,” she said. She is very active in educating the public through demonstrations in cohesion with the Florida Department of Health, focusing on topics like providing a smoke-free environment for pets.

v vThere are two ways that pets can be harmed by smokers in the home, she said. The first is through inhaling secondhand smoke. The second – less common yet equally as toxic – is ingesting cigarettes or tobacco products into the body.

Consider the following from breathenh.org;

Dogs that inhale secondhand smoke are three times more likely to develop lung or nasal cancer than those living in smoke-free homes

Allergic reactions to secondhand smoke are common in dogs that live with a smoker. Symptoms, which include scratching, biting or chewing of the skin, might be mistaken for skin or flea irritants or food allergies.

Cats can be susceptible, due to their constant licking while grooming, exposing the mucus membrane of the mouth to cancer-causing carcinogens. When exposed to chronic smoking, cats have an increased incidence of lymphoma.

Birds also are susceptible and may show symptoms of eye trouble and respiratory issues like coughing or wheezing. Since nicotine can stay on the hand of a smoker, birds that perch on the hand may develop contact dermatitis.

Ingesting cigarettes butts, chewing tobacco, or even nicotine gum or patches can be deadly, she said. The nicotine is absorbed into the intestine where it can cause death.

Consider that the amount of nicotine in just one cigarette can be toxic. Consuming only two cigarette butts can be deadly. Castrovilly is concerned since many tobacco products contain flavorings that attract dogs and puppies. Molasses, honey, fruit or even mint flavorings are attractive to dogs.

Therefore, they particularly at risk, she said. “Nicotine ingestion is really serious because nicotine is very toxic. With dogs there is a very marginal amount of nicotine they would have to ingest to have a toxic reaction.”

Puppies have indiscriminate eating habits, Castrovilly explained. They may chew or eat a couple of cigarettes found lying around or chew nicotine gum or patches. “They could make them have really severe toxic reactions.”

“If you weren’t aware of it, you wouldn’t even think about it,” she went on.

The problem is in the high concentration of nicotine. Nicotine first stimulates the nervous system, Castrovilly explained, which can be a good thing because it usually causes the animal to vomit. However, it then acts like a central nervous system depressant. “It is depressant on every level of the nervous system,” she said. “And it has a very narrow margin of safety.”

Should a pet owner discover their pet has consumed a tobacco product, Castrovilly said to seek emergency medical attention immediately. The sooner the product is removed from the pet’s system, the less damage it will cause.

As the community fights to bring objective information about the dangers of smoking to the public, it is Castrovilly’s hope that discussing the dangers to pets will at least get pet owners thinking.

“We love our pets,” she said. “They are like our children.”

Ideally she would love the information to have a strong enough impact to encourage smokers to quit. At the very least, she hopes bringing awareness to the hazards will get them thinking about modifying their smoking behavior.

Dogs and cats have no voice, she said. They rely on their owners to make healthy decisions to keep them safe. Prevention, therefore, is the best step toward that goal.

“People are very receptive when they understand the risk,” she said.

Garrison Animal Hospital is located at 8006 Spring Hill Drive. Contact Castrovilly at (352) 340-5928.

Vance gives readers an opportunity

Occasionally, readers query about famous people interviewed for this column. Over the years I’ve been asked, Which famous people affected by disability have you interviewed? Who was your favorite? Since 2002, I’ve featured more than 550 people affected by disability, and more than a few have been well known.

In years past, in terms of my most favorite person interviewed, I would have answered: Chris Burke, who was born with Down syndrome and played Corky Thatcher on the hit ABC series “Life Goes On,” or Boomer Esiason, former Cincinnati Bengals and New York Jets quarterback, whose son has cystic fibrosis.

The reason? Burke was a hoot to interview and Boomer was a Bengal, my favorite pro football team. I’ve also interviewed people like Bruce Jenner, Dave Dravecky, Debbie Macomber, and congresswoman Cathy McMorris-Rodgers.

About three years ago, my whole perspective on interviewing famous people changed. I began realizing that by regularly interviewing these people I had grabbed the interest of some additional readers, informed about disability in general and added an interesting twist to my job, but I had done little toward accomplishing my goal, which was to offer readers an inside look into the lives of everyday people with disabilities.

So I started featuring fewer famous people and concentrating more on the average Joe and Jane.

The United States has about 60 million people claiming a disability and nearly all those 60 million aren’t famous. Most organizations define disability as a significant impairment in at least one major life function, such as walking, talking, eating, driving, seeing, working or thinking.

Many of those 60 million are tucked away and out of sight, in places like group homes, nursing homes, bedrooms, assisted living facilities, alcohol and drug treatment centers, prisons and psychiatric hospitals.

As part of my desire to help everyday people tell their everyday stories, I’ve now begun offering readers with disabilities a special opportunity.

In addition to my regular columns going forward, every now and then I will be giving readers with disabilities the opportunity to write their own column and have that column published here. I will edit for space and clarity. So if you like to write, email for details. You can do it!

Alternative prostate cancer screening available

A test that studies suggest will do a better job of diagnosing prostate cancer and give doctors an idea of how aggressive a tumor they are treating is coming into use.

Developed by researchers at the University of Michigan Health System, the Mi-Prostate Score test detects three separate biomarkers associated with prostate cancer in urine samples from men.

The current standard prostate cancer screening test looks for one biomarker, the prostate-specific antigen, or PSA, in blood samples.

The MiPS test was developed in part to address the roughly 1 million men a year who are initially diagnosed with prostate cancer, often as a result of an elevated PSA test result, but who are found not to have cancer during a subsequent prostate biopsy.

In addition, although an elevated PSA test result indicates prostate enlargement, that enlarged tissue is not necessarily cancerous.

“Many more men have elevated PSA than actually have cancer, but it can be difficult to determine this without biopsy,” said Scott Tomlins, assistant professor of pathology and urology at the University of Michigan. Tomlins developed the MiPS in collaboration with Arul Chinnaiyan, the S.P. Hicks Endowed Professor of Pathology and Professor of Pathology and Urology at the University of Michigan Medical School.

The MiPS test in based on a 2005 discovery by Chinnaiyan’s lab of a genetic anomaly that can be detected in about half of the men with prostate cancer. In the defect a pair of genes, known as T2 and ERG, switch places on a chromosome and fuse together.

The University of Michigan holds a patent on the detection of gene fusion in prostate cancer that lists Chinnaiyan and Tomlins as co-inventors.

In addition, the use of the technology has been licensed to Hologic, a company based in Bedford, Mass., that develops diagnostic and medical imaging systems. Chinnaiyan has been a consultant to Hologic.

MiPS not only tests for PSA and the T2:ERG fusion marker but also a third biomarker, PCA3.

The PCA3 gene is only found in prostate tissue and is overexpressed by cancerous prostate tissue.

Chinnaiyan and Tomlins say the test also predicts risk for having an aggressive tumor, helping doctors and patients make decisions about whether to wait and monitor test levels or undergo an immediate biopsy.

“This combination test is not designed to say definitively at diagnosis whether a man has aggressive prostate cancer, but it can provide a more accurate estimate of the likelihood of having cancer and the likelihood of that cancer being aggressive,” Tomlins said.

For more information on the MiPS test, which requires a request from a doctor, is available by calling the University of Michigan’s MLabs, toll free, at (800) 862-7284.

Health events

Caregivers support group

SPRING HILL – HPH Hospice is excited to announce that Gary LeBlanc will be the guest speaker at the Caregivers Support Group from 11 a.m. to 12 p.m. Thursday at Forest Oaks Assisted Living Facility, 8055 Forest Oaks Blvd., Spring Hill. LeBlanc, author of “Staying Afloat in a Sea of Forgetfulness,” columnist and primary caregiver, has a straight-forward and common-sense approach to caregiving. The support group is free and open to the public. No reservations required. For information, contact Christine Adkins at (352) 597-1882.

Vista Grand health fair

SPRING HILL – The Vista Grand Apartments Annual Fall Health Fair will be from 10 a.m. to 2 p.m. on Oct. 10 at the Vista Grand Apartments, 10380 Quality Drive, Spring Hill. The health fair is free to the public and will have health care and wellness exhibits, seminars, Medicare insurance information, stroke screening (fee), eye checks, hearing exams, spinal adjustments and lots of giveaways. For details, call (727) 825-0018.

Hernando health fair

BROOKSVILLE -The ninth annual Hernando County Community Health Fair is only six weeks away. The Elks Lodge, 14494 Cortez Blvd., Brooksville, will once again host the event, which will run from 10 a.m. to 2 p.m. Oct. 12. The event will feature free health screenings and demonstrations, complimentary samples of signature items from local food establishments and live music. A special children’s fun area will again be available to participants.

Memory screening

HPH Hospice will host a free memory screening, conducted by a representative of the Alzheimer’s Association, from 10 a.m. to 4 p.m. on Oct. 17 at HPH Hospice, 12260 Cortez Blvd., Brooksville. Screening is for adults age 50 and older but not recommended for persons who have already been diagnosed with dementia or Alzheimer’s disease. The 15-minute memory screening is by appointment only. To schedule an appointment, call Carla Hayes at (352) 597-1882.

Culinary experience

The Crescent Community Clinic invites the public to a Culinary Experience with Chef Michael 2-4 p.m. Oct. 23 in the Crystal Room at the Residence at Timber Pines, 3140 Forest Road, Spring Hill. Tickets are $25, and all proceeds benefit the Crescent Community Clinic serving the needs of the uninsured and income eligible nonelderly adults of Hernando County. Enjoy a cooking demonstration and tasting of “Healthy Foods for a Healthy Hernando”, a selection of comfort foods for the holidays. Purchase tickets by calling the clinic at (352) 610-9916, Marcia at (352) 683-8552 or via Paypal at their website www.crescentclinic.org.

Hep C support group

BROOKSVILLE/SPRING HILL – A hepatitis C support group for veterans is forming. Contact Art Fryer at (352) 503-2569.

Comfort caregivers

SPRING HILL – HPH Hospice offers a Comfort for Caregivers support group for those caring for a loved one with Alzheimer’s disease or dementia. The group meets 11 a.m. to noon the first Thursday of the month at 8055 Forest Oaks Blvd., Spring Hill. Free to attend and open to the public. Call (352) 597-1882.

Prostate cancer group

BROOKSVILLE – Florida Cancer Institute-New Hope holds its “Man to Man” prostate cancer support group 6-7 p.m. the first Monday of every month at its Brooksville Center, 7154 Medical Center Drive, off Kadri Boulevard, across from the High Point community. Topics frequently discussed are: importance of early detection, signs and symptoms, prognosis, disease stages, incontinence, impotence, treatment options including hormone therapy and medications, and especially the latest research and treatment modalities. The support group is co-sponsored by the American Cancer Society. Call Mary Capo at (352) 596-1926.

Caregiver support

SPRING HILL – Florida Cancer Institute-New Hope holds its Caregiver Support Group meeting 4:30-5:30 p.m. the first Wednesday of every month at its Spring Hill Center, 10441 Quality Drive, Suite 203, Medical Arts Building, next to Spring Hill Regional Hospital. Call Pamela McGee, support group facilitator, at (352) 688-7744.

AFO support

BROOKSVILLE – Alzheimer’s Family Organization offers support group meetings at 1 p.m. every Monday at the Brooksville Regional Hospital, Medical Arts Building Enrichment Center, Suite 120, 17222 Hospital Blvd.; 1 p.m. every third Tuesday of the month at the Hernando County Mining Association, Enrichment Center, 800 John Gary Grubbs Blvd.; or 1 p.m. every second Wednesday of the month at Spring Hill Regional Hospital, Medical Arts Building, Suite 105, 10441 Quality Drive, in Spring Hill. For details, call John at (352) 232-0081 for Brooksville locations or Pam at (352) 688-1262 for Spring Hill. To volunteer, call (727) 848-8888 or toll free at (888) 496-8004. The DFLA is a program of the Volunteer USA Foundation. Go to www.volunteerusa foundation.org.

Chatterboxes group

NEW PORT RICHEY -Community Chatterboxes meets 3-4 p.m. every other Thursday at Community Hospital, 5637 Marine Parkway. Community Chatterboxes is a support group to assist individuals suffering from communication deficits (i.e., aphasia, apraxia, dysarthria, etc.) as a result of a cerebral vascular accident or other neurological disorders. Call (727) 845-0757.

Arc seeks volunteers

The Arc Nature Coast is seeking volunteers for its POSSE (Promoting Opportunities and Skills with Special Equestrians) enrichment program at the Education Center or Neff Lake Road facility, any of several office locations, community outings and special events. Applications and background screenings are required for any position that involves direct contact with customers.

There is a one-time fee of $28 for submission of paperwork to two outside agencies. For information and application forms, contact John DiRienzo at jdirienzo@thearc-nature coast.org.

Health news releases to be published in Health Events listing should be received 10 days in advance and will not be published without complete information, such as the time, date and physical address of the location of the meeting or event. Also, an information telephone number for the public and the name and telephone number of a contact person must be included. Email news releases to Michael Terry at mterry@hernando today.com, fax to (813) 579-9246 or mail to Hernando Today, 13045 Cortez Blvd., Brooksville FL 34613.

Study ties use of drugs to control schizophrenia to brain tissue loss

Researchers at the University of Iowa using imaging studies to probe the brains schizophrenics have made what they consider a troubling discovery: the drugs often prescribed for people with the neuropsychiatric disorder appear to increase the brain loss they have seen in people with schizophrenia.

Nancy Andreasen and her colleagues at Iowa’s Carver College of Medicine say they published the results of their brain-imaging studies in the American Journal of Psychiatry knowing the information could prove disturbing to people who take the antipsychotic drugs and the doctors who prescribe them.

Andreasen and her collaborators based their findings on MRI studies conducted on schizophrenia patients. The patients began undergoing the MRIs after their first schizophrenic episode and had them repeated at regular intervals for as long as 15 years.

What Andreasen and her colleagues found while combing through the data was that at the first occurrence of symptoms schizophrenics have less brain tissue than healthy people. This suggested to them that something must going to in the brains of schizophrenics before the disorder begins to affect them.

“There are several studies, mine included, that show people with schizophrenia have smaller-than-average cranial size,” said Andreasen, the Andrew H. Woods Chair of Psychiatry at Carver. “Since cranial development is completed within the first few years of life, there may be some aspect of earliest development – perhaps things such as pregnancy complications or exposure to viruses – that on average, affected people with schizophrenia.”

Another finding is that the majority of the brain tissue loss seen in people with schizophrenia happens within two years after the first episode and then hits a plateau. This information may help doctors time treatments meant to prevent brain tissue loss and other negative schizophrenia impacts.

What the researchers learned when they began to look at the effect of antipsychotic drugs on brain tissue proved “very upsetting,” Andreasen said. In general, they found, the larger the dose of these medicine at person with schizophrenia is receiving the great the amount of brain tissue loss.

This, however, is not the first time antipsychotic drugs have been found to have potentially negative side effects. Doctors have known for years that these medications can be associated with conditions such as discomfort and muscle and movement disorders, breast enlargement in men and sexual dysfunction.

Nevertheless, the Iowa researchers spent roughly two years reviewing the data on brain tissue loss and antipsychotic drugs “more or less hoping we had made a mistake,” Andreasen said.

“But in the end, it was a solid finding that wasn’t going to go away, so we decided to go ahead and publish it. The impact is painful because psychiatrists, patients, and family members don’t know how to interpret this finding. ‘Should we stop using antipsychotic medication? Should we be using less?’ ”

Although they remain the subject of controversy surrounding their effectiveness and possible negative side effects, antipsychotic drugs are generally credited with helping people with schizophrenia and other neuropsychiatric problems such as bipolar disorder avoid long-term institutionalization.

Because of her findings Anreasen is suggesting antipsychotic drugs should be used with “great care.”

The Iowa study was funded in part by Janssen Scientific Affairs LLC, the medical education department of Janssen Pharmaceuticals, which makes antipsychotic drugs such as Risperdal, Latuda and Invega.

The U.S. National Institutes of Health and the nonprofit Brain & Behavior Research Foundation, in Great Neck, N.Y., provided additional funding.

Robot-assisted surgeries becoming more common

Just 10 years ago, the idea of robotic-assisted surgery was still far removed from the typical patient’s ability to comprehend. But with the introduction of the da Vinci Surgical System to hospitals across the country, the idea of robotic assistance in the operating room is no longer a figment of a futuristic imagination.

It is now a common procedure in many of the nation’s top operating rooms.

The benefits to the patient, from less invasive procedures to shorter recovery times, are the main reason Oak Hill Hospital purchased their system in late February as part of their massive expansion.

“We have 10 surgeons out of Oak Hill that are specially trained on the da Vinci,” said Richard Linkul, Oak Hill’s marketing director.

In fact, Intuitive, the manufacturer of the da Vinci Surgical System, acknowledged that Oak Hill Hospital is the “fastest hospital in the nation as it relates to the launching of the da Vinci,” according to Linkul.

“It looks at the number of physicians, the number of specialties, the number of surgeries performed and the quality of the surgical team,” he added.

The da Vinci Surgical System is comprised of a robot with arms the surgeon controls from a console. A high-definition monitor displays the entire procedure on a screen. From the console, the surgeon sees three-dimensional images and controls the robot’s arms. It is important to note that the surgeon is still in complete control of the procedure and a highly trained surgical team is present to prep the patient and assist the surgery.

The surgical team is an important element, Linkul said. In fact, the same team works each da Vinci procedure.

“The da Vinci stays in that one room in a designated suite with designated surgeons and a designated surgical team,” he added.

Using a computer program called the Navigator, surgeons and surgical team members learn through simulated situations.

“And they are tested for dexterity and speed,” Linkul said. “It’s very sophisticated.”

The da Vinci also has thousands of safety checks built in. For instance, the surgeon’s head must be touching the monitor at all times.

“As soon as they move their head, the whole system stops,” Linkul said. Learning the robotic method for laparoscopic procedures requires several steps until the surgeon is comfortable with the procedure.

“The surgeries aren’t necessarily quicker, but the safety and technology is much enhanced,” he said. “And it is high-definition, three-dimensional clarity. It’s so far evolved from open (surgery), which then evolved to laparoscopic.”

More top surgeons are learning the da Vinci system, including experienced surgeons like David Buethe, a urologist by training with a subspecialty fellowship training in urologic oncology.

Buethe performs both urologic cases such as sacrocolpopexi and urologic oncology cases targeting cancers of the urinary tract.

“To my knowledge there is no other surgeon who is doing this within the local vicinity,” Linkul said.

Buethe’s resume is impressive, including an extensive two-year fellowship at Moffitt Cancer Center, accredited by the Society of Urologic Oncology. His expertise in areas of urology and oncology with da Vinci training is a huge benefit to Oak Hill’s surgical team.

As a urologic oncologist, Buethe deals with issues involving the urinary tract, including the kidneys, ureter, bladder and prostate and cancers identified within those organs.

“I spent two years at Moffitt specifically treating urologic cancers,” Buethe said. “I consider myself a urologic oncologist and am probably the only one in the Hernando/Pasco county region.”

The da Vinci is geared toward urologists and gynecologists,” he said, “as they often perform procedures deep with the pelvis where the working space is limited and visualization often obscured at time of open surgery.”

During his residency, Buethe performed all of his prostatectomies and cystectomies using an open surgical approach.

“It is a difficult space to work,” he said. “The amount of bleeding, especially during a prostatectomy is significantly more than we see with robot-assisted laparoscopic procedures. Further, the recovery times were significantly longer. With robotic-assisted surgeries, there is less bleeding and therefore less recovery time.”

Patients go home sooner, thereby decreasing the overall cost of surgically managing a specific illness.

Traditional laparoscopic surgeries use two instruments that move with limited articulation and range of motion. But robot-assisted surgery allows the surgeon to have a range of motion comparable to the human wrist, Buethe explained.

During surgery, Buethe sits at a console and uses his fingers to gently pinch and release the controller, and the robotic arms mimic the movement within the patient. The ability to see three-dimensional clarity from the console viewing apparatus allows for complete vision in and around the surgical site.

Monitors display the images in real time as the surgeon works, allowing the surgical team complete access to the procedure at all times.

Carla Hamilton, a surgical technician who worked with Bluethe on his first da Vinci-assisted surgery, admitted she was a bit apprehensive at first. But after learning the techniques, she is very comfortable with the system.

She and her colleague, Linda McMahon, an OR registered nurse, are part of the surgical team that is present for nearly all da Vinci-assisted procedures.

The technology has added considerable benefits to the patients of Oak Hill as well as the staff.

“It is becoming the standard in surgeries,” Linkul said.