Monthly Archives: April 2013

Patient Story: How Weight Loss Surgery Changed My Life and My Diabetes

After an adult life riddled with type 2 diabetes and high cholesterol, Ann Goldman decided it was time for a transformation. At 276 pounds, her health problems were diminishing her quality of life. That is, until she stumbled across an article about weight loss surgery and its impact on patients with type 2 diabetes. In some cases, the surgery cured the diabetes.

“I spoke to my endocrinologist, and he recommended I look into the surgery,” said Goldman.

Adults with diabetes are two to four times more likely to die of heart disease or experience a stroke. About 70 percent have high blood pressure, which is a risk factor for cardiovascular disease.

At the time, Goldman didn’t know much about weight loss or “bariatric” surgery. Within a month, she attended an informational seminar to learn about the benefits and options available.

“I felt better knowing I wasn’t alone,” said Goldman. “I learned being overweight wasn’t just a problem of overeating. It has to do with hormones and how the body processes what you eat.”

Goldman’s journey began with a series of appointments to ensure she met the requirements to be a candidate for surgery. From meeting with a cardiologist and dietitian, to being tested for sleep apnea and upper GI problems, doctors had to ensure her health could sustain the almost 4-hour long surgery. Goldman even lost 18 pounds during the pre-surgery process.

When the day finally arrived in September, Dr. Michael Tyner performed Goldman’s gastric bypass surgery at Rex Hospital in Raleigh. Rex’s bariatric program was the first in Wake County to be recognized as a Bariatric Surgery Center of Excellence® and a Blue Distinction Center for Bariatric Surgery®. In fact, more bariatric surgeries are performed at Rex than any other center in Wake County.

“Along with the doctor and staff, the nurses at Rex were warm and caring,” explained Goldman. “Having that support pushed me in the direction to obtain good health.”

Seven months after surgery, Goldman has lost 100 pounds.

“Friends don’t recognize me when I walk down the hallway!” she exclaimed. “I have a spring to my step, which I never had before.”

Another huge benefit from the surgery—Goldman’s type 2 diabetes was cured.

“The diabetes was pretty much gone right away,” said Goldman.

Goldman’s lifestyle now includes healthy foods and smaller meals. A daily diet may include Greek yogurt and a protein shake for breakfast, a half turkey sandwich with an apple and peanut butter for lunch, and a small plate of meat, vegetables and potatoes for dinner.

“Having this surgery truly changed my life,” explained Goldman. “If you have health issues and you’ve tried everything, don’t be ashamed to try the surgery. Sometimes you need an extra tool to get your body into the mode of eating what you’re supposed to. I look forward to a longer, healthier life because of my choice.”

To learn more about weight loss surgery, visit or call (919) 784-SLIM.

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The Importance of Vitamin D

Post by Jennifer Paschaloudis, MS, RD, LDN. Jennifer is a Registered Dietitian with Rex Wellness Centers of Garner and Knightdale.

Vitamin D has increasingly become part of the blood work accompanying a physical at the doctor’s office. This may be for good reason, as many people are falling short on this important vitamin.

Vitamin D is a fat soluble vitamin that is essential for proper functioning of many organ systems. It has two forms in fortified foods and supplements called vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Besides food and supplements, vitamin D can be produced in our skin by exposure to ultraviolent sunlight. With our ever-increasing use of sunscreens and avoidance of the sun’s harmful rays, certain populations of people may be deficient in this vitamin if not taking steps to get adequate amounts in food and supplements.

The classical diseases associated with vitamin D deficiency are Rickets and Osteomalacia. Rickets is a disease of childhood characterized by a failure of bone to mineralize properly resulting in soft bones and skeletal deformities. In adults, osteomalacia causes bones to weaken and symptoms of bone pain and muscle weakness often accompany, but may also be subtle in early stages.

Obtaining appropriate intakes of Vitamin D can be difficult to achieve, especially for non-milk drinkers. Vitamin D is found in limited foods naturally, so most Vitamin D in Americans’ diets is provided by fortified foods. The U.S. milk supply has voluntarily fortified milk. Other products that may be fortified include cereal, yogurt, and orange juice. Some foods with naturally occurring Vitamin D include cod liver oil, salmon, trout, egg yolk, liver, sardines, canned tuna, and cheese.

So, who is at risk? Breastfeeding infants receive the best nutrition available from nursing, but their vitamin D requirements cannot usually be met by human milk alone. The American Academy of Pediatrics recommends that exclusively and partially fed breastfed infants be supplemented with 400 IU of vitamin D daily until weaned and consume >= 1000 mL/day of fortified infant formula or cow’s milk. People who limit their exposure to the sun, women who wear head coverings and robes, or those who spend limited amounts of time outside are at risk. People with darker skin due to the larger amounts of melanin reduce the ability to produce vitamin D from sunlight. The elderly cannot synthesize vitamin D as efficiently as in their younger years, and they are also more likely to spend less time outdoors. Those who have undergone gastric bypass surgery will also be at risk for vitamin D deficiency secondary to malabsorption since part of the small intestine where vitamin D is absorbed has been bypassed.

What other long-term health risks are associated with low levels of vitamin D? Osteoporosis is more often associated with lack of calcium, but insufficient vitamin D reduces calcium absorption. Having adequate levels of this vitamin along with calcium may reduce the risk of osteoporosis. There is some evidence that certain types of cancer such as colo-rectal, prostate and breast cancers may be influenced by deficiencies, but more research is needed. Vitamin D deficiency has also gained interest in those involved in cardiovascular disease research. Evidence is limited, but growing, linking it to several cardiovascular risk factors including stroke, heart attack, and peripheral artery disease.

So, how much vitamin D do we need a day? The Recommended Dietary Allowance (RDA) is the average daily level of intake sufficient to meet the nutrient requirements of nearly all healthy people. Both males and females from 0-12 months should get 400 IU per day, 1- 70years old 600 IU per day, and over 70 years should get 800 IU per day.

The next time you are in for your annual physical, it may not be a bad idea to ask your doctor if they think it is appropriate to check your vitamin D level. In the meantime, make sure you are getting enough dairy, especially from skim milk, and consider a multi-vitamin and/or a calcium supplement with vitamin D. A registered dietitian can help you too!

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Seven soothing solutions to back pain

Most of us have been waylaid by back pain, whether it was a dull ache, a sharp, stabbing feeling or something in between. Simply getting older, having poor posture or being overweight or out of shape can be the cause of your pain, but you could have a disk or ligament problem. If you’re under stress or coping with a disease like arthritis, that may also be behind the ache.

For some people, the pain is acute, which means it comes on suddenly and lasts for less than six weeks. Generally, the pain will begin to ease within a few days, with the help of over-the-counter pain relievers. People who have chronic back pain, which lasts longer than three months, should see their healthcare provider, who may prescribe stronger medications, such as muscle relaxants and nonsteroidal anti-inflammatory drugs.

Whatever the source of your backache, take action to manage the pain and prevent it from coming back:

  1. Get moving. Talk with your healthcare provider about a safe exercise program that will strengthen your back muscles. This may include aerobic activity, such as swimming and walking, strength training and flexibility exercises and moves that strengthen your abdominal muscles. You may have heard that spending long periods of time in bed is a good treatment, but doing so can actually delay relief.
  2. Step on the scale. Maintain a healthy weight or lose weight if you need to. This will take some of the load off your back.
  3. Practice perfect posture. Stand and sit up straight. Pull your stomach in and align your head and neck with your shoulders and hips.
  4. Call in reinforcements. Avoid heavy lifting when you can, but if you have to lift, do so with your legs, not your lower back. Hold the item you’re lifting close to your body.
  5. Pack it up. Use heat (a hot-water bottle) to reduce muscle spasms and pain and cold (an ice pack) to lessen swelling and numb pain.
  6. Kick the habit. Stomp out smoking, which causes smoker’s cough and delays healing.
  7. Seek an alternative. Get a massage or try acupuncture, complementary treatments that may make you feel better.

Source: BlueSpire Strategic Marketing. Published with permission.

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When your job becomes a real pain!

If long work hours have left you with persistent aches and pains, you’re not alone. Work-related musculoskeletal disorders, such as tendonitis, muscle strains, carpal tunnel syndrome, tension neck syndrome and low back pain account for one-third of all occupational injuries and illnesses reported by employers every year. Pain, numbness and tingling affect your life at both work and home. Learn how to prevent and treat some of the more common occupational ailments.

Oh, my aching back
Back pain can range from a dull, constant ache to a sudden, sharp pain. Work-related back injuries affect many occupations like nursing, factory jobs and even office work. Poor posture, improper or heavy lifting or repetitive tasks and stress usually cause back pain.

  • Prevention: When standing, periodically rest one foot on a low stool. When sitting, choose a seat with good lower back support and arm rests. Keep your knees and hips level and take breaks to move around every 15 minutes. When lifting heavy objects, keep your back straight and bend at the knees.
  • Treatment: Over-the-counter pain relievers and hot or cold therapy may provide relief. You may need stronger drugs, cortisone injections, electrical stimulation therapy, physical therapy or exercise.

It’s all in the wrist
Highly repetitive tasks that require wrist bending or stressful wrist postures, such as typing or using small hand tools, can lead to carpal tunnel syndrome. The ache in your wrist may extend to your hand or forearm, and tingling or numbness may develop in your fingers.

  • Prevention: Bend and stretch your wrists every 20 minutes. Relax your grip during repetitive tasks and avoid bending your wrist all the way up or down. Practice good posture and don’t allow your shoulders to roll forward.
  • Treatment: Frequent breaks, stretching and ice can ease discomfort. Other options include wrist splinting, workstation modifications, medications or surgery.

Pain at the joints
Tendonitis is inflammation or irritation of tendons, which attach muscles to bone. You’ll feel joint pain and tenderness that’s aggravated by movement. Tasks that involve repetitive motion, bending and vibration (using power tools) and repeatedly grasping and turning objects, may cause tendonitis.

  • Prevention: Get a proper ergonomic assessment of your workspace to make sure your tendons aren’t being stressed or overloaded.
  • Treatment: Rest, ice and over-the-counter pain relievers may help. Your doctor may recommend physical therapy or corticosteroid injections.

A pain in the neck
Neck pain can come from bones, muscles or other parts of your neck or from your jaw, head or shoulders. Poor posture and overuse, such as talking on the phone or hunching over a computer for long periods, contribute to neck pain.

  • Prevention: Keep your head centered over your spine. Adjust your desk chair so your hips are slightly higher than your knees. Keep your monitor at eye level. Use a headset instead of cradling the phone in your neck.
  • Treatment: Ice and ibuprofen, aspirin or naproxen can reduce inflammation. You may need stronger pain medications or physical therapy.

Source: BlueSpire Strategic Marketing. Published with permission.

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Rising Heat

Brian TrabulsiBrian Trabulsi, MPT, ATC is a physical therapist at Rex Hospital Outpatient Rehabilitation in Raleigh.

As the 2013 Major League Baseball season kicks off this month, a record number of pitchers will be hitting triple digits. A recent article in the Wall Street Journal reported on the increasing number of pitchers throwing 100+ mph. “In 2003, there was only one pitcher who threw 25 pitches 100 mph or faster (Billy Wagner).” Since then, the number has quickly increased to seven. For years, experts believed 100 mph was the physiologic limit for throwing velocity based on bio-mechanical stressors placed on the shoulder. Power pitchers can exert as much as 7,000 degrees of rotation per second through his throwing shoulder. While the top speed has only increased marginally over the years, the number of pitchers near the physiologic limit has increased sharply.

Experts suspect the rise is likely due to both economics and technology factors. As pitchers salaries continue trending upwards, more top players are gravitating towards that position. Secondly, radar guns have become smaller and more accurate with most MLB stadium displaying the velocity with every pitch. Coaches specializing in the development of young pitchers are maximizing velocity by emphasizing posterior chain strengthening to optimize power from the legs. They’ve also started modeling some specific training techniques from successful Caribbean and Latin America players.

So as spring turns to summer and the thermometer starts to rise, be sure to take notice of the handful of players that are really bringing the heat.

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Our “Boys” of the Year

Every fall, hundreds of Rex co-workers participate in the Leukemia & Lymphoma Society’s Light the Night event. The poignant celebration and walk in downtown Raleigh helps raise thousands of dollars for blood cancer research and awareness.

This Spring, two people with close ties to Rex are playing major roles in another LLS effort to raise money. Rey Garcia, a clinical research nurse at Rex Cancer Center, is competing with a dozen other candidates to be the LLS “Man of the Year” for the Triangle. And Bryce Washington, the son of Rex co-workers Stacy and Bryant Washington, is the LLS’s local “Boy of the Year.”

“Rex is an important partner with LLS to raise funds to invest in research and provide information and services for patients and their families,” said Emily Blust, Development Director with the N.C. Chapter of LLS. “Rey and Bryce are two important heroes to our organization.”

Garcia has worked with blood cancer patients for 16 years, first at UNC and for the past year at Rex. Dr. Kristy Richards, a research oncologist at the UNC Lineberger Comprehensive Cancer Center and a member of the LLS board of trustees, nominated Rey for LLS’s “Man of the Year” because of his passion for helping patients and families struggling with leukemia, lymphoma and myeloma.

“I’m not really good at fundraising or asking people for money, but Dr. Richards convinced me I would represent both Rex and UNC and help make patients’ lives better,” Garcia says. “I’m honored to be a part of this campaign.”

Garcia is collecting tax-deductible donations through social media and by holding fundraising events, such as a wine tasting. Learn more about his efforts here:

The male and female who raise the most money during the 10-week campaign that ends May 2 will be crowned “2013 Triangle Man & Woman of the Year” at a celebration at the Raleigh Marriott City Center on May 4. Read more about the campaign here:

Bryce Washington, who recently turned 11, is helping the candidates for Man and Woman of the Year by sharing his story and being a “face” of blood cancer. Bryce was diagnosed a year ago with acute lymphocytic leukemia. He began intense chemotherapy, responded well to treatment and was in remission within 28 days.

Bryce will continue receiving “maintenance” chemotherapy until July 2015, but recently returned to school and is enjoying a normal life. In March, Bryce and his family visited Disney World as part of a Make-a-Wish trip to Florida.

When Bryce was diagnosed, his father Bryant, who is a Coordinator at the Rex Cancer Specialty Center, told co-workers he never expected to be experiencing clinical trials from the other side. He is so grateful to the physicians who are working every day to advance pediatric cancer treatments in Chapel Hill. It also means a great deal to him to know that the Rex and UNC family are supporting Bryce’s efforts to help LLS.

In his role as Boy of the Year, Bryce attends candidates’ fundraising events and discusses his fight against cancer. Read more about Bryce’s story here:

“We love sharing Bryce’s story with others because he’s such an inspiration to us and to everyone who comes to know him,” says Stacy Washington, a nurse and QA Specialist at Rex. “Supporting the Leukemia & Lymphoma Society helps pay for research so that someday leukemia will be a thing of the past and no child will have to endure such a horrible disease.”

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Emerging Trends in Exercise Science

Post by Logan Johnson, CSCS. Logan is a Certified Strength & Conditioning Specialist, Personal Trainer and Wellness Instructor at Rex Wellness Center of Raleigh.

A fellow co-worker forwarded a rather interesting article to me a few weeks ago regarding strength training and its effects on the “biomarkers of aging.” These indicators give a more accurate description of your “biological age.” In other words, if we had measurements of the ten variables indicated in the article, we would be able to tell you how well your body is aging relative to time. These are excellent indicators of an individual’s wellness and offer a more accurate representation of whether or not you are on the right path to living a long and healthy life. In the past, the emphasis for improving your biomarker profile has been placed on cardiovascular training. However, recent evidence suggests that strength training may be the best tool to improve your outlook.

Among the obvious benefits are an overall increase in muscle mass and power (which reduces your risk for falls later on in life), improvement or maintenance of bone density, and improvement in body composition. Emerging research is affirming the position that strength training also increases Resting Metabolic Rate by as much as 15% post-training. What I find to be one of the more interesting developments regarding improvements in these indicators is the research on genetic expression and “genetic aging” in response to strength and power training. More and more evidence suggests that strength and power training can serve as the elusive “Fountain of Youth” for aging seniors, reducing the oxidative damage that occurs as a result of environmental and dietary stress.

All in all, there are some exciting new developments in the field of exercise science which will continue to help us address and prevent the many health problems that we face as a nation. I find myself constantly reminding our members at the Wellness Center that there should be a great deal of emphasis placed on strength and power training. I hope as more of this kind of research makes itself visible to the public eye, we will see a paradigm shift in the implementation of exercise programs aimed at improving overall outcomes.

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Stay on Track, Even When You’re Busy

Jeanie StaskoJeanie Stasko is a Health Educator for Rex Wellness Centers who blogs about fitness, exercise & overall healthy lifestyle topics.

Make a plan
Set yourself up for success by pre-planning your workouts for the week. Look at your work and personal schedule and identify times for independent or group exercise sessions. Pen them into your daily planner or electronic calendars. These work-outs are now non- negotiable and just as important as any other commitment you’ve got for the week.

Adjust to be successful
When you know the week is slammed with early morning responsibilities and late work meetings you’ve got to achieve balance. Simply balancing the intake of calories with the level of your activity each day will reduce setbacks in achieving your goals. If there’s absolutely no time for exercise, make sure your diet is lean and mean. If you need help determining how many calories you’re eating, schedule an appointment with one of our registered dietitians. You can also check out (also available as an app) to help you balance your food intake and calorie expenditure.

Take time to organize the simple things

  • Make sure your favorite exercise clothes are clean, packed in your gym bag, and that your sneakers are in your car.
  • Have something healthy like a nutritional bar available for on-the-go snacking. If your day runs long or you miss a meal, “I’m starving” shouldn’t be an excuse for missing a workout.
  • Remember to pack your headphones and have an updated play list handy. No one wants to listen to the same 20 songs for months on end.
  • Pre-plan at least 2/3 of your family’s meals and you’ll have far fewer excuses for poor nutrition.
  • Pack your fridge and pantry with healthful foods and you won’t have the opportunity to maim your diet during the week. It certainly is a lot easier to avoid a giant bag of potato chips if they simply aren’t available.
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