Spring is in the air and gardening is a favorite hobby for many of us. But did you realize digging in the dirt becomes a solid workout with moving, bending, lifting and squatting? With the strenuous exercise involved, it’s no surprise many gardeners experience low back pain sooner or later. So before reaching for your shovel try these preventative tips to help limit low back pain. • Start slow, beginning with simpler projects, and break up larger gardening jobs. • Drink water and walk before, during and after you garden to rehydrate while taking pressure off the spine. • The discs in your spine move backward when you garden, so stretch your back by doing a “press-up” to equalize the pressure before you start. • To do a press-up, lie flat on your stomach with feet and hips firmly on the ground. Push your head and chest up while arching your back and keeping your chin up. • The hip flexor stretch also addresses the lower-lumbar area of your back, which is most susceptible to injury. Stretch alternating hips by slowly stepping into and holding lunges for 30 to 60 seconds. • Gardeners spend a good deal of time bent over, putting pressure on the spine. Back bends, similar to press-ups, help equalize this pressure. Put your hands on your hips and slowly bend backward a few times before, during and after gardening.

The dirt on preventing low back pain

the NeuroReportNews from Beaumont Neuroscience June – July 2015

Stroke warning signsSymptoms of a stroke may include:• sudden numbness or weakness of the face, arm or leg,

especially on one side of the body• sudden trouble speaking or understanding speech• sudden trouble seeing in one or both eyes• sudden trouble walking, loss of balance or coordination• extremely severe headaches with no other known cause

Risk factors for stroke include high blood pressure, high cholesterol, diabetes, heart disease, atrial fibrillation and smoking. If stroke or other risk factors run in your family, you are at an increased risk to have a stroke as well. By talking to your doctor and taking preventative measures, you’ll have a much better chance of avoiding a stroke.

If you recognize any of these symptoms, call 911 immediately.

In this issueThe dirt on low back pain Summer safety starts at the top Rontal-Akervall Clinic Bulletin: “Case of the Year Award” Tips to prevent hearing loss Research update Diabetic retinopathy

• Take a short break every 10 minutes by standing and repeating several back bends. Take a longer break every 30 minutes, working in a few more back bends with time

to walk around and hydrate. • Reduce bending at the waist by working closer to the ground on all fours. Use quality, long-handled gardening tools as well as a wheelbarrow or garden cart. • When lifting heavy objects, always bend with the knees, lift with your legs and keep the bulk of the weight close to your body.

Finally, listen to your body. “If you feel discomfort or pain in your spine, take a break, change tasks or stop gardening altogether for the day,” advises Beaumont neurosurgeon Rick Olson, M.D. Hot or cold compresses and over-the-counter anti-inflammatories can help to alleviate pain.

While gardening is not considered a sporting activity, it can still lead to low back pain or injury. Spring gardening is high time for low back pain. If you

take the time to warm up, stretch, hydrate and listen to your body, back pain in the garden can become a thing of the past. When pain or discomfort persists, contact your physician or request a spine evaluation with a Beaumont doctor by calling 800-633-7377.

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P R A C T I C E S P O T L I G H T

With warmer weather just around the corner, children are looking forward to getting outside and enjoying summertime activities. At this time of year, it’s especially important that parents ensure their children are properly protected to avoid injury.

Helmets should always be worn when riding a bicycle or skateboard. They have been estimated to reduce the risk of head injury by 85 to 87 percent. However, only 20 to 25 percent of all bicyclists wear helmets. During a fall or a crash, most of the impact is absorbed by the helmet, rather than the head or brain.

Neurosurgery nurse practitioner Holly Weissman is assistant director of the Beaumont Concussion Clinic. “While bicycle helmets do very little to prevent concussion, they are extremely effective in preventing skull fractures and death from traumatic brain injury,” Weissman says.

Not all helmets are the same. Helmets with Consumer Product Safety Commission

(CPSC) and American Society for Testing and Materials (ASTM) approval are good for biking and inline skating. Multi-sport helmets with a Snell B-95 approval are designed for skateboarding, roller skating and scooters, as well as biking and inline

skating. Helmets specifically designed for exclusive use in an activity other than biking (for example, baseball or skiing) do not have to meet the requirements of the CPSC bicycle helmet standards. These helmets should meet other federal and/or voluntary safety standards.

Helmets should also fit the head

correctly to ensure the most protection. They should fit snugly. With the helmet on your head, the front of the helmet should be one to two finger widths above your eyebrows to protect the forehead. The slide on both side straps should be adjusted to form a “V” directly under and slightly in front of the ears. If possible, the slide should be locked. The helmet should not be tilted forward or backward. The buckle should be centered under the chin, and no more than one or two fingers should fit between the chinstrap and the chin.

Helmets should also be replaced if they have been involved in a crash or are damaged. The same is true if there is no CPSC, ASTM or Snell certification sticker, or if the helmet cannot be adjusted or no longer fits.

Helmets are not just for children. They are important at every age, so parents should model this behavior for their children when riding a bike.

Summer safety starts at the top

P E D I A T R I C C O R N E R

the NeuroReport

The Neuroscience Center at Beaumont Hospital, Royal Oak houses several state-of-the-art clinics. The Rontal-Akervall Clinic, a subspecialty ear, nose and throat practice, treats patients with a broad range of issues, including head and neck tumors, nasal and sinus disease, cleft and craniofacial disorders, voice and swallowing disorders, allergy, gastroesophageal reflux, snoring, hearing loss and tinnitus.

The Rontal-Akervall physicians combine innovative clinical work with academic excellence to provide quality care. When treating sinus and laryngeal diseases, the physicians first aim to help patients avoid surgery with an array of systemic and topical medical treatments. When surgery is required, the physicians are adept at the latest procedures, including minimally invasive techniques. Drs. Michael, Gene and Daniel Rontal publish and lecture on these issues. The Rontal-Akervall physicians are also recognized in the management of more rare problems, such as sino-nasal cancers.

Rontal-Akervall Clinic

“Case of the Year”Beaumont reconstructive micro-surgeon Kongkrit Chaiyasate, M.D., was awarded the Best Case of the Year Award by the American Society for Reconstructive Microsurgery. The society recognized Dr. Chaiyasate for his talent and innovation in working with Charlotte Ponce, a girl whose face was significantly damaged when she was attacked by a raccoon as an infant. The case earned national attention. Charlotte has undergone numerous surgeries

with Dr. Chaiyasate over the past three years and

has made remarkable progress.

B U L L E T I NA diagnosis of a cleft or craniofacial

disorder can be especially difficult for new parents. At the Rontal-Akervall Clinic, the initial interactions with parents and their newborn are key moments in establishing relief and confidence for a clear plan to care for the child and correct the disorder.

“Our goal is to help the infant

to more confidently grow into a young adult who has developed very nearly normal facial form, normal speech, comfort with oneself and easy acceptance into everyday society,” says Matthew Rontal, M.D.

Head and neck cancers are challenging problems that require a multidisciplinary approach. Rontal-Akervall physicians lead and collaborate with a wide array of caregivers on the Beaumont head and neck cancer team. The goal is not only to cure disease but to improve comfort and quality of life. Jan Akervall, M.D., is a leader in head and neck cancer research and in minimally invasive surgery in the throat.

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A great advantage of listening to music via an iPod is that it allows our music to travel with us anywhere. With this advantage also comes the reality that how we listen to our music may lead to lasting hearing damage. The iPod can produce a maximum of 100-115 decibels. This is the equivalent of attending a rock concert.

It has been found that individuals in their early twenties or younger may have hearing loss equivalent to typical adults in their fifties due to iPod use. Here are some ways you can avoid irreversible hearing damage while still enjoying your tunes.1. Lower the volume. Keep your volume at

less than 70 percent of your iPod’s maximum.

2. Set limits. Some music players offer a volume limit setting so you are not tempted to exceed appropriate decibel levels.

Tips to prevent hearing loss

S E R V I C E H I G H L I G H TP E D I A T R I C C O R N E R

the NeuroReport

Rebbeca Grysiewicz, D.O., director of the comprehensive stroke program, recently published two journal articles, both in the Journal of

Stroke and Cerebrovascular Diseases. The first, “A Prototype Worldwide Survey of Diagnostic and Treatment Modalities for Stroke,” focuses on gathering stroke data from low to middle income countries regarding stroke care as an important step in developing and improving stroke initiatives. Neurologists from 12 different countries participated in a Web-based survey to provide a country-specific overview of stroke care. The second publication, “Incidence, Mortality, and Risk Factors for Oral Anticoagulant–associated Intracranial Hemorrhage in Patients with Atrial Fibrillation,” discusses the incidence, mortality and risk factors that predispose patients with atrial fibrillation to develop oral anticoagulant-associated intracerebral hemorrhage.

The Beaumont Neurology Research Laboratory, directed by David Loeffler, Ph.D., D.V.M., is proud to announce the recent publication of five different manuscripts in various journals.• “Effects of tau domain-

specific antibodies and intravenous immunoglobin on tau aggregation and aggregate degradation” was published in the journal Biochemistry in January 2015. • “Should development of Alzheimer’s disease-specific intravenous immunoglobulin be considered?” was published in the Journal of Neuroinflammation in December 2014. • “Beta anti-idiotypic antibodies are present in intravenous immunoglobulin and are produced in mice following its administration” was published in the journal Autoimmunity in November 2014. • “Development of antihuman IgG antibodies and hematologic deficits but not clinical abnormalities in C57BL/6 mice after repeated administration of human intravenous immunoglobulin” was published in the journal Comprehensive Medicine in June 2014. • “Specific binding of intravenous immunoglobulin products to tau peptide fragments” was published in the International Journal of Immunopharmacology in August 2014.

Daniel Arndt, M.D., section head of Pediatric Neurology, has a recent publication in the Journal of Child Neurology titled

“The Value of 3-T Magnetic Resonance Imaging in Acute Transverse Myelitis.” This research highlights the benefits of using high resolution MRI scans for acute transverse myelitis, an inflammatory spinal cord disease that can present abruptly at any age. The finding of acute transverse myelitis was not visible on a conventional MRI scanner, but was subsequently easily identified on a high resolution scanner. Its detection clarified the diagnosis and enable tailored medical treatment for the disorder.

3. Limit listening time. How long you listen to your music can also attribute to hearing loss. Allowing your ears to rest between listening sessions is important. Apply the 60/60 rule – listen to your music at 60 percent volume for a maximum of 60 minutes at a time.

4. Don’t use earbuds. Earbuds are more likely to cause hearing damage than over-the-ear headphones. Earbuds can also be up to nine decibels louder.

5. Use noise-cancelling headphones. Environmental noise may also attribute to how

we listen to our music. We may find that we compensate for it by increasing the volume on our iPods. Reduce the need to do so by

using noise-cancelling headphones.These helpful hints may help you have

a pleasant listening experience while not sacrificing your hearing.

R E S E A R C H U P D A T E

S E R V I C E H I G H L I G H T

Individuals with diabetes are at risk for developing diabetic retinopathy, which is the most common diabetic eye disease and usually affects both eyes. People who have diabetic retinopathy typically don’t notice vision changes in the early stages of the disease, but as it progresses, it can cause irreversible vision loss.

When blood sugar levels are elevated for extended periods of time, tiny blood vessels that supply blood to the retina can become diseased. Over time, these blood vessels can become damaged or even blocked, allowing blood, fluids and fats to leak into the retina, causing swelling and decreased vision. This is known as non-proliferative diabetic retinopathy (NPDR) and it is the earliest stage of diabetic retinopathy. Importantly, studies have shown treatment can be very effective at this stage of the disease, which is why early diagnosis is essential.

If NPDR is left untreated, proliferative diabetic retinopathy (PDR) can develop. PDR refers to new blood vessel growth and is the body’s natural response to the retina’s poor supply of oxygen and nutrients the diseased blood vessels are unable to supply. These new blood vessels are abnormal and do not supply the retina with sufficient blood or nutrition.

Additionally, they are accompanied by scar tissue, which may place traction on the retina and cause it to wrinkle or detach. PDR is a more serious and advanced form of diabetic retinopathy, typically causing greater vision loss than NPDR.

Diabetic retinopathy symptoms may include:• spots, dots or cobweb-like dark strings

in the field of vision that are also known as “floaters”

• blurred vision• vision that periodically changes from

blurry to clear• blank or dark areas in the field of vision• poor night vision• colors that appear washed out or

different• vision lossContact your eye doctor immediately if you experience sudden vision changes or your vision becomes blurry, spotty or hazy.

The keys to preventing diabetic retinopathy and vision loss are maintaining strict control of blood sugar and blood pressure. The only way to detect diabetic retinopathy is to undergo regular comprehensive eye examinations.

The American Academy of Ophthalmology recommends the following schedule for eye exams. Type 1 Diabetes – within 5 years following the diagnosis and annually thereafterType II Diabetes – initial examination at the time of diagnosis and annually thereafterPregnancy – pregnant women with diabetes should schedule an appointment with an eye doctor during the first trimester

In addition to blood sugar levels, blood pressure and how long one has had diabetes, other risk factors are:• blood lipid levels• ethnicity – African-Americans, Latinos

and Native Americans are at higher risk for diabetes, therefore also at higher risk for diabetic retinopathy

• pregnancy – can sometimes worsen diabetic retinopathy and is the reason additional eye exams throughout pregnancy are recommended for diabetic women

“For patients and their physicians, studies have shown the best way to prevent vision loss secondary to diabetic retinopathy is with careful management of your blood sugar over the long term,” says Robert Granadier, M.D., clinical director of ophthalmology. “Additionally, and very importantly, when found in earlier stages your ophthalmologist can treat diabetic retinopathy and help you preserve your vision.”

Diabetic retinopathy: A real risk for those with diabetes

the NeuroReport

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Editorial TeamFernando Diaz, M.D., Ph.D.Daniel Menkes, M.D. Renee HerbertGretchen HofmannAndrea MotleyLori SheridanRachael WadeSonja Young