Trust Your Intuition: Early Signs of Autism

By Dr. Erin Walton-Doyle, an Internal Medicine and Pediatrics physician with St. Joe’s Medical Group and St. Mary Mercy Livonia

Parents often tell me about a feeling or gut instinct they have about their child. Sometimes it’s a sense their child has an ear infection, other times it’s a premonition their child is in danger.

I tell parents to trust that intuition not only when it comes to a common cold but with concerns about developmental delays. Asking questions or sharing a concern about your child’s behavior is important in order to get a diagnosis and start treatment, if necessary, as soon as possible.

Autism, or autism spectrum disorder (ASD), is a serious developmental disorder that impairs the ability to communicate and interact with others. More than 200,000 cases of autism are diagnosed in the United States each year. While there is no cure, autism can be treated to help reduce symptoms and provide developmental support. The key is early diagnosis and intervention.

Autism can be recognized at a young age – even before a child begins speaking. If a child has autism, parents may notice the child struggling with communication challenges, limited social interactions or repetitive behaviors. Although every child is different, the following behaviors may be present:

  • Avoids eye contact
  • Does not respond to a smile or other facial expression
  • Does not look toward the direction in which someone is pointing
  • Facial expressions are different than what would be expected for a given situation
  • Unable to perceive what others are thinking or feeling by looking at facial expressions
  • Lack of concern or empathy for others
  • Lack of interest in making friends
  • Has not spoken a word by 16 months
  • Repeats what others say without understanding the meaning
  • Does not respond to his or her name but responds to specific sounds
  • Mixed pronouns, such as referring to him or herself as you and others as I
  • Lack of interest in communicating
  • Does not start or continue a conversation
  • Does not use toys or other objects to represent people or real life in play
  • Good memory of numbers, letters, songs or a specific topic
  • Rocks, spins, sways, twirls fingers, walks on toes for a long time, or flaps hands
  • Insistent on routine, order and rituals
  • Extremely frustrated and angry with change
  • Obsessed with a few or unusual activities and does them repeatedly
  • Plays with parts of toys instead of the whole toy (wheels of a truck)
  • Sensitive to smells, sounds, lights, textures or touch
  • Unusual vision or gaze
  • Challenging bowel control
  • Sleep disturbances

Parents who notice some of these behaviors in their child should trust their instincts. If you have a concern about the way your child plays, learns, speaks, moves or interacts, talk to your pediatrician. You are an advocate for your child and you know your child better than anyone. If you have a concern, trust your instinct. It is better to ask questions and begin a dialogue with your pediatrician now.  Autism can be diagnosed before the age of two and there are resources available to help your child progress developmentally. While it might be concerning to hear the diagnosis that your child has developmental challenges, knowing the diagnosis and how you can help will give your child the best possible outcome.

This article was written by Erin Walton-Doyle, M.D., an Internal Medicine and Pediatrics physician with St. Joe’s Medical Group and St. Mary Mercy Livonia. Dr. Doyle specializes in pediatric primary care and has a special interest and experience with children with developmental disabilities. She has a medical degree from Michigan State University College of Human Medicine and completed a residency at Wayne State University/Detroit Medical Center. Dr. Doyle is board certified by the American Board of Internal Medicine and the American Board of Pediatrics. Dr. Doyle can be reached at 734-655-8200.

Join us at our 2019 Healthy Kick-Off on May 18


CANTON – Join us on Saturday, May 18, from 1 to 4 p.m. for our annual Healthy Kick-Off event at St. Joseph Mercy Canton Health Center.

This free, fun-filled afternoon will feature bike helmets and fittings, access to our Health Exploration Station, health screenings, a meet-and-greet with players from AFC Ann Arbor, a rock wall and teddy bear clinic. Enjoy family fun including:
  • Bike Helmets and Fittings – Limited Supply
  • Skin Cancer Screenings
  • Arctic Edge Street Hockey
  • KONA Ice Truck
  • Meet players from AFC Ann Arbor
  • Semi Pro Soccer Team
  • Rock Climbing Wall
  • Teddy Bear Clinic

Health Exploration Station Celebrates 20 Years! Explore Michigan’s first interactive education center with exhibits to engage all your senses – walk through a giant human body, listen to the rhythm of your own heart beat and test your skills as a surgeon in the brain operating game. A must-see for kids and kids at heart.

We look forward to seeing you there! For more information, visit our website.

What You’re NOT Eating Might Be Hurting You

If you’re like most Americans, you’re not getting enough of one vital nutrient.

by Debbie Koenig

This article was originally published in Sharecare.

What if a single nutrient could:

  • lower your risk of death over time by 15 to 30 percent
  • lower cholesterol and blood pressure
  • help you maintain a healthy weight
  • reduce odds of developing diabetes, coronary heart disease, stroke and certain cancers

According to a new review, eating enough fiber—the humble roughage that passes through you undigested—may do all that and more.

The research, published in The Lancet, looked at data from 185 prospective studies and 58 clinical trials with over 4,600 participants. A clear link emerged between how much fiber participants ate and their health. Those who took in between 25 and 29 grams a day showed greater benefits, but it is suggested that even higher intakes of fiber could produce healthier outcomes.

Robert Breakey, MD

Why fiber?
Funny thing about fiber: It has a multitude of both direct and indirect health benefits, says Robert Breakey, MD, head of IHA’s Family Medicine Division, part of Saint Joseph Mercy Health System in Ann Arbor, Michigan.

Foods that contain fiber have direct benefits like an increased transit time and nourishing our microbiome. Fiber is also indicative of unprocessed plant-based foods that have a host of other beneficial nutrients like antioxidants, high quality plant proteins, and phytonutrients.

Fiber only appears in plant-based foods like fruits, vegetables, whole grains, nuts, seeds and beans, the very stuff stressed by the Dietary Guidelines. “Fiber is a marker for good healthy foods,” Dr. Breakey says. “People who eat higher fiber do better because of what comes with it.” Fiber also keeps you feeling full, which may help you to eat less and avoid carrying excess weight.

But fiber doesn’t just bring along all those powerful nutrients. While it’s traveling through your body, fiber feeds your gut microbiome, home to upwards of 30 trillion microorganisms that nourish the colon, eliminate toxins, produce nutrients, balance hormones, lower inflammation and support your immune system. If you don’t feed the microbiome properly, harmful bacteria grow, which can lead to a variety of illnesses. “We say a pregnant woman is eating for two,” says Breakey, “but we should really think that each of us is eating for 30 trillion and one.”

There are two types of fiber, soluble and insoluble, with most plant-based foods containing some of each. The soluble kind, which dissolves in water, keeps your body from fully absorbing dietary fat and cholesterol—which can help lower your “bad” cholesterol count. It also helps you digest food more slowly, which evens out your blood sugar levels.

Insoluble fiber, on the other hand, feeds the bacteria that make up the bulk of your stool, which keeps things moving through your digestive system.

Fiber in your diet
The recommended daily intake of fiber for adults 50 years or younger is 38 grams for men and 25 grams for women. It’s advised that men over 50 try to eat 30 grams of fiber, while women over 50 should take in 21 grams

If you’re anything like the typical American, your fiber intake covers around half that amount. That’s because processed foods make up more than half of our diets. On average, more heavily processed the food, the less fiber it contains.

If you’re averaging 15 grams of fiber a day, doubling that may seem daunting. Breakey advises starting slowly. “Even moving from the standard American diet to eating an extra serving of vegetables a day is progress,” he says. “Every time you eat, it’s an opportunity to eat something better.”

Adding too much fiber too quickly may cause a few unpleasant side effects like bloating, flatulence or gas. If you experience any of these, add fiber-rich foods to your diet slowly and be sure to drink plenty of water.

Once your body gets used it, there’s no need to stop at 25 grams per day. The study published in The Lancet found that higher fiber intake is associated with greater protection against cardiovascular disease, type 2 diabetes and colon cancer. Breakey personally recommends eating even more fiber—at least 60 grams per day. “Ultimately your goal should be to have fiber in every bite,” he says.

That doesn’t mean you should turn to a supplement. Breakey says that a supplement would only provide fiber from a single plant product. It won’t bring with it the nutrients you get from eating a variety of whole, fiber-rich foods. He advises reserving fiber supplements for the occasional bout of constipation, which is also a sign of a diet that’s too low in fiber. Once the supplement helps clear things out, aim to add more whole foods that are naturally high in fiber.

A high-fiber diet plan
Once you’ve started to add more unprocessed, plant-based foods to your diet, bringing your total over 25 grams a day isn’t as tough as it sounds. It can be as simple as starting to add a vegetable or fruit to every meal.

Here’s what a sample high-fiber day might look like:


  • 1 cup shredded wheat cereal (with no sugar) (6.1 grams)
  • Milk (0 grams)
  • Coffee or tea (0 grams)
  • 1/2 cup raspberries (4 grams)

TOTAL: 10.1 grams

Sandwich made with:

  • 2 slices 100% whole wheat or grain bread (3.8 grams)
  • 1/2 cup avocado (4.9 grams)
  • 1/2 cup tomato (1.1 grams)
  • Cheese or turkey (0 grams)
  • Banana (3.1 grams)

TOTAL: 12.9 grams


  • 1 ounce almonds (3.5 grams)
  • 1/2 cup dried apricots (4.5 grams)

TOTAL: 8 grams


  • Chicken (0 grams)
  • 1 cup roasted broccoli (5.1 grams)
  • 1 medium baked potato with skin (4 grams)
  • Butter or sour cream (0 grams)
  • 1 slice store-bought cherry pie (1 gram)

TOTAL: 10.1 grams

DAILY TOTAL: 41 grams

Once you achieve this level, continue to replace any food lacking fiber with whole plant-based alternatives to increase the amount of fiber you eat per day.

What about fruit?
Fruit is high in sugar, and you may have heard that nutritionally speaking, sugar is the bad guy. That’s not necessarily wrong—but added sugar is the real culprit. As you can see in the daily menu above, fruit can provide a significant amount of fiber to your day.

“The difference is that this is a natural form of sugar that comes along with everything else nature provided in that fruit,” says Breakey. “The fiber, the complex carbohydrates, the proteins, even small amounts of fat—everything else in that strawberry or apple slows the digestion of the sugar and this makes whole fruits a very healthy food.”

If you’re doing Keto (or Paleo, or Atkins…)
Low-carb diets have become extremely popular over the last few decades as a way to lose weight. Carbohydrates come in three main types: sugars, starches and fiber. By now you may recognize the problem: Because fiber is a type of carbohydrate, low-carb diets can make it very difficult for you to eat enough to provide all those benefits and nearly impossible if you are striving for a high amount of fiber intake.

While these plans restrict your total carbohydrate intake (and may even banish whole grains and beans completely), they do allow you to eat certain vegetables and fruits, as well as nuts. Still, for those seeking to increase their fiber intake, these diets likely will not match your health goals. Weight loss, blood sugar control and vitality may be better achieved with a healthy, whole foods-based diet.

Isn’t it time you have a colonoscopy?

Colon cancer kills 51,000 Americans every year. That’s more people than a full stadium at Comerica Park. But here’s the good news: Colon cancer is more than 90 percent preventable if detected early. Read that sentence again. Colon cancer is more than 90 percent preventable if detected early. Think of the lives we could save if we just got more people to talk about colons, rectums and bowels and go get checked out. Continue reading “Isn’t it time you have a colonoscopy?”

Probility Now Offering Comprehensive Pediatric Therapy

ANN ARBOR – Probility Physical Therapy now offers comprehensive pediatric services, including PT, OT and speech.

Led by Dan Santioni, PT, Katherine McKimmy, OT, and Erin Saotome, MA, CCC-SLP, Probility’s pediatric program is geared toward children 0 to 12 years old, and offers a full array of services that address developmental delays or disabilities, neurological disability, sensory integration disability, fine motor impairment, speech and feeding concerns, torticollis to toe-walking and post-surgical rehabilitation needs.

Services are provided at the Clark Road location Monday to Friday, 7 a.m. to 6 p.m.*:

PT , OT and SLP
Probility Pediatric Therapy
3145 W. Clark Road
Ypsilanti, MI  48197
Phone:  734-712-0566
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*SLP services can be arranged at the Howell Probility office for patients who do not need the entire pediatric team approach.

Be a Blessing for Others

(Pictured left to right) Connie Schuby and Amanda Saracino (Greenbrook Recovery Center behavioral health therapists), Evan Koorhan, and Suzie Antonow (manager of Outpatient Behavioral Services)

Evan Koorhan completed the intensive outpatient program at Greenbrook Recovery Center and now volunteers to help others fighting addiction.

Between managing a local eatery and volunteering with substance abuse programs several times a week, Evan Koorhan lives a busy life. He recently bought a house with his girlfriend and values fellowship with his friends – two gifts he says wouldn’t have been imaginable a few years ago, when he was stuck in the cycle of addiction.

For years Evan used drugs and alcohol to cope with stress and anxiety.

“The only joy I was deriving out of life was using drugs and alcohol and partying with my friends,” he said.

While he was able to hold a job as head coach of a varsity water polo team, and even graduate in 2014 from Eastern Michigan University, Evan kept reverting back to alcohol and marijuana, despite how hard he tried to stop. He even dabbled in therapy, to little avail.

“It was the same thing over and over again, and I couldn’t break the cycle. I would try,” he said.

Evan’s wake-up call came on Father’s Day 2015. A police officer visited the house after Evan, in a drunken state, had left the scene of a car accident. After receiving an alcohol assessment in the jail intake room, Evan was recommended to enroll in an intensive outpatient program (IOP) as part of his probation.

After calling around to a few places, Evan stumbled upon the Greenbrook Recovery Center at St. Joseph Mercy Ann Arbor, which offers comprehensive services to adults and their families experiencing alcohol and other drug-related problems.

Evan said he noticed right away that the team approach of Greenbrook’s intensive outpatient program – having one-on-one access to a therapist, but also to physicians who could explain the science behind addiction and to other people fighting addiction – created a strong foundation for true recovery to begin.

“I felt like I had a multi-pronged attack on my disease, and it also opened my eyes to the fact that I was anxious and depressed,” Evan said, crediting social workers Fred Prezioso and Connie Schuby for guiding him every step of the way. The encouragement and structured support in an outpatient setting helped Evan transition back into everyday life.

After completing 12 sessions over four weeks at Greenbrook, Evan attended weekly meetings for 10 months as part of his early recovery after-care group. During that time, he learned an important principle about addiction recovery.

“I have to share what my experience and what my strength and hope has for other people in order to keep what I’ve been given,” he said.

So when Evan was asked to volunteer as a co-facilitator for Greenbrook’s 12-step recovery program, he seized the opportunity to teach others what he learned on his journey back to health.

Today, more than two years later, Evan is hesitant to call himself “cured” of addiction, choosing instead to credit his success to his willingness to listen to the professionals at Greenbrook Recovery Center and those who lived this journey before him.

“Some would call it grace,” Evan said, adding, “one of the biggest things that I’ve done in order to carry the message and help other people is to stick around at Greenbrook and volunteer there,” Evan said.

Evan admits recovery isn’t a journey he can choose for someone else. But he hopes that by continuing to share his story, he will encourage others to realize there is help for addiction, and finding the right program and network can help guide them back to their best selves.

“That’s a huge blessing in my life today. I am who I say I am.”

To learn more about Greenbrook Recovery Center, visit

Want to Keep Your Heart and Brain Young? Do This

Making this key lifestyle tweak keeps you mobile as you age—but that’s not where the benefits end.

by Kristen Sturt

This article was originally published in Sharecare.

Here’s a startling fact: About 3 in 4 American adults don’t get the recommended amount of physical activity, according to the Centers for Disease Control and Prevention.

Even more sobering: Many adults don’t get any activity at all, aside from what they need to make it through the day. And as we age, more and more of us stop moving. Almost 23 percent of adults between age 18 and 44 are sedentary. For those 65 and older, it’s around 32 percent.

While you likely know that long-term inactivity weakens your bones and muscles, you may not realize that it can damage your heart and brain, too. This, in turn, raises your odds of dementia and heart disease, among other conditions, and can lead to early death.

But research suggests that getting exercise can help keep these organs healthy and delay or prevent their decline. And if you regularly work up a sweat over a number of years? All the better.

“You really need to think about ways to keep moving,” says Kevin Bohnsack, MD, a family medicine physician at Saint Joseph Mercy Health System in Ann Arbor, Michigan. “Everything that increases your overall activity can ward off that sedentary lifestyle,” he adds—along with the cardiac and cognitive problems that can come with it.

How exercise benefits the heart
As you progress through middle age, your heart gradually begins to weaken. Its walls get thicker and less flexible, and your arteries become stiffer. This raises your risk for high blood pressure (hypertension) and other heart problems, including heart attack and heart failure. And if you’re sedentary, that risk goes up even more.

When you exercise, your heart beats faster, increasing blood flow and supplying your body with necessary oxygen. The more you work out, the stronger your heart gets and the more elastic your blood vessels become. This helps you maintain a lower blood pressure and decreases your chances of developing many cardiovascular problems.

It’s aerobic exercise—also called cardio—that really does the trick. Research suggests that consistent, long-term moderate or vigorous cardio training may be most helpful, though any physical activity promotes good heart health. “It can be anything from running to biking to rowing,” says Dr. Bohnsack. “Anything that builds up that heart rate.”

Getting in shape benefits your heart in other ways, too, by helping neutralize risk factors linked to heart disease. Exercise is associated with:

  • A reduction in inflammation
  • An increase in HDL (“good” cholesterol) and decrease in LDL (“bad” cholesterol)
  • Maintaining a healthy weight and staving off obesity

And though more studies are needed, research increasingly shows that exercise can boost your heart health no matter your age. For example, for one small study published in March 2018 in the journal Circulation, 28 middle-aged men completed two years of high-intensity exercise training. Compared to a control group, scientists found the exercise reduced their cardiac stiffness and increased their bodies’ capacity for oxygen use—both of which may slash the risk for heart failure.

For another study published in the August 2018 issue of Journal of the American Heart Association, researchers gave heartrate and movement sensors to 1,600 British volunteers between the ages of 60 and 64. After five days, they found that more active people had fewer indicators of heart disease in their blood. Not too shabby, boomers.

How exercise benefits the brain
What’s good for your heart is generally good for your mind—and research shows breaking a sweat on a regular basis can boost brain health in several ways.

First, exercise is tied to improved cognition, which includes better memory, attention and executive function—things like controlling emotions and completing tasks. It can enhance the speed with which you process and react to information, too, along with your capacity to draw from your past knowledge and experiences.

Getting physical is also linked to slower age-related cognitive decline, where we gradually lose our thinking, focus and memory skills. “In other words,” says Bohnsack, “if you like where you are, it’s a good idea to continue to exercise because that may at least help you retain your current cognitive function.”

And though the jury is still out on whether it improves symptoms, exercise may help prevent or delay dementia, including Alzheimer’s disease. For example, one 2017 review in The Journals of Gerontology: Biological Sciences found that activity was associated with a lower risk of Alzheimer’s down the line. The link was strongest for people who purposely exercised in their spare time, rather than those who had physically active jobs. This suggests mental benefits may depend on your chosen activity, in addition to the time you put into it.

How does exercise do all this? Scientists aren’t completely sure. It’s thought that working out improves blood flow and oxygen delivery to the brain, helping it function better. Some research indicates it prevents shrinkage of the hippocampus—the part of the brain crucial for learning and remembering things. Experts also believe it stimulates chemical activity in the brain that could contribute to better cognition.

Finally, exercise may help lower your chances of developing other conditions connected to dementia, including cardiovascular disease.

When can you start?
No matter our age, pretty much all of us can gain from exercise. “There is evidence to suggest that doing more vigorous exercise earlier in life is more beneficial,” says Bohnsack, “but it’s never too late to start because everyone benefits from doing some sort of movement or physical activity.”

In addition to its rewards for the heart and brain, working out:

  • Boosts your mood and energy
  • Helps prevent injuries
  • Lowers your risk of other diseases associated with aging, like arthritis
  • Helps you remain independent

Government exercise guidelines recommend that adults shoot for 150 minutes or more of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity weekly. Ideally, it should be spread across several days. Cardio activities like walking, biking, swimming, bowling, gardening and dancing are good options for older adults.

Your regimen should also incorporate some strength training, along with balance and flexibility moves. (Think yoga or tai chi.) They can help keep you mobile and reduce injuries—especially from falls, which are often catastrophic for older people’s health.

Ease into your routine
Of course, older adults should always speak with a healthcare professional (HCP) before beginning any new regimen, especially if you have a chronic condition, like heart disease. Your HCP can help you decide on a safe, effective routine attuned to your fitness level.

And remember: Even if it’s just a short walk, any exertion is better than none. “Taking steps during the day to do physical activities or movement can be just as beneficial as if you joined a gym,” says Bohnsack. To start, he suggests simple moves like doing squats at work or parking farther away from your office so you can log a few extra steps.

It may help to use an app like Sharecare (available for iOS and Android) to help you track your daily activity.

Whatever you do, Bohnsack says, you must decide if planting yourself on the sofa is worth your long-term brain and heart health: “As I emphasize to patients, ‘A rolling stone gathers no moss.’”

Know Your Risk for Disease

Did you know heart disease is the leading cause of death worldwide? Stroke follows second. Even these conditions do not result in death, they cause disability and diminish quality of life. Know the risks and reduce your chance of having a heart attack or stroke.

Risks factors include:

  • High cholesterol
  • High blood pressure
  • physical inactivity
  • Obesity/being overweight
  • Diabetes
  • Stress (leads to poor lifestyle choices)
  • Alcohol (raises blood pressure and triglycerides)
  • Diet and nutrition (affects cholesterol, blood pressure and obesity)

What is PAD?

Peripheral Artery Disease (PAD) is a serious condition that causes arteries in the legs to become narrowed by plaque. When arteries are clogged, blood flow to the legs and feet is reduced, causing pain and making it difficult to walk.

Symptoms of PAD include muscle pain or cramping in legs after activity, wounds on the legs or feet that are slow to heal, changes in your skin color or temperature of your feet and legs and odd growth changes in your toe nails.

Your risk for developing PAD is increased if you have history of smoking or other health issues such as diabetes, high cholesterol, high blood pressure or obesity. Your age or family history may also be a factor.

There are new, minimally invasive ways for trained cardiologists to help open arteries, reduce symptoms and ensure quality of life is improved. If you’re concerned you’re at risk, talk to your doctor to learn what you can do to lower your risk for disease.

Understanding Your Heart’s Function

Understanding how the heart functions may help you feel more in control of managing your behaviors. The information offered is from the American Heart Association:


Tricuspid Valve

  • Closes off the upper right chamber (or atrium) that holds blood coming in from the body.
  • Opens to allow blood to flow from the top right chamber to the lower right chamber (or from right atrium to right ventricle).
  • Prevents the back flow of blood from the ventricle to the atrium when blood is pumped out of the ventricle.

Pulmonary Valve (or Pulmonic Valve)

  • Closes off the lower right chamber (or right ventricle).
  • Opens to allow blood to be pumped from the heart to the lungs (through the pulmonary artery) where it will receive oxygen.

Mitral Valve

  • Closes off the upper left chamber (or left atrium) collecting the oxygen-rich blood coming in from the lungs.
  • Opens to allow blood to pass from the upper left side to the lower left side (or from the left atrium to the left ventricle).

Aortic Valve

  • Closes off the lower left chamber that holds the oxygen-rich blood before it is pumped out to the body.
  • Opens to allow blood to leave the heart (from the left ventricle to the aorta and on to the body).