By Grattan Woodson, M.D., FACP and Kim Teasley 

Having a physician who is skilled in women’s health, understands gynecoendocrinology, and is comfortable prescribing compounded pharmaceuticals is a requirement for hormone therapy replacement success. It is this physician who will monitor your clinical response to treatment, evaluate you for any side effects you might have, and adjust the dose of your compounded prescription to precisely meet your needs. A vaginal cream with the components described below can only be obtained from a compounding pharmacy following the ordering physician’s prescription. All of these elements are necessary to ensure a successful outcome for a woman on balanced hormone replacement therapy.

How the Hormones are Delivered

In my opinion, the preferred way for a postmenopausal woman to use estradiol (a replacement for estrogen) is topically. I recommend this because the dose that effectively reverses the estrogen deficiency state caused by menopause is one-tenth of the dose needed if given orally.

The surface of the vagina is ideal for absorption of steroid hormones. Applying them in an elegant cream by applicator at bedtime is a simple way to deliver the product that serves two purposes. The hormones are easily and completely absorbed through the mucosa of the vagina, much more readily than through the skin because there is no cornified epithelium to penetrate. Secondly, the vagina, vulva and surrounding pelvic muscles are key targets for hormone replenishment in postmenopausal women.

The pelvic region is often inadequately treated with other routes of administration, be they topical, oral or injection. A dose of 10 milligrams of natural progesterone administered to the vagina via a cream combined with the other sex steroids at bedtime is usually adequate to protect the uterus. Annual monitoring Having a physician who is skilled in women’s health, understands gynecoendocrinology, and is comfortable prescribing compounded pharmaceuticals is a requirement for hormone therapy replacement success. with transvaginal ultrasound technology is a good way to be certain that this approach is effective. There should be a minimal effect on mammogram density with this dose and use of it allows adoption of the every other year mammography recommendations of the United States Preventive Services Task Force that avoids the pitfalls of annual testing.

The Importance of Staying Balanced

The forgotten sex steroid is testosterone. To obtain hormonal balance and return women to a simulated premenopausal status requires the addition of an androgen. Testosterone is necessary for women to maintain their muscle and bone mass. The loss of ovarian testosterone production at menopause robs women of half their androgen source.

The hallmark of frailty is the loss of muscle and bone mass and the replacement of that tissue with fat. Androgen deficiency makes it very hard, if not impossible, to build new muscle tissue. You can eat very healthy food, practice daily vigorous exercise but it is all to no avail. If you are androgen-deficient, the mesenchymal stem cells that become muscle, bone, cartilage, and other healthy tissues cannot change into those tissues. They become fat instead. To become a muscle cell, testosterone must occupy its receptor in the nucleus. Without testosterone, the stem cell will turn into a fat cell. This is why everyone needs testosterone.

Grattan Woodson, MD, FACP • 404-574-2373 • 1418 Dresden Dr., Suite #225 Atlanta, GA • FemeRegen.net 

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By Jill M. Golsen, DMD and Justin Parente, DMD

To understand why your tooth hurts, it’s best to start with a brief anatomy overview. A pearly, white shell called enamel covers the surface of the tooth. This hard enamel protects the core of the tooth, which is made of a substance called dentin. It’s important for dentin to stay protected because it is softer, porous, and has important microscopic tunnels. Any damage to the enamel, or to any filling repairing enamel from a cavity, acid erosion, or trauma, could expose the microscopic tunnels in dentin. These tunnels communicate with the hollow inside of the tooth, where a chamber houses a soft, pink tissue called the pulp. Tooth Sensitivity

The Source of Pain

The pulp tissue, often colloquially referred to as the nerve, contains pressure receptors and is the source of most tooth pain. Any damaged enamel or fillings can expose the dentin, which will allow fluid to shift through the tunnels and stimulate pain from the dental pulp.

Taking Care of the Problem

Whether temperature change or chewing is stimulating your tooth sensitivity, it’s time to see your dentist who will inspect your teeth and dental restorations for damage or cavities that need repair. Treatment could be as simple as a desensitizing toothpaste, a bite adjustment, or a small filling. If your tooth pain is severe, and the tooth is aching spontaneously, do not delay. Ask your dentist for a referral to an endodontist, a dentist who specializes in comfortably treating toothaches and tooth infections. Severe pain could mean the damage has caused irreversible harm to the pulp tissue, and that the tooth will likely require root canal treatment, a surprisingly gentle procedure that will quickly alleviate all of your problems. Jill M. Golsen, DMD and Justin Parente, DMD

Golsen Family Dentistry • Jill M. Golsen, DMD • (770) 667-0669 • GolsenDental.com

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By Scott D. Miller, MD

Everyone loves a great deal. It seems as though there is a sale for every season and every occasion. At some point, these falling prices create a new normal, and thereby a new expectation. But does a good price necessarily mean a good value? Of course not. But we often approach our health the same way.Fall Sale Items

We are inundated with ways of measuring our health. Here are several examples:

-Lower weight or body mass index

-Smaller waistline

-Lower cholesterol

-Lower calorie intake

All of these measurements focus on the elimination of a problem. However, the absence of disease is not the same as a picture of good health. Here are some of the questions that you should be asking yourself:

-Do I feel rested in the morning?

-Do I have the stamina to make it through a typical day without feeling totally drained in the evening?

-How many times per week do I feel stressed to a point that it takes me significant time and/or energy to return to a minimal stress level?

-What is my exercise tolerance?

Too many times in life we focus on the negative. For instance, if we feel that we are eating too many calories, we might reach for the 100-calorie packaged snack. In reality, a 250-calorie portion of fruit, cheese, and nuts would serve our health better, especially when we want to fuel our workout for the day. As a result, we focus on a positive—healthy eating rather than calorie reduction.

Study after study has shown that when we focus more on maximizing our strengths rather than minimizing our weaknesses, we boost our performance more effectively. Of course, making small decisions every day is the best way to form a good habit. So stop being your own worst critic. Stock up on a healthy item for your diet. Increase a physical activity that you already do every day. Go to sleep 30 minutes earlier (sleeping is most people’s strength).

Although all those numbers that your physician measures are important to keep in line, that should not be your daily motivation. Building on your strengths regarding healthy living is the best way to earn a good report in the doctor’s office. When it comes to our health, rather than shopping for the best sale, we should look for everyday low prices.

Look for my article on “Chapter 11 Medicine” in the next issue.

Scott D. Miller, MD, is the Medical Director of Robotic Surgery at WellStar North Fulton Hospital. He is a urologist with WellStar Urology in Roswell and has practiced in Atlanta for over 20 years.

WellStar North Fulton Hospital offers the Know Your Heart Screening that can determine your risk of heart disease, stroke and other serious conditions. Call 770-956-STAR (7827) to learn more or schedule an appointment.

Scott D. Miller, MD • WellStar North Fulton Hospital • 470-956-4230 • ScottDMillerMD.com

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By John F. Arnold, MD, MBA

The goal of any breast screening program is to find cancer early and reduce false positives.

The American College of Radiology Commission on Breast Imaging has performed a thorough review of the evidence that annual mammography screening starting at age 40 for women of average risk can decrease breast cancer mortality by about 40%. Benefits of screening also include tumors being found earlier and the ability to discover high-risk lesions earlier.Screening Mammography

Supported by Research

Over 70% of cancers occur in dense breasts. Mammography has limitations in imaging dense breasts. The ASTOUND study is defined as adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts. This was a multicenter screening trial of tomosynthesis and adjunct ultrasound screening in women with dense breasts. Adjunct ultrasounds led to significantly higher incremental breast cancer detection, the rate per 1,000 screening mammograms was 7.1/1,000 screening exams for ultrasound and 4.0/1,000 screening exams for tomosynthesis.

Three studies—European Asymptomatic Screening Study, SOMO•INSIGHT Clinical Study, and performance studies by Shane, et al.—included adding 3-D automated whole breast ultrasound to screening mammography to improve the performance of mammographic interpretation. Adding 3-D automated whole breast ultrasound has shown a significant increase in invasive cancer detection with a nominal insignificant decrease in specificity. Eighty-five percent of cancers found with screening ultrasound are node negative invasive cancer.

OPI is Leading The Way

OutPatient Imaging is introducing 3-D automated whole breast ultrasound at its Atlanta location. Even better, OutPatient Imaging will be performing an automated 3-D screening breast ultrasound as an adjunct to all screening mammograms with no additional cost to the patient during the introductory phase. Ultrasound is fully automated and takes approximately 30 seconds per breast. The exam requires no external compression other than the patient’s own body weight. The 3-D images generated from the ultrasound will be interpreted by the radiologist as an adjunct to the patient’s screening mammogram. Three-D automated breast ultrasound does not utilize ionizing radiation as tomosynthesis uses, therefore it can reduce the radiation exposure to the patient.

OutPatient Imaging is proud of its commitment to women’s health and will continue to offer patients a choice for all of their imaging needs.

OutPatient Imaging • 2284 Peachtree Road N.W., Atlanta, GA 30309 • (404) 225-5674 • OutPatientImaging.net

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TurningPointTurningPoint Breast Cancer Rehabilitation is a unique nonprofit organization that improves quality of life for breast cancer patients by providing, promoting and advocating specialized and evidence-based rehabilitation. Services include physical therapy, massage therapy, counseling, exercise classes, and education programs. TurningPoint is located in a clinic off Roswell Road in Atlanta.

Details: TurningPoint Breast Cancer Rehabilitation, 8010 Roswell Rd., Ste. 120 Atlanta, GA, 30350 (770) 360-9271, MyTurningPoint.org

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Massage Envy - Total Body StretchAs part of its mission to provide complete body care, Massage Envy recently added the Total Body Stretch service to its repertoire of massage and facial treatments. The assisted stretching option is rooted in the Streto® Method, which uses 10 targeted stretches to help muscles achieve maximum flexibility and boost exercise performance. The protocol was developed by a talented team of experts (a chiropractor, a massage therapist, and an ergonomist) exclusively for the nationwide spa.

Ideal for those who lead active lifestyles and would like to enhance their athletic performance or simply add to their workout recovery routine, the service is also a favorite of players of the PGA Tour. The TOUR Championship recently stopped by the East Lake Golf Club, and Best Self Atlanta received an exclusive look at the Massage Envy Player Performance Center. The mobile athletic wellness facility is a haven for players to receive crucial rehabilitative and preventative care, such as the Total Body Stretch, from physical therapists, chiropractors, and trainers.

Though the tour has left town, the signature service is available to weekend warriors and professional athletes alike at all Massage Envy locations. It can be added to the beginning of your massage appointment as a 30-minute segment or can be booked on its own just like any other appointment.

Details: MassageEnvy.com/Stretch

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Andria Lavine Inspire Yoga JournalIn 2016, local photographer Andria Lavine began sharing her transformational yoga journey and plant-based diet on Instagram—unintentionally inspiring an entire community of nearly 1,200. The outreach from followers motivated her to author “Inspire,” a series of interactive yoga journals. The mini e-books ($3) share a handful of poses, descriptions, and meaningful experiences, aimed at encouraging practitioners to document their own thoughts and journey. Today, Lavine has released five volumes, covering poses like the common Chaturanga to more complicated ones such as Bird of Paradise.

Details: ALavinePhotography.com/InspireYoga

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J.Hilburn - Grace DunnFor men, looking fabulous is a no-brainer thanks to J.Hilburn and the personal styling services of Grace Dunn. Based on your lifestyle and preferences, the company allows you to choose from Italian-made dress shirts and pants, polos, and more to build a custom wardrobe. Clients have a say in every detail, from stitching color to button material. This fall, look out for the brand’s new reversible bomber jacket and seasonal hues.

Details: GraceDunn.JHilburn.com

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By day, Dawn M. Richards is a legal executive for a Fortune 500 company. By night, she is the founder of the food, travel and lifestyle blog and brand, D.M.R. Fine Foods. The self-taught cook with over a decade of experience has also taken courses at the private Culinary Institute Lenôtre in Houston and Le Cordon Bleu Paris, been a culinary instructor for Williams Sonoma, and even won the taco category of the Cooking Channel’s “Perfect 3 Recipe Contest.”

Roasted Pineapple and Shrimp SkewersINGREDIENTS:

• 1 pound shrimp, peeled and deveined

• 1 fresh pineapple, diced into cubes

• 2 teaspoons Old Bay seasoning

• ½ teaspoon kosher salt

• ½ teaspoon freshly ground black pepper

• 2 tablespoons olive oil

• 1 tablespoon brown sugar

• 1 tablespoon cilantro

• Fresh limes for garnish

DIRECTIONS:

Preheat oven to 425 F. On a baking sheet, toss together shrimp, Old Bay seasoning, ¼ teaspoon salt, ¼ teaspoon pepper and 1 ½ tablespoons olive oil. Roast in preheated oven for 5-6 minutes. Set aside.

On a separate baking sheet, toss together pineapple, brown sugar, ¼ teaspoon salt, ¼ teaspoon pepper and ½ tablespoon olive oil. Roast for 15 minutes.

Add roasted shrimp, pineapple, and cilantro to skewers. Garnish with more chopped cilantro and fresh lime juice. Enjoy!

Details: DMRFineFoods.com

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By Wyndi Kappes

Mauro interacts with an angel in his dream.

Mauro Interacts with an Angel in his Dream.

In a magical land somewhere between heaven and earth, you’ll find Corteo by Cirque du Soleil. The Italian word corteo is cortege in English and means funeral procession. Corteo tells the story of Mauro the Dreamer Clown as he pictures his own funeral in a carnival setting. Exciting adventures unfold, both funny and bittersweet, as the clown relives old memories such as a childhood beach day (seen in the Artist Marionette act) and imagines out of this world new adventures like the Helium Dance where he holds the floating Clowness on one hand.

Venturing to places familiar and far out, the 51-person cast presents 16 intense acts from juggling to an aerial dance on swinging chandeliers. In the last act of Mauro’s dream, his friends (10 high-flying men of the Tournik act) send him off on his way with a celebration. Andre Kushneryk, one of the amazing Tournik performers, sat down with us to talk about what you can expect from the arena version of Corteo, why he joined the cast, and his life on the road.

Q: What sets Corteo apart from other Cirque du Soleil shows?

The Hula-Hoop Act

The Hula-Hoop Act

A: One big difference between Corteo and other shows is that all of the cast members are playing humans. We play real people, ourselves, compared to other shows where artists are playing the roles of imagined creatures like bugs or animals. The stage is also different. Reimagined as a circle, the audience is given a view of both sides of the stage, and can see things more from our point of view. The move from big top to arena has led us to add two new acts as well—the suspended pole and the hula-hoop act.

Q: How did you get involved with Cirque du Soleil, and Corteo, specifically?

The Helium Dance

The Helium Dance

A: Early in my time performing in the circus I saw Corteo on DVD—I had never seen a show live before I became a cast member—and I wanted to be a part of it. In particular, I remember watching a Tournik actor and I was impressed and inspired by what he was doing. A few years later, I was picked for the same show and ended up playing the same role that had inspired me to send in a tryout video years ago.

Q: What is it like performing in the Tournik act? Is there more pressure or is it exciting to be in the last act?

A: The ending should be strong and powerful so it brings a little more pressure on me because I want people to feel touched by the show. The pressure is manageable for me now because I have been doing it for 13 years but it is always a little bit nerve-wracking. In the end, I do enjoy being a part of the last act.

The Tournik Act

The Tournik Act

Q: What do you do to stay in shape for such physically demanding acts?

A: We travel with gym equipment where we can work out daily. We also warm up a lot before each training session and performance. Generally we have sit-ups included, along with several exercises that will vary according to our discipline on the show.

Q: What do you enjoy most about being a member of the Cirque du Soleil team?

A: It is wonderful to be on the road, meeting new people, getting exposed to new things, and trying different foods. I’m a nature lover, and in South America there was plenty for me to see. Places that impressed me the most were the Perito Moreno Glacier in Argentina and the whole Patagonia region where I ate the best lamb ever! Also, Ushuaia, a small town in Argentina, situated at the southernmost point of South America, is named “The End of the World” and has some nice wines. It’s also the motherland of penguins and sea lions.

The Artist Marionette Act

The Artist Marionette Act

Another experience that really touched me was the “Inca Trail”— a four-day hike through Peruvian rainforests to the top of Machu Picchu. Plus, I did a road trip through Costa Rica. I love how Costa Ricans take care and protect the environment and promote “Pura Vida” [Pure Life]. It’s a happy and meaningful way of life for all living beings including the planet itself. Discovering this made a big impact on me. Since the beginning of this year, I’ve been traveling in the United States. I really enjoyed New Orleans for the rich jazz culture and Colorado for the magnificent nature views.

Q: What is next for you?

The Chandelier Act

The Chandelier Act

A: I love this show. I hope to keep touring with Cirque du Soleil as long as Corteo is on the road. I do have some hobbies—I like music and play the drums as much as I can. Performing onstage is my main passion though and I hope to do it as much as I can for as long as my body allows me to.

Since its production in 2005, the big top show of Corteo by Cirque du Soleil has drawn 8 million people in 64 cities across 19 countries and four continents. Now reimagined as an arena performance, join in on the fun at the Infinite Energy Center Aug. 29 through Sept. 2. Tickets start at $35 and can be purchased through CirqueduSoleil.com.

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