By Grattan Woodson, MD, FACP

Having a physician who is skilled in women’s health, understands gynecoendocrinology, and is comfortable prescribing compounded pharmaceuticals is a requirement for successful bioidentical hormone supplementation. It is this physician who will monitor your clinical response to treatment, evaluate you for any side effects, and adjust the dose of your compounded prescription to precisely meet your needs. The bene ts described below can only be obtained from a compounding pharmacy because pharmaceutical companies do not manufacture bioidenticals. All of these elements are necessary to ensure a successful outcome for a woman on balanced bioidentical hormone supplementation.

How the Hormones are Delivered

Hormone Replacement TherapyIn my opinion, the preferred way for a postmenopausal woman to supplement with bioidentical hormones is by using an elegant cream formulation of balanced hormones given vaginally at bedtime. This is done by using a simple applicator and has four bene ts. First, the dose required for topical administration is only 1/10 the dose if given orally. Second, topical use avoids these hormones passing through the liver first before going through the body, which eliminates the high risk of blood clotting seen with oral estrogen use. Third, giving the supplement as a nightly vaginal cream restores the health and function of the vagina lost at menopause, which improves intimacy. Lastly, the veins that drain the vagina are the same ones that drain the ovaries, meaning that over the six hours the hormones are absorbed from the vagina, the body receives the same bioidentical hormones the ovary would make in small doses, similar to what it would expect to receive from the same entry point nature intended.

My goal is to provide patients with as normal a hormonal background as possible, mimicking nature, to provide her with what she had before menopause.

The Importance of Staying Balanced

I advocate using four bioidentical hormones in appropriately selected postmenopausal women whether they have had a hysterectomy or not. By appropriately selected, I mean healthy women within 10 years of menopause who have not had breast cancer or cardiovascular disease. I evaluate every patient before I prescribe hormones to her to ensure I keep her safe and I monitor her regularly to ensure she stays that way.

It’s my opinion that nature intended women to have all these hormones rather than just one or two. My goal is to provide patients with as normal a hormonal background as possible, mimicking nature, to provide her with what she had before menopause. This means including bioidentical estradiol, testosterone, progesterone, and DHEA, the four principal regulatory steroid hormones that become deficient or insufficient with menopause and aging. We need all four of these hormones because they have mutually supportive, and in some instances, opposing, effects that are important for health and well-being. Incomplete replacement, which has been the traditional practice, results in less than optimal results.

Brookhaven Women’s Health and Wellness is a full-service facility dedicated to providing women in early menopause with a suite of services to help them obtain optimal health and wellness using nutrition, exercise, compounded balanced bioidentical hormone supplementation, minimally invasive cosmetic services, hair restoration, weight management, osteoporosis management, and stem cell therapy for arthritis and tendonitis. For more information, call Kim Teasley, our Director of Women’s Health Services at 404.574.2373 or visit FemeRegen.net. 

GC Woodson, MD, PC • 1418 Dresden Dr., Ste. 225, Brookhaven, GA 30319 • 404.574.2373 • FemeRegen.net 

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By Laura Janelle Downey

I’m always on the go. From 5 a.m. workouts to long days at the office and after-work events, the minute I start my day, I don’t stop. So when I do have a chance to sit down and relax, there’s no other place I’d rather be than at The Spa at Mandarin Oriental, Atlanta. I was drawn to the spa’s new Sapelo Advanced Restorative Facial for a variety of reasons but for your sake, I’ll keep my list to the top three.

(L-R) Cindy Edwards and Stephanie Duttenhaver

(L-R) Cindy Edwards and Stephanie Duttenhaver

• The founders, Stephanie Duttenhaver and Cindy Edwards, are two charming Southern belles who make beauty a top priority.

• When at The Spa at Mandarin Oriental, Atlanta, the Sapelo Advanced Restorative Facial can be had in just 50 minutes or in 80. I recommend using your time wisely and experiencing relaxation at its best in the 80-minute treatment. Book the service (only offered at Mandarin Oriental, Atlanta) with esthetician Angela Gorham—you won’t be disappointed.

• Like what you experienced? Purchase Sapelo Skin Care products after your experience. Who doesn’t love the brand’s soft green and gold packaging?!

The science behind Sapelo Skin Care is an eye-opener. “By replicating the skin’s natural peptide cascade seen in response to injury, Sapelo’s restorative skin care regimen rebuilds the skin’s natural collagen and elastin as a true antiaging process, as opposed to the dermatology dogma that skin-inflaming agents are antiaging,” says Dr. John Duttenhaver (Stephanie’s hubby!).

With just six steps, my face was cleaner, brighter, hydrated, and healthier. From the B5-infused Gentle Seaweed Cleanser to the Milk & Honey Hydrating Mask, which comes complete with healing ingredients (think milk peptides), I was in heaven! Angela also applied Sapelo’s water-based Renewing Serum and papaya-, pumpkin-, and yeast-packed Anti-Aging Enzyme Mask to my face. The all-natural products were just what I needed to get my skin back to its happy place—long story short, I used a hotel soap that didn’t treat my skin right at all!

When my service was just about finished, Angela made sure to apply Sapelo’s Spring Tide Serum, Restoring Eye Serum, a Rejuvenating Cream, and a Softening Emollient to my face. The Sapelo Advanced Restorative Facial is perfect for the woman who deserves a little pampering.

The Spa at Mandarin Oriental, Atlanta | 3376 Peachtree Rd. NE. | 404.995.7500 | MandarinOriental.com/Atlanta/Buckhead/Luxury-Hotel

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By Karen Foley

Learn more about how Windy Hill Athletic Club (WHAC) can help you reach your fitness goals while creating lifelong bonds along the way. Fitness Programming Manager Tiago Kulaif, and Tennis Director Trip Baisden, tell us more. Tiafgo Kulaif and Trip Baisden

Q: How does being social and active help people in general? What does the research tell us?

TK: Our belief is that active and social people lead happier, healthier lives.
Studies have shown that a strong social support network can be critical to help people through the stress of tough times, whether they’ve had a bad day at work or a year filled with loss or chronic illness. Friends also play a significant role in promoting overall health. Adults with strong social support have a reduced risk of many significant health problems, including depression, high blood pressure, and an unhealthy body mass index (BMI). Studies have even found that older adults with a rich social life are likely to live longer than their peers with fewer connections. Since supportive family, friends and coworkers are such an important part of our lives, it’s never too soon to cultivate these
important relationships.

Q: How does WHAC help people get social?

TB: Not only do we have social events at least once a month, all of our club programs are built on building community. For example, our Tennis in No Time (TNT) program is developed by putting people together in groups of eight to learn tennis. This creates a social aspect to the classes, which creates relationships to build on, as the members become better tennis players.

Q: What are some of the most popular ongoing programs?

TK: Squash, tennis, boot camp, cycling, and dance classes.

Q: What are some of your members favorite events?

TK: Casino Night, pool parties, and Wednesday Wine Down.

Q: What “social tribes” are at WHAC? What are they centered around?

TK: Members that fall into the “all-out, fitness elite” category enjoy challenging fitness workouts such as Voltage, Warrior, and boot camp classes. Tennis and squash have always had a social aspect to them.

TB: In tennis, we have some members that like to learn more about the game. We call them Adult Instructional (AIP). We have many little groups that have stayed together for a few years to continue to learn together. Our Top Dog group has become its own special tribe. This group of men and women play flex matches against each other and then get together for food and drinks after their matches. Members meet each other that have never met before. It has become super popular and more social, as well
as competitive.

Q: Are there groups for men, moms, business professionals, tennis lovers and others?

TK: Yes! Between our great fitness programs and tennis coaches, and over 100 group exercise classes a week—from beginner Tennis in No Time to advanced drills—there’s something for everyone.

Windy Hill Athletic Club – WindyHillClub.com

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By David Park, MD, FACS, Alexander Park, MD, FACS 

Since VeinInnovations Johns Creek opened in 2013, surgeons David Park, MD, FACS, and Alex Park, MD, FACS, and sclerotherapist Laura Egan, RN, APRN, have been helping women and men alike have healthier, more attractive legs. Here is information on the vital importance of venous health to your overall health.Vein Health Problems

Why is venous health so important?

Venous health—the health of the leg veins carrying deoxygenated blood back to the heart and lungs—impacts more than just the health of a patient’s legs. Yes, varicose and spider veins, heaviness, pain, swelling, and restlessness can all impact the legs. But because these symptoms of chronic venous insufficiency (CVI) creep up slowly, many patients don’t realize how poorly their veins are functioning until they have bulging veins, a lot of pain, and/or venous stasis ulcers.

What if people are not treated?

The longer people postpone treatment, the more involved treatment becomes. Delay increases the likelihood that heaviness in the legs has become a reason to forgo exercise, or that pain and restlessness have compromised restorative sleep. Lack of exercise and sleep become quality-of-life issues, affecting weight gain, aging—health overall. Untreated, some patients develop venous stasis ulcers, which are dif cult to treat and heal.

What causes poor venous health?

When delicate one-way valves in leg veins fail, blood flows backward and pools, causing heaviness, pain, swelling, and bulging veins and/ or spider veins. Valves fail due to age, heredity, multiple pregnancies, and/or injury. Standing or sitting for long periods of time also causes problems. Many of our patients are also athletes, weightlifters, and men and women who played contact sports when they were younger.

Who has venous insufficiency?

An estimated 33 percent of women and 25 percent of men under the age of 50 have venous insufficiency. Over the age of 50, about half of all women and 40 to 45 percent of men have problems. The percentages increase with age.

What do patients find most surprising about treatments?

Most people don’t know varicose and spider veins are symptoms of a medical condition; they believe unsightly veins are just a “cosmetic” issue. Many people don’t know insurance covers medically indicated treatments. Patients are surprised to nd out that the condition can be addressed in the of office, with little or no downtime, and that treatments bring almost immediate relief.

What treatments do you do and what is involved?

All patients begin treatment with a thorough duplex Doppler ultrasound examination. When CVI is indicated, we choose the treatment that will work best for the individual. All treatments—radio frequency ablation, laser ablation, and ambulatory phlebectomy— are performed in the office, using local anesthesia. Ablative procedures shut down a diseased vein, rerouting blood to healthier veins. Procedures take less than an hour and most patients drive themselves to and from procedures. Spider vein treatment— sclerotherapy—is quick and virtually painless. In all cases, we encourage patients to walk and resume “light” normal activity and, depending on the patient and procedure, to avoid strenuous activity for a week or two.

For appointments, a free cosmetic ultrasound, or additional information, please call 678-731-9815.

VEININNOVATIONS • (678) 731-9815 • veininnovations.com

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By Jason W. Vélez, DO 

Neck and back injuries are a pervasive problem resulting in significant healthcare costs and missed work. The good news is that the majority of patients will recover from their neck or back injuries without surgery. With conservative management including rest, physical therapy, medications, and controlled return to normal activity, these patients are frequently back to full activity within a few weeks. However, some injuries do not resolve and may require spine surgery in an attempt to get the patient back to their baseline status.Minmally Invasive Spine Surgery

Minimally invasive spine surgery refers to an exciting and rapidly expanding set of surgical techniques that are becoming available to spine surgeons. The goal of these procedures is to use technologies that minimize tissue trauma, lower blood loss, lessen postoperative pain, shorten hospital stays, and achieve results that are equal to or superior to conventional techniques.

In this article, I will discuss a few of the procedures in which minimally invasive techniques are being used in order to enhance patient outcomes.

With the advent of tubular retractors, we are able to access the pathologic anatomy with less disruption of the surrounding muscle and fascial tissue. In the cervical and lumbar spine, this has led to the ability to remove herniated discs and bone spurs in an outpatient setting. With these techniques, studies have shown that patients experience less postoperative pain, use fewer narcotic medications, have a lower incidence of postoperative infections and return to work sooner than patients treated with traditional open surgery. Some long-term studies have shown a lower incidence of chronic residual pain as well.

When more involved procedures such as fusions are required, these less invasive techniques can, in many cases, still be utilized. With the use of larger or sometimes expandable retractors, lumbar fusion can be performed as well. These approaches still allow for the removal of nerve compression and the insertion of hardware and bone grafts. Studies have shown that patients can recover faster with shorter hospitalization and return to work sooner following minimally invasive lumbar fusion.

With the availability of minimally invasive techniques, one must bear in mind that there are situations in which a minimally invasive approach may not be feasible. There are situations in which a procedure may be started through a minimally invasive approach, but because of dif cult anatomy or complications encountered, the minimal approach must be abandoned in order to safely complete the procedure. Also, the degree of pathology, the patient’s unique anatomy, and the patient’s particular body habitus may influence the surgeon’s choice of whether to use a minimally invasive approach.

Recent advances in the eld of minimally invasive spine surgery are helping to improve patient outcomes and decrease surgical morbidity. It is clear that the future of spine surgery is moving toward minimizing the approach related to trauma while treating primarily painful conditions.

While it is clear that not all patients are candidates for minimally invasive spine surgery, when used in the appropriate patient, the results can be dramatic with rapid patient recovery and high patient satisfaction.

Resurgens Spine Center • Non-surgical & Surgical Spine Care • 24 Convenient Atlanta Locations • ResurgensSpine.com 

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Having a colonoscopy isn’t something people get excited about, but preventing colon cancer before it starts should be.

In the United States, colon cancer is the third most commonly diagnosed cancer in both men and women, and it’s the second leading cause of cancer-related deaths. If that isn’t enough to concern you, colon cancer also shows no signs or symptoms until it has advanced.Rates of Colon Cancer

The good news is that colon cancer is one of the most highly preventable and treatable cancers when detected in its early stages during a screening colonoscopy.

While other colon cancer screening methods are available, a colonoscopy remains the only test that can prevent the disease through early detection and removal of precancerous colon polyps. Oftentimes, when other screening tests indicate a positive or abnormal result, a colonoscopy is performed as follow-up care.

What is a colonoscopy?

A colonoscopy is a procedure performed under light sedation that allows a trained gastroenterologist to visually inspect the inner lining of the large intestine—or colon. A thin, flexible lighted instrument called a colonoscope is inserted into the rectum and guided through the colon. During a colonoscopy, the physician is actively looking for any abnormalities and is able to proactively remove any causes for concern at that time.

When should you get screened for colon cancer?

In May 2018, the American Cancer Society released new evidence-based guidelines that lowered the recommended screening age for all average-risk adults from age
50 to age 45 (regardless of gender or ethnicity). For those with a family history of the disease, or other risk factors, screening could start even earlier.Colonoscopy View

While the physicians at Atlanta Gastroenterology Associates support this new guideline, it’s important to understand that many insurance carriers have not yet adopted this recent change. Be sure to talk to your insurance provider about your unique bene ts before scheduling your colon cancer screening.

For more than 40 years, Atlanta Gastroenterology Associates has been dedicated to providing accessible, affordable, and compassionate digestive healthcare services to communities throughout greater Atlanta. To make an appointment at a location near you, call 1.866.GO.TO.AGA [468.6242] or visit AtlantaGastro.com.

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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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