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.

Breast Cancer ScreeningSupported 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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Jill GolsenBy Jill Golsen, DMD

Did you know? The number one cause of death from oral cancer is related to human papillomavirus (HPV). According to the Centers for Disease Control and Prevention, this will be an epidemic that affects more than 80 million people over the next 20 years.

While cervical cancer is associated with HPV, oral cancer is too. Here is the scary part—oral cancer doesn’t hurt. You often don’t feel its wrath until you have advanced symptoms.

We used to think that if you were a smoker, you had the highest chance of getting oral cancer. People are not smoking like they used to, so why are rates of oral and tonsillar cancer still so high? HPV.

There is a lot of buzz about getting your children vaccinated for HPV. The problem for adults is that if you have ever been sexually active, you could have, and still can, contract HPV. While there are over 200 strains of the virus, there are only two that are associated with cancer—HPV 16 and 18. Your general practitioner, gynecologist or urologist can test you.

Oral Cancer and HPVAs a dentist, I always do an oral cancer screening at every hygiene visit. Any sore in your mouth that hasn’t gone away in 2 weeks needs to be followed up by a visit to an oral surgeon or an ear, nose, and throat doctor.

Look out for advanced symptoms (conditions that last more than 2 weeks) that might include:

  • A persistent hoarseness or sore throat
  • Difficulty swallowing
  • A swollen but not painful tonsil
  • A red, white or black discoloration on the soft tissue in the mouth.

Make sure your dentist performs an oral cancer screening even though you don’t smoke. Cancer sneaks up on us!

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

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Jon RamirezBy Karen Foley

Why is it so important for mothers to take time for themselves?

Moms are often pulled in a million different directions and it can be difficult to carve out time for self-care. Having time to focus on their own health not only makes them stronger physically and mentally, it can even make them better moms.

Moms love the club as a respite and a great place for their kids to interact with other kids. Mothers feel comfortable bringing their children here and feel that their kids are safe and loved while they get a workout in.

What resources does Windy Hill Athletic Club (WHAC) provide so moms can make time for themselves?

We have outlets for moms to utilize our club in whatever way is best for them, which can be different every day. We have tennis teams where moms can play matches and socialize. We have group classes so they can sweat it out with their closest friends. We have cardio equipment for that alone time, yoga to quiet the mind, and a café to have a meal and enjoy adult conversations. For just plain relaxation we have a whirlpool, steam room, sauna and luxurious showers—having a moment to take a shower is a big deal when you’re a mom!

What about childcare?

We have Kidtown, which is a place where moms can bring children as young as 7 weeks all the way to 12 years old to play and learn for up to 2 hours a day up to 10 hours a week. Activities at Kidtown include puzzle time, homework helper, kid creation, storytime, and more.

Tell us more about the kid-friendly programs and amenities WHAC offers.

The club has children’s programs throughout the week so kids can enjoy swim lessons, tennis lessons, squash lessons, “Group X” classes, climbing the 50-foot rock wall, and playing tennis or basketball. There are programs for kids of all ages. We even have a “Learner’s Permit” program to help kids ages 8 to 17 know their areas in the club. As the weather warms up, children can head outside to play on the playground. Plus, there are swimming pools where moms can go to relax or bring the kids to have fun in. And if the whole family works up an appetite, you can stop by the café, which has a children’s menu, to have snacks, lunch, or dinner.

What do moms have to say about their experience at WHAC?

Moms love the club as a respite and a great place for their kids to interact with other kids. Mothers feel comfortable bringing their children here and feel that their kids are safe and loved while they get a workout in.

How does WHAC help moms create a sense of community?

We believe active social people lead happier and healthier lives. The facility provides that setting. You can meet friends here and people that you share common interests or similar goals with.

Windy Hill Athletic Club • windyhillclub.com

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By David A. Martin

Vein HealthA few questions for Darrell Caudill, MD, FACS, Medical Director of VeinInnovations (VI) from David A. Martin, the Founder and CEO of VI.

I recently caught up with Dr. Caudill at his office in Sandy Springs to ask him some questions about the future of vein treatments. Here’s what he told me:

DM: Dr. Caudill, you’ve been a full-time vein specialist since 2006. In the twelve years since you devoted yourself to this specialty, what changes have you seen?

DC: Surprisingly, most of the changes I’ve seen have not been positive ones. The basic procedures we do have remained more or less the same, with the thermal ablation techniques still the go-to therapies. There have been improvements in laser fibers for instance, with the advent of the radial fiber, which allows for more precise distribution of energy, but the mainstay of therapy remains the radio-frequency catheter that started it all nearly 20 years ago, and hasn’t changed much in the past 15 years or so. The negative changes I have seen involve the many physicians who have decided to treat veins as a sideline, rather than a primary form of practice. These doctors may do an adequate job at the partial treatments they provide, but they cannot provide the same level of care as a primary vein practice such as VI or others.

DM: So, the actual treatment techniques have remained about the same for 15 years? Isn’t that sort of unusual?

DC: Yes, it is a bit unusual for a widely practiced set of procedures to remain relatively unchanged for such a long period of time. This is the case with thermal ablation partly because the procedures were so good to start with that improving them happens only incrementally, in small ways. But that’s not to say we don’t look for improvement constantly. At VI, for example, we have utilized other techniques that don’t require the administration of tumescent anesthesia, which of course the thermal catheters do because of the tremendous heat they generate. Some of these new procedures have involved embolization coils to block the veins, and precisely controlled, ultra-sound guided injections of a new drug called Varithena. These things have shown some promise; the Varithena for example can be safely used in the lower leg without concern for tissue and nerve damage which remains a danger with the thermal devices.

“We have been asked to be the principal investigator for a brand-new procedure that involves a newly invented catheter.” — Darrell Caudill, MD, FACS

DM: So is there anything new on the horizon at VeinInnovations?

DC: Actually there is. We have been asked to be the principal investigator for a brand new procedure that involves a newly invented catheter. Our initial testing of this device was done last year, and we believe it has the promise to be a major advancement in vein treatment as it doesn’t involve heat or any sort of foreign body. It is also painless, and requires no anesthesia of any kind, nor does it require the use of compression stockings after the procedure. Because it uses no heat, it can treat the entire leg safely, and because it requires no anesthesia, more than one leg can be treated at a single session. The hope is that this will ready for general use sometime in the coming year.

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

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Hair Loss in WomenBy Grattan Woodson, MD, FACP

Atlanta women with androgenic alopecia (AGA), the most common cause of
chronic hair loss, now have access to an effective new therapy. This comes about
as a consequence of advances in our understanding of the pathophysiology of this disease. There is no cure for AGA, given its genetic cause, but when these advanced treatments are administered appropriately and the newly restored hair is conserved with Minca Scalp Spray, the resulting hair regrowth is almost as good as a cure.

A Common Conundrum

Androgenic alopecia is common and affects about 50% of Caucasian women. Hair loss due to AGA in women begins in the late 30s and accelerates during the 40s as women approach menopause. AGA advances significantly after menopause and can lead to loss of scalp cover. The rate of hair loss slows in the majority of patients once they are in their 70s and 80s. However, for 1 in 5 people with AGA, it can become more severe and result in hair loss from the entire head and leave large swaths of scalp uncovered. There are always some wisps of hair remaining, even in the most advanced cases.

A Simple Solution

Before there is loss of scalp cover, AGA is effectively treated with Minca Scalp Spray, which was designed in our laboratory exclusively for women. The Minca Scalp Spray contains pharmaceuticals, hormones, and antihormones that protect the hair follicle from the predatory effects of testosterone, increase its access to vital resources including protein, minerals, and fats, and augment the blood supply to the base of the follicle.

For more advanced cases of AGA, we add treatment with platelet-rich plasma in tandem with microneedling. Research and our patient experience show this approach to be a very effective form of management. We reserve it for women with scalp exposure to induce hair recovery within the affected and surrounding areas of the scalp. Treatment is repeated every month until sufficient organic hair regrowth has been achieved. Once hair cover has been reestablished it is conserved and maintained solely by twice daily use of Minca Scalp Spray.

Our goal is for patients to grow their own hair naturally and to be able to go anywhere and do anything with their hair. In most women, these therapies yield positive results that are visible within 3 months.

It is important to remember that a treatment is not a cure. A woman who has successfully regrown her hair using our therapies still has AGA, the underlying disease that caused her hair loss. If she stops use of the Minca Scalp Spray, she will lose the benefits she has worked so hard to gain.

Insurance companies or Medicare does not cover our treatment services. For more information about what we offer (including fees and more), please visit HairRegen.net or call Kim Teasley at 404.574.2373.

HairRegen • Grattan Woodson, M.D. • 404-574-2373 • 1418 Dresden Dr., Suite #225 Atlanta, GA • HairRegen.net 

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Recognizing and Understanding Celiac Disease

Gluten FreeBy Nirav R. Patel, M.D.

Celiac disease is an autoimmune disorder in which the small intestine is hypersensitive to gluten—a protein commonly found in wheat, rye, and barley. Gluten is typically found in foods such as bread, pasta, pizza, pastries, and cereal. Consuming these foods causes damage to the lining of the intestine. This leads to difficulty absorbing nutrients from food. While there are only 40,000 known cases of celiac disease in the United States, it’s estimated that this digestive disorder affects more than 2 million Americans—including adults, adolescents, and children. People who have a first-degree relative with celiac disease have a 1 in 10 risk of developing it. Other high-risk groups include those who have Down syndrome, type 1 diabetes, autoimmune thyroid disease, and juvenile chronic arthritis.

Signs & Symptoms

Celiac disease can be difficult to diagnose because it affects people differently. Some develop celiac disease as children, while others later as adults. The “classic” symptoms of celiac disease include:

  • Abdominal Pain and Bloating
  • Vomiting
  • Chronic Diarrhea
  • Weight Loss or Failure to Thrive
  • Pale, Foul-smelling, or Fatty Stool

Some of the less typical, non- gastrointestinal manifestations may include:

  • Arthritis/Joint Pain
  • Osteopenia/Osteoporosis
  • Dental Enamel Defects
  • Delayed Growth and Puberty
  • Dermatitis Herpetiformis (itchy skin rash)
  • Fatigue
  • Depression or Anxiety
  • Irritability and Behavioral Issues
  • Seizures or Migraines
  • Iron Deficiency Anemia
  • Missed Menstrual Periods
  • Infertility or Recurrent Miscarriage

Young children tend to exhibit more classic signs of celiac disease along with growth problems, while older children and adults tend to have symptoms that are not entirely gastrointestinal in nature. Recent research has demonstrated that only a third of adult patients diagnosed with celiac disease experience diarrhea. In fact, the most common sign of celiac disease in adults is iron deficiency anemia that does not respond to iron therapy.

Detection & Treatment

If you are experiencing these symptoms or have additional risk factors, you should be evaluated for celiac disease by a gastroenterologist. It is advised to see a doctor first before cutting out gluten from the diet, which will help make diagnostic testing more accurate. Highly sensitive and specific tests can be useful screening tools. If celiac disease is suspected, an upper endoscopy with small intestinal biopsies is recommended to confirm the diagnosis. Once confirmed, living a lifelong gluten-free diet is the only known treatment available at this time. Guidance from your physician or a registered dietitian can be quite helpful in maintaining a balanced, nutritious diet.

Atlanta Gastroenterology Associates offers comprehensive nutrition counseling at many of our offices across metro Atlanta. Our registered dietitians have helped many people suffering from celiac disease achieve and maintain a healthy and happy gluten-free lifestyle.

Atlanta Gastroenterology Associates • Nirav R. Patel, M.D. • www.atlantagastro.com 

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Physical Medicine & Rehabilitation Physicians and Resurgens Spine Center: The Perfect Combination

Back PainBy Marly N. Dows-Martinez, M.D.

Disorders of the spine constitute one of the largest public health problems in America, costing billions of dollars annually. Statistics indicate that in our lifetime, each of us will experience an episode of back pain requiring medical intervention. Enter, the Physical Medicine & Rehabilitation Physicians at Resurgens Spine Center.

What is a Physical Medicine & Rehabilitation (PM&R) Physician?

PM&R Physicians, also known as physiatrists, are medical doctors who have completed training in the specialty of Physical Medicine and Rehabilitation. In addition, they must pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPMR). Physiatrists are subsequently skilled in the diagnosis and management of a variety of nonsurgical musculoskeletal/ orthopaedic and neurologic conditions that cause acute and chronic pain, as well as musculoskeletal and neurologic dysfunction.

What areas do PM&R Physicians specialize in?

There are numerous areas within the eld of PM&R in which to specialize. Among these are interventional spine care, electrodiagnostic medicine, sports medicine, spinal cord injury, and brain injury to name a few. Because back pain, spine disease, and spinal injury are responsible for such a large percentage of disability in the general population, many physiatrists have chosen to specialize in treating those particular entities.

Six ways we manage your care conservatively and maximize your outcome without surgery:

  • Obtain a complete history and perform a physical examination to assist in directing your care and in determining the source of your pain (muscle, disc, bone, joint, etc.)
  • Use different diagnostic studies (X-ray, MRI, CAT scan, bone density), and interpret and review these studies with you to assure your complete understanding of the results
  • Implement the use of a variety of anti-inflammatory, muscle relaxant, neuropathic, and, if needed, narcotic pain medications to help alleviate your symptoms
  • Perform electrodiagnostic studies, electromyography (EMG)/nerve conduction velocity (NCV), to assist in diagnosing and determining prognosis for neurologic disease processes and nerve-related injuries of the spine and limbs
  • Prescribe a focused and individualized physical therapy program utilizing therapeutic “hands-on” exercises and various modalities specifically effective for your problem
  • Offer diagnostic and therapeutic interventional spinal injections and procedures. Included among these are epidural steroid injections, selective spinal nerve root blocks, facet and sacroiliac joint injections, and discograms to name a few. Our patients are injected at one of our state-of-the-art outpatient surgery centers, with the assistance of uoroscopy (X-ray) and contrast, to reinforce optimal placement of the medicine.

Resurgens Spine Center Physical Medicine & Rehabilitation Physicians:
At Resurgens Spine Center, we have a dynamic team of specialized board-certified physiatrists to provide comprehensive care for the diagnosis and treatment of spinal disorders and spine-related pain. We utilize the most up-to-date research to identify clinical protocols and utilize the latest technology to maintain the highest standards of care.

From Day One until discharge, at any of our 23 office locations in the greater Atlanta area, our physiatrists will assure personal and professional care. Our team approach to treating patients of all ages will secure continuity of your care within the Resurgens family.

Resurgens Spine Center • Non-surgical & Surgical Spine Care • 23 Convenient Atlanta Locations • resurgens.com/spine 

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Perfect Day PhotosIt all begins with the heart

By Scott D. Miller, M.D.

We all want to be healthy. We search for the best diets, try to exercise regularly, and wonder which supplements are the most beneficial. There is an abundance of information on how to become healthier, but what is “healthy?” In order to achieve a goal, we must define it.

As a urologist, I am often asked, “What can I do to keep my kidneys healthy?” My answer is a very simple one: whatever keeps your heart healthy will keep your kidneys healthy. After all, a kidney is a specialized collection of blood vessels. Whether we want to keep our minds sharp or our “man parts” working beyond their years, it all starts with the heart. A rich flow of blood will supply us with all of the nutrients and disease-fighting elements that our body craves.

What are some measurements of a healthy heart?

The best indicator is how you feel on a daily basis. Is your energy level good throughout most of the day? Can you climb a flight
or two of stairs without becoming short of breath? Are you generally happy with the way your life is going? These subjective measurements can be the most reliable indicators of good health, but we should not ignore the following objective metrics:

• A reasonable exercise tolerance, adjusted for age and any existing medical conditions or limitations

• A sensible and realistic body weight

• A good report from your physician at your annual wellness visit, including blood pressure, cholesterol, and blood sugar levels

What is HealthyWhen it comes to maintaining a healthy heart, the checklist is a simple one:

• A diet with a balanced variety of fruits, vegetables, protein, complex carbohydrates, and “good” fats

• Avoid processed foods and “simple” sugars

• Caloric intake to match your daily energy expenditure (or slightly less if you want to lose weight)

• Moderate exercise on a regular basis

• Stress reduction

• A good night’s sleep every night

• Don’t smoke

• Health screening by your primary doctor at least once a year

• Tightly manage chronic medical conditions such as high blood pressure and diabetes

Of all the diet and exercise programs out there, the best ones are those that work
for you—not the other guy. Instead of searching for the latest fads, keep it simple and consistent. Not only will you keep your heart healthy, but you will also keep that male machine running smoothly for years to come. As your Partner in Health, I look forward to guiding you in disease prevention and health optimization. Look for my article on “Good Stress, Bad Stress” 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 to schedule an appointment. 

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

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Rafal

 

Chopin Society of Atlanta presents award-winning concert pianist, Rafał Blechacz, as he performs works by Polish-born Frédéric Chopin and more. The event, which will be held on April 15, is sponsored in part by Drs. Anna and Richard Paré, in honor of Anna’s parents who died in a car accident in Atlanta two years ago.

Details: 1280 Peachtree St. NE., Atlanta; Ticketmaster.com

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Is your teen interested in becoming a member of the Children Helping Children 2018 Junior Board of Directors? Have them fill out an online application, check the meeting dates below to ensure there are no scheduling conflicts, and email a photo of themselves to: info.chcatlantaorg@gmail.com by April 30.

Michelle Hodgson (back row, middle) and the 2017 Children Helping Children Junior Board of Directors at the 2017 Little Hands, Big LOVEFEST event.

Michelle Hodgson (back row, middle) and the 2017 Children Helping Children Junior Board of Directors at the 2017 Little Hands, Big LOVEFEST event.

June 11-15
Junior Board Training Program

July 26
Junior Board/Parent Dinner

September
Lantern Festival

Oct. 21
Little Hands…Big Lovefest!

Details: CHCAtlanta.org

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