Venous disease is one of the most common conditions affecting our health. It is estimated that about 20% of adults may be suffering from venous disease. Although many people may have visible varicose veins, there are many others who have no visible signs of the disease. Individuals with venous disease range from those with small vein disease (spider and reticular veins) to patients with large bulging varicose veins. When varicose veins are present, patients may experience swelling in the legs as well as skin changes such as discoloration, thickening of the skin, and in advanced cases, skin ulcers. Occasionally, large varicose veins may develop blood clots, a condition called superficial phlebitis. Patients without visible signs of venous disease may have symptoms such as leg pain (aching or cramping), leg heaviness or fatigue, swelling, throbbing, burning, itching or tenderness. Some people also experience restless legs.

Men and women of all ages can be affected by venous disease although women are affected more than men due to hormones. Venous disease has a very strong genetic component but there are certain risk factors that can also contribute to its development. These include obesity, pregnancy, prior trauma, surgery, lifestyle and occupations that require prolonged standing.

shutterstock_181680125The treatment of venous disease has come very far in the past 10 years. Today we know much more about this medical problem and the diagnosis and treatment is far superior to that of times past. Venous disease can be easily diagnosed with the use of painless, noninvasive ultrasound performed in the office to determine if you have venous reflux. Venous reflux is the back flow of blood in the legs caused by weakened valves in the veins of the legs.

If you experience any symptoms of the disease, you need to make sure that your physician is aware. Venous disease can be a serious medical condition which left untreated, can lead to long standing complications.

Treatment for venous disease may involve a procedure called EVLA which is a laser procedure done in the office to close down some of the larger superficial veins. Most patients also require sclerotherapy injections to shut down some of the smaller, more superficial veins of the legs. Treatment can help manage the disease and improve the overall health and appearance of your legs as well as greatly improve your quality of life. Most procedures are also covered by insurance.

Dr. Lisa Perez


Be proactive about your circulation and prevent further damage to your legs by having them evaluated for venous disease.

What is superficial venous reflux disease?

Superficial venous reflux is a condition where the valves in the veins become weak or damaged, causing blood to pool in the veins in the legs. This can cause symptoms such as leg heaviness, pain, swelling, fatigue, varicose and spider veins.

What is EVLA and how does it differ from vein stripping?

A vein stripping procedure typically involves making an incision in the groin through which the vein is tied off and then pulled out through a second incision in the calf. In the EVLA procedure, there is no need to surgically remove the vein. The vein is sealed closed using a thin laser fiber that is inserted into the vein through a small i.v. placed in the calf. The vein is left in place and once closed, will dissolve and be absorbed by the body within 6 months. This procedure is done under local anesthesia and eliminates much of the pain, bruising and down time associated with surgery as well as decreasing the risk associated with general anesthesia.

How does the EVLA procedure actually work?

The laser energy damages the walls of the vein, causing them to shrink and seal the vein closed. This prevents any blood from continuing to flow through the vein.

shutterstock_183638447Will closing a vein down cause problems with circulation later on?

Elimination of backwards flow in the superficial veins of the legs actually improves circulation by preventing pooling of blood in these damaged veins. Closing down these veins will cause blood to be redirected in the proper direction through the healthy veins.

How soon after treatment will my symptoms improve?

Although it may take up to 6 months to experience the full benefits of the procedure, most patients feel a noticeable difference within the first few weeks after undergoing the procedure.

How effective is the EVLA procedure?

Endovenous laser ablation has a 98% success rate in closing down the damaged veins.

Is this procedure covered by insurance?

Most insurance companies cover the EVLA procedure based on medical necessity. Many also cover subsequent sclerotherapy for smaller veins to complete your treatment plan.

What is the recovery period like after EVLA?

Since the procedure is minimally invasive, the recovery is fairly quick and easy. There is some mild soreness and bruising that can last up to several weeks and can be managed with over the counter anti-inflammatories. After the procedure, patients are encouraged to walk and can resume their normal activities with a few mild restrictions.

What are the benefits of EVLA?

The benefits of this procedure include significant relief from discomfort, more efficient blood circulation and improving the overall health and appearance of your legs.


Dr. Lisa Perez


Be proactive about your circulation and prevent further damage to your legs by having them evaluated for venous disease.


The mini neck lift procedure was created for individuals just starting to see some mild fullness and laxity in the neck.  This procedure is ideal for patients between the ages of 30-50 with mild neck tissue prominence, mild to moderate fullness or double chin, and are looking for a result-oriented alternative to other gimmicks.  There have been several machines developed to address this mild or early change in neck tissue including ultrasound, infrared, radiofrequency, and even laser techniques to create an improvement; however, though these techniques may produce an improvement in some, it is not as consistent as a mini neck lift.shutterstock_162497138

A mini neck lift requires a small incision behind the ear along with a small incision under the chin.  The 'behind the ear' incision is to help tighten skin and muscle while the incision under the chin is for liposuction.  Liposuction is not just to remove fat, but more importantly, the neck liposuction creates an inflammatory response which by itself helps to tighten the overlying skin.

The mini neck lift procedure has a downtime of 7 days.  You are on restrictions during that time so no working out, heavy lifting, or bending over.  You will be required to wear a neck garment that will support the neck tissue for the first 2 weeks but will primarily be worn during sleep.  The stitches come out at 7 days and you are off your restrictions at that point as well.  The biggest variable to downtime is the patient's ability to bruise.  Some patients bruise yellow-green and others bruise black-blue.  If you're the former, then 7 days to be presentable should be fine.  If you're the latter, you probably want to give yourself another 3-4 days to let that subside. On the other hand, some patients will use creative scarfs to be presentable at any time.  For more information, visit our mini-neck lift page at

Northside Facial Cosmetic Surgery
770-239-6343 |

Mike Majmundar, M.D. is a double board certified facial plastic and reconstructive surgeon. He is the principal of Northside Facial Cosmetic Surgery.

Tuesday, 22 April 2014 13:37

Closed Rhinoplasty – Is it Better?

Over the years, master rhinoplasty surgeons have confessed their love for either closed or open rhinoplasty techniques.  Some consider themselves closed rhinoplasty surgeons, while others consider themselves open rhinoplasty surgeons.  In the modern world, rhinoplasty surgeons need a grasp of both techniques to offer their patients the optimum variety of procedures but also the best outcomes.

The advantage of closed rhinoplasties, also known as endonasal rhinoplasty, is reduced time for surgery, less swelling, and no incision. Closed rhinoplasties do have a smaller time for surgery but most reputable surgeons only perform closed rhinoplasties on minor nasal changes or changes that involve other structures of the nose besides the tip.  This inherently speeds up the process.  There are surgeons who prefer to do their tip work through a closed approach but the open approach may be superior as it allows better visualization of the tip structures that need more precise intervention.  Because less work is generally done in a closed rhinoplasty, there is less swelling, especially at the tip since less is done in these procedures in this area.

shutterstock_178675202There is no incision in a closed rhinoplasty; however, some surgeons argue that an incision at the base of the nose is barely noticeable once healed and provides a significant amount of direct visualization of the structures that is not left to the imagination.  Others argue that any incision can create a scar, but in skilled hands, these scars should heal so there is no concern of visibility.  We have performed several hundred open and closed rhinoplasties and have not had an issue with the incision.  We try to avoid one where possible but don't hesitate to create one if it will provide the patient with a superior result.  In the end, allow the surgeon to be an artist and do what needs to be done appropriately.

There is also the concern of less bruising and quicker recovery with a closed rhinoplasty.  However, consider this.  If you are more concerned about recovery than the best procedure for your nose, are you doing yourself a disservice?  Bruising and recovery can be less with a closed rhinoplasty but several factors such as time of surgery, amount of work performed, history of previous surgery, patient's medical history, patient's tendency to bleed, patient's fluid or electrolyte equilibrium, etc., all play roles in bruising and recovery.  The surgery is only one part.

Northside Facial Cosmetic Surgery
770-239-6343 |

Mike Majmundar, M.D. is a double board certified facial plastic and reconstructive surgeon. He is the principal of Northside Facial Cosmetic Surgery.

Spring is here, the vernal equinox has passed and the earth has awakened. With milder temperatures and gentle breezes inviting us to partake in nature, those annoying spring sniffles and scratches may actually be hindering us from enjoying the season. In addition to reducing pollen exposure by closing windows and limiting early outdoor exposure during the day, there are several non-drug options for allergy sufferers.

The first is sublingual immunotherapy (SLIT), a viable and relatively safe alternative to "allergy shots" that consists of placing drops under the tongue each day. This procedure can be performed at home, avoiding unnecessary office visits and injections, and carries a much lower risk of a reaction. SLIT has been in use in Europe for over two decades and is gaining popularity here in the U.S. The pill formulation was recently FDA approved for grass pollen allergy. We have several patients successfully treating themselves with SLIT and it has the potential to permanently change your allergic status.

shutterstock_136036196To cover up your symptoms without resorting to medications, nasal and sinus irrigation can help mildly decongest and remove retained mucous. Here are a few botanicals that I recommend as well:

  • Butterbur (Petasites hybridus) – Commonly used for headaches, two studies confirmed its efficacy in head-to-head trials versus OTC antihistamines. Make sure you purchase "PA-free" formulations to avoid liver toxicity. It is safe for children but please make sure you adjust the dose accordingly.
  • Thryallis (Galphimia glauca) – This is a small evergreen shrub found in the tropical regions of Mexico and Central America. Studies confirm its efficacy in treating allergic rhinitis and conjunctivitis. It may also be effective for treating anxiety, but must be given under the guidance of a doctor and is not approved for children.

Lastly, consider the role of diet, emotions and stress in inflammation. Remember that the body is always trying to restore homeostasis, so try and lead a lifestyle that fosters this process.

In summary, there are diverse approaches to treating and overcoming your allergy symptoms, many of which do not involve a trip to the pharmacy.


Avicenna Integrative Medicine
1000 Johnson Ferry Road, Suite E200, Marietta, GA 30068
(770) 977-9300  |

Maziar Rezvani, MD, FAAAAI serves as director of Avicenna Integrative Medicine and Avicenna Allergy and Asthma. He is board certified in internal medicine and allergy and immunology and specializes in integrative medicine, having just completed a fellowship at the world-renowned Arizona Center for Integrative Medicine.

It happened during Rachel Cruze's first day of college at the University of Tennessee. While sitting at freshman orientation, she met a fellow student – a girl with a BMW. It wasn't the name of the luxury car that stood out to Cruze. "She had a car payment, and her mom co-signed the loan," she says with as much surprise as she felt that day years ago. "At 18 years old, I realized, in that moment, that I had grown up in a financial bubble. I learned that if you don't have the money, you don't buy it. You save up and pay for things. You work to make money. And I thought that's how everyone handled money. But when I met this girl, my little bubble popped. I saw the lack of knowledge on the subject of money when it comes to my generation."

While it may sound like a profound perspective for such a young person, it's all Rachel Cruze has ever known. The daughter of famed financial expert, New York Times bestselling author and successful radio personality Dave Ramsey, she grew up understanding the ins and outs of money and what it really takes to be financially secure. She watched her parents work their way back from bankruptcy – which they filed for the year she was born – to true financial stability. After earning a degree in communications, she embraced what she felt was her professional calling and joined her father's Nashville-based company full time with the intention of helping the next generation take charge of their financial futures. She worked tirelessly to earn the respect of her colleagues and prove that "it's not just because I'm Dave Ramsey's daughter that I'm here." And today, 26-year-old Cruze, a well-known personality in her own right, travels the country speaking to packed audiences of young adults about their own money habits and how they can apply the fiscal principles that have been ingrained in her since childhood. On April 22, she and her father will celebrate the release of their co-authored book, "Smart Money Smart Kids," which gives parents practical steps for raising money-smart kids in a debt-filled world.

"Every parent wants their child to have a better life than they've had. And I think that some parents feel stressed about the topic of money in their own lives. They don't want their kids to experience that, and many are saying, 'I don't want my children to have to struggle or to make the mistakes that I've made. I want to be able to teach them to avoid those things,'" Cruze notes. "That's what this book really does. I think it answers a lot of questions that parents have."

dave_rachel_dockChock full of information about how to teach children of any age about money basics like working, spending, saving and giving, as well as dealing with debt, paying for college and more, "Smart Money Smart Kids" brings together the perspectives of both father and daughter and offers no-nonsense tips based on their personal experiences of living financially smart in the Ramsey household. "Mom and Dad really do live what they teach. I can recall only a handful of times that we talked about money. We learned just by watching them. More is caught than taught, and the example you set for your children is huge," Cruze explains.

"I was the dad who made big money mistakes and failed early on. But I was also the dad who decided to change my family tree and intentionally raise money-smart kids," says Dave Ramsey, who has helped millions of families learn to manage their money matters over the years. "It gives me great satisfaction to stand back and watch how confident and competent our grown kids are. So watching Rachel write about how the principles we implemented early on impacted her life, and seeing her passion for sharing those with others, has been a great experience."

What Cruze brings to the book is an understanding that children, teenagers and young adults are facing new challenges when it comes to money in today's world. "Today, you can get everything instantly. You can purchase things right now from your smartphone. Young people have to learn to step back, have patience and save," she asserts, adding that while her father is known as the "emergency surgeon" for people with financial troubles, she considers herself to be the "preventative medicine" for tomorrow's generation. If she can encourage parents to start teaching their children about money now, and to have those children listen and follow the advice, then she can help an entire generation grow up like she did and keep them from having to face major financial dilemmas throughout their lives.

"What we teach are basic principles, and they work. They've been proven over 20 years," Cruze says. "When it comes to money, 80 percent is behavior, and 20 percent is knowledge. You know you should live on a budget. But doing it is hard. Changing your behavior is difficult. What parents need to know is that no matter what your financial situation is now, you can implement these principles today. You don't have to have a Ph.D. in finance to do it. You just have to find teachable moments in your day-to-day life, and you can change your family tree."

Of course, Cruze also notes that parents don't have to change who their children are – and she uses herself as an example. "You're either a spender or a saver, and I am the spender of the Ramsey kids," she muses, noting that her older sister Denise and younger brother Daniel, as well as her husband Winston, are savers. "For parents, there are going to be cases when you bail your kids out. There is grace involved. You can let your kids make mistakes, but let them make those small mistakes while they're under your roof. Mom and Dad guided me, but they let me be who I am. I had to learn boundaries. My parents taught me those lessons, and they shaped who I am. I learned early, and it was better for me to learn at 7 years old instead of 27 or 37."

Cruze's passion for spreading a message of hope to young people everywhere is unmistakable. And the lessons she has learned from her parents, Dave and Sharon, and their experiences are going to change lives for years to come if she has anything to do with it. "The older I get, the more appreciative I am of their story," she concludes. "To come alongside my father and promote his message is wonderful. It's where my heart is. I'm a kid who was raised on these principles, and it works. Now I'm able to succeed. And it's really exciting."

Rachel will be signing "Smart Money Smart Kids" on Friday, May 2 at 6 p.m. at the Books-A-Million on Sugarloaf Parkway in Lawrenceville. For more information about Dave Ramsey, visit

Friday, 21 March 2014 18:25

Jazz Up Your Fitness with Dance

Many of us took ballet lessons as kids or watched our children don sparkly stage outfits for their own dance recitals. For some reason, though, as the years pass, very few young women and men continue with dance. And some never even start, despite dreams of twirling across the floor. Perhaps they had a little stage fright, or simply enjoyed dance but didn't want to turn it into a career. The good news is that these days, there's a widely accessible approach to dance that is catching on in cities all across the country: dancing for fitness. You can have all the enjoyment of dancing regularly, but this time around, with a focus on physical, mental and emotional health.

Build Up While Breaking It Down

Physical benefits of dancing include body conditioning, increased metabolic rate, improved muscular endurance, flexibility, improved coordination and improved rhythm. One of the most basic benefits, though, is that it challenges your heart with every routine. "Dancing is actually a very high demand form of exercise," says Erroll Bailey, MD, of Resurgens Orthopaedics. "It stresses cardiovascular, coordination, strength and endurance." The CDC recommends two hours and 30 minutes of moderate-intensity aerobic activity each week. Taking a few dance lessons throughout the week can definitely cover that requirement. Whether you're perfecting your plié or learning to pop and lock in a hip hop class, you'll consistently be moving and reaping the benefits of an increased heart rate. "[Dance] is very equivalent to playing a sport," points out Nicole Kedaroe, Community Programs and Adult Division manager at Atlanta Ballet. "You're always moving."

Dance-1In addition to getting your heart in shape, Decatur School of Ballet instructor Jessica Reese says, "Dancing helps you develop long, lean, strong muscles." But what exactly makes dance such a great muscle sculptor? Let's look at the technical side of it.

Dance includes movements that are both isometric and isotonic. Isotonic exercises are ones you're probably familiar with from gym workouts – squats, lunges and bicep curls, for example – that involve a lifting and lowering phase. Isometric exercises, on the other hand, involve very little joint movement, instead focusing on muscles bearing weight – these are exercises like planks, or a bridge pose in yoga, where your muscles may get shaky from the continued exertion. When you take a dance class like ballet, jazz, or even contemporary or modern, the huge variety of choreography will no doubt include both isotonic and isometric movements, helping build overall strength for every muscle group.

Styles like belly dance even offer unique muscle strengthening benefits, like preparing the muscles a woman needs for childbirth. "Even if my heart rate never goes up, I'm getting all of those other things," Reese says.

Dance Down Memory Lane

Dancers of any age will see increased cardiovascular ability and muscle strength, but older dancers can gain benefits beyond the physical. Dance has been scientifically proven to improve mental health, too. "It's an intellectual stimulation as well as a mental one. It's mathematical and intricate," Reese says.

Kristine Knipp, director and owner of Ballroom Dance Clubs of Atlanta, cites research from a 2003 study published in "The New England Journal of Medicine." The study found, "Ballroom dancing at least twice a week makes people less likely to develop dementia," she says. This was more than the reduction in risk from reading or doing crossword puzzles. Dance is a good choice of an aerobic activity for older people because it helps keep the mind engaged through moving to music and changing patterns, Knipp explains – everything from counting beats in the music, to incorporating rhythm and geometric patterns, to being aware of your physicality in space. And that's just the beginning; in some classes, you even learn about the history of dance.

dance-2Even if the effects of aging have already begun to set in, dance can still be beneficial. "Fitness is a vital component of programs geared toward residents with dementia to help lead to a brain-healthy lifestyle," says Molly Boone, memory care director at Emeritus at Sandy Springs Place. "Aerobic exercise causes the heart rate to increase, thus increasing the level of oxygen to the brain, an important biological process that creates an optimal environment for the nerve cells in the brain to communicate with one another. Various parts of the brain are stimulated as messages from the external environment, such as the sound of music, are filtered to areas of the brain that control rhythm, coordinate movement, sequencing and a number of other operations controlled by the brain."

Sue Schroeder, artistic director of CORE Performance Company, often works with seniors, using dance to help them recover. "We say, 'move it or lose it.' You have to keep things moving to be agile." With Alzheimer's and stroke patients, the goals are different, but the movement of dance helps with both. With stroke, you activate and rewire the brain with cross-body movement. For Alzheimer's patients, the problem is in another part of the brain and the body's ability to remember. This could be spatial, kinetic or touch memory. "We get them moving and incorporate stories from their own long term memories," she says. "They really blossom. When you can draw on something of the time and place for them, it relaxes them and excites them."

Do a Happy Dance

Whether or not you're dancing for mental fitness, a regular dance practice certainly can contribute to emotional health. "Dance is a stress reliever, and I think the music aspect adds to that. When you hear music, there is a change in emotion. You may not even realize it," says Kristy McCarley, founder of Shazzy Fitness, a company that has a series of dance fitness DVDs fusing modern dance with faith-based contemporary music. "There is a mood change from the time you start [a class] to the time that you finish. People who dance know this. There is something that goes on physically and psychologically when you dance, and it can last for the whole day."

Another way dance can elevate mood and increase your happiness is through its social aspect. "Nobody is a stranger if you're a dancer," Knipp says. "Chronic stress, depression and social isolation all wreak havoc with memory and add to cognitive deterioration, but ballroom dancing can keep you current and flexible, both physically and emotionally."

Plus, if you just need something to break the monotony of the treadmill, dance fits the bill. "I love to dance for exercise because I don't love going to the gym," says Emily Harrison, former Atlanta Ballet company dancer who is a registered dietitian and oversees the Centre for Dance Nutrition at Atlanta Ballet. "I think dance is the best activity. It's just so physically demanding, and it's mentally demanding. It's fun and it's social."

Dance-lastTake Your Pick

No matter what your preference or skill level, Atlanta is home to a variety of dance classes like salsa, belly dancing, Capoeira (a Brazilian style of dance) and tap, just to name a few. Any of these can offer you a myriad of benefits, but you should also consider your personal preferences when choosing the best type of dance for you. Ask yourself the following questions, and then go cut a rug!

What am I looking for in a dance class? What are my goals? If you seek technique, maybe ballet is the right class. If you simply want a good workout, hip hop or tap will get you moving right away. If you're looking to make friends, try a weekly social at a ballroom dance studio where you can try new moves with new people.

What is my ideal type of class? Are you interested in a small class or one that is more packed? Try several different classes to find your groove. Many studios have free introductory classes or passes. "We offer intro through advanced [classes]," Kedaroe says. Like many studios, at Atlanta Ballet, adult classes can be taken on a drop-in basis.

What is my limit? How fast-paced do I want the class to be? "If you are young, it's just another sport," Dr. Bailey says. However, for anyone who has had a heart attack or stroke or experiences joint problems or arthritis, high impact dancing is not recommended.

What kind of music do I like? "The music can make all the difference in the world," McCarley says.

Would I prefer a group class or private lessons? Particularly with ballroom dancing, private lessons can be helpful for couples looking to reconnect or for those who might not enjoy learning through a group class.

What do I need in an instructor? Some are more technical; some are more fun. Find out how long he or she has been teaching and how much direction is provided.


Editorial Resources

Erroll Bailey, MD, Resurgens Orthopaedics –
Molly Boone, Emeritus at Sandy Springs Place –
Emily Harrison, Atlanta Ballet –
Nicole Kedaroe, Atlanta Ballet –
Kristine Knipp, Ballroom Dance Clubs of Atlanta –
Kristy McCarley, Shazzy Fitness –
Jessica Reese, Decatur School of Ballet –
Sue Schroeder, CORE Studios –

Friday, 21 March 2014 18:13

Stroke: Warning Signs and Treatment

The number one cause of adult disability in the United States is a surprisingly subtle event that can happen quietly and at any time – a stroke. In addition to incapacitating millions of Americans, stroke is also the fourth leading cause of death in the country. And if you live in the state of Georgia, the odds are even greater. Along with the Carolinas and a handful of other Southern states, Georgia resides in the Stroke Belt, an area of the country statistically proven to have a higher number of strokes than the rest of America.

The Science Behind the Stroke

But what exactly is a stroke, and why is it so dangerous? Michael Frankel, MD, Chief of Neurology and Director of the Marcus Stroke & Neuroscience Center at Grady Hospital, explains that a stroke occurs when part of the brain is deprived of blood flow. This can happen for two reasons: a blockage in an artery, known as ischemic stroke, or when a brain artery ruptures and causes a hemorrhage, known as hemorrhagic stroke.

Matthews Gwynn, MD, the medical director of the Northside Hospital Stroke Center, notes that age is a risk factor for either type of stroke. "As we age, our arteries get more and more damaged from the buildup of scar tissue related to high cholesterol, high blood pressure, high blood sugar and the normal aging process," all of which can increase your stroke risk.

Sometimes, though, strokes can happen for reasons other than age. "In younger individuals, stroke is often caused by a heart defect, arrhythmia, or split in an artery wall caused by sudden mechanical force in the artery, such as rapid turning of the head or a whiplash injury," says Bruce Bosse, MD, a neurologist at North Fulton Hospital.

And if you think you're too young to be at risk, think again. A 2012 study published in the journal "Neurology" revealed that the average age of stroke is falling across the nation, meaning the number of young stroke victims is rising. A different study, published in the journal "Annals of Neurology" in 2011, showed that stroke-related hospitalizations for people ages 15 to 44 rose 37 percent over a 13-year period. These numbers could be due to an increase in risk factors like obesity, diabetes, use of oral contraceptives, smoking, high blood pressure and cholesterol, but doctors aren't entirely sure.

No matter who you are, this dangerous condition could affect your most crucial organ – the brain. "It's important to know that the brain is dependent on a constant supply of well-oxygenated blood. The brain does not store energy," says Daniel Barrow, MD, Chairman of the Department of Neurosurgery and Director of Emory MBNA Stroke Center. "If blood flow is disrupted, the brain begins to dysfunction. If it is deprived of blood for more than a few minutes, it begins to die."

So the severity of the stroke depends on how long the brain cells are deprived of oxygen, and it also depends on the location of the blockage or hemorrhage. "There are parts of the brain the size of your fist that could be removed and you would see little difference," Dr. Barrow says. "But there are parts of the brain that are very small, and if damaged, you could go into a coma or worse."

Stroke Symptoms

"The symptoms of stroke are dependent on the location of the injury in the brain," Dr. Frankel says. "Ischemic strokes commonly cause weakness on one side of the body, difficulty speaking or problems with coordination and balance. Hemorrhagic strokes cause similar symptoms, but often the symptoms are more severe and can cause loss of consciousness. If bleeding occurs from an aneurysm, a symptom may be sudden, severe headache. All these symptoms should prompt immediate attention by calling 911."

FASTSymptoms also depend on which side of the brain was affected by the stroke. "Generally, a stroke on the right side of the brain affects the left side of the body and may cause weakness or numbness, vision problems, trouble with perception and changes in behavior," says Lisa Billars, MD, a board-certified neurologist with Kaiser Permanente of Georgia Glenlake Medical Center. "A stroke on the left side of the brain affects the right side of the body, often resulting in weakness or numbness, trouble with speaking and comprehension, as well as problems reading and writing."

In addition to all these symptoms, others include trouble walking, dizziness, visual deficits and even difficulty swallowing and breathing. None of these symptoms should be overlooked because, as Dr. Billars says, "Time is brain."

Think FAST

As in any emergency situation, time is of the essence. And this could not ring more true for a stroke. Not only do oxygen-deprived brain cells begin to die, but the treatment options and treatment window for stroke narrow with every passing minute. You have to think fast, literally and figuratively. Sunil Bhole, MD, Medical Director of Glancy Rehabilitation Center with Gwinnett Medical Center, explains the acronym FAST to help analyze common stroke symptoms and seek treatment as soon as possible:

Face: "Ask the person to smile. Does one side of the face droop?"

Arms: "Ask the person to raise both arms. Does one arm drift downward?"

Speech: "Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?"

Time: "If you observe any of these signs, independently or together, call 911 immediately."

"With a stroke, time equals brain cells," Dr. Bhole says. "Every minute, two million brain cells die, increasing the person's risk of permanent brain damage, disability or death." Regardless of the severity of symptoms, Dr. Billars says you should pay attention. "Even a seemingly insignificant event should be taken seriously, as it may be a warning sign that the person is at risk for a larger stroke."

Treatment and Recovery

The current most common treatment for ischemic stroke is called tPA, or tissue plasminogen activator. This clot-busting medication must be administered within three hours of the onset of stroke. Heidi Woessner, MD, a neurologist at Piedmont Atlanta Hospital, says she uses a point system to identify a stroke victim as eligible for tPA. The score and onset of symptoms determines if a patient is eligible for tPA. "I ask them, when was their last-known normal state? That's when I start the clock for the tPA window," she says. "If they cannot receive tPA based on recent surgery, heart attack, certain medications, or any type of urinary or GI bleeding, we consider a mechanical embolectomy," which utilizes a small wire to snare and pull the blood clot from the artery.

As medicine continues to advance, new options are on the horizon for stroke treatment and management. Dr. Frankel says treatment for acute stroke is rapidly evolving with newly FDA-approved devices to more effectively remove clots lodged in the brain's arteries, and Dr. Bosse notes new blood thinning drug substitutes are currently offered. Dr. Barrow says stem cell transplants into the brain, gene therapy and stem cell therapy will be used to actually regenerate parts of the brain that have been damaged by stroke.

Dr-Ford-Vox-Shepherd-CenterOngoing research is also looking to improve the ability to recover after stroke. Locations like Glancy Rehabilitation Center have innovative rehabilitation practices, such as pet therapy and real-world practice with things like grocery shopping and walking on a variety of surfaces, among others. At Shepherd Center, severe strokes can be treated successfully, and rehabilitation therapy can help even years after a stroke occurs. Ford Vox, MD, one of Shepherd Center's board-certified rehabilitation physicians, explains, "With targeted, intensive therapy, a new skill can be developed even many years after a stroke. Continued rehab is also often necessary to maintain what has been gained and to treat later complications. We continue to treat patients for the psychological and cognitive effects of stroke as well." And if you're younger than 65, the news is even better. Dr. Vox points out, "More so than most other stroke programs around the country, Shepherd serves young patients who were in school, raising families or in the most productive years of their careers when they suffered a stroke. Our intensive services are targeted toward those under age 65 in order to result in the biggest long-term yield to the patient. This reality is backed up by extensive neurorehabilitation research demonstrating that the central nervous system is more able to adapt and change in response to injury in younger patients." So if you or a loved one experiences a stroke, keep in mind that rehabilitation may be within reach.

The Best Defense is a Good Offense

Despite wonderful advancements in medical treatment, the best treatment for a stroke is to do your best to avoid one entirely. The good news is that up to 80 percent of strokes are preventable, and you are also in control of many of the major risk factors. Dr. Bosse says the risk factors under your control are high blood pressure, high cholesterol, diabetes, smoking and obesity.

rehabilitationNurse practitioner Chika Ugwuoke, clinical stroke coordinator for DeKalb Medical, suggests a few lifestyle changes to put you on the right path:

Know your blood pressure. "High blood pressure is a major stroke risk factor if left untreated. Have blood pressure checked regularly."

Identify atrial fibrillation (Afib). "Afib is an abnormal heartbeat that can increase stroke risk by 500 percent. A doctor must diagnose and treat Afib." A doctor can catch this during your annual physical, or it can be diagnosed through an electrocardiogram (ECG).

Stop smoking. "Smoking doubles the risk of stroke."

Control alcohol use.

Know your cholesterol levels.

Manage diet and exercise. "Excess weight strains the circulatory system. Exercise five times a week. Maintain a diet low in calories, salt, saturated fat, trans fat and cholesterol."

If you take care of yourself in these ways, in addition to learning your risk for stroke and recognizing stroke symptoms, you will be well prepared to deal with this common health issue in yourself or a loved one. Just remember to keep calm, call 911 and act FAST.


Editorial Resources

Annals of Neurology, published by the American Neurological Association –
Daniel Barrow, MD, Emory MBNA Stroke Center –
Sunil Bhole, MD, Glancy Rehabilitation Center with Gwinnett Medical Center –
Lisa Billars, MD, Kaiser Permanente of Georgia Glenlake Medical Center –
Bruce Bosse, MD, North Fulton Hospital –
Michael Frankel, MD, The Marcus Stroke & Neuroscience Center at Grady Hospital –
Matthews Gwynn, MD, Northside Hospital Stroke Center –
Neurology, published by the American Academy of Neurology –
Chika Ugwuoke, DeKalb Medical –
Ford Vox, MD, Shepherd Center –
Heidi Woessner, MD, Piedmont Atlanta Hospital –

Wednesday, 05 March 2014 14:07

Feeding the Skin at the Cellular Level

Medical spas are one of the fastest growing industries in the United States today. This is because they provide fast and effective medical-grade treatments that require little to no downtime, yet achieve optimal results. One of the benefits of a medical spa is that pharmaceutical grade products are used and recommended by medical doctors and licensed estheticians. A typical skin cycle will renew itself every 28-42 days. Pharmaceutical grade skin care products will expedite this process allowing new skin cells to reach the surface much more quickly than it normally would resulting in smoother and refreshed skin. Pharmaceutical grade skin care products, such as Image skin care products, are only available through a licensed physician. They contain a higher amount of active ingredients that by law are allowed to penetrate the skin down into the dermis. The dermis is the live portion of the skin where skincare products can truly cause long term changes. Over-the-counter products and department store brands by law cannot penetrate the skin, therefore they only penetrate the top layer of the skin which consists of only dead skin cells.

eyedropIn addition to giving your skin the absolute best pharmaceutical grade products on the market, why not also feed your skin at the cellular level through food? Sugar, fried food, junk food, artificial sweeteners, preservatives, chemicals, processed carbohydrates and alcohol all wreck havoc on your skin. These foods can cause dryness, dehydration, redness, and acne on your skin. The best foods for your skin are pure clean water and foods containing omega-3's fatty acids. Foods like wild-caught salmon, cold-pressed olive oil, raw nuts and seeds can lower inflammation in the body. Incorporating a natural and raw diet consisting of fresh fruits and vegetables can nourish the body, giving it the essential vitamins and nutrients, and in turn detoxing it from harmful substances. This type of diet feeds the body at a cellular level revealing hydrated and youthful skin.

At Renew Laser & Cosmetics, we help our clients get beautiful skin using a combination of proper nutrition and skin care products that actually penetrate the skin. We believe in results-driven services such as IPL photofacials, microdermabrasion, chemical peels, cosmetic injectables (such as Botox and Juvederm), and laser hair removal. We provide high quality skin care at an affordable price with our membership program. Your skin is your calling card, take care of it!

Renew Laser & Cosmetics

(770) 212-2242  |  11720 Medlock Bridge Rd., Suite 170  |  Johns Creek, Ga. 30097

227 Sandy Springs Place NE, Suite 378  |  Atlanta, GA 30328  |

Allison Hillyer, CTN, ND, LE, NMT, is co-owner of Renew Laser & Cosmetics. She has been in the skin care industry since 2001. Allison is a Naturopathic Doctor, a Licensed Esthetician, and a Neuromuscular Massage Therapist. She is board-certified as a Traditional Naturopath by the American Naturopathic Certification Board, a Diplomat member of The American Council of Holistic Medicine, and a member of the American Association of Nutrition Counselors.



When you've opened several restaurants, braved the reality TV circuit (and survived), written a book and are raising a family, you're bound to know a thing or two about balancing your time. And if you're Chef Richard Blais, you take everything in stride. "I'm still trying to figure it out, but I put my family first. That's the main thing."

This grounded attitude served Blais well throughout the twists and turns of his career. He graduated from The Culinary Institute of America in New York, but his first job was at McDonald's. Then he rose from that role to become one of the most recognizable winners of Bravo's "Top Chef All-Stars" in 2010. His biggest takeaway from being on "Top Chef" is "Improv, in anything, is a great skill to have."

Blais honed his creative culinary skills next to notable chefs such as Thomas Keller, Grant Achatz, Daniel Boulud and Ferran Adria before making his way to Atlanta in 2000 to run a seafood kitchen. Then in 2004, he opened BLAIS Restaurant. Although this venture was short lived, closing its doors after six months, Blais was undeterred and continued to forge ahead. He went on to work in other restaurants such as One Midtown Kitchen and opened his own company, TrailBlais. This culinary consultant company allowed him to partner with FLIP Burger Boutique, for which he helped create the menu. Then in October 2012, Blais opened The Spence in partnership with Concentrics Hospitality.

Blais' culinary creativity is evident if you've ever dined in one of his Atlanta eateries. As each restaurant evolved, Blais learned what worked and what didn't. "I continue to learn how difficult they are, what a hard life it is for restaurant workers, and I continue to ask 'Why do people open restaurants?'" For Blais, the answer evidently seems to be for the love of cooking because he shows no signs of slowing down.

Richard-Blais-cooking_In addition to another restaurant project, Juniper & Ivy, which opened last month in San Diego, Blais took on another TV gig in December 2013. Along with co-host and nutritionist Keri Glassman, Blais now hosts HLN's Upwave network show, "Cook Your Ass Off." This show pits chefs against each other in a race against the clock to create dishes that "balance the nutritious with the delicious" for a cash prize of $50,000. "I was stoked to hear of the premise [of the show]. Being that health and wellness have become so important to me, it was a perfect fit," Blais says. "The message is that you can cook and eat delicious food that is still good for you. I think 'Cook Your Ass Off' can help change lives."

Staying fit and cooking healthy are topics that are now near and dear to Blais, who once weighed in at 225 pounds. When speaking to HLN on this subject, Blais admitted, "I just really lost control of myself because I was tasting food all day long."

Blais confesses his journey to losing the pounds started with "wanting to get a girl." The "girl" was his now-wife Jazmin, who helped motivate him to get moving. They began running together and after several months of training, Blais competed in the Peachtree Road Race for the first time. At the end of the race, he proposed to her, and they've been together ever since.

He also credits his two daughters for helping him stay on track. "Well, [at first] I didn't consider nutrition or exercise, so the biggest changes were to make sure they were a part of my daily life. My kids certainly have helped too, because I want to feed them healthy meals."

Although Blais says the food he eats now is usually healthy, he does sometimes indulge in "chicken wings, cheeseburgers and ice cream like everyone else!" Blais acknowledges that it was a challenge to keep the weight off, but he learned, "It's a marathon not a sprint, so once you feel comfortable with that, it's all gravy. Mind you, it's a gluten-free gravy!"

It's been a long journey since making Filet-O-Fish sandwiches at McDonald's, and Blais has learned a lot along the way. He shares some advice with aspiring chefs, saying, "You will most likely make minimum money for six to 10 years, working holidays, all while spinning around in the same five-foot space for each 12-hour day. You will get burned, cut and smell like burning wood and garlic for a long time. You will most likely lose most of your existing friends and most certainly your boyfriend or girlfriend. You in?"


Get to Know Chef Blais

What advice do you have for someone who is struggling to lose weight?
Have small goals and realize it’s mostly mental. Controlling what you eat or cook or buy is the first decision to make.
What is your favorite way to stay fit?
I run maniacally and recently started swimming. But right now, trail running is my jam.
Best advice for parents who need some inspiration for weekly dinners?
Cook vegetables, always make a salad, and get your family and kids involved in meal planning, preparation and cooking.
Best book you’ve read?
I’m a big Malcolm Gladwell fan.
Best place in Atlanta to relax?
Piedmont Park.
Favorite restaurant?
The Spence or Bacchanalia Star Provisions.
Who are the people that help you be your best self?
My wife is my consultant in all things. Mind you, she is a yoga-practicing, organic-vegetable-shopping, vegetarian consultant.


Meet Co-Host Keri Glassman

As a nutritionist, owner of New York-based practice Nutritious Life, and co-host of the new show “Cook Your Ass Off,” Keri is passionate about teaching people to “reach beyond a healthful diet and take a whole person approach to health and wellness, both inside and out.”

Richard-Blais-Keri-GlassmanWhat was your reaction when you heard about the premise of “Cook Your Ass Off”?
I thought “I love this idea! How has it not been done before?” People seek out health information everywhere, and people love cooking competitions. Yet the concept of adding the health element to the competition had never been done. My passion is teaching health, so I fell in love with this format.
What do you hope the audience takes away from the show?
Healthy does not mean deprivation or lack of flavor. The healthiest foods for you are naturally incredibly tasty.
What is your best piece of advice for someone who is struggling to lose weight?
I would say the thing that has the greatest impact without changing anything else is learning to listen to your body — stopping eating when slightly satisfied and eating when slightly hungry. And eating as much real food as possible.
What is your favorite healthy dish to cook?
My go-to healthy meal that my kids can’t get enough of is baked wild salmon with sesame crust, burnt broccoli and quinoa. Super simple, super healthy, and I always know it is well received.