Since March 2010 when the enrollment period opened up, much has been written, commented on and deciphered about the Affordable Healthcare Act. Still the confusion continues. The new law mandates that every individual have health insurance, but what about the cost? Is it free? Can I keep my existing doctor? What happens if I do not choose to have health insurance? Some of the changes include new rules in the insurance market to increase participation in health plans by expanding eligibility, offering protection against loss of eligibility, improving the quality of services and expanding choices for insurance coverage.

Prior to the new law going into effect, there were approximately 50MM uninsured Americans. The new law is expected to decrease that number by over 30MM people. The sources of coverage will also change due to the implementation of the Affordable Care Act. Previously, the major source of healthcare coverage in the United States came from employers. That will remain the same under the new law only at a lower overall percentage. The newly created insurance exchanges will handle 14% of healthcare coverage, gaining clients from the previously uninsured ranks. While some may choose to continue to proceed without health insurance there will be a penalty in the form of an additional tax starting at $95 per individual or 1% of their taxable income in year one. That penalty will increase in 2015 to $325 per person or 2% of taxable income and will increase once again in 2016.

To help translate and answer questions how ACA will affect individuals, employers, and insurance companies, Dr. Karen Minyard from the Georgia Health Policy Center joins us in the studio to share her in-depth knowledge of the new law. A nurse and hospital administrator for over 13 years, Dr. Minyard is the Director of the GHPC at Georgia State University and the Andrew Young School of Policy Studies. Listeners may find more information about the GHPC at www.gsu.edu/ghpc.

Dr. Karen Minyard

• PHD, Business Administration, Georgia State University
• MSN, Nursing Administration, Medical College of Georgia
• Bachelor of Science, Nursing, University of Virginia
• Board Member, National Network of Public Health Initiatives
• Board Member, Physician’s Innovation Network

Hyperbaric medicine is recognized by most of us as the treatment of choice for deep dive sickness via decompression ( a process for removing excess nitrogen gas bubbles from the blood stream). Well-hyperbaric medicine has come a long way, is appropriate for many indications and can be the treatment of choice for conditions requiring hyperbaric oxygen therapy (HBOT) such carbon monoxide poisoning. Hyperbaric medicine has also provided great success in providing evidence-based, advanced wound care technology to improve chronic diabetic ulcers, radiation injuries, burns, and crushing injuries to tissue.

Treatments are provided in FDA approved, multiplace or monoplace hyperbaric chambers that delivers 100% oxygen in an environment that is pressurized 2-3 x normal atmospheric pressure. The theory is that with the additional oxygen and pressure, the oxygen transport cabability of the blood is greatly enhanced bringing an oxygen rich blood supply to promote faster healing in compromised tissues. The chamber also promotes vasoconstriction which can help in some conditions like burns. Patients are monitored by clinical staff throughout the treatment, which normally lasts about 2 hrs. Depending on the severity of the affected area, physicians prescribe and supervise a set number of treatments over time to obtain the healing results. There are not many contraindications for these treatments. Side effects are usually minor and ear or sinus pressure related, which often is naturally resolved within a few hours after treatment. Health insurance companies often cover the costs of the treatments for a variety of clinical indications.

For this segment, we are joined by guest, Charles Hall, BSN of Hyperbaric Physicians of GA (the largest hyperbaric medicine group in the Southeast) to provide the latest information on hyperbaric medicine. Listeners can find more information at www.hbomdga.com.

Dr. David Swhegman

• Medical Degree from The Ohio State University
• Residency completed in Emergency Medicine from OSU
• Former Asst. Professor of Emergency Medicine at Emory
• Chief Medical Director in private practice at Hyperbaric Physicians of Georgia
• Named 2011 “Top Doctor in Atlanta” by Atlanta Magazine

Charles Hall

• BSN from South University
• 8 yrs experience in surgical/cardiovascular intensive care
• Joined Hyperbaric Physicians of GA in 2010

March is Colorectal Cancer Awareness month in the United States. Colon cancer is the third leading cause of cancer death in the US- and it is often preventable! The American Cancer Society estimates that approximately 140,000 people will be diagnosed with colorectal cancer this year and there will be about 50,000 deaths attributed to this disease. Yet almost 20 million Americans have not been screened (the current screening rate is 65.1%). The lifetime risk of developing colorectal cancer is 1:20.

Although it is possible for young people to get colon cancer, 9/10 people diagnosed are > 50 yrs old. A large percentage of colon cancers begin as polyps in the lining of the colon. Risk factors include: a history of polpys, a family history of colon cancer, inflammatory bowel diseases, smoking, and Crohn’s disease. Colonoscopy remains the “gold standard” for colorectal cancer screening, although there are blood tests and lower GI series that can also aid in the diagnosis. Early stage colorectal cancers can have as high as a 95% cure rate. Screening guidelines recommend starting regular screening at age 50 (unless there are risk factors that indicate earlier) and continuing until age 75. Signs and symptoms include: rectal bleeding, changes in bowel habits that last longer than a few days, abdominal pain, nausea, vomiting, fatigue and unintended weight loss. Treatments depend on the size and location of the tumors. Early stage disease can often be treated with surgical removal only. Late stage disease can include surgery, chemotherapy and at times, radiation.

For this segment, we have asked a local expert, Dr. Marc Sonenshine from Atlanta Gastroenterology Specialists to return during this month focused on screening to provide us with both basic information and updates on Colorectal Cancer. Listeners can find more information at www.atlantagastro.com.

Dr. Marc Sonenshine

• Board Certified in Internal Medicine and Gastroenterology
• MD from Medical College of GA; Residency completed at Johns Hopkins in Baltimore, Gastroenterology fellowship at Emory University
• MBA from Terry College of Business at University of GA
• Volunteers with Crohn’s and Colitis Foundation of America Camp Oasis for kids with IBD
• Special interest areas: inflammatory bowel disease, prevention of GI malignancy and management of chronic liver disease

Excluding skin cancer, colorectal cancer is the third most common kind of cancer in the US and the third leading cancer-related cause of death in the US. Although the CDC reported in November of 2013 that 20 million Americans still have not completed a colon cancer screening test, the incidence of colon cancer has been steadily decreasing over the past 20 years. Possible reasons for this decline are improved screening finds pre-cancerous polyps early, treatments have improved and screening procedures have improved. It is expected that as the Affordable Care Act advances and more people have insurance (and this type of screening is covered) , that screening rates should improve. A procedure called a colonoscopy is the primary screening procedure (62%) for colon cancer screening. In addition, a colonoscopy has many other GI related indications, such as : bleeding, abdominal pain, polyp removal, unexplained weight loss and inflammatory bowel disease.

Until recently, many patients were fearful of going to get the colonscopy test completed due to discomfort during the procedure, an unwillingness to complete the required preparation or lack of insurance coverage. Beginning at age 50 (45 for African Americans), screening for colon cancer should begin if the pt. has no symptoms. A colonoscopy may be indicated earlier for patients with GI symptoms, a family history of colon cancer, or IBS. Now, in the news, are virtual colonoscopies- which require no sedation but do have additional radiation exposure risk.

For expertise in this segment, we have turned to a board certified GI specialist in Atlanta, Dr. Max Shapiro- who has a special interest in colon cancer screening . Dr. Shapiro is board certified in both internal medicine and gastroenterology/hepatology and is in private practice at Metro Atlanta Gastro at St. Joseph’s Hospital in Atlanta. Listeners can find more information at www.metroatlantagastro.com.

Dr. Max Shapiro

• Medical Degree from Tufts University in Boston, MA
• Internal Medicine fellowship completed at Emory University
• Fellowship in Gastroenterology and Hepatology from Georgetown in DC
• Board certified in Internal Medicine and Gastroenterology
• Private practice at Metro Atlanta Gastro with interest in colon cancer screening

Urinary incontinence and an overactive bladder is not only a significant social and economic health problem, but it can be a “bother” for many women. There are large variations as the the degree of this problem and when to treat it. The prevalence of urinary incontinence in women peaks around menopause and some have estimated this health condition affects 3-17% of women. Urge incontinence is more likely to require treatment than stress incontinence. Causes for this condition are typically bladder or sphincter dysfunction or both.

Urodynamic testing are some procedures administered that can be administered in clinics, doctor’s office and at times the hospital. These focus on the bladder’s ability to hold urine and empty steadily and completely. Indications for urodynamic testing include: urine leakage, frequency of urination, painful urination, sudden strong urges to urinate, problems with starting a urine stream, problems with emptying the bladder completely and recurrent urinary tract infections. Testing procedures range from simple observation to sophisticated instruments and imaging. Types of urodynamic tests are: uroflowmetry, post void residual measurements, cystometric tests, leak point pressure, pressure flow studies, electromyography, and video urodynamic testing.

Tune in to this segment for more information about the “What, When and Why” of urodynamic testing as presented by local urogynecology expert, Dr. Jennifer Elliott, a local Atlanta gynecologist. Listeners can also obtain more information on www.whaatlanta.com.

Dr. Jennifer Elliott

• MD from LSU School of Medicine
• Completed residency at Atlanta Medical Center
• Board certified OB/GYN
• Named “Best Doc” by Lifestyle magazine
• In private practice at Women’s Health Associates