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Colorectal Cancer

March 13, 2014 by angishields

The Doctors Roundtable

Colorectal Cancer

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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

Hypersomnia

March 6, 2014 by angishields

The Doctors Roundtable

Hypersomnia

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What would your life be like if your body craved sleep- as much as 16 hrs per day? Could you work? What would your family life be like? In America, approximately 5% of the population has this problem-hypersomnia. Hypersomnia is a large group of disorders characterized by excessive daytime sleepiness (EDS) or prolonged nighttime sleep (> 10 hrs/night) over a 3 month period. This condition can have a direct or secondary cause and occurs in men slightly more than women. Symptoms often begin to occur in late teens or early twenties. Hypersomina can be disabling, is poorly understood and the medical understanding of hypersomnia is in its infancy.

There are no known cures for hypersomnia. However, there are treatments (usually medications) that can help the patient to improve their quality of life and have more waking hours. These medications typically fall into three categories: stimulants, non-stimulating, wake –promoting medications and sodium oxybate. The Emory University Sleep Disorders research team has been doing some work using somnogen type medication that appears to influence tha GABA activity. The team also completed a study that examined cerebrospinal fluid in hypersomnia patients which resulted in a breakthrough in determining the cause. The hope is that in the future,with this new information, new rational approaches can be devised for treatments of patients suffering from hypersomnia.

For expertise in this segment, we have tapped Dr. David Rye, and internationally known and respected researcher and leader in this field to lend his expertise and experience to educate listeners and followers about hypersomnia. Listeners can find more information at www.hypersomniafoundation.org.

Dr. David Rye

Medical Degree from University of Chicago
Residency in Neurology , University of Chicago Hospital
Ph.D in Neurobiology, University of Chicago
Board certified in Psychiatry and Neurology
Internationally recognized researcher in sleep disorders featured in
Wall Street Journal, ABC News and CNN

DeMystifying Colonoscopies

January 30, 2014 by angishields

The Doctors Roundtable

DeMystifying Colonoscopies

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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

Urodynamic Testing in Women: What, When and Why

January 16, 2014 by angishields

The Doctors Roundtable

Urodynamic Testing in Women: What, When and Why

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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

Dealing with Holiday Stress and Sadness

December 26, 2013 by angishields

The Doctors Roundtable

Dealing with Holiday Stress and Sadness

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As the holidays approach us, many people look forward to spending time with family and friends and to the joys of the season. However, the holidays can bring some unwanted guests- stress and depression, for adults and children. Changes occur from year to year and these changes can affect is especially around the holidays- even positive changes. For others, the holidays are associated with negative feelings. Even after the holidays, many people experience the “Post Holiday Blues.” A recent poll showed that 8 /10 Americans experience stress around the holidays.

External triggers for holiday stress and sadness may include: loss of a loved one through divorce, death or a move, loss of a job or home or toxic relationships. Internal triggers can may be unresolved grief, underlying medical conditions, fear, isolation and loneliness and the contrast between expectations and reality. Sometimes, these feelings may be more than the “blues” and mental health professional involvement may be warranted if problems such as changes in appetite, sleep and weight persist for more than a few weeks or there is a lack of energy, social withdrawal and continued sorrow.

For most of us, however, planning ahead and using some key strategies can get us through this season. Seeking serenity, practicing forgiveness, letting go of unrealistic expectations, avoiding substance abuse, staying away from toxic people, practicing self care, reaching out to others, planning things we enjoy ourselves can help.

Tune in to this segment for more information about holiday stress triggers and causes and some strategies to make your holiday experience be filled with more hope and gratitude. Dr. Theodore Morgan, a local Atlanta psychiatrist will lend his expertise on this timely topic and also discuss when more than our own strategies may be warranted and professional help enlisted. Listeners can also obtain more information on www.gabehavioralhealth.com.

Dr. Theodore Morgan

Medical training at Meharry College of Medicine
Completed psychiatry fellowship at University of Alabama
Board certified in child and adolescent psychiatry
Member of the America Academy of Child and Adolescent Psychiatry
In private practice at GA Behavioral Health

Clinical Research

December 19, 2013 by angishields

The Doctors Roundtable

Clinical Research

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Clinical research is a systematic approach to finding out what clinical approaches do and do not work and then using this gained knowledge in to advance and improve clinical decision making. There are many kinds of research, but in the US, about 59% of research focuses on drug research. At any one point in time the FDA has approximately 9-11 thousand clinical trials registered and these trials are seeking 2.8- 3 million subjects. Clinical trial investigative work is conducted in every disease state. Currently, a great deal of research is ongoing in cancer, cardiovascular, Neurology, and anti-infectives.

Bringing a drug to market in the US is a long (10-15 years) and expensive endeavor as about 90% of drug trials do not make it past the first phase of clinical trials. High quality results, timeliness and actionable evidence remain key indicators for a clinical trial. There are four phases of drug trials. Phase I involves safety testing in small numbers of patients. Phase II tests the drug in larger patient populations who have conditions or diseases the drug is meant to treat. Phase III is a pre-approval round where large populations of subjects with affiliated health issues test the new drug as compared to standard treatment. Roughly, 2/3 of Phase III clinical trials are approved by the FDA. Phase IV trials are post- FDA approval trials to explore additional adverse events, performance vs. competitive drugs and additional possible uses.

Patients often enroll in clinical trials with the belief that their experience may be of benefit to future patients. Clinical trial management is highly regulated with involvement and monitoring from many agencies. Informed consent is required. Most consumers and clinicians think of clinical trial research as being performed in large academic medical centers. However, there are many community level models that are available to extend participation and the quality of the research across populations as we are finding that drug response may vary more than previously expected due to each person’s unique pharmacogenomics.

Tune in to this segment to learn about clinical trial research in general and for more information about unique and highly successful community based models of research occurring in GA and the Southeast. Dr. Jeff Kingsley, a clinical research veteran at the national level and his associates will lend their expertise in the field of drug clinical trial research. Listeners can also obtain more information on www.serrg.com and the FDA’s research site at www.clinicaltrials.gov.

Dr. Jeff Kingsley

Medical training at Philadelphia College of Osteopathic Medicine
Completed residency in Family Practice at Columbus Regional Medical Ctr
MBA from Emory University
CEO/Founder of Southeastern Regional Research Group

Winter Allergies Triggers and Treatment

December 12, 2013 by angishields

The Doctors Roundtable

Winter Allergies Triggers and Treatment

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The CDC reports that over 50 million Americans suffer annually from allergies and that globally, the number of people that suffer from allergies is on the rise. They estimate that in the US, over $18 billion is spent annually on allergy related health care. Although, it may not seem that allergies are a serious problem at first blush, allergy problems can greatly affect quality of life in terms of sleep, work and school productivity and even the quality of our relationships. The same allergens that trigger a response in the spring’s high allergy season – pet dander, mold and mildew, can be intensified with increased exposure as we move indoors during the winter months. Colds are also common during winter months , but many people do not know how to distinguish between a cold flare and allergies. Climate changes can also affect allergic responses.

The most common signs and symptoms of allergies during this time of year include sniffling, sneezing, watery eyes and nasal congestion. Treatments include avoidance of allergens, lifestyle changes and both over the counter and prescribed medications. Desensitization treatments are also now an option that saves time over the long run. In this segment, Dr. David Redding, a board certified allergist, who has been featured on The Weather Channel and TLC will join us to discuss the triggers and treatments of winter allergies. Listeners can also obtain more information on www.reddingallergyatl.com and www.cdc.gov/niosh/topics/asthma.

Dr. David Redding

MD training at Medical College of GA in Augusta
Double Board-Certified in Internal Medicine and Pediatric and Adult Allergy
Residency at University of South Carolina
Fellowship completed at University of Texas Medical Branch
Featured on The Weather Channel and TLC

Patient Healthcare Literacy and Advocacy

December 5, 2013 by angishields

The Doctors Roundtable

Patient Healthcare Literacy and Advocacy

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Medicine is not “one size fits all” and medicine involves making decisions- many of them. Traditionally, patients have relied on their health care providers thinking that “the doctor knows best” in the areas of medicine, treatments, procedures, surgery and hospitalizations. However, some of the most important and potentially life altering healthcare decisions are not the clinicians’ alone to make. Many believe that with shared medical decision making- when the provider brings evidenced based medical expertise and the patient brings their preferences and values, benefits soar such as: a focus on prevention, an increased ability to manage chronic conditions, increased patient satisfaction and decreased costs. Examples of common healthcare decisions include: elder care, end of life decisions, management of chronic back pain, charting a cancer treatment course, elective surgery and maternity care.

Health literacy also is a component of making better healthcare decisions as many providers overestimate the health literacy of their patients. Patient may lack the fundamental tools to understand what is happening in their bodies and what to do about it. They may not have been brought into the decision making by their provider, know how to work within the medical system, understand the right questions to ask or believe they have power to help heal themselves.

In this segment, Dr. Joseph Pinzone, a double board-certified physician who specializes in endocrinology and the provision of care through the concierge model, has written a new book titled, “Fireballs in My Eucharist” (which was a patient’s description of fibroids in her uterus!). He will discuss the book and how patients can get educated, obtain tools to help in their decision making and help better heal themselves and be an active participant in their healthcare. Listeners can visit www.medamai.com and www.informedmedicaldecisions.org for more information.

Dr. Joseph Pinzone

MD training at NYU in New York
Double Board-Certified in Internal Medicine and Endocrinology
Private practice in Santa Monica, CA
Author of the new book, “Fireballs in My Eucharist”

Diabetes and Eye Disease

November 28, 2013 by angishields

The Doctors Roundtable

Diabetes and Eye Disease

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November is Diabetes Awareness month. Did you know that diabetic retinopathy is the leading cause of new, irreversible blindness in adults from industrialized nations for people aged 20-74? Globally, 93 million people suffer from Diabetic Retinopathy alone. Four primary eye diseases are linked to diabetes: cataracts, glaucoma, macular edema and the most common- diabetic retinopathy. Duration of diabetes, poor glycemic control and hypertension are the highest risk factors for diabetic eye disease. Diabetes affects the eye in specific ways.

First, high blood sugar can cause swelling in the lens of the eye. This can be a temporary condition. Over time, diabetes damages the tiny blood vessels in the retina and can cause blind spots, blurred and double vision, “flashing lights”, floating spots and decreased vision. Visual acuity can also fluctuate. Decreased vision, however affects daily living. There are four stages of Diabetic Retinopathy and eye exams for diabetics include more specialized test than a routine annual comprehensive eye exam. There are no treatments available to restore lost vision. However, there are treatments that can minimize further damage and aid in coping with the damage including: lasers, medicine, surgery and vision-related rehabilitation.

In this segment and as part of Diabetes Awareness Month, Dr. Janelle Davison, a local optometrist that specializes in clinically complex eye care will provide a general overview of how diabetes affects the eye, diabetic eye diseases, treatments and preventive strategies for diabetic patients to maintain their vision. Listeners can visit: www.brillianteyesmarietta.com, www.visionaware.org or www.diabetes.org for more information.

Dr. Janelle Davison