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Hyperbaric Medicine

March 20, 2014 by angishields

The Doctors Roundtable

Hyperbaric Medicine

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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

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

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

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”

An Overview of Male Infertility

November 7, 2013 by angishields

The Doctors Roundtable

An Overview of Male Infertility

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The male role in contraception has been thought of as relatively simple, when in fact, it is actually quite complicated. The Mayo Clinic estimates that 15% of couples are infertile (frequent , unprotected sex of childbearing age with no pregnancy in one year). Research estimates show that 7.5-10% of all males of reproductive age are infertile. Male infertility is a major cause of no conception in 50% of childless couples. Male infertility can be defined as abnormalities in sperm production, maturity or delivery that impedes the establishment of pregnancy.

The male reproductive cycle involves testosterone secretion that is the common link between the pituitary gland and the testes. To achieve a pregnancy from the male component the following is needed: 1) healthy sperm 2) enough sperm is carried to the semen 3) the sperm is correctly shaped for motility and 4) no ejaculation problems. Causes for male infertility include varioceles (swelling of veins that drain the testes-42%), obstruction, infection, chromosome abnormalities, hormone imbalances, tumors, ejaculation problems, anti-sperm antibodies, sperm duct defects, some chronic diseases, environmental causes (exposures) and lifestyle causes (weight, stress, smoking and drug use). Male infertility evaluation often includes a semen analysis, an extensive medical history, a physical exam, lab testing and ultrasound examination.

Treatment of male infertility usually focuses on correction of the underlying problem or using treatments to help with the infertility. Possible treatments include: surgery, medications and assisted reproductive technologies such as sperm retrieval, sperm donation and cryopreservation. The process of identifying and treating male infertility can be stressful for the individual and couple. Costs can be high and this treatment is typically not covered by health insurance. The outcome is often unknown for some time period and stress can be high. There are many coping strategies and support groups for psychosocial support.

In this segment, Dr. Michael Witt, a board certified urologist and male infertility specialist (one of the few in the southeast) will discuss the a general overview of male infertility. Listeners can visit: www.rba-online.com and www.resolve.org for more information.

Dr. Michael Witt

MD obtained from Oregon Health Science University
Completed residency in urology at Boston University Hospital
Fellowship in male infertility completed at Baylor College of Medicine in TX
Board-certified in urology
Featured on CNN, The Learning Channel, named one of Atlanta’s Top Doctors
Now in private practice at Reproductive Biology Associates in Atlanta

Year End Planning for Medical Practices

October 31, 2013 by angishields

The Doctors Roundtable

Year End Planning for Medical Practices

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The healthcare environment changes daily and physicians often struggle to keep up with regulatory changes, competition and reimbursement changes. There are many challenges looming: Obamacare, ICD-10 and Meaningful Use. Providers must spend time working on their practices as well as in their Atlanta Business Radio practices to thrive and not just survive. However, practices do not have to stay in a reactive mode. Taking time to plan can put a practice in a proactive mode to be able to anticipate and appropriate respond to opportunities, changes and challenges.

Quarter 4 is the perfect time to take action to minimize tax burden, maximize retirement plans, reconcile inventory, create the coming year’s budget and evaluate the coming year’s capital needs. Taking inventory, updating depreciation schedules, retirement planning, fee schedule analysis, A/R cleanup, tax planning, productivity and compensation evaluation are just some of the year end financial activities that can really make a difference in achieving solid financial performance.

Planning for retention of market share and growth is key to future practice viability yet how many practices have a formal, annual marketing plan. Marketing is often viewed as an expense vs. an investment yet new patients are a critical piece of revenue generation for every practice. The same marketing plans often do not yield different results and how providers reach, communicate with and message to current and potential patients is changing. Year end is a great time to acknowledge referral sources and examine the ROI of existing marketing efforts, brand cohesiveness, content relevancy and process, social media effectiveness and to make adjustments as needed. In a recent poll, 51% of patients said that digital communications would make them feel more valued as a patient and 41% said social media would affect their choice of healthcare providers. Is your practice keeping up with the interactive“new word of mouth” ?

An overall strategic plan can be the differentiating for success. Yet, many providers either don’t know how or feel they don’t need it. Yet, evaluation of Key Performance Indicators (KPI’s) to show the current standing of a practice, a SWOT analysis, a competitive overview and then making and implementing a strategic plan will help all businesses be positioned to recognize and capitalize on growth opportunities, assist in overcoming challenges and help protect market share for any business. Why should the business of medical practices be different?

In this segment of The Doctor’s Roundtable, three industry subject matter experts will weigh in on tips, strategies and considerations for year end planning for 2014 for medical practice success. Join Sharon Allred of LW Consulting ( a healthcare strategic planning expert), Beth McCauley of McCauley Marketing and Mark Estroff, CPA and medical practice tax expert as they share their best advice for positioning your practice for success in 2014. Listeners can visit: www.lw-consulting.com , www.mccauleyadvertising.com and www.pyagatesmoore.com for more information.

Mark Estroff